Tuesday February 24th: NIMS

Still sick.

These last days have been the pits. Still fever-y, throat is still sore, lymph nodes are still the size of one of Jupiter’s moons (albeit, one of the smaller moons I would say).  Also, my poor laptop is dead. dead. dead. Which means no movies. And very little contact with the Western hemisphere.  I’ve finished reading (and then re-reading) all my books. So I pretty much nap all day.  I’ve been averaging about two hours of sleep for every one hour of being awake. In between naps I listen to my ipod. Its a pretty boring existence.

So on Sunday I convinced Theresa against her better judgment to go with me to the bookstore, in order to replenish my reading stock.  We got a car to take us downtownn to Bhanjara Hills (which is the rich and fabulous district in Hyderabad.) They have a mall there with a McDonalds (that delivers! oh la la!) and a bookstore that carried novels from the UK. Theresa was nervous about me being anywhere but my bed, but I was ecstatic to be in  a bookstore–my home away from home (away from home).  Theresa kept telling me that I looked like “a jumping fish” because I was so excited. Books! I bought 12.

I was more content than the lizards who live in my sink (i’ll tell you what, those lizards are happy campers) because I had booooks! Novels! Long ones!  But my poor mother (and father, and boyfriend, and grandmother, and extended family members, and close friends) have been very worried about my non-specific India fever. I had zero response to the antibiotics, which successfully ruled out strep. And I was starting to develop a “rash” which is really just a few red dots on my torso.  I have been inciting mass panic in Cleveland, so I agreed to go to a major hospital for blood testing.

While everyone else in my life was worried about malaria (dum dum dummmm), I was worried about getting stuck with a needle. I spent waaay too much time seeing patients with blood borne diseases like HIV and hepatitis to feel comfortable being pricked in an unfamiliar hospital, in an unfamiliar country.

So today I went to NIMS (a large hospital here in Hyderabad) with some general angst. This time I was on the other side of the Indian health care system, and had no idea what to expect.

Being at NIMS was just surreal.  I timidly walked into a sea of indian people, just waiting.  The outpatient department is an open air square, and the perimeter has offices and labs all around.   In the middle of this huge space were hundreds of people, just waiting. The sun shines down into the space, but otherwise it is pretty intimidating with all the concrete, tile and fluorescent lighting–a far cry from the painting and fountains at University Hospitals! There don’t seem to be any appointments in the out patient department. You just walk in, register, and wait.  Sometimes all day, I suppose.

Dr. Y’s colleague who agreed to see me was named Dr. Subblaxmi, and she was very kind. She emailed me her office number, and told me to just come right in at 9:30. I bypassed all the paperwork, long lines and waiting. She handed me a form, I filled it in, and we were good to go.

Dr. Shubbalxmi was in her 40s I would guess, and usually works with HIV patients. But she saw me as a favor to Dr. Y.  After checking me out she ordered lots of blood tests, just to be on the safe side. My palms were a little sweaty, and I asked her if all the needles were disposable. She looked affronted, if not insulted, by the question, and nodded with a raised eyebrow.  She even asked a male nurse to take me to the blood draw station.

Sitting outside the station, I was feeling pretty anxious. There was an 11 year old boy sitting next to me with the same uncomfortable expression. I reached into my purse and gave him one of the Mickey Mouse stickers my aunt had sent for the Orphans, and he smiled.  We were both worrying about the needle. I took great comfort in my solidarity with this little man. When it was my turn to go in, he gave me a grimace that said you can do it! I nodded back at him solemnly.  I took a deep breath, and in I went.

I’m pleased to report my blood draw was completely uneventful, and my angst was an unreasonable overreaction. I saw a needle come out of sterile wrapping, I was tested with perfect sterile procedure and into a biohazard bucket it went.  All of my concerns were met.  They  tested me for malaria, dengue, encephalitis,  in addition to a regular blood count that includes hemoglobin and white blood cell counts and a whole bunch of other tests I couldn’t quite distinguish on my chart. (In interesting news, in India it seems all patients are responsible for his or her own chart. You carry it around with you, you bring it to the doctor, to the hospital etc. They write in it, and hand it back to you and you take it to the next doctor or to the lab or the pharmacy. Even Madam’s HIV patients bring in their own chart. Isn’t that bizarre?)

