Only a few hours left

I’m sorry that I have really fallen off the blogging  wagon. I promise that I have been making lots of memories and have tons of stories to tell, but right now I just can’t tear myself away from the children to sit in front of my computer. I am leaving India in 36 hours and while I can’t wait to go home, I am utterly heartbroken.

Its a difficult thing to describe, but somehow its so hard to understand that on the other side of the world, my American life is still happening without me. It seems unimaginable that I am leaving this strange, fascinating and amazing place that has completely consumed and redefined my whole sense of self these last several months. And that when I go home, this will all still be here. Madam will still see patients. The children will still play “sky blue.” Sunita will still cook everyone carrot curry.

I have no idea how I am going to say goodbye to the friends who  have become like family and to the 30 children who have brought so much perspective, joy and love into my life.

Pray for me. I can’t wait to see all of you so, so soon.

Hello from Rajastan!

We are having so much fun gallivanting around India!

Backtrack: my cousin Andy, the dermatologist from New Mexico, has flown out to Hyderabad to hang out with me and learn about leprosy from the experts. In the US leprosy is super rare (obviously) and is generally only contracted by people who spend alot of time working with Armadillos. Who knew?

Anyways, Andy spent the first week with me at SRH. And let the record show that he slept in Guest House 1 in the 107 degree heat, on a coconut mat, like a CHAMP.

Now in his second week in India, we are having a great adventure traveling around North India in what they call the “Tourist Triangle.” At Jann and Darryl’s recommendation, we are working with a travel agency who has sent up a series of excellent adventures for us. So far we’ve been to Delhi where we stayed in a fabulous hotel (I slept in a BED and took a SHOWER and it was AMAZING!) and toured around the capital.

india 829b small  resWhile we were out driving in Delhi there was an elephant in the road, walking right along next to us. The elephant’s owners decorate their trunks with chalk mandalas. I was so excited. I wish my morning commute was on the back of an elephant.

We saw the second largest Islamic mosque (second to Hagia Sofia) with the relics of the prophet Mohammed in it, which was cool. And we visited a big tower that was constructed by some king in 1191 to show how awesome he was (yeah like THATS never been done  before.) We also visited a Sihk temple, where I made some flat bread with a sihk woman and talked learned about “ritualistic cleansing.”  Consquently, I washed my feet at both the sihk temple and the mosque, so they even though they are dusty and gross I’m ritually clean?

Part of the Sihk religious tradition is to feed the poor. Here I am helping the church ladies make chapati (Sunita will be so proud!)

Next we drove several hours to Agra to see the Taj Mahal. Turns out, I’m not much of a fan of Agra. Our tour guide was telling us that over a century ago some law was passed? (decreed?) that the area is not allowed to industrialize because the air pollution would tarnish the white marble of the Taj Mahal. So.. imagine pre-indutrial revolution India, but in 2009. That’s Agra. There are beggars and slums down around Hyderabad, but this is a whole next level up. The tour guide was also telling us that because this is an international tourist destination there is alot more “pimping” of beggar children with very clear “territories.” It all makes me very sad. The Taj Mahal is absolutely worth the hype, it is truly magnificent. But after we saw it, I was ready to get right out of Agra.

In other news, I “charmed” a cobra today with an old guy on the side of the road (from a reasonable distance–who knows if these snakes are de-venomed?) and saw a whole ton of monkeys running around.  The babies were hanging on the mothers and they were running around all over this temple we went to go see.   Apparently the monkeys are a huge problem for people because using their opposable thumbs those little sneaks can open doors, refrigerators, cabinets and steal food (and make a huge mess). charming

We went to Amber palace here in Rajastan, and it has been my favorite of the palaces. The palace is next to a fort on the side of a small mountain. The entrance is up a long sloped walkway, and I rode a small elephant to the top. It was great fun!

