the first few days

last night i slept well through the night; the past few days i had been sleeping from 9 pm to 3 am, waking and writing for two hours, then sleeping until 7 or 8. it was wonderfully calm in those mid-night hours, and i was alert and able to reflect during those times, though i'm still not sure i have realized i am here in india. it is very easy to feel stuck behind a viewing window when you are in a culture so different and seemingly inaccessible, but i'm hoping (and finding just a bit) that recapping what i've seen makes little cracks in the clear divider; hopefully it will shatter soon!

yesterday was an amazing day. we woke to a delicious breakfast and made our way to the hospital, where we met dr. shobha for morning rounds of the inpatients, stethoscopes in hand. we saw a patient with cellulitis that had spread to his scrotum that was becoming gangrenous. he was referred to a larger hospital because the infection had spread to his blood. we also saw some men who were recovering from prostate surgery, performed at CRHP by shobha; a child who had a parotid abscess (a salivary gland on the cheek near the ear); a boy who was recovering from paralyzing guillain-barre syndrome who, through rehabilitation, has gone from being paralyzed from the neck down to walking! we also saw a woman who had been treated for malaria, several women being monitored for bleeding during pregnancy, and - quite a story - a man who had a scrotum the size of a basketball. in surgery, it was found to be many loops of bowel - a huge, years-old hernia! they are all doing fine.

two nurses in white saris followed shobha, dave, amy, june and me around, writing hospital notes in english, which is surprising because enven in mumbai people speak very little english. i've had to get on with a demure smile and “namaste" (greetings) to everyone. following shobha around the hospital certainly adds to the smile return rate, but in the streets, there are looks – no, staring (i hope just curious). children in the village run up to us and, smiling and laughing, shake our hands and say “hallo” and “what is my name?” the latter means “what is your name,” we’ve learned, so we exchange names and off the children run. other groups of kids wave from a distance and when we wave back, they giggle into their hands. it's pretty amusing to us, too!
after we saw the inpatients at the hospital, we went to shobha’s office to see the outpatients. we saw a 15-year-old girl with an enlarged spleen and liver who we sent to get blood tests (they do most tests at their onsite laboratory); an HIV-positive woman with tuberculosis and an infected wound from a biopsied lymph node that had been enlarged; and a boy who had burn injuries on his hand that healed leaving his fingers unable to extend.

after another amazing meal for lunch, we went to a village wedding that was taking place behind shobha’s house (a site with a stage that is often used for weddings and other village celebrations). they carried in the groom, who was wearing a special turban, and then the bride – covered in a red shawl with gold ruffles on it, and wearing gold jewelry on her forehead and a chain from her earrings to her nose-ring. a hindu priest arrived on a motorcycle, as someone came around spooning into our cupped hands a mixture of rice and orange powder that we would later throw seven times throughout the ceremony toward the stage where the ceremony took place (we were all seated in chairs and cross-legged on the grass in the “audience”). the hindu priest sang a prayer, as did some village girls who might have been relatives of the couple, and the ceremony concluded with drumming. very auspiciously, it rained very hard for just a few minutes right after the ceremony ended, which was lucky for me too, because we all had to run onto the stage for shelter. that's where two village girls grabbed my hand and, introducing themselves and asking my name, dragged me to the bridge and groom to congratulate them.
that afternoon, we went into the village of jamkhed, on the edge of which we are located. i am glad i got another look, because the side streets of jamkhed on a sunny afternoon are very charming and very different from the main drag, muddied and dark in the monsoon rains on which we entered jamkhed on saturday. i bought some shampoo, laundry detergent, a notebook, two outfits, and face wash for about Rs. 800 ($20). they have bangle bracelet shops, bakeries, phone booths, schools, clothing stores (with both ready-made and material-for-fitting saris/salwar kameez), and numerous other convenience store type shops selling toiletries, snacks, jewelry, religious icons, and more. there were cows like the one pictured above everywhere.