After the blood test, my male nurse escort led me through another sea of waiting sick people, and dropped me off at radiology.  Here, I waited an hour.  In radiology I was most struck by a sign above the room where the ultrasounds were done. I even copied it down, it read, “Determining the sex of the foetus in any pre-natal diagnostic test is a seriously punishable crime for those who do it, those who get it and those who advocate it.”  Why is it illegal to determine the sex of a fetus you may ask? Theresa told me its because girls get aborted at a much higher frequency. No one wants girls, they are too expensive to marry off and a burden to their families. It made me really sad.

I had an ultrasound done on all my internal organs. Why?  I’m not entirely sure.  I’m guessing because in malaria cases the spleen gets enlarged due to the destruction of the red blood cells?

There were no ultrasound techs, it was a  radiologist who operated the machine and went over with me everything as it was happening.  All of my organs are great. Not like I expected anything not to be, but I guess the doctor also wanted a status update on my spleen, liver and appendix for good measure.  All of which are fine.

Interestingly enough, all of my ultrasounds, printouts and consultation with the radiologist cost me 300 rupees, or $6.  My bloodwork was more expensive, for over 10 tests it was 1,200 ($24).  My travel doctor at UH, Dr. Armitage, told me not to worry about any kind of health insurance because its cheaper just to pay out of pocket- and he sure was right! Apparently you can get a total hip replacement in india for like $5,000. Socialized medicine. Crazy.

I tested negative for all the scary jungle stuff (I could hear my mom’s sigh of relief halfway across the world.)  In the end, they went with an unofficial diagnosis of “acute mono.”  I don’t think they ever did a mono spot, but whatever they saw in my bloodwork was apparently enough to make a diagnosis. Additionally, the “rash” I had is a pretty typical outcome of patients with mono who take antibiotics due to misdiagnosed strep.

It also explains all the napping.

lots of love,

g

“Sick” or “gina vs. OR part 2”

Ugh. I am sick. Before you panic, I am doing just fine. Obviously, being sick is bogus and I just lie in bed all day reading–but I’m not in any danger, or scared or anything. Based on the response my fever and sore throat have gotten from the faculty, however, you’d think I contracted the bubonic plague. Let’s go back to the beginning…

Yesterday, I had the chance to redeem myself in the OR. I was shadowing Dr. Anthreddy, the number 2 surgeon, and he had a reconstructive surgery that involved grafting the tendons in a patient’s hand (which was very cool). The surgery lasted a little over an hour, and I really enjoyed observing. The patients are locally anesthetized and then the tendons are delicately sewn together in order to reform the limb into a more useable form. Sometimes this takes multiple procedures, and lots of physical therapy. In the end however, the patients can feed themselves, sew, drive or work in ways they couldn’t with the previous state of their hand (which is also known as “clawing.”) Its remarkable how much these doctors can accomplish with the resources they have.

The reconstructive OR was a far cry from the septic OR. This room smelled strongly of “ dettol“ which is a disinfectant that has a sour, musky smell. Our scrubs were mint green, and our facemasks were made of cloth (as opposed to paper). The surgical nurses removed scalpels and tools from big metal drums that had been heated in a sterilizer to over 100 degrees Celsius. Syringes were made of blown glass, and bright lights overhead illuminated patients draped in sterile sheets. The whole setup reminded me of something out of a 1950s movie. Dr. Beine was working on a foot reconstruction in the same room, less than 10 feet from where Dr. Anthreddy was working, and I was observing. It was surreal.

When the procedure was completed, Dr. Anthreddy and I went to the small office next to the OR in order to discuss what I had just seen. There was a second small procedure scheduled, so we were taking a quick break while the nurses turned over the OR. I was sitting across from him listening to him talk about tendon anatomy, when I suddenly felt woozy. “I’m sorry Dr. Anthreddy, I’m not feeling well” and slumped to the floor. Passed out cold.

