Happy birthday Sunita!

Today was Sunita’s 23rd birthday.  The other girls and I decided that it would be fun to get her a cake, and have a little kitchen-staff party.  The HIV kitchen and the HIV nurses are sort of my India posse, if you will.  We eat lunch together everyday and they include me in all the gossip and happenings around town. For example– Shobha: “did you hear Joythi’s daughter had 2 cows and 4 goats in her wedding dowry?! Me: [gasp] “no! my, thats alot of goats!” (etc etc.)

We’ve been planning a little surprise party all week. The tenative plan was for Rubina and myself to run across the street (the 8 lanes of crazy India traffic on national highway no. 9, which is certainly easier said than done) to the bakery and buy a cake for Sunita.  Then after dinner we would all gather and surprise her!  Birthdays aren’t really a big deal in India, especially for citizens of lesser socio-economic status (peasants, working class, the uneducted, HIV orphans, etc).  Its just not practical to have birthday parties or celebrations. In fact, Sunita has never had a cake for any of her past 22 birthdays .  I was excited to celebrate with her, she was overdue.

Then, this morning, I got a call from the chief!  Turns out in addition to Sunita’s birthday, January 30th is Anti-Leprosy Day in India.  Dr. Hrishikesh was recieving an award at the governor’s palace for 30 years of service to leprosy patients.  And he invited me to come to the ceremony!  I was honored, and accepted–but ack! what about Sunita!?

I told Rubina (the HIV counselor, who speaks English very well, and my closest friend in said posse) about the dilemma.  We were scheduled to leave for the ceremony at 4:30, but our little party was to be at 7. I’d never make it back!  Rubina and I put our heads together and decided the best possible solution would be to have the party at 4:00, right after work, so everyone could still come.  “But how will we get the cake? We have to work until 4?”  I was concerned. Our birthday plans were looking distressed.

“Well,” Rubina said, “we’ will just have to be..what is the word?” she tapped her forehead to jog her English vocabulary, “sneaky.”

“Oh! I can be sneaky! Sneaky is my new middle name!”

“What’s a middle name?” Rubina asked.  The colloquilialism was obviously lost on her.

So after wolfing down our lunch, Rubina Begum and Regina Sneaky Pestak, dashed across the street to the bakery. We walked quickly through the crowds, navigating around motorcycles and autos parked haphazardly along the road.  We needed to make it back before lunch was over, or else Rubina would be in trouble (I don’t really get in trouble, its one of my special dispensations. People just shrug and say, “shes American”).  Our birthday plans were kept on down-low. We were afraid that if any of the administraters heard about our little party for Sunita, they might think that she put us up to it. Which wouldn’t go over too well for her.  I felt like a secret agent.  Mission: birthday cake!

We found the bakery, and purchased the cake.  They didn’t have any chocolate, or even white cake.  Our options were pineapple and plum. We went for the pineapple. And hurried back to the office, sneakily, of course.

Mission accomplished!  No one noticed our absence (clearly, we were excellent snesunitaakers), and we were able to gather all the girls (and even Uncle!) after work.  Everyone brought Sunita little gifts that included: new bindi stickers, a 20 oz. bottle of mango juice, a new comb, embroidery thread, and a small pair of earrings (from yours truly).  Sunita was so touched!  We all sang “happy birthday,” cut cake, and then Marheswarie started a frosting fight!

There we were, 6 Indian girls, 1 American, and 1 white haired Indian body guard, running around shrieking swiping each other with frosting!  Mary kept breaking out in gigglefits, and thus got annihilated.  (Frosting wars are especially hard on the silly.)  Then, suddenly, in all her sensibility, Rubina checked the clock. “gina! 4:25! You have to go!!!!”  She threw me a wet towel.

ohman ohman! With all the birthday festivities I lost track of time!  I couldn’t be late for the governor! For the chief!  I went sprinting down the path to the administration office, hoping the car didn’t leave early.  I shouted “namaste” to patients along the way, while trying to wipe all the frosting off my arms and face!

I made it in time! Just as I was huffing around the corner, I saw Dr. H walking out of his office towards the jeep which was pulling up.  His wife was with him, along with Dr. Beine (see “epic OR fiasco”), and the head nun who is the matron of the leprosy patients.  I wore my blue and gold tunic that I bought while out with Theresa, complete with gold wrap, and Mrs. Hrisikesh smiled.  She whispered to Dr. H in telugu who laughed and translated telling me, “my wife thinks you look very indian!” which made me feel good.  I scooted in next to the chief and we started off.  Five minutes into the ride he leaned over and said, “theres something in your hair, Regina” scooping out a big pink blob of buttercream.  Very sneaky, agent Pestak.

