Leaving Chennai

OK, finally going.....I'm definitely ready for some relaxation, and some time with my favorite person and his family in the Philippines.

I have been back at the Dr. MGR University Dept the past few days and a nice send off lunch today with some biryani, I'm heading to Kuala Lumpur for a 36hr whirlwind Malaysian experience.

In the mean time, check out some of my pics on smugmug. They are all out of order right now cause I had some crazy issues with how my disk formatted and not enough time online to sort it all out....they're not labeled either really....just a few labels for orientation- I'll fix them later and put up the other 200 pics I have!!!

Wedding fun...and not so much fun

I feel very privelaged to have had the experience I had last week at the wedding. So far, I had been to a few wedding receptions. One shows up at a big wedding hall, waits in line to go on stage and take a picture next to the bride and groom who are done up to the nines, and then walks down and gets fed in a very mechanical, rotating feast, where one sits down in front of a clean banana leaf and servers place piles of rice, iddly, chutneys, sweets, etc in front of you, and when you're done, you just go...and someone else sits down infront of a new leaf and eats...

This wedding was different. As I mentioned before, Anandani's Auntie is close friends with the groom, so we spent a lot of time during the week with the family. We met the bride on Monday and went saree shopping with her and her mother and the groom's mother...so we know the bride almost as well as the groom- he's only met her 2 more times than we had prior to the wedding! We also stayed at the groom's parent's house and watched all of the wedding preparations and got to hear about how to plan a wedding with 15,000 invites sent!
When we returned from Ooty, we got a hotel (even though the groom's family said we could stay with them! This is really hospitality...but we didn't want to make them crazier than they were). We got up early to attend a 6:30am ceremony at the groom's house. He was dressed in a dothi (like a wrap skirt that is traditionally worn by men) and barechested so that he could receive a ritual bath from his brother in law and grandmother in the front yard. They poured hot water over him and then circled his head with pongal (a rice mixture) and then blessed him with ash and placed a putu (like bindi- vermillion and ash on the forehead). Then he had "wedlock" toe rings placed on both 2nd toes. These are worn after marriage (instead of finger rings) by all married Hindu women. Somehow now, traditionally men wear them from this ceremony only for 3 days and take them off...after that they have no sign of marriage (hmmm why do women get burned for presumed extramarital affairs and it's pretty much ok when men do it....) Anyway, after the ring was placed, all the older family members followed the mostly now-extinct tradition of giving him money in auspicious denominations (11 rs, 101 rs, 1079 rs etc). For every relation who gave money, no matter how little, the groom's parents gave that person an article of clothing. Then breakfast was served to everyone (there were only 50 people at the house for this, not all that were invited to the wedding).
Then, before the reception that evening, I suddenly came down with a bad case of gastroenteritis, so I spent the rest of the day in the hotel room/bathroom, while everyone else got dressed in new outfits and glamorous fake gold costume jewelry, new bangles, etc for the reception...but then Anandani got sick half way through and came home early to share my misery.

At 4:45am when we had to get up for the actual wedding ceremony on Monday morning (the aupicious time ends at 7:30 so everything had to be done before then), I somehow felt good enough to shower and go the wedding hall....Anandani didn't. She stayed back and watched the porecelin horse go by.
I dressed in a really "grand" platinum and burnt orange colored silk saree with gold embroidery and beading lent to me by Anandhi, put on her costume jewels, a really sparkly bindi, bangles, embroidered slippers, and went to the ceremony. We got there early and went to the groom's quarters, where about 25 people had slept on the floor that night and were busy trying to take bucket baths and tie beautiful silk sarees, and coconut oil their hair.
The ceremony was long and complicated. First the 2 hindu priests sat on the stage- all adorned with flowers and garlands- and prepared the ritual fire and did some blessings with the groom and his brother and law only (bride still away). They put a traditional turban on him and vermillion and ash on the forehead again. After about 40mins the bride came out in about >$1,000 saree that had so much gold work, you could hardly tell that the silk background was orange and copper underneath. She also had fake hair extension braid down past her rear, small gold charms hanging off her hair, a real!! gold belt and gold necklaces, earrings, chains, and arm bands probably totalling over a 1lb. (PS: gold here is sold by weight so about $25/gram and the price of each piece changes with the market. So a nice necklace is all gold so they just put it on the scale and tell you how much it costs...same no matter the design... and this is how she has a dowry....they buy thousands of $$ of gold to put all over her and later if the couple needs money they sell pieces. )
So...the bride came out and with her attendants, circled the fire and the groom 3 times and then sat. The priest did a few blessings with the couple and then the groom tied the thali around her neck. This is a necklace, usually on a cord rope, but with 2 solid gold figurines on the bottom that she NEVER takes off in her life...she showers and sleeps always with it and it is long, but tucked under her saree blouse so the actual religious part (that varies based on caste etc) is not usually shown in public. After the groom tied the thali around her neck and the parents of each helped him, the crowd threw rice.
And, for a strange turn, they all went back to their rooms behind the stage to await the arrival of the big movie stars/politicians who were the guests of honor and partial wedding sponsors. But, as movie stars are, they were late...so after a 15 minute break, the wedding procession came on stage again and walked to the back of the auditorium to greet them. AND THEN ALL HELL BROKE LOOSE. 5,000 people rushed the stage....screaming and crying and trying to see them. These are (old) movie stars but some of the biggest names in Tamil movies- Sarathkumar and Radhikha. Sarathkumar is now the party head for a Tamil political party and the groom is the Coimbatore district secretary for the party, hence their closeness and appearance at the wedding. After about 20 mins of chaos, people kind of settled down and only 1/3 of people were on the stage. Sarathkumar addressed the audience. A family friend dragged myself and Auntie Victoria onto the stage and formally introduced us to Sarathkumar and Radhikha and we got to take a picture with them and the bride and groom.