WHY is this happening AGAIN?!

When I came to, a whole gaggle of worried looking Indian nurses were standing over me. I was shivering so one of them stuck a thermometer in my mouth. I had a low temperature of about 100 degrees. Thats strange, I thought. I went back to my room, and slept the rest of the day.

Well, when I woke up this morning I got my explanation. I was sweating with a fever, my head was aching and there was an all too familiar pain in my throat. Oh no. Here we go. In case you are unaware, I am the reigning monarch of strep throat. I get it almost every year. It would just figure that I managed to pick it up in India.

I went over to the administration office to find Dr. Anthreddy in order to explain/apologize for my fainting yesterday, but he wasn’t there. I waited for a half hour, but he didn’t come and I didn’t have the motivation to romp all over campus and try to find him since I still feel like garbage. I left a note on his desk saying that I was sick, I would be sleeping at home and to please call me when he was available.

I went back to my house, and about 40 minutes later someone was knocking at my door. None other than Dr. Hrishikesh, the chief!, flanked by two more of our doctors, Dr. Viajaykumar and Dr. Thirapureddy were standing on the front step of Guest House 1, making a house call! Three great men, triple awe-inspiring doctors, here to see me! And then I though, Am I in trouble?  I really like Dr. H alot–he reminds me of my grandpa. When I opened the door he said gently, “hello great lady. I heard you were not well. Why didn’t you tell me?” The three of them escorted me to the hospital on-site 200 feet away from my door to get checked out.

When I walked into the very small hospital with the chief and two SRH doctors, everyone jumped a mile. People started moving very quickly, buzzing into intercoms hastily, “the chief has come!” and the hospital director (also my neighbor) approached us, clearly shaken by Dr. H’s unannounced arrival with myself and the other two clinicians in tow.

“What can we do for you, sir?” he asked.

“Regina is sick,” Dr. H answered.

So much pomp and circumstance! I was ushered into the administrator’s office, where he, another doctor and four nurses cooed over me, under the watchful supervision of my entourage. I felt a little silly with all the fuss. When they said “what is the matter” I answered, “well, my throat hurts and I have a fever. I think its probably strep.” With all the staff whirling around me, you’d think I was presenting something a little more significant. Dengue, maybe?

They stuck a thermometer in my mouth, and an hour after taking an extra strength tylenol, I still had a fever of 100. Several physicians all looked in my throat which was very red (and apparently had some tell-tale white patches) and diagnosed me with “tonsillitis.” They offered to admit me to the hospital to remove them, and I almost laughed. “Um, thats okay. But maybe some penicillin?” Well they didn’t have penicillin, so they gave me ampicillin, which is still a beta-lactam and should do the trick just fine. So I was pleased.

Dr. H also informed me that in 6 years of medical students from American and Germany staying at SRH, I was the first to get sick (that wasn’t GI related). So I suppose I’ve made my place here, something to be remembered for.

If nothing else, I am so grateful that so many amazing people are all looking out for me.

lots of love,

gina

Prassana

Golthami, who is 15 and the oldest of the HIV children, rode her bike over to the office to see me this morning which is unusual.

“Its teacher’s birthday.”

The children’s teacher is named Prassana, and she is fantastic. She is in her fourties, and lives just outside of the compound.  Moreso than anyone else in the children’s lives, Prassana is extremely nurturing towards them.  Although the children have full time caretakers, these women who live and work in the children’s home are also HIV positive. For them, working at SRH is a dignified way to earn a livlihood. However, most of the matrons have been shunned from their own families and children, and while they don’t resent the SRH children, they aren’t particulary invested in them either.  They are all good women, but not very warm.  Prassana, on the other hand, just lives for the children.  She is always providing them with structure, encouragement and love.  The children suck this up like little sponges, and they absolutely adore her.

