The rest of our time in the rural area!

Get ready, get set-here's another long post from the rest of our week in the rural area!

The following day I woke up earlier with the MSc students to make breakfast. They cook everything on a propane stove, from coffee to curry. For breakfast we made a porridge, which is vey different from what we would call porridge at home. It starts with fried peanuts, and they add curry leaves, cumin, split peas, chilies and a few other non typical porridge items. We also had what they call yellow rice here, which is more like a fried rice where they add roasted peanuts, tumeric, curry leaves, chili powder, ground coriander, and some other spices too.

Our cooking set up in the rural area

After breakfast, we walked to the nearby village to do home visits. It took us about 20 minutes and it was nice to be able to walk peacefully somewhere without constant smog and honking. When we arrived we went to a rice paddy. It was so cool! The rice grows it little green shoots that are in semi deep water plots that are divided by thin strips of dense grass that you can walk along. We balanced our way through the fields, trying hard not to fall into the deep, mucky water that lay beneath us. We made our way towards a group of workers in the fields. Using our MSc friends as interpreters, we learned that the women working in the fields work from the early morning til 6 pm and make only 100 rupees a day, which is less than 2 CAD. I talked with one of the sisters at the convent after about til, and she said that this was not enough to even buy food for one person for one day. After watching the women work for a while, we decided to get in the field and give it a try. It was really fun going in the high mud trying not to fall, and working alongside the women grabbing the young stalks, putting them into bunches and tying them with straw. These will be used for replanting in other fields later. After we cleaned the mud that was up to our knees off, we made our way to the village. The village felt very different from the "village" in the urban area we visited. There are nearly no men in the village during the day. Many women seem to congregate at one family's house and visit during the day. We visited with these women, but it requires 2 translators because only the community health nurse could understand the local dialect, so she conferred what the women said to one of the MSc students in Telugu, who then told us what was going on in English. All ages of women were in the home, from very old looking women to ones who had just finishing her Bachelor's degree. It is common for mothers to live with their son's family. We also learned why all  the post natal mothers wear either a scarf over their head or have cotton balls stuffed in their ears. It is because they believe that if air gets in their ears after birth it will cause their muscles to go loose and it may stop evil from coming in. We had noticed some of the nurses in the clinic who had this and stated that they did it despite the fact that there was no scientific proof.

Wandering through the rice paddies

The women working in the rice paddies-we gave it a try after!

Us on a home visit

After, we made our way back to the convent and had coffee and tea. Here they make it by boiling water and adding a tea powder or instant coffee to the water, and leave it simmering for about 15 minutes. They then boil milk in a separate pot, and add the boiled milk to the water along with sugar. The tea is strained through and then served in tiny cups, about the size of an espresso cup. The tea is never strong, and though they call all tea chai, it is more like orange pekoe tea than what we would consider to be a chai tea. We had lunch pre made in the morning, and we made something that they call "meal makers" which is like a processed soy, meatless alternative that comes dry and looks like a brown Captain Crunch. They soak it in plain water until it expands, and then they squeeze out the water and slice each piece in two. Then the typical spices are added along with some potatoes and green beans. It was actually quite tasty, but I feel as though my stomach has shrunk because I cannot eat more than a third of a cup of rice with just a bit of curry before I am full. Not a problem I am used to having, that is for sure. In the afternoon after a short siesta, I did my laundry outside on this massive smooth laundry block that you can really scrub your clothes on. It was really peaceful and I felt as though it was the first time since I've been here that I've really cleaned my clothes. As I was working one of the sisters at the convent came along and was teaching me how they do laundry. She then took my around the massive grounds, pointing out all of the food that they grew. I saw coconut trees, lemon trees, guava trees, plantaine trees, mango trees, rabbits, water buffalo and their own rice paddy. It was interesting to see how self sufficient the convent is in many ways, and it made me jealous that we are not able to grow such delicious foods in our own backyards. Another thing about here that we've become accustomed to are many questions about our families. When you meet someone new, they always want to know what your mother and father do, how many siblings you have and what they do, and whether your are married or not. Often we are answering these questions 2 or 3 times a day for the various people we meet along the way.

Since some of us had been having troubles eating the lovely food the MSc students had been preparing for us due to sickness, they asked me to help them prepare the chicken in such a way that we'd be happy to eat lots. Using some input from the other girls I tried to get creative with he ingredients we had and made boiled chicken with onions and tomatoes, and then fried it with their super yummy ginger garlic paste, butter, chili powder, pepper and more onions and tomatoes. It was bland compared to the food we had been having which was I think we needed for just one day. I loved being out in the little house beside the convent cooking with the girls, especially when they finally let me actually help with something. They definitely treat us like guests here which is nice but it's strange being serves by people you're becoming friends with, and i always like to help out in the kitchen. While we were out there I talked with the girls about arranged marriages vs what they call love marriages. They said that parents will allow a love marriage as long as the partner is of the same religion and caste. They said if the parents don't approve and the couple wishes to marry anyways, they will be separate from the parents and have very little contact, which is a big deal in India where parents often financially support their children for long into their adulthood, and the favour is then returned in their old age. The girls then told us how they would likely have arranged marriages, with one girl's parents already looking around for a good match for her. If both parents agree its a good match, the people will meet to see if they get along. If everything is set and the the groom's family asks for a dowry, the girls told us that this is not only very offensive, it is also illegal and can earn you jail time. I was very surprised by this, because of the benefits given to parents who have female babies in order for them to pay in part for the dowry. From what I understand, dowries may be more common among poorer families, where the belief that taking on your daughter into our family will be very costly, and you should pay us something for taking the expense off your hands. This is definitely a simplified version of the seemingly endlessly complicated process of Indian marriages. I also found it interesting to learn that the rules of love marriage apply to all religions, so even though the caste system is a protect of the Hindu religion, it permeates deeply into Indian culture. The girls also said that though they and most people know that discrimination based on caste was bad, it was  nonetheless widely accepted as part of the culture. 