After this, I still felt like a dead dog, so I left before the gigantic mechanical meal event occurred because I hadn't yet eaten in 2 days....and I unfortunately didn't take any pictures, but I will be getting a CD from the wedding photographer with the famous people! Anyway, I left, slept for a few hours, and by that time Anandani was feeling better, so we managed to travel back home to Namakkal 5 hrs in a car, and here we are, back at work!

Flashback: A Newer, cleaner Special Ward

Saturday. It was the day when we shook stuff up at the hospital before leaving that night- I just didn't get to talk about it yet...so here goes.

Earlier in the week our shipment of new mattresses, rubber sheets, etc arrived from the medical supply company in Salem.

Anandani was more than half the financial partner on this enterprise, but unfortunately had to leave already for Salem (to meet with before mentioned Auntie), so I enlisted people to help with the ward swap. The medical superintendent of the hospital nicely let us "borrow" some "low level workers" to help clean and move....but funny how they showed up and then just left again after taking out the garbage can. So, Antony, Vijima'am, Anandhi, and a few positive people from other organizations as well as sons, husbands, etc of family members helped us with the tremendous task...so we had no janitors/housekeepers as we were promised, but instead people with lots of masters degrees, medical students, other willing hands, etc got down and dirty! And since it was a pretty rought job, I made sure people wore respirators/masks and gloves (stop worrying, Mom).

First we took all of the ambulatory patients from 1 ward half (8) and others who couldn't walk, and layed them on sheets out on the terrace. Then we carried the old mattresses outside to await incineration. Most of these mattresses were soooo broken down that they couldn't even be carried without sagging or pieces coming off. One was soo soaked with water, black mold, and (i don't want to know what kind of bodily fluids) it was 2x as heavy as the others!!! Then, we took bleachwater and soap and scrubbed down the metal frames, scrubbed the fans and the wall tiles, the shelves, the floors....everything. Nothing had been cleaned for months or years- there was food and who knows what else on the walls. Old X rays hidden under the beds....stashed meds.

After everything was clean and dry, we brought in the new mattresses, covered with clean rubber sheets, and brought the patients back in. For patients that were very sick, we cleaned 1 bed, then transferred them, then cleaned their original bed. Then, we did the other ward room- 7 beds on the 2nd side...

After working straight 11am-4:30pm, about 10 people, we finished. We brought in spray bottles and instructed the nurses how to mix bleach and water and spray down beds between patients and requested we do this EVERYTIME after patients got discharged. Patients were soo excited about the new look of the ward- one girl set for discharge even asked to stay another night to sleep on the new bed.
The reason we had to do rubber sheets is because the hospital doesn't provide laundry service for the about 10 cloth sheets the ward actually has (somehow all the other wards have sheets and they get cleaned....subliminal message about the status and stigma of HIV infected people) so they are never used since they can't be cleaned....this was our way to have sustainable cleanliness.

Hopefully I"ll be able to post pics of the ward before and after soon!

Coimbatore and Ooty

After a very tumultuous couple of weeks including politics at the hospital, difficult situations in our staff house, and some sad news from home, I decided to join Anandani and her Auntie from Malaysia on a trip to Coimbatore, Ooty, and returning to Coimbatore for a wedding next weekend. The Auntie went for a week of Ayurvedic treatment there, so she sent us off exploring with her sort-of-nephew as a chaparone ( he's 19, but he is just supposed to make sure no scary men bother us...Indian women aren't really allowed to travel alone, we felt comfortable doing it since personal safety is really not a problem, but anyway...we have a non-English speaking chaparone).