The leprosy ceremony was a.) long and b.) boring.  Albiet, the governor’s palace was beautiful.  The grounds especially were full of gorgeous flowers and lush trees and fountains, as one may expect to see at a palace.  I felt like the whole ordeal was something of a PR stunt, with news cameras rolling and photo ops of the governor shaking hands with lepers. Not cool, your excellency. I was pleased for Dr. H, he deserves recognition for all his great work, but after he got his award I was pretty tired and checked out.  The whole ceremony lasted over 3 hours! Dr. Beine slept through about four fifths of it.  By the time we finally got home, it was past 10 oclock. I was wiped out, and went straight to bed.

The next morning I rethought some of my negative judgment of the governor and decided that a little PR never hurt anyone. That being said,  Dr. H’s picture was in the Hyderabad paper, and I appeared on the Telugu morning news sans frosting.

 

Dr. Hrishikesh recieves a lifetime achievement award from the governor of A.P.
Dr. Hrishikesh recieves a lifetime achievement award from the governor of A.P.

Sunnat

Today was a rough day.

Sunnat is five. He is really small, with huge eyes and a little tuft of black hair.  He has an impish smile that always gives him away when he’s up to mischief.  I always catch that little smile when he cheats at freeze tag, subtly scooting towards a teammate (and freedom) when he is supposed to be “frozen.” His favorite animal is a tiger, and he likes to  run around making growling noises.  And he loves to do cartwheels for my entertainment.  Sunnat is one of the SRH babies, the youngest. The other children look out for him like a little brother.  He is always scraping his knees, practicing his alphabet, and singing funny little songs whenever they pop into his head.  I just adore him.

Today we were playing “goats and tigers” and to Sunnat’s joy, it was his turn to be the (growling) tiger.  Its a pretty running-intensive game, chasing down those elusive goats until you’ve got them all.  Sunnat was trying to catch the last two goats, an older boy and girl, and all of us “eaten” goats were cheering them on from the sidelines.  Suddenly Sunnat started to drag, and dropped to his knees, his chest heaving, struggling to breathe.

My mind snapped into action. He’s so small, and with all the running, the inability to catch his breath– I drew my most probable conclusion: He is having an asthma attack.

Watching Sunnat struggling on all fours, belly breathing and heaving, I yelled up the stairs for the orphan matron. Then I sprinted into the doctors office, grabbing Sunnat’s medical basket lined up among all the children’s on the high shelf.  I dumped its contents across the table, riffling through his packets of medication and foreign information cards, searching frantically for an inhaler.  I couldn’t find one.

All of the children were still standing along the perimeter of the play area, watching me with confused interest.  Frustrated, and panicking I yelled to one of the girls who speaks English, “Rosi, GO GET DOLGA.”  There was silence.

After a beat, she looked at me and said, “Akka, why?” My mind was racing. How to get him to breathe? Where is his inhaler? Why are all the children just STANDING there?!

Suddenly the silence was shattered with a sound I have become all too familiar with here in India.  A deep, heavy cough.  I knelt over Sunnat as he coughed at the ground gasping for air.

It hit me hard. What was I thinking? He has HIV. Of course he has respiratory distress. He is so fragile and so susceptible to any insult. Then another realization sunk in: the children knew all along.   For them, this is routine. This is how things are.  Their friends collapse in fits of coughing, and no one panics.  I held Sunnat and started to cry, when Dolga aimlessly entered the scene.  She surveyed my tears with a quizzical look on her face, whats wrong with you?

Sunnat is fine (relatively speaking).  We gave a boatload of nebulizer treatments and some other medicine, and we will alert Dr. Sugena  when she visits Sunnat tomorrow morning.

I love these children.  I know that they are sick, but on a day-to-day basis we  practice songs and the Shabba and the English alphabet.  We learn new games. And do cartwheels.  And its easy to forget how delicate they are.

But I don’t think for as long as I live, I will ever forget the sound of that cough– it just broke my heart.

sunnat

Tuesday January 27th: The Shabba

When I went into work today, my little buddy and his mother were gone.

I immediately thought, oh God–she must have died. And panicked, because I would have no way to find him, or find out what happened to him. I ran to Rubina’s office and nearly tore the door off its hinges. She was ready for me.

“Shes dead?” I asked

“No.”

I exhaled in relief. I waited for an explanation that didn’t come, so I looked at her expectantly, “well, where are they?”

There was a long pause, Rubina wouldn’t look at me. “We discharged them this morning. We thought it would be best if you weren’t here.”

I felt like I had been kicked.  We can only keep patients in the ward for a maximum of two weeks, after that they are either referred for hospice care or sent home.  My little buddy’s mom has no permanent address, no phone, and we have no way of contacting her.  I felt my face flush.  She could die out there, and then what would happen to him? Where would he go? Who would watch out for him?  I wanted to yell at Rubina, How could you do this to him? And to me? You were supposed to find him a home! He was my friend, and I didn’t even get to say goodbye.

Instead I mumbled something about needing water, and left. Its so frustrating, and debilitating–feeling like there’s nothing I can do.