Prassana teaches the younger kids (up to 4th class) here on the SRH campus, and also monitors the older children’s education once they start attending government school. In addition to reviewing their homework, and helping them acquire school supplies, she  also hold multi-level tutoring in the evening for the students. She prepares them for exams, teaches them study skills, and she encourages them to do well in school.  One of the older boys (who is the son of leprosy patients here on campus) just got accepted to a major university in Hyderabad to study biotechnology.  Golthami will be starting junior college in the fall.  Needless to say, Prasanna is an amazing influence in the children’s lives.  (And in addition to all of that, she has been a great friend to me.)

I went over to the children’s home immediately after their school day was over. They have a 3 hour break after the daytime classes until Prassana comes back for the evening tutoring session.  We got straight to work.

First I showed the children how to make paper chains.  They all colored strips of paper with their crayons and we looped the strips into circles.  Nitish acted as the “tape tree” holding out all ten fingers, wiggling long stripes of clear plastic tape in front of anyone who beckoned him.  They were so cute in their determination.  Mahesh colored every single one of his strips solid blue, insisting that it was “teacher’s favorite color.”  Once the whole  chain was long enough, we hung it over the door of the school with a sign that read “Happy birthday” in Telugu.

The older children all made birthday cards while I ran across the street to the bakery.  I found the largest pineapple cake they had (which still wasn’t very big), some candles and paper plates, and then ran back to the school.  When the children saw me coming, they all gathered around me to see the cake.  Their eyes lit up, not for the cake itself, but for the fact that we had a cake with which to honor her.

I thought they were going to burst out of their skins with excitment.  The leprosy kids all joined up at the HIV children’s home, and brought cards with them as well.  The kids were bouncing all around, keeping lookout and comparing their respective “links” in the chain. Suddenly somone spotted Prassana coming up the path, and a whole swarm of children ran to greet her to ask her to come inside so they could “show her something.” Which was of course, very subtle.

Prassana didn’t even make it into the school. The rest of the children ran out, with Golthami at the end holding the lit birthday cake.  All 70 children belted out a chorus of “Happy Birthday to yooooouu,” puffed up with of pride and excitement.  When they finished their song, Prassana blew out the candles and said with tears in her eyes, “God bless all of you children.”

We all gathered in the home to cut and serve the cake.  Its traditional in India for the birthday person to feed the first slice of cake to an elder or honored guest (almost like we do at weddings). All of the children gathered around, and Prassana called Sunnat up for the first piece.  Gothami, Rubina and I passed out small slices of yellow pineapple cake to the rest of the children.

One the children were sufficiently sugared up, we sent them out to the playground to burn off some of their excitement and hyperactivity.  They ran around beaming at each other, reviewing the success of the surprise. Each child mentioned his or her contribution to the party for everyone else to hear multiple times.

While we were cleaning up paper plates, post-excitement, Prassana leaned over to me with a raised eyebrow and a smile, and said “gina, who could have been be behind all this?”

I laughed and said, “trust me, it was their idea.”

So excited
So excited

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My laptop

My computer is on the fritz.

Its a bad bad scene. My laptop isn’t getting power. I would say that for every 30 times I plug it in, it will start charging once. I’ve spent the last few nights on hardware message boards, and talking with  my tech savvy brother and super genius friend David.  We have diagnosed the problem as a faulty AC pin.  According to some guy online, if I continue to “jiggle” the connection, my motherboard will soon be fried. David gives it, at the most, 3 more days to live.

The apprent solution to the problem is to resolder the faulty pin.  My brother claims that its an easy fix and that he could “do it in thirty seconds.”  He has offered to talk me through the procedure on the telephone. I should point out, however, that the said procedure requires that I 1.) find and purchase a soldering iron in India 2. ) crack open the laptop shell 3.) locate said faulty pin 4.) successfully weld tiny pieces of metal together 5.) correctly reassemble my computer.

I called for professional help.

I mean, its India for pete’s sake. I am living in the tech support capital of the world. Someone out here should know how to fix this thing, right?  Jothi, who is our resident computer girl, gave me the number of the guy who does all their hardware work.  So I called him up and this guy showed up on a motorcycle later this afternoon.  I have faith that he could fix my computer because he is kind of nerdy looking, and he is also Indian. So I mean, not to be stereotypical or anything, but he definitely met all of my criteria.