Today I found to be a very rewarding day as it was nice to do as the locals did instead of just observe. I also really enjoyed talking with our new friends, as I feel I have so much I can learn from that and I am just starting to wrap my head around the intricate Indian culture. I also feel very fortunate to have the experience of getting to know people in the country you are traveling in, as often sightseeing along doesn't allow a full picture of what life is like for the people living in the area.

 

The post office in the rural area

Us riding in the back of the rickshaw

On our following day we awoke to French toast, or what they call omelet bread or Bombay toast. Though I don't really like French toast at home, it was so nice to have some familiar food for breakfast instead of such spicy food. We made our way to a school today to do health checks on the children. We measured their height and their arm circumference to assess their nutrition status. We then did an impromptu health education session on hand washing where we sang the kids a song. It was fun, and then the kids sang us a song as well. We also visited what was basically the mayor's office in the village we were staying at and learned about how taxes were collected and forwarded to the state government. When we arrived back at the convent we had the most amazing surprise - what seemed like one hundred monkeys were all out and about on the convey grounds. There were all ages of monkeys, with some of the bigger moms carrying little babies hanging from their stomach. They were literally everywhere-crawling up the convent walls, on hydro lines, all in our cooking shed, climbing along the sharp glass coated exterior walls of the convent, swinging from the trees eating guava. It was such a cool experience as we watched quietly trying to let them get close to us. They are definitely not afraid of humans, and I think that we were actually more afraid of them and their unpredictable patterns of movement. It was basically like being at African Lion Safari except that this was real life. Very cool!

One of many monkeys we saw

Our reception back at JMJ College of Nursing

Today we made our way back to Hyderabad, and presented our experience to the MSc students and faculty at JMJ College of Nursing.  I found it kind of sad to say bye to our new friends who we had gotten to know over the week. After we were treated to such a lovely feast of food, and we made our way back to CHAI.  Only one week left here in Hyderabad before we start our travels, so we have a list of things to finish up for our program, as well as a list of things to get done in the city before we leave. As always, thanks for reading! Until next time...

The weekend + Beginning of our rural posting

Hello all! Since we were in the rural area, I had a lot of time to update my blog while I was away, so this week's is a bit lengthy and detailed. Bear with me if you can!What an interesting week we've had.  Unfortunately mine started off on Saturday afternoon with some sort of vicious stomach illness that left me sick all afternoon and night. Luckily the nausea stopped by Sunday and I was able to go visit Golconda Fort in Hyderabad, a 500 year old fort that housed the palaces of the Muslim kings who ruled Hyderabad. It was really cool to walk through and we had a guide who was able to fill us in on cool details like how the acoustics of the fort were built such that if someone clapped at the entrance of the fort, it could be heard as a signal way up the hill. Probably the most interesting thing we saw was a goat being sacrificed. We didn't really know what was going on, but there was a Hindu festival occurring that day and all of the sudden two men grabbed the goat and there was a knife and the rest is history I guess! Jessie and I were both quite disturbed by the experience, especially since I personally haven't gotten that used to eating goat here, or mutton as they call it. I think it's because all the butcher shops hang the entire animal's meat in the front of the store with a metal hook and there are plenty of flies and no refrigeration. Anyways. After the fort we made our way to some tombs, which were not at all what I was expecting. The tombs are huge-like stories and stories high-and each house only one Muslim king or his wife. There were seven total in the yard which seemed to go on forever. It was very tranquil and we were far enough away from the traffic to not hear the constant horns which are normally inescapable. After, we grabbed dinner and I had some KFC which was just the thing I needed to get my appetite back!