I spent the rest of the afternoon feeling pretty bad, and moped my way over to the children’s home after work.  They were so happy to see me, and I couldn’t help but to smile at them.  The children call me “Akka” or “gina-akka” which is Telugu for “big sister.” 

A large group of the children dragged me by the hand, saying “Akka! Shabba!” over to a blue cabinet that I had never seen before.  They looked at me, and then at the cabinent expectantly, and said, “shabba?” I pointed to it, thinking that “shabba” must be telugu for cabinet and said, “very good.”  The children laughed at me, opened the cabinet to reveal a small stereo, and pressed “PLAY.”

A drum intro filled the air in a foreign tempo. The children took the floor forming two lines next to each other: boys and girls. They crouched to the ground and the music filled out with horns and telugu lyrics. The children broke into dance, beaming at my stupefied expression that turned into a broad smile.  They sang along with the music, and bounced around with each other in perfect choreography,  and none of us could stop laughing.

Three or four rounds of later of The Shabba (which I have found is a bollywood dance from a movie. Think “macarena” only a thousand times harder.) I was starting to get the hang of it.  The children patiently taught me all the appropriate moves (three minutes or so of non-repeating indian steps) and cued the music.  I don’t have it entirely down yet, but I’ll get there.  The children are excellent dancers, and showed me their CD that has multiple dance tracks. 

As always, it looks like I have alot to learn.

shabba1

Golconda Fort and Laundry Detergent

Today I went on a outing with Jann, and her 10 year old daughter Natasha.  We visted Golconda fort, which was built in the late 15th century, and is very cool.

Natasha is a really cute girl.  She reminds me of Sophie in alot of ways.  She is smart as a whip, extremely articulate, and loves to read.  We had many long conversations about Harry Potter during the car ride.  This was Natasha’s third visit to Golconda, so she was very familiar with the tour and had lots of interesting stories and facts to share.

The fort is a huge stone structure, designed by Persians and built by slaves.  The acoustics are amazing, and were used as a security measure.  At the gate  a guard can clap, and alert a watchman over a kilometer away on the side of a cliff of who has come to visit.

We also saw a crazy weight in the slaves quarters.  If a slave could lift it with one hand, he was promoted to the rank of solider.  Natasha and I threw our combined weight into it, and it didn’t budge.

golconda
Natasha and I unsuccessfully try to upgrade our rank

My favorite room in the fort was the queen’s bathroom.  It had a really advanced water system that included sewage removal, drinking water and even hot water.  Additionally the walls have intricately carved patterns in them, with holes ranging from the size of a marble to the size of my fist.  Once upon a time, these holes were filled with jewels and an light from oil lamp would reflect through them and illuminate the room.  I’m thinking about implementing a similar lighting design back at guest house one.

After touring the fort, we went to Q-mart which is my own personal oasis in the desert.  Jann was apologetic to take me on her errands with her, but when I saw Q-mart I literally almost cried.  It is a very nice grocery store (the Whole Foods of India, if you will) and had American imports!  I was able to purchase a small box of oreos, cheese, flour, Honey bunches of oats and (wait for it) Tide!!

Prior to this I’ve been washing my clothes with this sketchy little soap bar that I bought here in Kukatpally.   The women here have been trying to teach me how to scrub my clothes with the aforementioned bar, and then smack them on a rock. I’m not sure what role this plays in the cleaning process, but they are very insistant about that step. Then the clothes are rinsed in a bucket, and smacked on the rock again. I’m convinced this is not effectively cleaning anything, but rather decreasing the lifespan of my jeans (maybe its a bad attitude, but my heart is just not in the smacking).  Additionally, sitting out in the hot sun fully dressed, throwing wet shirts around is really just causing the clothes I am wearing to get more dirty.  So in order to have net laundry gain, I have to clean more clothes than I am wearing–which doesn’t always happen.  Clearly, I have been failing miserably at laundry, and I was just about to run out of clothes.  Chorus of angels! Hallelulia! Tide has come to deliver me!

After grocery shopping we went back to Jann’s house to meet up with her husband Dayrl and go to dinner.  Their flat is in a very beautiful compound with lush gardens and millions of flowers.  We hailed an auto (yess! I love the autos!) and rattled our way over to the new cineplex, which they tell me is THE hotspot in town.

The four of us had dinner at TGIFridays which is the place to see, and be seen in Hyderabad (not kidding).  Dayrl told me that people came from all over the city to see the escalator when the complex first opened last year. Dayrl and Jann are a very intellectual couple, so I can see where Natasha gets it from.  We discussed Indian politics, books we’re reading, HIV, and Lebron James.  Dinner came, and  I had a chicken sandwich and french fries.

It was quite possibly the best meal of my life.

 

golconda-2

My first day in the OR

Yesterday was a bad day.

I was working in leprosy, as I have been all week. If I can just get off topic before I’ve even gotten on topic: have you stopped and thought about blinking? Because I hadn’t until yesterday. Turns out, some patients have nerve damage from mycobacterium leprae in their facial nerve. This causes a breakdown of muscle function, and results in the inability to blink.