In the meantime, I’m back at the office computer for basic emailing, etc. I am not totally plunged into the dark ages, but I’m a little too close for comfort.

Multi-Drug Therapy: A Treatise

I am finding that medicine in a developing country is a very delicate balance of resources, practical know how, intense dedication and resilience. The doctors and staff at SRH are inspiring, especially when you consider the scope of what exactly they are up against.

So HIV/TB coinfection is a really big deal. We see tons of it in the patients at Sivananda, and globally its a major epidemiological concern. TB is the most common opportunistic infection in patients living with AIDS, and depending on the patient’s CD4 count, it is often lethal.

To complicate this, drug resistant strains of both HIV and TB are big problems. HIV is capable of rapid mutation since reverse transcriptase is prone to error (but you knew that. See “a crash course” if you didn’t). Additionally, drug resistant strains of TB do exist, especially around here, which is bad, bad, bad.

Drug resistance is prevented by hitting the antigens on lots of different fronts, with multi-drug therapy. That way if the mycobacterium tuberculosis (or the HIV for that matter) is resistant to a particular drug, one of the other drugs in the cocktail will kill it off–and that way the resistance doesn’t get passed on. I mean it makes sense, right? So if the patients just take their medicine, we can avoid drug resistance. Whats the problem?

The PROBLEM is that the drug regimens are craazy complicated! I mean, I have a degree in biology, and I’ve studied this stuff for a few years now, and it STILL makes my head spin. How the HECK is a patient, living in a village in the middle of India supposed to manange this stuff?  It’s a lot of work! And if the patient doesn’t fully buy in, or fully participate, then you’ve got even bigger problems. Incompletely treating something creates an opportunity for further drug resistance.

So, for example, a sputum positive patient (which means that we stain the gunk that the patient is coughing up, and there is TB bacteria in it) on category two drugs (catII, if you want to use the cooler lingo) gets put on the following regimen:

“2(HRZES)2 / 1(HRZE)2 / 5(HRE)3”

…um, what?!

So to translate the above: each letter represents a drug. Each drug hits the bacteria in a different place. So for example, “R” is for “rifampin” which is a powerful drug that stops the bacteria from being able to transcribe DNA into RNA and ultimately blocks the the bacterium from making proteins (so, basically, if the germ has got an instruction manual, but no equipment, it’s out of luck and ultimately dies).

The subscript following the letters within the parenthesis is the number of times each week the patient has to take each of the drugs.  The number in front is how many months this regimen goes on for.  Once the first set is completed, you move onto the next set. So the patient above takes 5 meds twice a week for 2 months, then 4 meds twice a week for 1 month and then 3 meds three times a week for 5 months. Keep in mind this is the formula just for catII–there are two other categories as well!

Pfffft!

Ok, so the WHO has figured out that this might be just a little bit difficult for the average peasant to understand, care, and remain compliant about.  As a result, they have made a huge campaign called DOTS which stands for “Directly Observed Therapy Shortcourse.”  What that means, basically, is that someone who knows what’s going on, needs to watch the patient take his or her pills (directly observed? get it?) to make sure that they are getting the correct sequence and dosage. This ultimately makes for effective treatment. (Also prevents drug resistance in the population). Easy enough?

Here at Sivananda we have a DOTS program. Its an office in the back of the outpatient department, and really isn’t much to look at.  Tons of boxes full of drugs are stacked on shelves all over the place, and theres one small white haired doctor who sits behind a big desk.  I sat down with Dr. Venkanareddy for my introduction to the program.

Turns out, SRH, in cooperation with 4 other regional DOTS centers, reaches almost a million patients in the Hyderabad area! So what does that mean exactly?  We have a fleet of healthcare workers who go out in jeeps piled full of drugs each week. They literally go knocking door to door, handing patients some pills, and watching them get swallowed, and checking them off a little notebook for the day. Then they move onto the next doorstep… Almost a million times.

