Fever dreams and Molish

Hmmmm….. How can I describe the despair of delirium and fever when you are isolated in the middle of rice paddies, no reliable medical services for at least 5 tortuous hours in a jeep, no one who speaks English to understand why you’re sobbing, and of course you’re in the tropics and have a medical education so the differential diagnosis running through your clammy brain is … prodigous?

Finally Asha arrived, and was kind of shocked to find me in this state. I had just been in bed all day, so no one realized! She was fantastic and cared for me, forcing me to eat, drink tea, and doing molish (I guess it means massage, mostly it was just a pressing/rubbing on my sweaty skin) for a couple of days, until she took ill herself. Then her daughter caught it from her. I felt awful to have spread my contagion so far. They both have recovered fully, but Asha took Suni to the doctor. He gave her a couple of shots of who-knows-what and that cost her 100 Rs (about $2.50). It’s a lot for her.

When Asha couldn’t come, Chinnamuru (the cook), and Parathi, (the wife of the handyman) would show up 3 times a day, cluck over me in Telegu, make me eat a few bites, and do some molish on me. I can’t express how even though being touched felt kind of icky, it was mostly just profoundly healing. It was such an incredibly pure expression of concern and desire to do something to help. Thank goodness for the ladies.

People always think it’s ironic when “the doctor” is sick. I think it’s an important reminder for us, and helps renew our compassion. I know I’m feeling very compassionate right about now! It was interesting, in a way, to observe my own symptoms – fever, pain, weakness, anorexia, maybe a touch of delirium. I felt the illness leave my body pretty abruptly. One day I just could walk steady. Two days later I actually had an appetite. The first time I ate a decent meal, Asha glowed with pride (and some relief, I think).

Now that I’m feeling better, I’m ready to start preparing the teaching modules. I don’t think there will be any more field visits. :[ They’ve been really interesting. Sambamurthi asked me, “Madam, how was field today?” I told him “It was fun.” He nodded and said “Fine.” I had to clarify, “No not ‘fine’, it was ‘FUN.’” First he looked confused, then bemused. He's a very serious man, so it was nice to get a smile out of him.

Here are some last pictures from the field, and one of my Molish Team.
Songs for fever (sangitam oka jwaram): a dreamy mix of iron and wine, Dead Can Dance, Mazzy Star, Sufjan Stevens, Joshua Radin, Sia, Nick Drake.

P.S.
I want to send a shout out to everyone at the Petaluma Health Center. I miss you!
And a huge Happy Birthday to Sadie!! 8 pounds 8 ounces and a head full of hair. Jena, you're a star.

Mysteries of India

We had an overnight at the coast. It was a long drive to get there, but Asha insisted we stop at the Akulamma Talli temple. She is Ammavaru -- mother to the whole world. Here is a picture of her feet. Asha is Muslim, but she likes all the female goddesses, especially. Indians seems pretty flexible that way. I see her giving money to beggars all the time, especially if they’re women. She also likes Sai Baba (not the current fuzzy headed one, the old skinny bandana’d one) and does this kiss your finger touch it to your forehead thing whenever she sees a picture of him. He’s really popular and there are pictures of him painted on buildings everywhere!

We stayed in Palassa. It’s a bigger city with a train station, major cashew processing industry and lots and lots of mosquitoes (doma). We visited a few coastal villages: Baruva, Sompeta, Baipali and Kunduvanpeta. One issue that keeps coming up is “over-bleeding” (menorrhagia). (Very) informal survey reveals at least 50% incidence and 30% of all women ultimately getting a hysterectomy.

So it goes like this: you get married in your early 20’s, have your two babies, usually within 5 years, then you get your tubal by the time you are in your 30's. By your 40's, you start “overbleeding”. Menopause is around 45 years here. So the doctor might treat you with hormones for a few months, but then they explain that without a hysterectomy, you will develop cancer. Sometimes an endometrial biopsy is done that confirms this. The women are scared, and get the surgery, which they pay for out of pocket. It costs about 10,000 Rs, which puts these women into debt. After the surgery, many women feel chronic "loss of energy", knee pain and back pain too.

What in the world is going on here?! It has been suggested by some that the surgeons deliberately 'overstate the problem' for personal gain. There seem to be a lot of unethical aspects to medical practice here. For instance, whenever a doctor orders a lab test or an x-ray, he gets a cut of the fee! The prices of course are highly inflated because of this. I can't say how shocked I was to hear of this practice. I think it's 10 kinds of illegal in the states.

More Indian mysteries: Why the 6 year old boy who was cinnamon color 1 year ago is now 6 shades darker? What kind of water contamination is going on to cause all the kidney disease concentrated in these coastal villages? What is it about cashew processing that causes asthma? Is there really a 5% incidence of breast cancer in some of these coastal villages, as I’ve been told?