Jessie and I after seeing the goat being sacrificed

The whole group hanging out at the fort

The massive tombs we visited neaby the fort

The following day we woke up early and went back to JMJ College to pick up the MSc students and the lecturers before we headed to the rural area for the week. We were told that the area was actually semi-rural and not rural, but considering that it'd be about a 30 minute walk to the village from where we are staying, I'd say it's pretty rural. It was nice to drive through the country for a change of pace and I'm always interested in seeing what people are growing. We saw lots of green fields and rice paddys along the way, as our driver somehow navigated along the narrow road, dodging cows, water buffalo, goats and whatever else came along our way. Our first stop was at the District Medical Officer's Head Office (DM HO). Basically, the state of Andra Pradesh that we're staying in is divided further into districts. Each district has a heck of a lot of bureaucracy it seems, with the head district medical officer having an incredible amount of power. We listened to a talk by a different officer, who explained how the district was set up, how primary health care services were delivered, and how they were developing various programs in the community to improve health. He talked a lot about the presence of corruption in the system, and about how it is relatively easy for doctors working at primary health centers to not show up for work, or only show up for half of the time they are supposed to. It seems as though people are not punished for absenteeism here, if your position is high enough-perhaps this is because these people have they have the means to pay people bribes, which, from what I can tell, is very common here. Today, actually, we heard from one of the MSc students about how the Indian Nursing Council has some corrupt members who are allowing some very sub par nursing schools to be accredited despite the students not being prepared to be nurses, just by having the owner of he school pay the council member. Corruption, it seems, exists everywhere in India, from the highest to the lowest levels of government. While I know corruption exists to some degree in Canada, it is much more widely known and accepted as a part of life here. Anyways, the man who have the talk was really on the ball with recognizing some of the problems with corruption in the system and was implementing some accountability measures to help with the problem. He also talked about how he had undertaken some disciplinary measures when a medical officer demonstrated negligence which resulted in death. Not that big of a deal to discipline by Canadian standards, but I am pretty sure this doesn't occur very often here. Some of the important things he told us about were similar to programs at the UFWC, like encouraging all women to deliver at the primary health centre instead of in the home, as these births are often not attended by any skilled attendant, resulting in a higher infant and maternal mortality rate than in Canada. In the primary health centre, if the delivery is uncomplicated it will be attended by a nurse midwife, who is at the centre 24 hours a day providing care. If there is some complication, then the delivery will be referred to a hospital or centre who can perform a safe delivery. One thing thats interesting, though, is the fact that some centers don't offer 24 hour C-sections, and so women who medically need one are forced to go to private hospitals and pay 8000 rupees for the section. The man who gave our talk talked about one initiative where the women only have to pay 3000 rupees to the hospital to help mediate the costs. Still interesting though, and points to how the public healthcare system here is not nearly as universal as it is in Canada. After the presentation we were off again, and stopped along the road for a picnic lunch of rice, potatoes, curry and egg. When we finally reached our destination, we learned that there was some problem with the accommodation that had been arranged. The sister who had accompanied us said she would've felt bad leaving us there as there were no fans and many mosquitoes due to the rainy season and stagnant water in the fields. So, she arranged for us to stay at a convent with sisters in training. The convent is much more comfortable and clean. Though we are sleeping on the floor for the week, we've been given mattress pads, which are similar to an outdoor chair cushion, and we brought enough blankets to be comfortable. Plus, there is running water and fans! We have also all strung up our mosquito nets, which are getting good use here. While in the UFWC one of the nurses told us that although the government had declared that malaria was eradicated, cases still exist. We learned that in the past year, this district had 20 cases, which doesn't seem like too much but considering how many districts there are in Andra Pradesh, I guess it's high enough.

The entire group who went to the DM & HO Office

Our roadside picnic feast

On our first full day of placement, we awoke to a wonderful breakfast of toast (which we had all desperately been missing) and omelets. My appetite was finally back and I certainly ate my fill. After, we made our way from the convent to the PHC where we'll be observing things daily. We had to walk down the country road a bit to get a rickshaw, and once we did we were surprised to learn that all 14 of us would be going in the same one. While this was a larger than average rickshaw, with a small trunk of sorts, the whole thing cannot be any bigger than a mini Cooper. So just try to imagine the squishiness that ensued! It was fun though, and riding in crowded rickshaws has become part of our daily routine now. Once we arrived at the PHC we learned that the doctor was 3 hours late-big surprise! We toured ourselves around the small centre, which serves the entire sub district of Toopan. It has an immunization clinic, delivery room, 6 bed ward room, an Integrated Counselling and Testing Centre for HIV, a TB DOTS Clinic, as well as regular drop in services. If the patient comes and no doctor is available, the nurse can dispense medications for simple cases. We had a listen to the doctor once he arrived on the activities of the centre and the types of programs it provides. Afterwards, we made our way back to the convent and had a delicious lunch of grilled cheese sandwiches, which also quite pleased my tummy. It is not that I haven't been liking the food, but more so that I needed a break from the same taste that had made me so sick. I hope to be back on curry soon though!

Nicole, Michelle and Jo-Ann getting comfy in their mosquito netted beds

Our time at JMJ College of Nursing

Hello All! Lots of updates to tell regarding our second week at CHAI. Well, actually, this week we were not staying at CHAI, but at a nursing college called JMJ (Jesus Mary Joseph). We stayed there from Monday to Saturday, living in dorms similar to what the BSc Students would stay at.  Our hosts there were very accommodating and lovely to be around.  They were able to adjust the spice of some of the food to make it more tolerable for our Western bellies. Each day at JMJ, we spent the morning doing a community placement alongside the BSc students, and spent the afternoon taking a brief class, then exploring Hyderabad.  One thing that this experience has taught me is how much more formal school is here in India. We learned that the professors had very high academic expectations for us, such as doing presentations and writing a report on our experiences.  Since I am a bit pressed for time here, I am going to cheat and incorporate some of that report into my blog here. Promise that I will try not to bore you too much! Another interesting thing about the college is how little freedom the students have. Basically, from the time they wake up until 8 in the evening, they are busy either in school or studying. Then, for about an hour each night, all the Catholic students spend time praying, and they also do a procession, or a walk, through the campus each night, saying prayers over and over again, and holding candles. The students are only given free time during one afternoon of the week, during which time they are supposed to go to the Internet cafe across the street to do research. The weekends are also spent studying or in clinical placement. Definitely not the typical undergrad experience by Canadian standards!

Jessie and I in our Saris!