I swear, DOTS is just like reverse trick-or-treating.

And thats just for TB by itself. HIV/TB is a different story all together.  Like TB, HIV also requires a complex multi-drug therapy (here its not as complex as it can get in the States, just due to a lack of the newest, aka most expensive resources).   This therapy, ART, also comes in different lines of defense.  Unfortunately, the ART centers in Hyderabad can only provide patients with free first line ART. If the patients don’t respond to that, and need second line ART, it is really difficult to accomodate them. ART also needs to be followed really closely. Studies have shown that if a patient misses just 5 of the 60 pills in that must be taken in one month, the effectiveness of the therapy drops by 50%!! Unreal.

To make matters worse, the TB drugs and the HIV drugs in the first line regimen often react with one another. So if a patient isn’t watched closely and was put on CatII by their TB doctor, and then unaltered first line ART by their HIV doctor, the rifampin plus the nevirapine results in decreased effectiveness and liver breakdown. Not to mention the the drugs are toxic themselves. So that’s a problem.

Patients often have severe reactions to the drugs since they are powerful, harsh and semi-toxic. The physicians have to find a balance between effectively treating the patient’s disease, opportunistic infection, and avoid hazardous side effects.

As if all these factors didn’t make the treatment of HIV/TB difficult enough, don’t forget to add into this equation the patients fear of social stigma (often causing them to lose their employment, home, community, family, etc), ignorance, economic status, “quack” doctor scams, transportation, and the general political instability of the country.

Phew! Crazy, right? Public Health is really an uphill battle out here, but I am really excited that I get to participate in the action!

A severe Nevriapine rxn in an SRH patient
A severe Nevriapine rxn in an SRH patient

Charminar

This weekend I went out with Jann, Chad, David, Natasha, and a collegue of Jann’s husband named Debbie. We drove down to the “old city” to visit Charminar, which is a major landmark in Hyderabad.
The CharminarCharminar translates to mean “four minarets.” It is located in a very Muslim part of town. Hyderabad is about half Muslim and half Hindu, and Christianity is gaining hold. Unlike many parts of India, the Hindus and the Muslims co-habitate really harmoniously here. The monument was built in the late 16th century supposedly to thank Allah for answering a prayer of the king. On Fridays the area is flooded with devotees who come to the area to worship. Charminar is a square structure, with towers on four corners, and arches on each side. It’s beautiful.
Surrounding Charminar is a huge market which extends about a kilometer in all four cardinal directions. The street on the south side is jam-packed with shops selling fabrics, and glittering bangles. And when I say glittering, I mean glittering. Jann and I went into one of the small shops to purchase a pair of bangles. David followed to try and get a picture, and we all almost had a seizure. The bangles are brightly colored and set with rhinestones and glitter that has been enameled over. The shopkeepers really play this up, installing bright lights that beam down into the counters. The intense light refracts in the rows and rows of bangles and sends sparkles everywhere. My bangles are blue, green and gold. I liked them because they reminded me of the peacocks in india.

The east side of Charminar was full of vendors selling everything from pocket watches to handmade perfumes. We stopped to watch a man grinding ginger and gardenia flowers down, making a sweet smelling extract. We also saw many beggars, most of which were terribly disfigured. I really struggle with the homeless and destitute out on the street here. Mostly because I don’t understand how to effectively help them, or how to emotionally process the magnitude of poverty and suffering. I looked to see if any of them were notably afflicted with leprosy, but that didn’t seem to be the case.

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The Pom! so good.

The north side of Charminar is a huge fruit market. I loved all the noise and the color. Vendors pushed carts piled high with guavas, oranges, mangos, grapes and pomegranates! (I looove pomegranates). The fruits, like oranges, were often stacked in pyramids or piled high in baskets. On the top of the display there were fruits that were cut open, exposing their sweet interior, in order to tempt hungry shoppers. I found myself inevitably drawn to the shiny red pomegranate seeds (but ultimately opted to wait and eat the poms waiting in my refrigerator for me at home.) Some men carried long stalks that still had bunches of bananas attached to them. These men would unsheathe a large knife and slash off a bunch, bargaining with a customer for the best price. For the record, the fruit in india is amazing. It will be hard to adjust to the produce back home, especially the pomegranates (can you tell I’m fixated? I’m going to need a 12 step program to get off the pom).

