12 July, 2012

Welcoming a new adventure.

My love of travel, exploration and health education has taken me to an entirely new part of the world, to a country bustling with life. India is home to nearly 1.2 billion people and well known for being infinitely diverse, with a wide array of social and familial customs, religious beliefs, cuisine and language varying across each state. There is so much to learn and so much to take in! Your senses are immediately overwhelmed by the sea of vibrant colors, strong smells, the incessant sound of car horns and booming music and most notably, by the masses of people maneuvering through what you can only hope is some sort of organized chaos.

I have heard before that the challenge for those traveling to India for the first time is in merely coping with your new environment. That the ones who survive are those brave enough to dive head first into the chaos. And so it would have to be that instead of succumbing to the madness, I would use this approach and learn how to adapt. Patience and an open mind were crucial.

This being my second global health education program with Child Family Health International (http://www.cfhi.org), I was so curious how my feelings at the end of this month long trip would compare with my impression throughout the first week. As I have learned through experience, spending a prolonged amount of time in one place can bring about dramatic changes and a whole host of unexpected emotions. For the most part, I have always been pleasantly surprised at the outcome of each trip and know better now than to hold on to any initial thoughts and feelings because almost always they develop into something entirely different.

And so with fear coupled by excitement, I dove head first into the whirlwind that is India, surrendering gracefully to the power of this experience. 

Remembering what is important: A gentle approach to medicine.

I found it interesting that a good majority of people did not understand what palliative care was. I myself was at a loss for words when asked what I was going to be learning about in India. What I came to know was that palliative care practices medicine in such a way that aims to treat the patient as a whole, taking into consideration the physical, mental, emotional and spiritual components of the person's battle with illness. And interestingly, with the patient also comes the family, a so-called extended unit, who as caretakers should be looked after as well. Families in India have an extremely strong sense of togetherness and so often one person is not recognized as an individual, but as part of a whole. With all this in mind, palliative care strives to help people suffering from life limiting or life threatening illnesses through effective pain relief and end of life care tailored to make the patient feel comforted and dignified.

I felt such a sense of relief to be amongst people who understood that medicine should be practiced in this way: a wholesome humanistic approach. It was an honor to observe doctors and nurses of Pallium India (http://www.palliumindia.org) bringing their expertise and care into the homes of patients. They would often sit near to the patient, exchanging words in an attentive and soft-spoken manner and allowing the patient and family members to openly express their concerns, fears and hopes. Without question, many of the situations I witnessed were emotionally heavy, and I could feel the weight especially in particular moments. Moments when I could see photos hanging on the walls of the patient in there former healthy self; when observing spouses, children and parents in their new unaccustomed role as caretaker; and when it was expressed that many families were crippled by treatment costs, accumulating an unrealistic amount of debt and forcing family members to act out of desperation. Most homes were full of family and friends wanting to help, but others were empty. The patient potentially abandoned by family who were too fearful or selfish to care for them, wanting only to run.

Unfortunately, these problems are all too common and are only a drop in the ocean as to what families in India face when illness comes knocking. Resources are poor to begin with, but to further the impact the national government has yet to devise an insurance system or a plan for socialized medicine. Often people are forced to pay out of pocket, feeling neglected and helpless. And even though India is said to be the pharmacy of the developing world, a good majority of medicines produced are exported, and the government has imposed unreasonably strict regulations for obtaining morphine and the legal right to administer it.

This entire clinical experience was very black and white for me, alternating between two extremes. Where I saw misfortune and sorrow, I also saw smiling faces and simple ways. By extending medical care into the community, usually at no cost, Pallium India has become a monumental source of relief for many families. Even still there is something to be said about the people. It was rare for me to see homes filled with material riches because most families endured daily struggles to survive. But I could see that even they were smiling and that these homes were full of love and support. These were people with an obvious appreciation for the simple, yet more valuable, things in life.

A city surrounded by so much natural beauty: Thiruvananthapuram, Kerala, India

The lighter side of challenges faced.

It was clear that culturally I was a bit out of my own element. This was something that I had willingly chosen and in my best effort to adapt I did so respectfully and without much fuss. At the same time, I couldn't help but find humor in so many of the situations where myself and the other American girls found ourselves culturally torn. Everyday there was something new to laugh about!

To begin with, had I known what "appropriate dress" meant in southern India I could have spared myself half the time spent packing and all the energy I exerted lugging my suitcase through three different airports. Nearly all of my clothes, considered classy and respectful by Western standards, were labeled provocative and inappropriate by Kerala standards. A dear friend of mine told me that dress is a language and that what we wear expresses the type of attention we hope to attract. It seemed my wardrobe was sending invitations to men to make advances towards me. And so rather quickly and with a bit of hesitation at having to let go of what I felt was a small part of my identity, I tucked my clothes under the bed and went shopping!

It took some time for me to realize that even though it initially appeared that women were more or less wearing the same thing, I came to understand that this sea of vibrant colors was in fact unique. Despite having to wear one layer too many under a scorching tropical sun and sweating profusely for most of the day, I eventually came to appreciate and admire how elegantly and beautifully the women were dressed. I liked the fact that what lay beneath a woman's sari or kameez was left to the imagination and that each color and pattern was thoughtfully chosen to represent who they are.