On our first day at JMJ College, we visited an Urban Family Welfare Centre with the year 4 BScN students and some MScN students. The UFWC services a population of 60 000, all of which are urban dwellers. The UFWC provides primary healthcare services that are prioritized towards woman and children.  The clinic provides drop-in services for minor ailments like cold or cough, as well as antenatal and post natal checks, well baby checks, immunizations, family planning services, uncomplicated deliveries, TB DOTS clinic, lab testing and post partum ward services. The first thing I noticed was that the students were wearing purple saris-we were told that nurses working in the community do this as community health nurses are one with the people. This is similar to Canada, where in a community setting we wear plain clothes in community health to lessen the power difference between nurse and client. Once at the centre we learned that simple care provided here was actually far more complex that what would be done in Canada. For example, deliveries and simple surgeries are not done in the community. Additionally, the government provides incentives for people to undergo certain health behaviours. For example, woman receive an incentive of 500 rupees for having a tubal ligation after they’ve had 2 children, as the government is attempting to control the population. Also, if a family gives birth to a daughter, the family receives an incentive of 60 000 rupees for 2 female daughters once they turn 18. This is to compensate for the cost associated with providing a dowry for daughters when they are married. We also learned that is illegal to do prenatal sex screens to determine the gender of the baby, as male babies may be preferred and families may abort female pregnancies due to the high cost associated with providing a dowry for marriage. The UFWC was actually conducting a sterility clinic today, and women would line up to get their tubal ligations, kinda like it was no big deal. They bring a surgeon in from outside, and after the procedure the women quickly go home. So interesting. 

After our time at the UFWC, we went to a nearby market, and I of course spent too much money, but am now well outfitted with a couple of Indian style shirts and some other cool trinkets we found along the way!

On our next day at JMJ, we did a community scan and home visits. I found it interesting to walk through the neighbourhoods where community nurses work, as we were able to get up close and personal with the community of Borabanda. I found it interesting that nurses will follow up with clients who had visited the UFWC in their homes for things like blood pressure monitoring and health education. The part that I enjoyed most about today was the opportunity to see inside of people’s homes and how they lived. I was surprised by the lack of natural light and ventilation in many homes. I also found learning about family and neighbourhood dynamics and structures very interesting, such as renters vs owners, how people utilize the healthcare system and who tends to use the public system, and how people take care of daily activities like cleaning and cooking. I was pleased with how readily people welcomed us into their homes, despite not knowing us or being able to communicate with us. Also, it was interesting that most of the homes contained little to no furniture-there were no beds, tables, chairs, etc, despite the homes being very clean and some, very modern. This may in some cases be because once you fit the entire family in the home there is little room leftover for furniture.  Soo interesting!

A picture of the community we visited

The following day the UFWC held an immunization camp. Some interesting things that occurred include the fact that the nurse cleans the area using a cotton ball and friction only-in Canada, we use alcohol also to sanitize the area. Additionally, I also observed the TB Directly Observed Therapy (DOTs) clinic today. The clinic is run by the TB officer.  Known TB patients come in approximately 3 times a week to receive their medication. They are given their medication in the clinic, and the officer observes them take it.  TB diagnosis occurs based on sputum testing.  The sputum is tested in the centre using gram staining, much like in the microbiology labs we have taken in undergrad. The lab technician visualizes the stain on a microscope slide, and counts the number of acid fast bacilli present to determine whether the patient has TB, and the severity of TB as well, based on the density of AFB.  If the sputum is inconclusive, we learned that the patient may be sent for a chest X-ray outside of the UFWC. For treatment, the patient is treated for 6 months at the TB DOTs clinic if it is their first occurrence, or 8 months if they had TB previously and there was not cure.  I found it interesting that the TB officer did not don personal protective equipment when treating TB patients. 

Inside the Urban Family Welfare Centre, our MScN friends dispensing medications!

Us sporting our bindis from the BSc students

In the afternoon, we decided that we wanted a break from the hustle and bustle of markets, and so decided to go to a park. A little miscommunication later and we ended up at a place called NTR Park- a sort of strange amusement park located near the big lake in Hyderabad.  We decided to might as well go for it, admission being only 20 rupees (less than half a dollar) and all. The only way one can describe this place is that it is like being in a dream. As soon as we walked in we descended down these stairs to a “time machine” which was basically an old basement with a ton of old arcade games, a bowling lane, weird bumper cars, and men shouting at you trying to get you to play their games. It was like being in a different world, with old machines and games lying everywhere in a dimly lit basement.  The grounds themselves were immaculately kept, but there were these larger than life figurines of bugs and spiders spread throughout. We also decided to go on the pirate ship ride, for only 30 rupees. Scariest thing ever. Basically, there is no safety bar to hold you in, and our butts were definitely off our seats as the creaky old ride went higher in the air than we ever expected. Also, before we got on the ride, we hadn’t seen anyone else on it. After we got on, the ride seemed to instantly get busier.  We have noticed this a bit-lots of people asking to take their picture with us, and an entire family rushes in to get in for the shot. We asked one guy why he wanted a picture, and he told us, “to upload to facebook.” Huh? I guess this is something I may not understand, but c’est la vie. On our way out of the park, we stopped to get our first henna. I got a beautiful design done on my hand, which is sadly starting to fade now, about 4 days later.  On our way back to JMJ, we were feeling adventurous and decided to go 7 people in the rickshaw. O my god. It was a squishy ride for sure, and we weren’t happy to get charged more at our final destination because our driver got lost. Often we’ve found that when drivers get lost or confused they bump up the price. It’s really annoying at the time, but with some perspective we realize that it usually amounts to paying about$1 extra, so its not THAT big of a deal.

Michelle, me and Jessie before we knew we were risking our lives taking the pirate ship ride at NTR Park.