The west side of Charminar I found to be pretty strange. Its “dental row.” We walked up and down just to see it, because trust me, none of us was about to get a root canal in the old city. Dental row is hard to articulate, but imagine an open air market hybridized with a dentists office. But not a clean, sterile, professional dentist’s office. They were kind of dark and creepy dentists office, like you might see in a haunted house, or Little Shop of Horrors. Oftentimes the “offices” would be about the size of a garage, open in the front so you could see inside. Inside I’d see an old dentists chair, and some faded posters advertising braces or cavity filling.  Behind the dentists chair would be a table containing dental tools.  In one of the corners of the room, waiting patients could sit on a wooden bench. Most of the offices were empty, but I caught the eye of a few people sitting on those benches. The anxious look of waiting for the dentist seems to be pretty universal. That whole strip was pretty bizarre.

With the exception of the west side, the whole market was packed with people.  Kukatpally, where I live, is a traditionally Hindu area and is starting to undergo some growth and renovation due to the nearby “high tech city” which is spilling over into the suburb.  The result of that is boutiquey shops (like where I bought my dresses), new businesses, a growing local economy, and a more cosmopolitan perspective.  Prior to my visit to Charminar, I haven’t had a ton of exposure to the Muslim culture in Hyderabad. And certainly not the like that of the “old city.”

Most strikingly, a large majority of the women I saw were wearing full Burqas. Black. So in addition to the long cloak that reaches down to their shoes, the women’s heads and faces are covered by thick, dark cloth.  Tiny slits allow for visibility.  When I looked at these women’s eyes, they usually showed surprise.

I would imagine they were looking me in surprise because while  they were fully burqa-ed, I was wearing long capris and a t-shirt (which might as well have been a bathing suit by the looks I was getting.)   I’d also like to point out that the temperature was over 90 degrees today. How these women don’t pass out from heat stroke is beyond me.

I’d rather not get into the whole discussion of culturally oppressed women right now, because I recognize that the burqa is (in theory) for the protection of the woman’s dignity. Rubina and I talk about it alot. She is very devotely Muslim, but refuses to wear one. She claims that in many cases, strict Muslim marriages are a form of slavery. Consequently she also refuses to wed anyone.  I think its fair to say that for the most part, the women out here don’t wear burqas based on their own free choice, but rather at the dictation of their male family members. (Have I mentioned, by the way, that I think Rubina is a really amazing woman? She’s inspiring.)

I was glad to be flanked by Chad and David on each side, who gave glaring looks back at the men who stared at my arms and ankles. At one point we (half) jokingly talked about buying me a burqa, which were available for purchase all around Charminar. The good news was that whenever we needed to cross the street, the traffic all but came to a halt.

At the end of the long afternoon in the Old City, we all piled in the car and went out for dinner. We ate at a beautiful italian (italian!!) restuarant, and I ate my dinner with a fork. It may seem inconsequential to you, dear reader, but this is the first fork I have used in over a month. I was really excited!

So to sum it all up: another day, another adventure in India!

lots of love,

g

Charminar
Charminar

“Strong bridge!”

Today Jann (see: “My Fellow Countrymen“) came to visit SRH, and brought with her two more friends from Seattle! I’ve never been to Washington, but if I had to guess, Chad and David are probably the nicest couple in the whole state. Both are young (later 20s? early 30s?), and extremely fun, warm people. Chad, with sandy blonde hair, a medium build, and eyes that crinkle a little when he smiles, is an elementary school science teacher.  David, 6 foot 6ish with dark hair and glasses, is a musician who masquerades as a software engineer. They are spending three months backpacking through India, and are visiting Jann’s family this week.
Chad, being Mr. Science Guy, brought an “educational activity” to do with the HIV children. When we showed up at the ward, the kids just flipped with excitement. They remembered Jann, and their eyes lit up over two new friends. They started chattering away in Telugu, pulling us into the hostel by the hands, pointing out taped up pictures that they drew and a new set of curtains along the way.  Chad’s eyes got really big, and he whispered to me “they don’t speak English!?”  Well, no. Not really.   I told him obstacles or not, science must go on!