Well if you can’t blink, your eyes dry out. And become more susceptible to infection. Additionally, you can’t blink stuff out of your eye, like dust (um, have you ever seen india? because dust is the national pastime) or bacteria. This results in some horrible infections, and often results in damaged vision and blindness. Not to mention if untreated, those horrible infections can end up progressing into some serious face eating bacteria.

There is nothing that can be done about the blinking, since the nerve damage is permanent. We give the patients goopy drops to put in their eyes to keep them moist (which I think they have to do every other hour?) and they wear special goggles during the day to try and reduce anything getting into their eyes. Additionally, these patients have to wear some pretty extensive bandages over their eyes at nights. And that is to maintain their current vision.

Blinking. geeze.

Anyways, so I was in leprosy, seeing patients who can’t blink, when Dr. Bhaskarao says “Hey, have you ever seen the operating theater?” I told him that I hadn’t and he offered to take me over there. Sounded good.

So after we see all the patients, Dr. B and I walk over to the OR and there is a surgery going on. He hands me some scrubs and says, go check it out. Um, really? Just like that? He sensed my hesitation and popped his head in “Dr. Beine, Regina is going to observe your procedure.” (Do you remember Dr. Beine? The old, tough German doctor with whom I am not yet on friendly terms?) Dr. Beine gave the slightest indication that he acknowledged Dr. Bhaskarao, who walked me into the room, and turned, and left me there. I suited up, and scrubbed.

So here I am, observing my very first surgery. I took a deep breath and immeditely gagged. I should clarify at this point, that I was visiting the “septic OR” (as opposed to the reconstructive OR), so the procedure I was watching was a debribement of a patient who had a severe gangrene infection that was eating away the insoles of his left foot. Its difficult to articulate the exact stench of gangrene. I’m not sure when the last time you smelled rotting leper foot was, but take my word for it- it’s rough. I tried to stifle the smell by breathing through my mouth, and concentrate on Dr. Beine’s technique.

Turns out the infection was pretty extensive and permeated all the way down to this guy’s bone, which is called osteomyelitis. I’d also like to point out that “this guy,” the patient, was awake! The whole time. Just laying there like he was having his teeth cleaned (leprosy, no feeling, remember?) For the doctors and some of these patients, this stuff can get pretty routine I guess? Dr. Beine began to scrap at the bone, and that sound, coupled with the lazy squeaking of the ceiling fan, created a tiny drone that gave me the heebie-jeebies.

The room was hot. I was breathing in my own exhale through a paper surgery mask. There is no air conditioning, much less ventilation, and the windows had to be closed during the procedure. It was over 80 degrees yesterday. The patient’s leg was covered in weeping ulcers. Dr. Beine muttered something about a tourniquet that I didn’t catch. His incisions were getting obscured by non-specific goop that was primarily composed of blood and pus. The bone kept scraping. The heat kept heating. The smell kept smelling.

I felt the blood drop from my head.

It took me about .2 seconds to realize that I was about to pass out in the middle of the OR. I considered my limited options, and bolted! I mean, it was an awkward stumble and fight to remain conscious, but I ran as best as I was capable. Its most accurate to say that I fled. I fled from the operating room! The nurses peered out the door, and I careened down the hall, smiling weakly at the LPNs as I passed and made it outside, and out of view before I heaved bile into some unsuspecting bushes.

I stood there on the path, thoroughly shaken for a minute, and then loped back to my room. Once inside, I shut all the doors and hid. I didn’t go back to the OR, I didn’t go back to Dr. Bhaskarao. I didn’t even go to my data at HIV. I just sat on my bed and cried.

Needless to say, I felt like garbage. I felt like a loser, and I felt like a baby. I mean, this was my first surgery. Its not like I was performing surgery, all I had to do was try to stay conscious. I also felt like, here I am on this great adventure, I’m supposed to be learning about and alleviating suffering, and I can’t even stomach to watch. Not to mention, the last thing I wanted to do when I was the person who has no business being in the OR in the first place, was screw up. I mean, some future medical student, right?

Just then, my phone rang. I thought oh no, here they come. Probably Dr. Bhaskarao wondering, “what happened to you?!” I answered reluctantly only to hear a familiar American voice, “Hey gina! It’s Jann- how are you?” She was like my personal angel from Seattle. Hearing her voice just opened a floodgate. I tearfully told her the whole story, which was really what I needed- to talk to someone in whole, unbroken English. She was very sympathetic, and advised me to take the rest of the day easily. I felt infinitely better having someone to talk to, but was still beating myself up.

I wrote my cousin Andy (he is a doctor in New Mexico, and a great friend) an email, telling him about the whole experience and expressing my feelings of self-deprecation over the whole debacle. Then I took a cold shower, and went to sleep.