My first henna in NTR Park

On our next day, we attended an inservice put on by the MSc students at the UFWC on waterbourne diseases. Unfortunately, the presentation was in Telugu, so we didn’t understand it. In the afternoon, we had the opportunity to take a tour of St. Theresa’s Hospital, the hospital located on the same campus as JMJ College, where the students have their clinical placements. The tour was probably one of the more informative experiences we’ve had here, especially since we’re been learning a lot about the healthcare system in lectures, but hadn’t seen too much of it ourselves. Some interesting things that happened on the tour include the fact that we were introduced to the hospital’s chief administrator. Also, in order to see basically anything in the hospital, including the ICUs, NICU and operating theatres, the nurse guiding us just basically told people the Canadian nursing students were here for a visit, and in we went.  The hospital was so different from that in Canada. There are windows EVERYWHERE. There are also people and families everywhere, congregating and eating in the dimly lit hallways. Hand sanitizers are no where to be seen, and cloth curtains form makeshift doors between units.  The beds look to be hard an uncomfortable. Also, when we saw the delivery room, it kinda looked like something out of a horror movie. The mother was lying on a stainless steel bed with a hole in the middle of it. Interestingly, she was on an electronic fetal heart monitor. Aside from that, the use of technology as we know it in Canada is so limited. The emergency room basically just had oxygen on the walls-no other technology was in sight. We also got to see the CT and MRI machines, and I would have to say that they were comparable if not better than the equipment used in Canada.  Lots of interesting things to see, but unfortunately I didn’t bring my camera so no pictures to share!

The next day was the antenatal check day at the clinic. We observed the flow of patients, and came to understand the types of checks that are provided. Women come to the clinic once every month on Fridays for examinations. They bring with them a record of their health, or their own chart, which the nurses use to record information and given back to them. When women come to the clinic, their blood pressure, weight and height are checked.  When they present initially, blood work and urine testing may be done. If these are found to be normal initially, usually no further testing needs to be done. However, we have learned there is a high incidence of anemia in India, so many women will receive additional testing, health education and treatment regarding this.  Additionally, nurses will check the fetal heart rate using a cone shaped device called a fetal scope pressed to the woman’s stomach. We had the opportunity to listen to the fetal heart rate using the device, which was interesting! During our time off, we went to a market selling handmade goods in a part of the city called HiTech city. It is a world of difference from the rest of Hyderabad, where all the multinational corporations call home. The streets are lined with trees, the skyscraper’s yards are well kept, even the traffic seems more civil in these areas. We drove past magnificently huge homes-one was actually shaped like a diamond! When we got to the market it was basically pouring rain but we had a good time regardless. I had to budget the money I brought, and bought just 2 pieces of beautiful art. Our plan is to go back, though, as there were many things we saw and wished we bought, had we brought more money!

Phew, that was a long one. Congrats to those who actually made it reading to the end. Wish I had been able to do a better job on this one, but I am feeling ++tired right now. I promise that I’ll try harder come next week. Until then…!

To the semi-rural area we go! Our first placement in Karunalayam

Early Wednesday morning we awoke for our first train ride in India! We got on no problem amongst the seemingly 1000 other people also at the train station at 530 in the morning. Our seats were comfortable enough, and we ended up talking to a young man about travel tips in India for most of the duration of the trip. There are at least 3 classes of train tickets that you can buy, with the lowest being free for all, non-ac seating, and then various levels of ac seating. When we arrived in Kazipet, the small city of half a million near the town we’d be staying, we were met by Father Jyotish, the priest who is basically in charge of the centre and is also a doctor at the hospital, and another volunteer who had been working there from Scotland named Kathleen. The rural area was so different and refreshing in a way from Hyderabad-fewer cars occupying the streets, less honking and madness, more trees. We arrived at the centre, which is basically a large piece of land that a priest purchased with the hopes of various charities having space to develop there. Aside from the orphanage for children infected and affected with HIV/AIDS and the HIV hospital that we were involved with, there was also a leprosy rehabilitation centre, and a high school for the deaf, to name of a few.  Kathleen toured us around the plot, and afterwards we took our afternoon siesta.  The area was soooo much hotter than that of Hyderabad, and it was routine for the workers to take a siesta from lunch til tea time, around 3:30 pm. So, we took a nap in our hot, but comfortable, rooms.  Afterwards, we were introduced to the children in the orphanage. They are split into boys and girls, and there were about 25 girls and 45 boys ranging in age from 18 months to 17 years. Some of the children attend school at the centre to catch them up before they are able to join the others and go to school in the town.  Many of the children had superb English, and we were able to play and communicate with them quite a bit. One thing that was so inspiring was the amount of joy the children had.  It seems as though they were not unlike any other children, however these kids were without parents and had a serious disease.  I found it very inspiring, and reflected on how sometimes the issues we think of as so important at home can be so miniscule compared to the things some of these children had experienced. It was a fun, but sobering experience to play with these children on the daily.

                                               Me, Jo-Ann and Michelle on our first train ride!