We passed another herd of goats on the road and they’re such a lovely breed (I *really* like goats). I asked Asha “Do people keep goats just for meat, or also for milk?” She said, “No, no. Men and also children. They get it from the forest.”

I guess some Indian mysteries will never be solved….

Caste feelings

I went to a huge meeting in Kotturu of all the angan wari teachers in the district. These ladies are incredible. They are on the frontlines, in the most remote villages, giving basic education to kids who would otherwise have no access, giving midday meals where kids would otherwise go hungry, monitoring children for malnutrition, etc. I asked them about some of their accomplishments and they told me about increased school attendance, improved immunization rates, increased prenatal care. I heard a story about a child whose mother died in childbirth. The teacher was so proud that although the baby was a little undernourished, he was actually surviving and developing well.

I asked what one thing they would do if they had a magic wand. They got excited, and mostly said they would build more angan wari centers. I asked if they like what they do, and YES, they started beaming. It was so inspiring! When I asked about some of the challenges, one of the things they mentioned was “caste feelings”. Some of the teachers are lower caste and parents in the community don’t want to send their children because of that. Never mind that the kids can’t get education anywhere else. Never mind that they’re all equally poor! The caste thing….. I don’t even know what to say. The teachers’ union is having a meeting soon, trying to get guaranteed salaries. I told them I hope they get it and everyone cheered.

They had great questions for me, too. They asked why do newborns sometimes turn yellow? Why do they sometimes have trouble breathing? It was fun to give an impromptu talk about neonatal jaundice, and causes of respiratory distress. We finished up with the surya namaskar, and they got totally got into it!

In the next village, I was approached by the panchayat sarpanch (president of the village). “Shoulder pain,” he said. After some questions, I asked him to take his shirt off for an exam, and actually had to insist cause he was acting shy. I didn’t get it – village guys go around mostly naked all the time! In the jeep ride home, in the middle of all the Telegu chatter, everyone started cracking up. Eventually they told me, he didn’t mind having his shirt off, but he was afraid my range of motion testing would make his panchi (man-skirt) fall down, and he wasn’t wearing any underwear!

Here’s a picture of a lady holding a piece of bellam. It’s an iron rich food, good for pregnant ladies. I tasted it – it’s canela! Yummy cane juice before the molasses is extracted and it’s turned into sugar. In Hindi it’s called jaggery.

My Caste

The other day, I wore some silver anklets like all the ladies here do. Today, before we left my room, Asha held them out for me to put on again. "Compulsory".

We visited a really nice angan wari center in the village of Navatala. Kaluamma is the teacher there. My friend Rachael in Petaluma is an Orf-trained music teacher with a special interest in world music and she’s asked me to bring home a children’s song. Kaluamma taught me the yenegu (elephant) song while we waited for community members to arrive.
Yenegu yenegu nallana,
Yenegu kommalu tellana.
Yenegu meeda Ramudu,
Yetto chakkani devudu!
How beautiful is Lord Rama sitting on the elephant’s back!

This day we met with pregnant ladies. It was so sweet! One woman in particular was just beaming and pleased to be in the 8th month of her first pregnancy. You know her labor will be lovely. Another woman with disheveled hair and sari had sallow skin and such an obviously anxious expression on her face. It was heartbreaking. She looked anemic and neglected. We spent time talking about how important nutrition is, for baby’s development, and for her health. She’s at increased risk for infections like malaria and severe complications at delivery. We tried to make a plan, who was going to help her with food, and care for her. I just wanted to be there with each of them at time of delivery.
**But mostly, Jena, I wish I could be with you! Good luck and make sure Denise is your nurse!**

We talked about how you know when labor begins, and what to expect during labor. We also reiterated that babies need colostrum until mother’s milk comes in. There was a common belief that babies should not eat the first 3 days of life. Sometimes they were given water or cow’s milk, but colostrum was devalued. How can such ideas persist when they so clearly compromise survival? Infant and maternal mortality rates have been so high in this area, there is a big push for institutional (hospital) deliveries. Women are even given cash money (1000 Rs!) if they deliver in the hospital. The program has been very successful and the mortality rates have dropped significantly in the past 2 years.

The government had a similar strategy to address family planning. They gave every woman who (voluntarily) underwent tubal ligation a free sari. (I emphasize voluntary because India has a horrible history of enforced sterilization campaigns, fictionalized memorably in Rohinton Mistry's incredible book A Fine Balance.) Now, most women get the tubal after babies, even without the incentive, but it really makes you think what someone’s life is like when a decision like that can be influenced by the price of one sari.

The first picture is me eating nuvulu (sesame seeds) while the telegas grinds them in the press used by his father, grandfather, etc. The telegas have their own caste even! I decided I'm in the 'field worker' caste with people like Asha and Nell. There's also one of me and "Sir", A. Ramakrishna Raju, the head of BREDS.