Jaipur is just gorgeous, certainly my favorite of the places we’ve visited. After Amber palace we went to a museum and saw alot of weapons and different forms of carpet weaving and textile making, then we saw a palace in the middle of a lake, had lunch, then we went to this giant observatory.  The king who founded Jaipur was a big time  astrologer and  made all these huge instruments out of marble and sandstone in the middle of a garden in order to map out the sky. Among these instruments are the world’s largest sundial which is accurate to two seconds, huge structures that measure all the zodiac constellations and these huge iron plates with tiny holes in the middle that are used to align stars.  The people in Jaipur are crazy about the whole zodiac sence. One’s horoscope is usually the deciding factor in arranging a marriage. Apparently if two people really seem to like one another and the families agree to the marriage, but the zodiacs dont match, its a no-go. Saisree has been trying to defend the whole concept of arranged marriage to me, but it just doesn’t work with my western sensibilities. I’m sure Scott will be relieved.
We also rode some camels this afternoon. It was fun, but I guess I never considered mounting and dismounting a camel. When I climbed on, the camel was kneeling. But in order to stand up, it does so one enormous leg at a time. So the saddle tips waay back, and then swings waaay the other way, and then kind of levels out. I almost fell off.

We are having such a wonderful time, but it feels strange. I miss the children back “home” in Hyderabad. Its been so wonderful to introduce Andy to everyone at SRH and have this great adventure with him, but it is making me homesick for the rest of my family. I wish they were all here too. I can’t believe its been 5 months, but I also can’t believe its only been 5 months.





“Can you feel that?”

I’ve been back working in leprosy this week. Today, a bunch of patients were referred here from a nearby hospital as suspected leprosy cases.  Now, as you recall from earlier blog posts, leprosy is a disease caused by a bacteria that ultimately results in decreased to lost nerve function in peripheral nerves (but you knew that already, of course). So to diagnose a patient with leprosy a few things go down:

1. The patient will have a “skin smear” taken. In a skin smear, a little clump of tissue is clipped off the patient’s ear lobe. Its heated, stained, and looked at under the microscope.  If there is massive amounts of mycobacterim leprae then voila!  You’ve got yourself a diagnosis.

Here’s the hangup: if someone doesn’t have a positive skin smear that doesn’t clear them as being leprosy-free.  In fact, many leprosy patients test negative on the skin smear since you have to have a pretty heavy load of bacteria to get them to show up in your earlobe. So there needs to be another way to look for leprosy.

Enter Lilly.

Lillykutty, better known as Lily to her friends, is certainly one-of-a-kind. She is the head nurse in the leprosy ward, and she is a tiny woman with cracked teeth and thick glasses who has no qualms whatsoever about bossing people around and showing everyone how its done. “How what’s done?” you might ask. Ah, poking.

So today, Dr. Thirapureddy told me to help Lilly. As soon as I appeared in her doorway, she grabbed me by the arm and half walked, half dragged me outside the office and out into the sun. “Here!” She thrust a ball point pen into my hand. I looked over at the blank chart sitting on the wall nearby, thinking that I might be taking notes? She called the first patient out here into the open air foyer, also directing him into the sunlight. “Off!” she said in Telugu and this young guy flipped off his shirt and dropped his trousers right on command. Standing there in his boxer shorts, Lilly looked at me and then cocked her head towards him. “Now, poke!” she said sharply. “Gently, of course” she added as an afterthought.

We asked the young man to close his eyes, and gently poked his skin with the tip of our pens. “Can you feel that?” I asked him. He nodded.

“Where?” Lilly jumped in.

The young man pointed to his arm, about 8 inches away from where I had touched him with the pen. Lilly clicked her tongue. And we poked some more.

We poked all over his arms, poked all over his legs. We even poked parts of his face. Lilly carefully sketched in the chart the areas where the patient had no feeling. She also pointed out to me some dry patches of dry, hairless skin in the same areas that had no feeling. “You see,” she said, “no nerve function means he cannot sweat in these places. And no sweat means dry skin. So if his skin is very dry in the same place he has no feeling, it is from nerve damage. And that nerve damage is probably leprosy.”

So there you go: Leprosy Screening Method: Poke with pen, scan for dryness.

She finished the chart and handed it to me. I walked with the young man into the office to see Dr. Thirapureddy.

“How was it?” he asked.

“Good.” I held up my pen to show him, and slid the chart to the doctor.

He nodded knowingly and opened the chart, scanning it quickly. “Ah Lilly” he sighed “she is the best.”


Today was balloon day! Being Sunday, I don’t have to work, and the children didn’t have school. Its also incredibly hot (41C).

My aunt Clara (my far-away partner in fun) sent me a packing full of “punching balloons” which are enormous balloons that have a rubber band attached to them so you can bounce them around off your fist, flat surfaces, or friends.  As soon as I opened the box, I knew this was going to be a good time.