After cleaning up and taking dinner, it was basically pitch black out. It seems to get dark here much earlier than at home, so we spent our evenings playing endless rounds of president, or reading.  The first night spent there was a restless one for me.  The rooms were quite hot, and while they had a ceiling fan, electricity regularly cuts from these areas and the rooms became even warmer during this time.  Additionally, each time I looked down at my mattress I’d see many bugs, which meant I kept having a creeping crawly feeling each time I tried to close my eyes to rest.  Regardless, slept some I did, and before long we were heading to the hospital to help out the nurses in the morning.  I was surprised to find that many of the medications had the same name in Canada, which made it easier to understand why they were being given. The nursing station was very well organized, and mostly everything was in English. We assisted the nurses in taking vital signs only, which in itself was a learning experience.  We used a manual blood pressure cuff, which was no problem, but the non-automated thermometers took some getting used to. After the patient would hand us the thermometer, two of us would stare at it and confirm the reading before documenting it.  Also, the way vitals are done themselves is quite interesting. Instead of nurses going room to room like in Canada, patients congregate in the hallways and wait their turn in a makeshift line to have their vitals done. Also, there is no identifying armband on the patient-the nurses knew the names of the 25 men and women staying there, and therefore, identified them for us.  There was also significantly less talking between nurse and patient, which for us was due to a language barrier, but we also didn’t observe much conversation between the clinic’s nurses and patients either.  Morning medications are done in a similar fashion, with the nurse rolling a stock med cart into one of the ward rooms, and calling out patient’s names and handing them medications. We noted that privacy and confidentiality was basically lost in this setting, but wondered how relevant or important patients felt this was. Maybe this was a necessary concession for receiving care at a publically funded centre, which overall appeared to be surprisingly well resourced. Clean needles were used every time, and they have a machine that burns off the tip of the needle after it’s been used. Adequate sterilization and cleanliness was also able to be maintained by the nursing staff as well. Overall, I would say that based on observation, the centre appears well equipped and well run, even by Canadian standards.  However, the patients were undeniably very, very sick, which is likely the condition that they arrived there in.  So, it seems as though to improve the health of these patients, more services or care may be needed in their communities.  I am unsure whether the patients had access to ARV therapy when in their communities or not, but it seemed as though all who were admitted were very, very sick.  I thought that in some ways, this is not unlike Canada in that patients often fall between the cracks and receive inadequate care in the community for whatever reason-lack of resources, access to clinics, inability to pay for medications-and end up in hospital with acute disease exacerbations. Just a thought…

 

The place we stayed while at the centre!

The medication cart-similar meds to at home!

Hanging out in the nurses' station with our N95s!

Another interesting thing I found, however, was that the patient’s chart had their caste documented as part of the cover page, along with information like marital status and number of children. When I asked Father Jyotish what BC stood for, he simply said “Backwards Caste. This is not something you have in Canada, but its something we have here.” I found it surprising that the caste was so outwardly documented on a patient’s chart. While in Hyderabad, we had asked Ruchika about the caste system, and her response was that the caste system is still relevant to the richest and poorest sectors of society, but mostly irrelevant to others. It seems as though one’s caste may still play a role in terms of their social status and therefore, social determinants of health and access to services and health.

The view from here!

Chilling at our digs after some time in the hospital

Us, Kathleen and father Jyotish

A monkey eating a banana at the train station!

We spent three days in the rural area, and most of us got progressively more ill as time went on.  On the Friday, I was experiencing bad intermittent stomach pains and was soooooo exhausted that I slept most of the afternoon and was still fine to sleep through the night.  My diet changed from trying most things to basically a modified BRAT diet of rice, bananas and bread, which must’ve done something right as I am feeling quite a bit better now as I am writing this. We are now back in Hyderabad, only for 2 short nights, however, before we head to our next placement at a nursing school.  There, we will be staying with the nursing students in their dorms and learning from and with them.  This will still be in Hyderabad, but we’re unsure of what to expect in terms of internet, the comfort of the rooms, and regularity of electricity. More updates to come!

Our time at CHAI Begins!

So we’re just finishing our first whole week since being at CHAI, and about a week and a half since being in India.  Seems strange to say that it’s just been a week, as it feels like so much has happened in the last seven days.  I’ll try to be brief on the recount!

When we arrived at CHAI initially, we were shocked by how nice our accommodations were.  We’re staying at a guest house a hop skip and a jump by the CHAI headquarters, and it is SO luxurious, even compared to the place we were staying in Hyderabad-nice beds, clean sheets, clean and new rooms, ac, flat screen TVs, wifi, showers…basically the works! After settling into CHAI and having our first meal with Sister Sudeepa, the very lovely lady and former nurse who is looking after us while we’re here, we ventured out to a market called Charmina with some girls from Florida also staying at CHAI.  It took us about 30 minutes by rickshaw to get there, which in itself was an experience, being our first time and all.  I don’t know if I’ve mentioned the roads yet, but they are a sight to be seen.  It absolutely amazes me that the flow of traffic seems to work with minimal accidents, since rules basically seem to involve honking and pointing where you want to go, and somehow, certain vehicles yield at the right time.  We did, however, witness one accident while at a fruit stand in old Hyderabad-two small motorcycles basically ran into each other, and after minimal shouting and a bit of dusting off, the men picked up their bikes off the ground and went on their way, while we were still watching, mouths gaping wide…

Anyways, back to the market! It was unlike any of the markets we had been to yet. It. Was. Crowded. Like, insanely crowded.  Couldn’t move, couldn’t talk, couldn’t stay as a 9 person group like we came, crowded. As we left our rickshaw, the driver even warned us to be careful, and careful we were, even with our minds set on shopping.  After being dissatisfied with a set of rings a merchant had on the street, he ushered us up to his “store”, 3 stories up a sketchy hallway, to see more.  So interesting.  After some browsing without much finding (we were looking for long shirts to wear but the market was a Muslim one so they mostly sold burkas) we made our way back home to CHAI, but not without having our driver get us lost about 10 times along the way.  Luckily, it was still daylight, and a positive attitude will get you far in India, and we eventually arrived home safe (and for a good price!).