tuesday, we awoke early to go to a village when CRHP-trained Village Health Workers (VHW) are working. the VHWs are low-caste females who have once-a-week training here in jamkhed to provide healthcare to their villages. they deliver babies, provide prenatal care, learn how to treat common diseases, counsel women, men and children on how to improve their health, and advocate for their community. the reliance on these women has dismantled the caste system in these villages to quite an extent over the 30 years they have been working, as high caste families must depend on them and have seen that the “untouchables” (the sub-caste group from which many of the VHWs are chosen) are thinking human beings who deserve to be treated equally. seeing that women can contribute so much has improved the status of women in these communities by showing the women how to advocate for themselves.

we arrived at the village with the Mobile Health Team from CRHP, which visits every village with which they have a relationship once per month, ready to provide HIV testing for pregnant women, along with counseling about the illness, which has much stigma here in india (which has the second highest rate of HIV/AIDS in the world, after south africa). we also got to watch a VHW do a prenatal exam using only her hands and a metal funnel-like instrument to hear the fetal heartbeat. she also looked at the tongues and inner eyelids of the women to see if they were anemic, and – if so – prescribed a certain kind of roasted bean with the size and taste of a chick pea for them to eat for the remainder of their pregnancy. we also learned about a lime juice-salt-sugar-water mixture that village women can make as an oral rehydration mixture for their children’s diarrheal illnesses. the number one killer of children under five in the developing world is diarrheal illness, which kills not because of a pathogen, but because the diarrhea dehydrates the children so quickly. the oral rehydration solution restores important electrolytes and water to the children, and improves survival. in the village we visited, only 3 children under five had died in the last fifteen years, and two of those were due to an accidental death and a birth defect that could not be fixed. these local efforts have improved health so much here – seeing all this has made advocacy and education seem like such accessible solutions to many of the world’s problems.

later, after returning to CRHP in jamkhed, we hopped into another CRHP bus to go to their farms where they sell some produce for a profit, but mainly provide refuge for ostracized patients with AIDS, leprosy, and mental illness, as well as teach farming techniques to local communities and individuals. they also have cows to produce milk for CRHP and some of the poorer communities they serve, and they raise chickens.

we sat with dr. arole – the founder of CRHP and father of shobha – in an area of young fruit trees, under a covering that filters out UV light and provides wonderful shade. we discussed the water-saving technologies used on the farm, much needed since this part of maharashtra state (the southern part of the ahmednagar district) is a drought-prone area, and there have been many monsoon seasons during which little rain fell, although mumbai – eight hours to the west – would be flooded.

this morning, a dutch medical student named rinske arrived, who will be here a little longer than us and will be taking the course with us. the four of us spent the morning with a group of korean students who are also here listening to the stories of several women working here at CRHP in jamkhed who have overcome abuse, both physical and social, from being in a low caste, for being women, for bearing girls instead of boys [a sidenote: feticide is common if an ultrasound determines that the fetus is female; it is therefore outlawed to tell families the sex of the child during prenatal ultrasounds, but this goes on illegally anyways.], and simply for being seen as the property of their husbands (their husbands are their gods). CRHP actively taught the women that they are thinking human beings . during this powerful session, i wondered whether we naturally believe that we are worthless or worth something. is there a natural inclination to feel one or the other, or are both taught?

the women who spoke to us were all beaten by their husbands and families, and had been married by age 14. now, they are property-holding entrepreneurs and contributing members of the CRHP community and their villages – no longer mistreated. they are advocates for themselves. one muslim woman was harassed by her community for opening a store when her husband died and for not wearing the veil and for being outside the home. she asked to have a meeting with the muslim leaders and said “if you give me money to live off of and feed my children, i will stay in my house, wear the veil, and stop working to earn a living.” the prospect of having to financially support her was too much for them, and they never bothered her again. the very fact that she could not be bullied brought her a lot of respect, and she does very well in her store today. she and the other women who told their stories have empowered many women in their communities by example.

this afternoon we had our first marathi class with pushba, a wonderful woman who did some of the HIV counseling in the project village the day before. she, like most here, has a wonderful smile and beautiful lines around her kind eyes to show she uses it often. we learned introductory phrases and pronunciation.