This morning, I had a message from Andy in my inbox:

Gina,

Welcome to the world of medicine! From your description I think your initial response was quite appropriate, and I think you handled it splendidly, actually. I’m not kidding and I’m not just saying this to make you feel better. Lots of people, even future surgeons, get light-headed the first time in a sterile surgical suite, or at a trauma in the ER, or actually, in my office doing a simple skin excision. And that is Disneyland compared to a 3rd world surgical suite, hot, muggy, and with a stench that could stun an ox. (I know the smell of gangrene and it’s not for the hearty, let alone the faint of heart).

But this is why you are a star. You realized you were getting sick and you left the room. You have no idea how profoundly smart/common sensical that was. Because if you had stayed, you would most certainly have passed out, possibly vomited in the OR, compromised the procedure, and then they would have had to stop the surgery to attend to you. I have seen it happen (in a clean, sterile, air-conditioned surgical suite–with soft music in the background no less).

You have also stumbled upon one of my favorite sayings.,”You haven’t experienced a 3rd world country until you’ve smelled one.” I tried to explain this to people when I got back from Nicaragua but you really can’t imagine it–you have to experience it. And I am glad that you have, and I would be pleased if you would use that saying some time.

In summary, I know it doesn’t feel like it, but you showed great character and I am proud of you.

I love your guts,
Andy

I mean, do I have a great family or what?

So this morning, I went to Dr. Hrishikesh’s office with my tail tucked under, but my head held high, to apologize for crashing into, and subsequently out of, the surgery. He apologized as well, explaining that it was a miscommunication among the staff. They didn’t intend for me to get put into wound debribement so soon, with so little preparation. He also told me that he’s very impressed with how well I’m doing in India, and that he appreciated my contribution to Sivananda. Its a complement that I took to heart.

So overall, I’m good. I learned something about medicine. Saw (most of) a surgery. And learned a thing or two about myself. Theresa is helping me concoct a plan to get into Dr. Beine’s good graces that involves making and delivering spetzel (I’m German myself, you know), and one of these days I’ll conquer the gangrene. Please continue to pray for me, and thank you for all your support. It keeps me going!

lots of love,

gina

My Fellow Countrymen (and women)

Today, three Americans came to visit Sivananda!

Jann, who I spoke to on the phone yesterday, is living in Hyderabad for one year with her husband and ten year old daughter, Natasha.  She is a friend of Mrs. Rao’s (who’s mother in law founded SRH. Dr. H. is the boss, but she’s sort of the executive, if you will).  Jann helped raised some money for medications, and wanted to drop off the donation and visit the HIV kids.  She brought with her two friends from Seattle, Diane and Diane’s nephew Simon.  We met in Dr. H’s office.

Jann is a lovely, fit, middle-aged, cosmopolitan woman.  She looks a little bit like Francis McDormand (you know, Margie from Fargo).  She has a master’s in public health, and lived in Cambodia for a little while in addition to traveling all over the world!  She’s really good with people–doctors, leprosy patients, children, American post-graduate students.

Diane is Jann’s close friend from Seattle, and she is a smaller woman with brown hair.  Diane loves children, and they gravitate towards her.  She is gentle and friendly, and has a kind smile.  Simon, her nephew, is younger, in his early 30s or so, with fair skin, a long sharp nose and curly dark hair, like a Greek statue.  All three people were very warm and interested in the work going on here. I was really really happy to spend the afternoon with them.

The four of us went on a walking tour of the compound. I was so excited to show them around, and speak in full, unadulterated sentences.   In the past two weeks I’ve eliminated most adjectives, adverbs and almost all the prepositions from my speaking repertoire.  I’ve been down to monosyllabic nouns, and simple declarative subject-verb sentences (I go. Lunch, eat, 12:30. Thank you.) You can’t imagine how much I’ve missed conversing in English (well, yeah, you probably can).  Jann had visited Sivananda before, but this was Diane and Simon’s first time.  We saw the HIV clinic, the outpatient clinic, leprosy, guest house 1, and ended up at the children’s home.

Simon brought a storybook to read the children, and was very captivating with his animal voices and animated expressions.  He is a trained actor who studied in California, and brought a book for the children about an artist titled “That’s How I see Things.”  In the story the artist paints pictures of imaginary animals like a pig with peacock feathers, or a lion with blue bird wings.  When the story was over, Simon passed out sheets of paper and markers and we all drew our own animal creations.

The markers were a big hit, and the kids were very enthusiastic.  I was really impressed with the children’s artistic skills.  Some of them drew the animals from the story, but others were quite inventive.  Its funny, in America if you give a child some markers and ask him or her to draw an animal, they often come up with cats and dogs, maybe a rabbit for good measure.  Give child in India the same, and he or she will produce an elephant, tiger or peacock.  Sometimes a cobra.

I drew a tiger with butterfly wings and a penguin wearing ballet shoes, just for fun.