The next day our learning at CHAI began. We became oriented to the healthcare system in India, which we all found to be a very interesting lecture and peppered the speaker with questions.  I was surprised to learn that the government only alots 0.9-2% (we received different figures in different talks) on healthcare, yet there is an entire public system with free care for all. However, this free care doesn’t look similar to that in Canada, and by the time funds allotted trical down to communities, after corruption and bureaucracy, there is often very little left to spend providing healthcare services. We also learned about some of CHAI’s projects, including their Stop TB program, which utilizes volunteers and chemists/traditional healers that already exist in communities to implement their DOTs programming. 

That evening Ruchika, the woman who has organized our time here at CHAI, took us out for an evening on the town, which oriented us to our direct surroundings, including grocery stores, coffee shops and a spa! We then went to visit the massive lake in the centre of Hyderabad, and took a boat ride to see the big Budha statue in the middle.  The Budha was donated to the city by the Dalai Lama, and is a massive monolith.  It was cool to see, and we had our picture taken with many Indians, our first experience of being asked for a picture!  Which reminds me, while in Hyderabad, apart from being at CHAI, we haven’t really encountered other tourists. We’ve gotten stares for sure, but nothing really besides that, and overall we’ve felt safe here.

After Big Budha, Ruchika took us SARI SHOPPING! Since there was a festival going on there was a deal on the sari’s and I scored a lovely pink and yellow fancy number for the equivalent of about 7 bucks (its about 6m of material!) After dinner, we attempted to youtube a video of how to tie it, with mixed results, but it was fun trying to sport our new gear. After sari shopping, we went to a restaurant called Paradise, home of the best biryani in Hyderabad, where the dish is native to.  I found it SO interesting when Ruchika explained that the restaurant has 3 levels, all with varying prices on the biryani, and I am sure, varying levels of comfort. We were on the top level, which was quite luxurious-I felt underdressed in my tights and shirt. After a delicious meal of tikka paneer (bbq tasting cheese mmmmmmhmmm) and chicken biryani, we went home, happy and full! 

Me in front of Big Budha!

More to follow soon on our experiences in the rural area!

Arrival in Hyderabad-Adventures in a new city!

Today was our first full day in Hyderabad! The day started with my first bucket shower-I think I did pretty well! Basically, just used a scoop to cover myself with water and tried my best to rinse the shampoo out of our hair. After we all had French braided our hair, we were off for the day. Our first stop was a breakfast stand right down the street from the hotel. The stand was quite crowded with families and men all ordering food. It was set up similar to a hot dog stand, expect it had no electricity-all the food was cooked on propane or fire.  We had a breakfast that was similar to what Happy had provided us the day earlier-four small fried, airy pitas with 2 types of curry sauce for dipping, served on a metal plate. The cost? 12 rupees (equivalent to 20 cents!). It was quite delicious, and afterwards you put your plate in a basin on the street and can rinse your hands with the water.  While the other girls were waiting for us to finish eating, we were getting asked for money for the first time.  Most accepted our “nos” or our “not this time”, except one man who approached Amanda, who was very stern with him. Regardless, he put his hand on the strap of her cross body purse. Immediately, two men working in a nearby stand selling newspapers shook their heads at him, and he promptly left us alone. 

Amanda, Cassie and I eating our first street breakfast

After breakfast, we attempted to make our way to a bazaar.  We turned down what we thought were the right streets and were just taking in the morning-the different shops selling clothes and other household supplies were largely closed at 10am on a Saturday morning. We stopped to talk to two young men for directions, and asked where they were going. They said that they had college today-something that was a bit surprising considering it was a Saturday.  After walking for a bit, we came upon a number of fruit stands, and walked down an alley that had many vendors selling fruits. We then happened upon an internet café down a random alley, which we used for an hour for only 15 rupees. Afterwards, we kept on walking through alleys, happening upon fewer shops and more homes some of which appeared very nice.

Eventually, we happened upon a road filled with many vendors, similar to a market, that sold mens and womens clothes, household items and jewellery.  We were all excited, looking at the long shirts we might buy, negotiating prices with vendors, and buying our first bangles.  I managed to only buy jewellery, but am excited to buy some long shirts and a sari soon!  After, we grabbed lunch at a place that could maybe be described as a type of fast food restaurant. It was all behind bars though, and you had to go through a metal detector before entering, and men were frisked by a guard standing outside (this place was by no means classy, so I found this a bit surprising). They had a list of hot and cold menu items on the wall written in English, and we asked people who ordered before us which dish they had.  I had a samosa ragada, which is basically a samosa covered in a SPICY curry sauce for 30 rupees (about 75 cents).  It was good, but too spicy and I couldn’t finish the whole thing. Afterwards, we bought mango ice cream pops, which were sketchy for sure but yummy.  After, we attempted to make our way back to the hotel we were staying at, which involved a lot of guess work and some help from strangers who always told us to go straight, even if that involved making a turn of some sort. Along the way we stopped to buy sugar cane drink and fresh pomegranate and mango.  We knew we were close when we passed the “Big Bazaar”-a department store that sells things for about double as what we saw on the streets, but it was airconditioned so we went in for a look and a drink.  We made our way back to the hotel and had a long nap. Now I’m wired at midnight, writing this post. We’re having so much fun so far. Things that are surprising to me here are:

-the fact that basically ALL signs-private and public-are written in English, and that most everybody has some knowledge of English

-that its not sweltering hot-we were certainly hot and sweaty during some parts of the day, but overall found it to be very tolerable

-people don’t seem to be bothering us too much, even though we only came across one other pair of tourists during our entire exploration today.