We left from Namakkal to Salem to meet Auntie Victoria last weekend by bus, stayed overnight, then took a rented car at 5am the next morning about 4hrs to Coimbatore. The driver was supposed to take us everywhere this week, but we hated the way he drove and swore at other drivers, so we let him go and decided to just wing it. In Coimbatore we stayed with a family friend of Aunty's where we've been experiencing some famous Indian hospitality. Just to be clear- Auntie Victoria is in no way related to Anandani- their families have been friends for about the last 20 years. And the people we stayed with in Coimbatore met Auntie's family on a train many years ago and have kept in touch and she stays with them whenever she comes to Tamilnadu. AND this family is the family whose son is getting married Sunday. And they insisted we stay with them and have been amazing to us...and oh, only 5,000 people are expected at the wedding. I think they're insane for having total strangers in the house the week before, but I guess they also wanted to show us all around....and also give us very expensive sarees to wear for another wedding and want me to keep mine as a wedding present....yeah....and the mother rubbed oil on my tummy when I got a stomach ache...this is hospitality!

So, now we've escaped to Ooty (which is short for Udhagandamanadamandnan or something like that). This is the most famous British hill station in south India and is a favorite honeymoon spot. We hired a car to take us up the mountain- which is about a 3hr ride up a nearly single lane, switch back, through beautiful eucalyptus trees and finally reaching the tea estates with miles of terraced fields full of tea. We stopped along the way at a tea estate/factory and watched people picking tea, toured though the roasting process and got to sample masal tea, chocolate tea, green tea, etc...and bought some for home. Then we detoured for several hours through small roads impossibly switchbacking between the terraces and went to really picturesque viewpoints, saw some monkeys, visited the hillstation of Coonoor, and finally ended in Ooty late in the afternoon. We're staying at the YWCA bungalows here- after a great experience in Chennai- and they are very nice with beautiful flower garden. However, it is really cold here- which is refreshing, but still a little chilly without heat- maybe close to 30 last night (which is a big change from highs of 110, lows 80)...

Today, we toured around Ooty- took a peddleboat out in the lake, visited the botanical gardens, and went up to the highest peak in the Nilgiri hills (part of the western Ghats that run from Maharastra down through here and Kerala...we're just a few miles from Kerala and Karnataka states here). Sadly, there was not so much view at 8,800 feet because of dense fog, but it was still nice...bought some fresh mango, carrots, custard apples.... actually the climate and flora is kind of like coastal Oregon or Northern Cali except the Eucalpytus trees and tea. They are growing a lot more root veggies and cabbage, sqashes and things because it is cold here, though warmer in the summer. They also have lots of conifers and deer, which is amusing because pinecones are really exotic things to bring home here.... and it is so beautiful. The tea trees are kept pruned to about 2 feet high and are in neat clumps that form rows that are on terraces down impossibly steep terrain. And each section is a different shade depending on how long it's been since it's been plucked. The newest leaves are very light, bright green, and after plucking, those rows become darker and less yellow, so they look sort of like a baseball field that is mowed in different directions. And there are beautiful tall trees planted in perfect intervals between them to provide shade and also regulate the water in the ground, so this provides another level of gracefulness of the fields. And the land just falls away for thousands of feet below with fields stretching as far as one can see.

We wanted to go to Mudamalai Nat'l park tomorrow, except during dry season, I guess only deer are out. Usually there are elephants, tigers, wild boars, and buffalo etc. We've been wondering where they go. Maybe on vacation to Bombay during the off season? We're sad we can't see them.

Maybe the best part of the day today was having a pizza for lunch. I haven't seen any kind of food besides very good, but monotonous south Indian food, with occasional breaks of Tandoori and Indian "chinese fried rice", so the pizza today was amazing. I haven't seen cheese in 7 weeks!

Looking forward to a few days of lots of tea, gardens, yoga, and reading before heading back to what I assume will be an insane wedding, followed by a return to hospital work next week.

I'm a real Indian woman now!