after watching wimbledon on tv last night in shobha’s house, we had a spaghetti dinner. what a western evening!

each day makes me quite grateful to be learning so much from these remarkable people – of CRHP and india. i do feel that i am in the presence of greatness here because of what i have seen and read in just a few days about the impact they have on the community.

at last... jamkhed

our smiling faces surrounded the table at dr. shobha’s house on saturday evening. the meal was delicious, but our joy stemmed from our relief at arriving in jamkhed after much travel, anticipation, and a finally dissipated baseline level of unease.

before we encountered folks from CRHP in pune, and outside of our hotel in mumbai (which had attendants posted outside and is gated), we were always on guard; constantly being the focus of attention makes it hard to feel either welcome or safe. furthermore, each leg of our journey required road travel (which is somewhat terrifying – more on that later) and meeting drivers - - the latter having a large possibility of not working out since we depended on the presence of english speakers and payphones to find the way to the next driver and vehicle. but things did work out, despite a few moments of dread at each stop before a friendly face emerged from the crowd. at least we are easy to spot!

the taxi from mumbai had to take us back to the airport to catch our shuttle to pune on saturday morning, which went smoothly. As we fussed with a payphone we didn’t know how to use, a friendly gentleman – who at first we ignored because he just seemed too friendly - - offered us the use of his cell phone. thank goodness, because it made it very easy to find our driver. then we felt badly – is it better to distrust and be proved wrong? we made our way to the shuttle, which i thought might be a van or large bus, but to my surprise and simultaneous consideration of the vast spectrum of wealth and poverty in india, we were led to an air-conditioned SUV, just for the three of us, which provided a very comfortable ride to pune.

the road to pune is called the mumbai-pune expressway, which is a modern highway (though i must say that i was surprised by the quality of all the roads we traveled on – even the rural ones – paved in cement, marked [though of course not heeded], with traffic signals in the cities). before we got to the expressway, we were stuck in gridlock for an hour in a mumbai suburb, moving along at a snail’s pace, being examined by passersby in autorickshaws, on scooters, and on foot. this suburb was exemplary of what we saw in many of the smaller villages, including jamkhed – mud and packed dirt on the sides of the road where store-fronts line the street. most shops look like storage units, some even with a sliding overhead garage door that, when open, exposes the entirety of the interior of the shop and the people – always more than one – sitting on stools or cross-legged on the floor inside, looking out. there is so much trash on the streets – from piles of trash to colored speckles kneaded into the mud, piles of wood splinters, old bicycle wheels, many of them the object of trade in stores, but - i feel sorry to say – i cannot discern what is trash from what is merchandise. there are also tarps and bits of plastic strapped everywhere as roofs and covers for doorways, which adds to a look of poverty and pollution. many of them are the blue tarps i associate with those handed out by aid groups to refugees. there are so many people everywhere. most adults – even those who are very poor – generally wear flip-flops or sandals, but there are tons of children and babies who run around barefoot, holding their mothers’ hands or playing with other shoeless children. the poorest children wear either tops or bottoms. there are also – as expected – tons of shrines, which are fascinatingly always clean, without chipping paint or trash around them, exteriors draped in marigold chains. trucks – or “goods carriers,” as is painted across the fronts of their cabs – are ornately painted, often have a picture of a god on the front and have marigold chains or little green chili peppers strung onto ornaments on the fronts of their cabs. little children sell these at toll booths on the highways.

despite the poverty observed in these towns, the indian women look so put together and beautiful. maybe this is a product of their dress: they wear saris or salwar kameez, which include a stole draped over the shoulders. to me, the stole is an unnecessary garment in that if you were without it, you would be covered and still – by western standards – dressed. perhaps it is this flowing element of the outfit that makes it seem so luxurious to me – and, of course, they are all dressed in bright colors, have the hindu red marking between their eyebrows, and beautiful jewelry – anklets with bells, dangling earrings and nose rings, bangle bracelets up their arms. indian men and children, on the other hand, often wear western clothes, so poverty is sometimes more readily apparent, though some hindu men do wear all white and caps that look like 1950s soda fountain busboy hats.