Amanda, Nicole and Cassie enjoying some mango popsicles after our spicy lunch

Anyways, that it for now. Tomorrow we head to CHAI to get settled in.  Hopefully will have some internet access there! Ta Ta for now!

Up, up and away!

Today we arrived in London! The flight went off without a hitch and now we’re getting cozy in the airport. We made a bed out of a sewed sheet and the AirCanada blankets and pillows we stole from the plane. Didn’t sleep much, if at all, on the floor of Heathrow and we were eagerly waiting our flight after being there for 10+ hours in the am.  When we went to the desk to attempt to check in we were offered a killer deal if we were willing to spend MORE time in the airport and take a later plane-600 euros! Needless to say we signed up for the deal, and just as we were getting pumped and planning a trip into London to see Buckingham Palace, we learned we would be getting on the earlier flight, and the only good side of that was that we’d be getting out of the airport earlier!

Once we boarded the plane the flight attendant announced that they’d be spraying the cabin with a spray that prevents illness and disease. Since we had never heard of this before, and since we were quite tired for basically not sleeping for 24 hours, we found this quite hilarious.

After a five hour sleep on the seven hour flight, we landed in Delhi. Customs was a breeze-the officer didn’t even say a word to me-he just stamped passport and I was good to go. As expected, a driver picked us up from the airport and took us to our hostel. He pointed out the luxury hotels that we passed along the way near the airport as we had our first driving experience in India-this was around midnight and we learned that lanes basically do not exist.  Everything seemed nice enough, until we took a turn down the street our hostel was on. There were half dressed or naked men sleeping on the street everywhere and many skinny stray dogs, and absolutely no other sign of life-the streets were empty. The driver took us to a small sign naming our hostel and announced we were there. I was nervous, because the hostel didn’t appear to be anywhere, and wasn’t quite ready for this introduction to India. Luckily, he walked us down a winding alley to arrive at the hostel door. The hostel was comfortable but BASIC and the front desk staff very nice.  We settled into our room, where Jessie cleaned off the cow poop she’d stepped in as she got out of the cab that I had barely noticed happen because I was too preoccupired taking in our surroundings.  The room was simple, had “air conditioning” (basically a unit blowing out hot air) and a basic bathroom with a shower. 

The next day, the hostel arranged for a driver to take us to the tourist centre , where an absolutely lovely man named Happy listened to what we hoped to get out of our trip and planned multiple itineraries accordingly.  He then priced the entire trip for us, including all hostels, trains, transports from trains, drivers, tours and more I am sure.  While we deliberated over the plan Happy provided us with breakfast cooked by his mother-absolutely delicious fried airy pitas with a chickpea masala for dipping and our first sweet chai with milk. If he was trying to get on our good side, it definitely worked-that has been the best meal I’ve had so far in India!  Since we didn’t know the end date of our time with CHAI, we couldn’t commit to Happy’s plan, but will hopefully be taking him up on the offer of the all inclusive tour.

Upon arrival at the Hyderabad airport, we negotiated a price for a taxi after checking with the tourism desk to seem how much it should cost.  It took us about 1 hour to get to the hotel.  Right near the airport we noticed huge boulders stacked on top of each other on big cliffs-kinda looked like Jurassic park. The hotel seemd luxurious compared to where we had spent the night previously-triple beds with nearly clean sheets, a flat screen TV and a bathroom and ac. It overall just seemed cleaner and more secure.  We met up with the other girls, Joanne and Amanda, and ventured out to find some dinner.  We ate at a nicer looking place, wanting to ease ourselves into the cuisine.  We ordered butter chicken, tandoori chicken, vegetable biiryani, naan and multiple pots of rice, with four huge Kingfisher beers plus water, for about 5 bucks each. It was more than we could eat, and we realized that it was quite expensive, but it was good and filling. Had a great sleep in a comfortable, clean, cool (needed a blanket midway through the night) room, and were ready to take on Hyderabad the following day!

O the places we'll go!

Hello everyone! Welcome to my blog following my adventure to India!

For the past few weeks (months, really), I've been busy preparing for this trip-booking flights, researching travel spots. Deliberating over things that I am sure will seem ridiculous once we're there, like what footwear we should bring or what clothes may be appropriate.  It was not all for not though, as miraculously I am already packed over a day in advance (for those of you who know me well you will understand that this is a major accomplishment).  Just a few errands to run tomorrow and I am officially as ready as I can be for this trip!  I say that because, while I've been dreaming of India for months now, I feel as though what I am expecting and what it will actually be like are going to be very different.  I've told myself that there'll be heat, overwhelming smells, overwhelming crowds, delicious food that will likely make me sick.  From what I've heard, our travels will be filled with both maddening and awesome experiences.  Cannot wait for this adventure to start, though there are definitely some nerves mixed in there with the excitement.  We fly out Wednesday July 4th, and will arrive in New Delhi the following day. After a night there, we'll be making our way by flight to our destination for a month, Hyderabad, in central India.  While there we'll be working with an NGO called CHAI-Catholic Health Association of India-learning from and with them about the healthcare system in India and social determinants of health. Here's a link to their website if you want to check it out! http://chai-india.org/. Once we're there I am going to try to update this blog as I can depending on how much fun we're having and internet connections.  That's it for now!