When it was all over, Jann and I traded cell numbers and she suggested we go out to dinner sometime.  Diane and Simon are leaving for the states (tomorrow actually) but Jann will be here for as long as I am.  I have lots of amazing friends here at SRH, but getting to know Jann was a great comfort.  She shares my America/India perspective, and she is an amazing role model and she reminds me of my friends back home.

I have been so blessed in my stay in India thus far to meet such amazing people.  Being away from everyone and everything really helps me put the value of kindness into perspective.  From doctors who take me under their wing, to kitchen staff who make my food less spicy (Sunita calls it “chili, zero-zero”) to fellow Americans who reach out to me– I have been treated with unparalleled hospitality and warmth.  It reminds me of the passage in Matthew’s Gospel, “I was a stranger in a foreign land, and you welcomed me.”  I never really understood its importance until now.

lots of love,

g

 

 

 

New game

Today I had my first day in leprosy outpatient. I’m shadowing Dr. Bhaskarao, who is in his later 60s I would guess, and has a very fun personality. He is short, round, wears wire-rimmed glasses and has a white mustache. I think he feels cool having me follow him around and ask a million questions. He is very patient with me, a good teacher, and loves to tell everyone “this is my assistant. She is from America.”

Leprosy outpatient is unlike anything I’ve ever experienced of medicine in the states. The patients shuffle in and produce pressure ulcers ranging from the size of a quarter to the size of my fist. Most of them are kind of green and oozy (ack! gangrene!), while others are dry and resemble holes. The ulcers and infections are not painful. In fact, the lack of feeling caused by the nerve damage is really the reason they get so many ulcers to begin with (but if you read “the crash course” post about leprosy, you already knew that).

Dr. B. showed me how to properly palpate the ulnar (near the elbow) and common peroneal (near the knee) nerves to see if they were thickened. He also showed me how to test for anesthesia, which is the very complex process of poking the patient with a pen and asking, “can you feel that?” Many of the ulcers are treated with oral and cream antibiotics, and dressed in sterile bandages. Some need to go for debriding surgery, and those patients get admitted to the ward. I have photos of some of the more gnarly ulcers which I will not post, as they are pretty grotesque. I can certainly produce them by request if you are interested.

The nerve damage also affects the muscles. About 20% of leprosy patients experience either “claw hand” or “drop foot.” In clawing the fingers curl downward, but the palm remains open and the hand freezes in this position. A reconstructive surgery of tendon grafting can straighten the fingers and place them at an angle with the thumb to that the patient can feed his or herself, work, or even drive. In drop foot, the muscles behind the ankle contract, and the resulting position is a pointed foot. As you can imagine, this patient’s mobility is severely compromised. Reconstructive surgery, along with special boots (which are manufactured on the compound) can allow this patient to walk again. Its pretty amazing.

In some ways, working in leprosy is easier than working in HIV. While the images in leprosy are certainly more striking (deformities, ulcers etc) there is a lot that the doctors can do to help treat the patient. Some days in HIV I want to beat my head against the wall, because all we can do is treat symptoms, work against opportunistic infections, and try and prolong a patient’s life. Its certainly an uphill battle. Not to say that leprosy isn’t, but its definitely a nice change of pace.

While I was in the ward, the phone rang. A nurse popped her head into the office, and gestured that the phone was for me. Me? Who is calling me? “Hello?” I said.

“Hello” an unmistakably American voice answered! “This is Jann, I was calling to let Dr. Hrishikesh know that I am coming tomorrow at 11am to see the children.” I almost dropped the phone. I couldn’t believe how much I had missed the sound of my own language. Here I was, talking to a fellow countrywoman!

“Hi Jann” I said back, trying to sound professional, casual, and to contain my excitement. “I will let Dr. Hrishikesh know. I’m new here at Sivananda, and would like to meet up with you tomorrow as well, if that’s okay.” From there I explained my connection to SRH and found out that she is living in Hyderabad with her husband, who is here on business, and her daughter for a year. They are from Seattle. I am very excited to meet her tomorrow.

After work, I went to go play with the children–which is always the bright spot in my day. Even though we don’t speak the same language, we are communicating pretty well. Two of the girls speak English, and the rest of the children pick up on what I am saying very quickly. Its fun to learn each child’s very definitive personality. Children are children no matter where in the world they live, or background they come from. Some of the kids are leaders, some are shy. Some are competitive, while others are very creative. Each one is different than the next, but they are all really awesome.

The children were a little burnt out on “goats and tigers” today, which is reasonable because we have been playing it everyday. (Its hard to describe rules of different games, so we’ve been sticking to what we know.) Today, however, I gathered the kids around and said, “ok guys, its time for a new game.” They repeated after me, “New game.” And murmured among themselves, ” new game.” I never know if they are repeating me because they understand me, or if they are just trying to encourage me by saying whatever I am saying.

So I taught them duck-duck-goose. They are so cute, and they did really well. They haven’t quite internalized the concept of “goose” yet, so we really just played “duck, duck, DUCK!”