Secondly, regardless of what your eating habits are, I refuse to believe that any amount of preparation can prepare you for the mounds of thick-grained rice that you are expected to devour at each meal. During the first week, myself and the other girls obediently and respectfully ate every last rice grain on our plates. Without exaggeration each person received a serving of rice fit for a family of four. Our stomachs were stretched to the max and by the time lunch came around the rice consumed in the morning hadn't made any attempt to move on. We were left wondering where would all the rice go? By the end of the month, the outcome of consuming this much rice would either leave us overweight, with diabetes or feeling incredibly backed up and sent off to travel home on a plane for nearly twenty four hours.

This was not to say that the food wasn't delicious. There were so many new flavors and textures to try and I did so happily. I especially enjoyed the abundance of fresh fruit! But even though this type of rice was considered a staple in Kerala, by the second week we had to make it known that although we enjoyed the rice, it needed to be done in smaller quantities, so as not to be wasteful (or require hospitalization). Ironically, one of the main concerns for travelers to India is avoiding getting sick and having diarrhea. Yet due to the diet in Kerala we were faced with just the opposite. Who knew we'd be desperate to go to the bathroom in India.

The third challenge was mastering the art of eating with my right hand only. I was surprised to find no utensils or napkins on the dinner table. It was just me, my plate and my cup of boiling hot water. At first, I thought it best to grab food with my fingertips and throw my head back as I simultaneously attempted to get the food in my mouth. This poor technique only left a mess on the floor and most of my food nestled in my scarf. Through observation, I learned that the trick is to pack the rice using curry and create a sort of rice ball. Then while leaning forward use the strength in your fingertips to scoop the food and toss it in your mouth. I was impressed to see Keralites maneuver their food with such ease, but at the same time as someone who habitually speaks with exaggerated hand movements, I never knew what to do with my curry hand. Needless to say, my utensils and I shared a loving embrace once I returned to the States.

Lastly, what I found to be the most challenging of all was my experience on an Indian bus. A true test of my patience! For a society that shies away from most public displays of affection, it seems that as soon as you step onto a bus all rules go out the window. Several times a day I found myself packed tightly between people, my body contorted into positions I didn't know were even possible on a vehicle where all you can do is sit or stand. People managed to create space even where there was none. If ever you thought a bus was full, think again! Indians have an impressive ability to utilize space, a result of living amongst so many people. The bus environment was a mad rush of people, everyone fighting for a spot. And without a steady breeze it would become unbearably hot and smelly. There were times I became desperate for air. It didn't even have to be clean air, something hard to come by in Indian cities, just circulating air.

Each morning the four of us would arrive at the bus stop, mentally prepared for what would be required of us to find a seat on the right bus to take us twenty minutes into the city. We stepped into the crowd, frantically asking numerous people if this bus was going to our stop and trying to interpret a head bob that could mean a number of things! I needed a quick response before the bus pulled away, and yet each time I became dumbfounded, not knowing whether the head bob meant yes or no. Utter confusion! And worse yet, all of my polite words were lost on people. There was simply too much commotion to even bother.

In the end, whether it was clothing, food or bus chaos, I managed to survive. All of these experiences were character building, teaching me new ways to adapt. I left India with beautiful clothes bought at great prices, a heavy but happy stomach and not a care in the world if someone preferred to sit on my lap on a San Francisco bus.

Leaving India feeling happy and refreshed.

It is important to understand that it takes time to get to know India and to understand its complex story. Even after a month of cultural immersion, I can only say with confidence that I came to know a small amount about the city of Trivandrum and its home, the southern state of Kerala. It took nearly two weeks for me to accept that I was capable of coping in this environment and in the weeks that followed I was pleasantly surprised to learn that the people and all the chaos around me were beginning to leave their mark. I felt very fortunate to be learning from them.

The relationships I build are always the most important in all my travels. Each time thinking that I could not meet a better people or have a greater experience. However, it seems that even when you believe that things can’t get any better, somehow they do. This is not to take away from the previous experience, but new experiences build upon the old ones. And they are not necessarily better, but always different and unique.

My feelings towards India can be simplified into one word: patience. If you can hold on for long enough you will begin to see that behind all the chaos-masses of people, street congestion, loud noises-there is peace and feelings of tranquility, sought out in religion and strong family values. One of the American girls told me early on in our trip that the Indian people have love in their hearts. I didn't fully understand this until I became the recipient of many acts of kindness and generosity. Thanks to the ways of the people I will walk away from this experience with a renewed sense of family unity and a healthy dose of self-discipline.

When I return to India there will be many things to look forward to. Kerala's natural beauty, the sound of tropical rain falling on the palm trees, small seedless watermelons, endless cups of chai tea, lawless roads, music in the streets, always having company and most importantly, the reunion of unforgettable friends.

LIFE Before Death "Grassroots Palliative Care"

Visit this link to learn more about palliative care on a global scale and the importance of effective pain relief.

When words are simply not enough.

My deepest gratitude and thanks to Child Family Health International and Pallium India for this monumental experience. Without their tireless efforts, people around the world would not have the opportunity to see some of the changes we hope for in the world.