I brought the whole box over to the orphanage (there were 35 balloons, so everyone got one) and the children swarmed me. I had them line up (we’re slowly and steadily making progress on waiting turns) and passed out the balloons. Then, I demonstrated how to blow them up.  Apparently, if you’ve never blown up a balloon before, its not the most natural concept. Most of the kids ended up just slobbering on the ends of their balloons, blowing air in and then having it compress back out into their mouths. After a few more trial runs, the bigger kids figured it out. Between myself, Goulthami, Lalitha, Sridhar and Davedenum, we got all 30 of them blown up with only minor hyperventilation.

Tying the balloons was another issue all together. Once the balloons were all blown up, the children had to hold them pinched shut and stand in line again so that I could tie them off.  Everyone was being very patient. I had finished tying about 6 balloons and those children with the tied balloons were off thwumping and shrieking and playing when someone in the back of the tying line accidentally dropped his balloon.

The rogue yellow balloon zoomed around the room and the children screamed with excitement. Just then, 24 more balloons started zooming around the room and just as many children broke into giggle fits. And we had to blow them all up again.

It was a great day. Total chaos. We did manage to get organized enough to play “keep the balloon in the air,” and “pickle in the middle.” We had balloon boxing matches,  made balloon towers, and played balloon tag. Best of all, we managed to pop only a few of them.

A lesson: On Meningitis and Compassion

Life out here  is hard.

Today I went into clinic, and we had a patient with really advanced AIDS. He has progressed into the “wasting syndrome” and additionally is suffering from other symptoms from an additional opportunistic infection, seemingly, meningitis which seems to have localized in his nervous system, and it is affecting his ability to walk and it is causing him intense pain. This patient was carried in this morning by two members of his family.

He was too weak to eat, so Sunita puréed him some rice, which his wife spooned to him. I just kind of watched this couple from afar, and thought about how difficult their lives must be.  Rubina, always the oracle who answers all of the questions I can never really articulate, broke my contemplation: “he has been out of work for 8 months, they have no food for the children.”  She is working to connect them with a program that provides food and clothing to destitute HIV patients.

I thought about this all afternoon. About hunger. I imagined this couple’s children, and superimposed the faces of the children I see each day on the street into my vision of their family and their struggle.  I suddenly felt more grateful for the sticky rice I eat day in and day out, and the vegetable curries Sunita piles on my little tin dish.

As the day was winding down, Dr. Suggunama (we call her “madam”) informed me that this patient needed to have a lumbar puncture (a spinal tap)  in order to collect some cerebrospinal fluid for lab analysis. She invited me to observe.

Uncle helped position the man into the fetal position, his back facing us. He was so gaunt his skin stretched over his vertebrae like tight leather, and I could clearly see the demarcation from where madam would pull the fluid.

Now, I’ve never had a spinal tap, but I can’t imagine its entirely comfortable.  On top of that, this poor man was already in so much pain he couldn’t walk—much less have a needle stuck into his spine.  Uncle held him, so he could stay steady. As madam started the puncture, this man began to whimper and eventually he cried in discomfort. The whole time, this man’s poor wife was standing next to me. She began to wail so loudly and so severely, I thought she might hyperventilate. Uncle shot me a sharp look, so I took this lady by the arm and led her outside.

Once in the sunshine, I sat her down under the tamarind tree where she continued to wail. This woman’s voice was full of agony and pain. I went to the kitchen and found a small bottle of cold water and brought it out to her. I sat with her as she sipped it slowly, and then she slowly slumped into my lap. Quietly, she shook as she wept into my Punjabi.  Immediately, I began to cry as well. Then how strange, I thought. This woman and I don’t speak a word of one another’s language. We’ve never met. I don’t even know her name. And yet, I can feel her sorrow  and here I am, sharing in her pain. Is this what doctors do?

The spinal tap revealed that the patient does, in fact, have cryptococcal meningitis. I turned the sharp focus knob on Mary’s microscope and got a clear look at the tiny blue circles on the slide that was the cause of all our tears this afternoon.

Cryptococcus spores in spinal fluid

Madam had to send him away to a bigger clinic since he needs some very advanced treatment outside of our scope, but truly, he won’t live much longer even if he survives this (which is unlikely). I thought about my time at NIMS and imagined this man and his wife navigating through the giant crowded hospital, weak and brokenhearted.

As they carried him out into a waiting vehicle, his wife followed behind with her head bowed. I whispered a prayer for them both, and then they were gone.