we finally made it to pune, though the monsoon rains started again while we were driving. just after exiting the highway, but before entering downtown pune, we drove through a gated community that reminded me of hilton head or golf course homes on long island. SUVs, gates around home, huge mansions. another world right there. apparently pune is a rich town, developed in recent years by indians returning from the west. the downtown – where the train station is – is not lined by mud as were streets in even mumbai, but is well-designed with parking spaces and even some sidewalks.

we were dropped at the train station to meet drivers from CRHP, and after a quick call (we figured out how to work the payphone), we were met by the smiling face of hakim. oh, the relief. to belong to someone here. to be able to small-talk. he walked us over to the car, and it was another air-conditioned SUV with the welcome decal words “Comprehensive Rural Health Project” on the front window. We put our bags in the back and climbed in. hakim sure puts the pedal down, boy. off we went.

this leg of the trip was quite different from the first – rural maharashtra is very lush. once every 20 minutes, we would pass through a village like the suburb of mumbai, but in between we saw beautiful green farms, herds of goats, grazing cattle, even two camels. there are stones with white powder on them and shrines on every farm – religious folk are everywhere, which you can also tell by the red powder dots on the foreheads of the hindus. stray dogs are everywhere, too; i wrongly assumed they were a fixture in cities alone. they are even on the compound here in jamkhed (but they are clearly not actively rabid – i do stay clear, however). there are also little goats and bristly pigs that eat the trash. we pulled into a rest stop one hour from jamkhed called “The Smile Stop,” where i ordered a masala dosa – a kind of freshly made pancake with potato curry in it that is served with coconut chutney and a kind of spicy broth/gravy. then i had my first encounter with the hole in the floor bathroom. here, you are only supposed to eat with your right hand, as you left hand is used to wash off after using the bathroom – there is no tp but rather a faucet in each stall. i luckily have my “charmin to go” roll – I think mastery of the faucet skill will have to wait, at least until my charmin runs out, if not longer.

shortly after this break, we arrived in jamkhed, and drove the the main drag to the CRHP property on the edge of town. there are houses for staff, a garden, little covered pagodas for sitting. we were led up to our rooms in a cement building with cool stone floors that feel wonderful on bare feet. there aren’t any scorpions or snakes, but there are these very cute little geckos that crawl up the walls – they are about 4” long, with those amazing little bubble toes. i've only seen two in two days, so it’s not as if we are infested!

my room is painted yellow, with a ceiling fan, two twin beds (i'll have to share my room during the july course), a bookshelf built into the wall, a mirror, and a little table I use as a dressing table under the mirror. i strung up my mosquito net, but there are dense screens on the windows, so i've only used it for a few hours each night. (i have two bites, but got them walking outside – not in the apartment.) our bathroom has a western toilet and a shower with a hot water heater. we also have a sitting area and a fridge stocked with bottled water.

we went to dr. shobha’s house with amy, the arole fellow who has been here for ten months, and enjoyed a wonderful meal and introductions. then we got a little tour of the grounds. when we came back, it was only 8 pm, but we were so tired that we took showers and went to sleep.

sunday we relaxed, read, napped and ate more delicious meals cooked here by the staff. at every meal so far, there has been white rice, dhal (lentils in sauce), chapati (a delicious whole wheat tortilla, made fresh), and a dish made primarily of dill, with garlic, tomatoes, and some little beans or grains in it. i've never had dill in such quantities; i've only had it as a condiment on fish before now, but this dish – forkfuls of the stuff – is delicious.