We all trampted up the stairs to the classroom where the children sat down on the floor, still buzzing with excitement. Chad resolutely dumped out his bag of supplies and armed himself with a bit of chalk. A hush fell over the room. He drew on the board a boy, a pit, and a house.

We all stared blankly.

Jann leaned over to me and muttered, “I’m not sure where this is going…” Chad said to the children, slowly,  “how can I get to my house?” They didn’t understand. He was starting to sweat a little.

David jumped in to assist!  Chad narrated enthusiastically: “We can’t walk…” David started pantomiming jovially strolling along, arms swinging, and then tripping and falling into a pit. (stiffled laughter from the children). “We can’t fly…” David flapped his arms. There was giggling from the children. “We can’t swim..” David held his breath and paddled the air. Chad paused expectantly, “soo.. what do we need to do?” Silence hung for a second while the realization sunk in.  Then one of the children chirped “bridge!”

“Yes!” Chad yelled victoriously, breaking the chalk. “We need a bridge!”

We divided the kids into pairs. Jann and I helped the teachers pass out strips of paper, and these little card box things (that’s a technical term) that Chad was up late last night making. The idea was that the children were to put the paper between the little card box stands to make a bridge from point A to B. We used dried lima beans in order to measure the strength of the bridge (I should have asked Chad if they consider lima beans an SI unit in Seattle). The variable in question was the structure of the bridge. They children had to figure out some way to maximize their beanage with a single sheet of paper. Chad tried explaining this. Even with David’s pantomime skills, it didn’t quite go over. He looked at me, and I looked at the children. “Strong bridge?” I told them, shrugging. “Strong bridge!” they chanted back.

We spent a solid hour making “strong bridges.” Every second I turned around there was a team of kids calling for attention “Look ginaakka! Strong bridge!” Our little guys, Sunnat and Nitish, were proud of their bridge, that held “one, two, three, fourteen beans! Strong bridge!” I didn’t actually count their beans, but I know for a fact that Sunnat, coincidentally, only knows how to count up to fourteen in English. If I had asked him the number in Telugu, it might have been a different outcome. (The incident alerted me to the fact that I have to work with them on the importance of accurate data reporting. The little buggers need to learn to be good scientists! We‘ll start by adjusting the confidence intervals.)

The girls were creative with their folding, making different shapes with their paper and arranging their beans in patterns, asking me “strong bridge, akka?” The older boys were very competitive, cheering for each bean and making big muscles, saying “strong bridge” with deep voices! I had to laugh. Chad, David, Jann and I were moving through the classroom of beans, bridges and budding architects, passing out supplies and offering our encouragement “oh! Very good! strong bridge!” It became the mantra. Finally, the children caught on by accordion folding their papers, they could make the strongest bridges of all.

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Strong bridge!

After finishing the “educational activity” we went downstairs for some less structured playtime. Chad and David jumped into a game of freeze tag, and we also got in a round of “January-February” which is a patty-cake like game. We sit in a big circle and you pat the hand of the person next to you, calling off the month subsequent to what you were patted on. If you get patted on “December” you’re out. David made it to the final three and was looking hopeful, but was tragically Decembered by Lalitha. He took it like a champ.

When it was all said and done, Chad marveled to me how children are so universal. “It reminds me of my classroom full of third graders.” He was certainly in his element. I marveled how good teachers make all the difference.  Chad, with David’s help, took some printer paper and a bag of lima beans and in one short afternoon fostered teamwork, pride, and academic interest.

After they left, Sunnat carried around his “fourteen” beans all day telling anyone who would listen about the “strong bridge” that he made.