I survived all of yesterday in a saree. I was kind of excited to try one one, but also fearful since I have been hearing that it takes a lot of composure to keep your saree arranged properly all day and white girls don't do so well in sarees. In fact, young girls here traditionally wear a pavida (a saree blouse appearing shirt over a long gathered skirt because they would never be able to manage saree. When they are older, like 9-12, they transition to pavida-davini, or half saree. This is a saree blouse and the same long broomstick skirt but with a long swath of cloth looped around the waist and over the shoulder- like just the top half of the saree over a skirt. They often wear matching skirt and half-saree with contrasting shirt, as if the skirt and cloth were one piece. Nowadays, a lot of girls in Namakkal and a lot of young women in Chennai wear salwar kameeze instead (this is the long shirt with loose pants and a scarf worn across the chest- think Pakistani dress).
So, since I've been here, I've been wearing a few salwar kameeze I had made by a tailor and also some pants and shirts or long skirts....but never saree. Many friends and coworkers had offered to lend me beautiful sarees, but you have to have the very fitted half-shirt to go underneath. This is a huge problem because everyone here it very small boned and the biggest girls are 5'2" and I can't even get their sleeves past my elbow because the bone is just bigger (not even talking muscle or fat parts...my elbow is bigger than the bicept part of their sleeve!!). So, in anticipation of a wedding we're attending, I had a saree blouse made to wear a really phenomenal silk saree of a friend's. And another friend let out a few inches from her blouse so it would fit and I wore her casual saree (synthetic, light summer material, not gold embroidered silk like a fancy one) to work yesterday.
The saree was actually pretty easy to wear...because Anandhi spent 20 minutes tying me into it! And then it was pinned in 3 places (this is a newbie thing to do) so it wouldn't fall off. And the middriff ventilation was nice...except I'm not used to having my upper back and part of my side showing at work...but here this is much more acceptable then having your ankles or cleavage showing...and I got so many compliments that I looked like I'd been wearing one for years.

And yesterday- Venus and Serena Williams played at a tourney in Bangalore and they posed wearing saree also...except they looked not nice at all...they had their stomachs all showing and they weren't tied right...but it was amusing. OH well, I"m glad I look better in saree then the Williams sisters cause I sure as heck won't ever play tennis like them!

The Magic of ART

Amidst all of the sadness of caring for very sick patients that often have problems that beat our capability of diagnosis and often our ability to treat, it is rewarding to see the magic that is Antiretroviral treatment.
The voluntary testing center here has tested about 20,000 people for HIV since they started 2001. Since they are the referral center for several hundred km around, they have registered around 7,000 HIV+ people that they follow with CD4 tests every 6 months. Over 3,000 people are on Antiretroviral treatment. They get seen every month and given a months worth of medications.
I love seeing patients come in that were very sick when they were diagnosed- very wasted, maybe weighing 70 lbs, tuberculosis, bedridden, etc...and then they come back, maybe only a year later. They've gained 10,20, 30 lbs. Their hair is shiny again, they have meat on their cheeks, they look well, and maybe they've even gone back to work. It's really amazing what these drugs can do when people take them every day. People are so thankful once they get on them. But sometimes it's a stuggle convincing them it's worth it to start. People often live very far away and coming here every month is a financial and time burden. But people go to incredible lengths to come here...and slowly, more centers are opening so that people can transfer care to closer to home. It's really amazing that this small town (400,000 people is small here) is considered the best place for HIV treatment anywhere in India, except maybe for 2 big gov't hospitals in Chennai and Delhi!

New Mattresses

Anandani and I have been brainstorming on how to best serve the hospital with the sum of extra money in our grant that is set aside for this type of thing (Thank you kindly to the University of Washington, the Puget Sound Partners for Global Health, and the University of Arizona!). The situation in the Special Ward is a bit dicey, as I mentioned before, in that there are multiple funding parties and responsible parties for that ward, but difficulties in allocating funds for things other than direct patient care for AIDS-related infections due to how the money is provided. We have opted to donate new mattresses since the ones in this ward have the stuffing coming out of them and also at times have small creatures coming out of them. Also, this ward has no sheets, so the patients are lying directly on these mattresses, which is not at all sanitary, since the mattress covers are so destroyed that there is no intact layer to wipe clean between patients or to clean body fluids up when they inevitably land on the bed. Also, there are 16 beds and usually about 16-19 patients, so many patients are sleeping in the hall on the floor. I won't say any more about why this is, but it involves politics.

Today when I went to speak with the hospital's superintendent about this donation, there was for some reason a news crew in the office, and so when I made the announcement (Anandani was at another hospital) they asked me to pose for pictures with the hospital superintendent and pose for pictures in the ward (which was difficult because we had to make sure they didn't take pictures of patients). So apparently, I'm going to be on the local news and in the newspapers tomorrow! I hope that they use the publicity correctly to show the needs of the hospital and specifically HIV/AIDS patients....we'll see about this. I have a little bit of apprehension about how everything will turn out. But the mattresses arrive tomorrow, so this will be great news for the patients.