monday we will round at the hospital and go into town for errands. this week will be very laid back, as our course does not begin until july 2. it is quite a luxury to have time to write and read, though naps thus far have creeped into the schedule more than i would have liked. it's been two days, but i am starting – just – to feel settled in. there are still many cultural barriers to cross that i can’t imagine crossing; it seems to me now that it is entirely conceivable that i could leave india without having made any progress on understanding the culture. but one step at a time…

mumbai

my overwhelming sentiment, having been in mumbai for two days now, is wonder at the notion that life here exists the way it does while we exist the way we do. this is not a statement on poverty, or on the neglect of the developing world by the developed; my point is that the "entire world of india" seems a discrete dimension from ours. there are so many people, so much dirt, so many sounds and smells - - all packed together. there is no buffer zone between the rich and poor areas - our 4-star hotelin the kemp's corner area of mumbai is next to a construction site where a small family lives, sitting shoeless at all hours of the day. people all over the city lie languidly on public benches, sleep on the sidewalk. there are stray dogs and cats everywhere, and of course the cows (though they seem to prefer the slower pace of side streets to the main roads).

there are lots of three-lane roads in mumbai, but - i kid you not - they might as well not exist. taxis that would certainly not standards elsewhere (in addition to not having seatbelts) straddle street markings and drivers honk at those who drive within the confines of the lanes. meanwhile, islands divide main roads, but pedestrians scurry across between the moving traffic of bicycles, taxis, and the wealthy's cars and scooters to hop up on the dividers, then weave to the other side.

the largest slum in asia is here in mumbai, but i don't see how it is a single slum; we drove through several areas of densely-packed hovels with corrugated tin roofs. the highway from the airport passed by these, and the most indelible image i saw was a little girl of no more than seven, wearing only underwear and her hair in pigtails, barefoot on the highway, holding the hand of a toddler who must have been her sibling as they scanned the traffic looking for an opening in the flow for them to cross.

after our taxi driver (who didn't speak english) drove us to the wrong area of town, we finally made it to our hotel - the shalimar hotel. a lovely woman named doris gave us a special deal and took care of us, sending us a complimentary fruit basket and some cookies, claiming "it is important to take care of the doctors of tomorrow."

after showers and a good rest, we took a taxi to a fabulous restaurant called chetana in colaba where we were served vegetarian thali - - a kind of all-you-can-eat variety platter. it was delicious and filling. we attempted to stroll for a bit, but the streets were deserted at that late hour, save for some sleeping people and street dogs, so we took a taxi back and went to sleep.

today we awoke early and - a few complimentary indian newspapers in hand - made our way downstairs to the breakfast included in our hotel bill. we drank mango juice, ate parsley potatoes, lentil and mushroom balls with tomato-based curry sauces, and dosas with curried onions inside. after sending off some emails at the business center (from where i am currently writing this), we went off to mahatma gandhi road to stare and be stared at (a white girl and two east asians definitely garner a lot of attention). we walked by the campus of bombay university, through clothing stalls and saw the "maidans" - field used for playing cricket. we also walked by the victoria terminus - a vestige of the colonial empire still in use in a bustling area of town. then we went to waht i can only describe as a very first-world store called fabindia where we bought a few items of clothing - two short kurtas (a short-sleeved long dress worn over pants called salwars - the outfit together is called salwar kameez), one salwar, and a stole (worn over the shalwar kameez outfit). then we were off to mahesh lunch home - a mangalorean seafood lunch restaurant that was packed when we got there and had to wait outside. while we were waiting, a cow came barrelling down the SIDEWALK as if she owned the place - - and she did; the mass of people parted, some patted her on the rump, and off she went. i don't think you can prepare for something like that - yes, i knew cows would be everywhere, but in the flesh their presence is absurd - especially when i picture them on the streets in new york city or how well they are taken care of when so many indians are not. once we made it inside to the restaurant, we had delicious house special spicy prawns and vegetables in gravy with garlic naan. utterly fantastic food - heaven. the best thing is that we haven't gotten sick yet (knock on wood).

as we wrapped up our late lunch, we realized that elephanta island - one of the sites we had planned to visit - was no longer open, so we went instead to the gateway of india and to gawk at the beautiful taj mahal palace hotel. by 5 pm, we were pooped from the heat, smells, humidity, dirt and long walk. we came back to our hotel and took a nap in preparation for our next adventure tomorrow: our voyage to pune, then onward to jamkhed.