I think tomorrow I want to move on to freeze tag.

lots of love,

g

Material girl

I’ve decided that I need to take further measures to assimilate into Indian culture. Moreover, I’ve been jealous of the pretty saris I see the women around me wearing. So this afternoon after church, I went shopping in downtown Kukatpally with Theresa. Our mission, to find me a dress!

As I mentioned, Theresa is very frugal. She insists that we walk everywhere, and will not allow me to hail an auto-rickshaw. The “autos” as they are called, are the Hyderabad equivalent to a taxi, except they aren’t actually cars. The are much more like golf carts or maybe even tin cans on wheels. Each auto comes fully equipped with three wheels, a bicycle horn (think Honkers from Sesame Street), and a souped up engine that resembles my dad’s lawnmower. They don’t move very quickly, but nothing does since traffic is so congested. The fare is about 10 rupees for a couple kilometes, but I’m finding when you’re American that price goes up to about 20 rupees (which is still only 40 cents). The little yellow autos whiz around like bumblebees, beeping their horns and scooping up passengers. They have so much character, they certainly don’t seem very safe, but I absolutely love them!

I tried to use all of my most convincing persuasion skills (read: whining) to get Theresa to let me grab us an auto, but alas, we walked. The exercise is good for me and all, but have I mentioned that I love the autos?

While we were walking, a small crowd of street children started to follow us. Its hard to tell if the children are following because they are begging, or because they are curious (most have never seen a white person before). Its probably a combination. They did hold out their hands asking for money, but kept calling “auntie auntie” and pointing to my shoes, my skirt and my skin. Its also very hard because they are children. I mean, we have homeless people in Cleveland, and social workers advise citizens not to give money to the homeless, but to rather donate money or time at a shelter or homeless facility. But these children don’t exactly have those kinds of options. Additionally, many street urchins in India are pimped as beggars, and they don’t keep their earnings. So supporting begging is really reinforcing this kind of abuse. I asked Theresa if we could stop at a fruit stand and buy them some food. I saw a quizzical look in her face that softened. She refused me, and explained that we would be swarmed by many more children who could potentially become unruly or even dangerous, and that they would all follow us home. That may be true: but. they. are. children. Small 5 and 6 year-olds with big brown eyes and hungry tummies. I kept walking and felt tears stinging the back of my eyes.

Theresa snapped at the children sharply, and waved them away. Eventually they disbanded, but I think about them often.

We made it to the department store, called “Taruni,” which was very exciting. This was my first shopping trip in India that involved going inside a building. When I walked into the store, I approached the desk and showed the clerk my credit card asking very slowly “Visa? Accepted?” His eyes lit up, thinking I’m sure, Woo Rich American carrying plastic! Big Sale! He said, “Yes Madam” and called over 6 (I am not exaggerating, there were 6) store attendants to help me find a dress for work.

We took the elevator upstairs to the ladies dresses and I was in awe. Indian fashion is extremely colorful and decorative. The whole room was lined with tall shelves containing piles and piles of neatly folded dresses and sari materials. The head clerk, a tall English-speaking man who was impeccably dressed with a Rico Suave hairstyle and subtly lazy eye, asked me what color I was interested in, and I answered, “something bright.”

The attending clerks pulled out a chair for me, and rapidly began unfolding dresses before me carefully gauging my reactions. I made them get a chair for Theresa, and told them I was most interested in her judgment. She was amused when they directed the fuss towards her, since I get the impression that slick people like these clerks generally treat her like a peasant. The clerk would say, “madam, this embroidery is exceptional” and I’d say, “hey Theresa, what do you think of this exceptional embroidery?” She kept laughing saying, “Regina! I don’t know, they are all nice!” I tried to get Theresa to try some dresses on with me, but if I learned anything on this trip, it would be that Theresa is a rock against my persuasion efforts.

Because it is such a hip and fashionable store,”Taruni” only sells Indian dresses called Punjabis (for the younger, more emancipated woman who likes to take steps wider than 6 inches) as opposed to tightly bound saris. I ended up purchasing one full Punjabi outfit, which included a long tunic (the dress part) which was bright blue with tiny gold pinstripes and gold beaded embroidery. Additionally, it came with little pantaloons (gotta keep those ankles covered!) that had matching blue and gold beading, and a blue chiffon shawl which also matched. The whole set cost a little over 900 rupees (or a rough $20, Theresa almost died). I also bought two additional, less ornate Punjabis (each 600 rupees) that were not part of a set: one that is a rusty red color, and the other is greenish blue.

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New Punjabi!