i must say that i am eager to be in a small town; one day in mumbai is really quite a bit to process. as i sit here, reading over what i've written, i realize that there is so much left out - so much that i'm not sure i can describe. the streets are infused with whiffs of sweet juice being made on the sidewalks, body odor, waste, incense, flavored cigars, herbal body perfume some people seem to wear that smells like cucumber and a mix of herbs, and roasted nuts. there seems to be a haze in which all these hang, or else the scents are bounced up in the air and kept afloat on the sea of people that densely fill each walkway and taxi in the street. deteriorating cobblestones underfoot lead to packed dirt, then to freshly laid bricks and cement paths. winding wide boulevards have tributaries of unpaved roads but feed into grandiose rotaries with central fountains. the city is as close to a jungle as i can imagine. there is no feeling of being unsafe, just being very foreign and pulled along in the sluggish current.

i picture myself as a speck on the map in asia, and think of you all many times each day across the globe at your own various sepcks. take care.

the night before the night before

welcome to my blog. this will chronicle my summer in jamkhed, india. i leave for mumbai on june 20, will stay in mumbai for 2 days, then head on to pune, where i will meet members of the comprehensive rural health project who will drive us to the village of jamkhed in a rural part of the ahmednagar district. all of this will be about 8 hours away from mumbai. i should arrive there on saturday june 23 late at night. i will be updating this as i am able, between taking a course in community health and development for the month of july, and carrying out research on chronic pain management for the month of august. i will also hopefully have the chance to teach some kids in the village how to play ultimate frisbee as i am taking a few discs with me to give them! there are errands to run today before i leave, so off i go...

counting down

in around 12 hours, i'll be leaving for the airport to begin the 18 hour journey to mumbai. and we still don't have a hotel... yikes. it does say, however, on the first page of my guidebook: "india rewards those who go with the flow," so i am trying to tone it down and get ready to be at the mercy of the "flow." a friend told me recently that when one undergoes "bite training" [if working with disturbed youngsters who have violent tendencies], you don't pull away at the risk of having your skin ripped off; instead, you push towards the biter. hopefully india won't be like having my arm chewed on, but ... it's an analogy.

i think the contents of my suitcase are pretty incredible. i haven't yet taken a trip like this, so i really went above and beyond to cover all the bases.

- medical creme: antifungal, anti-itch, antibiotic
- bandaids
- laxative, anti-diarrheals ["it's not a matter of if, but when..."]
- bug juice, sunscreen
- purell
- clorox wipes
- hand wipes [we will be eating with our hands]
- aloe
- anti-malarial drugs
- antibiotics
- duct tape
- mosquito net
- string
- sneakers, sandals
- raincoat and umbrella [monsoon season!!]
- sunglasses and hat [apparently there are bursts of rain, then hell-hot sun...]
- trail mix and granola bars
- flashlight
- hindi book
- midnight's children by salman rushdie
- love in the time of cholera by gabriel garcia marquez
- guidebook
- journal
- notebook for research
- toothbrush, toothpaste, soap
- two skirts, two pairs of pants, a shirt or two and plans to buy shalwar kameezes there!
- flash drive [they have computers there so you can email me]
- 2 frisbees
- plug to (bottle my anxieties and) stick in the sink when i wash clothes
- playing cards
- disposable cameras
- stethoscope

and i managed to get it all into one suitcase and a backpack - with an extra suitcase jammed in there to bring stuff back!

i have traveled enough around europe that i feel very comfortable doing so; in anticipation of a trip to europe, i can really picture the types of things i will do and how i will do them (eg. subway to train, what to expect from a 1-star hotel, what's safe). my insecurities about india are that i can't even picture myself there because - despite this modern age - i don't really know what it will be like. it's an adventure into the unknown. i anticipate writing again once i get to jamkhed in a few days, after having experienced the chaos of mumbai. i don't know what i will have seen, but i can't wait to share it with you...