We went to the next department store to purchase a sari. This store provided us with four clerks, none of whom spoke English, so Theresa ran the show. In essence, a sari is just a really big piece of pretty cloth. From this piece of cloth, a chunk is cut off the back and a blouse is tailored for the individual. The blouse is kind of like a sports bra with sleeves. Indian women generally sew their own blouses, but I have to see a professional tailor to make mine  because  1.) I don’t know how to make this blouse and 2.) even if I could, I don’t sew.  (Sunita offered to do it, but she won’t allow me to pay her, and she has enough work). The clerks pulled sari after sari from the shelves and unfolded them between two people like they were airing out a sheet. These colorful billowing fabrics were displayed for me to inspect the intricate beading patterns, which kind of reminded me of butterflies. If I didn’t seem immediately pleased, the clerks would unceremoniously drop the yards of fabric and try and capture my interest in a new pattern. It was really fun. Each sari was more beautiful than the one before it, and I had no idea how I would chose one!

Eventually Theresa and I narrowed the selection down to a green sari with blue and silver embroidery, and a red sari with gold beading. The clerks whisked me out of my chair and swirled yards of fabric around me, then he directed me towards the mirror. It was really remarkable, how quickly they transformed me from a dumbfounded observer into an Indian lady. I deliberated between the two, making a “pros” and “cons” list. Then, out of the corner of my eye, I saw a clerk folding up a royal blue sari on the other side of the room. I pointed and said, “oh! that’s the one I want.” The clerk holding the red sari barely suppressed rolling his eyes but I could feel the exasperation.

I ended up getting the royal blue sari with silver embroidery and also a purple one with gold edging that I just sort of picked up (any of my close girlfriends will tell you that I’m something of a compulsory dress buyer). The first was about 1100 rupees, and the second was 600. I’m hoping to wear the blue one for Easter.

They are beautiful. Theresa and I dropped them off at the tailor on our walk home.

My Address!

Alot of you have been requesting my contact information, so if you’d like to reach me:

gina Pestak

Sivananda Rehabilitation Center

Guest House #1

National Highway No. 9

Kukatpally

Hyderabad, A.P. 500072

INDIA

(visitors welcome!)

phone: 040-9640110290

Please know that I really appreciate all of your emails.  I wouldn’t be able to get anywhere without all of your love and support.  I am so blessed to have such amazing family and friends!

all my love,

g

The HIV children: an introduction

Today was a very exciting day because Theresa took me to meet the HIV children! There are two groups of children here at SRH: the leprosy children and the HIV children. The leprosy children are all completely healthy and live here on the compound with their families. One or both of their parents is categorized as a “class II disabled” (paralyzed limb, severe disfigurement etc), and would have difficulty living a dignified life on the “outside.” The community here provides the family with housing, work, and schooling for the children. These families are welcome to live here forever, if they so desire. The leprosy kids are really fun, and are always romping around all over the place (see “Pongal”).

The HIV children, on the other hand, are pretty self contained. All of these children contracted HIV at birth, and have lots their parents to AIDS. Many of the children were brought to Sivananda straight from their parents’ (usually the mother’s) deathbeds. Some of them were pulled of the streets.

They are secluded from the leprosy children and the majority of the community because they are very susceptible to outside infection. Additionally, they are all orphans and don’t have any family that could or was willing, to take them in. They don’t get many visitors.There are 30 orphans total: 17 girls and 13 boys, but SRH recently got a grant to increase that number to 50. They are building a brand new boys home next to the existing home.

The children’s home is all inclusive. It is a large rectangle with bedrooms arranged around a the perimeter of a courtyard on the first floor. (So even if you are inside the building, you look up and see the sky.) Additionally, the first floor contains medical examining rooms where the children see their doctor, Dr. Sugena, every day. They also see a psychologist once a week, and the SRH dentist once each month. They have three women who care for them, and a teacher. All of the caretakers are also HIV positive patients.

The second floor contains the kitchen, the eating space, a recreation area and the classroom. The children that are below 4th grade are taught by a teacher on the compound. Above 4th grade the children go to public school. One of the girls, who is 15, will be starting college in the fall (you start college after the completion of 10th grade in India). Each child has a school uniform, a set of play clothes, a set of pajamas, and a pair of shoes.

Outside the building the children have their own play area with two swings, a slide, and one of those merry-go-rounds that makes me a little nauseous.

When I got to the home, all of the children ran out of their rooms and stared at me, whispering quietly in Telugu. I stared back, taking in the gravity of their little lives. Most of them are pretty young. The youngest is 4, the oldest girl as I mentioned is 15 and the age distribution is pretty stable between those two ages. It was quiet for a minute until one brave girl stepped forward and said, “name?”

I introduced myself, “gina!”

“Thanmy” she answered.

All of the children chorused “Hello gina” and I said,

“Hey, do you guys like games?”

We played goats and tigers, which is a game the leprosy children taught me. Its basically like playing tag, except if you are a goat, and get tagged by a tiger, you have officially been eaten—and you are out. The game goes on until the last goat standing becomes the next round’s tiger. Its really convenient to play inside the building because there are clear boundaries in the courtyard, and everyone plays together really well. I can’t remember the last time I had so much fun (…probably Pongal).

These children are absolutely amazing. I am so excited for all my new little friends.