Speak Softly, and Carry a Big Stick

Uncle has been my faithful guardian since the day I landed here. You may recall on my very first day, he showed up at my door and wordlessly escorted me through my introductions at SRH.

Since then, he arrives at door my door to walk me to breakfast everyday. He always carries the same huge walking stick and silently accompanies me from my house to the facility kitchen where I sit and have breakfast Sunita and the other girls.  He doesn’t speak a word of English, and usually acknowledges me with a nod and raised eyebrow. Our walk is a short one: we walk down a light slope, following the path through tall grasses where the peacocks roam and take the little bridge over the creek which has dried up in the hot season. The creek bed is totally overgrown with bright grasses and wildflowers. Then we turn sharply and head over to the HIV ward and kitchen. Our morning walk takes us less than 10 minutes.

The morning commute

He is always around the clinic, helping with whatever needs to be done. Sometimes he assists Mary the lab technician. He always takes out the trash. Other days Shobba puts him to work moving hospital beds or running saline bags around. I’ve seen him escorting admitted patients in, helping the discharged patients get on their way home, and  also taking the bodies of patients who pass away out of the hospital. Some days he even comes with Sunita to deliver the chai at tea time.

During lunch, all of us girls squabble and laugh in the kitchen. The ladies catch up on their gossip and we sit together talking about the day. Uncle is always there with us, a quiet smile among the noisy chaos, and his walking stick resting in the corner. An occasional quip from Uncle throws the girls into giggles and cackles, and then he’s quiet again.

After work I usually go home to decompress for a half hour or so, and then change into my play clothes to head over to see the children. The children and I know that our playtime is over when Uncle appears on the playground to walk me over to the kitchen for dinner.

At one point towards the end of my first month, I was debriefing with Dr. Hrishikesh (“chief sir” as we call him) and I mentioned to him that it seemed unnecessary for Uncle to walk me everywhere.

Like a proud child who wants to be treated like a big girl, I insisted, “I know my way around now. Everyone knows me, I won’t get lost! I don’t need him anymore.”

Chief Sir smiled gently and spoke in his measured English, “Yes, gina. I know you do. But if it’s alright with you, we would prefer that he continues to escort you.”

I shrugged my shoulders, feeling moderately patronized, but soothed. “Okay. If you say so.”

Well, today it all made sense.

Like every morning, Uncle arrived at 8am to walk me down to the kitchen. I gathered up my things for the day, rushed out the door. As we walked, I was working on my mental checklist to make sure I remembered everything for the day. Satisfied that I had, I began digging through my bag to find a bindi which I stuck to my forehead and rooted around for a hair tie to braid back my hair. Finding once, I started plaiting while walking and thinking: I wonder what’s for breakfast? Ideeli, no doubt. Absentmindedly, I nearly walked straight into Uncle, who had stopped dead in his tracks.

There in the middle of the path was an enormous (and I mean, ENORMOUS) snake. I have no idea what kind of snake it was. Not a cobra. Not a copperhead. It was green. And HUGE. It definitely could have been up to 6 feet long and was about as thick as my bicep (Did I mention it was a big snake?). It hadn’t noticed us and I certainly hadn’t noticed it. But when it did note our presence, instead of casually going on its snaky way, this thing faced us, started hissing, and was striking in our general direction. In the spilt second I had to think, I regarded my feet looking vulnerable in pink sparkle flip flops. All I came up with was, Oh great. Now I’m going to get poisoned by an enormous Indian snake.

Not so! Before I could even panic, react or run, Uncle transformed into a snake killing Ninja before my very eyes. He baited the green serpant with his stick, and that enormous reptile made its fatal error in striking for the walking stick that crushed its head. Just like that, in a flash, it was dead.

So there’s this HUGE DEAD SNAKE that is bleeding from its eyes, lying in the middle of the path (tail still twitching) and Uncle casually steps over it and keeps walking, when finally my brain caught up with what just happened. I started freaking out.

“ohmygodUNCLE!Thatwasamazing,youkilledthatGIANTsnake! IdidntevenknowwhattodoandIwassoscaredand youjustKILLEDIT. Youwerealllike, ‘POW! TAKETHATSNAKE!’ AndthenitwasDEAD! ohmygod WHAT IS WITH THAT GIANT SNAKE?!”

He stopped and stared at me for a quick second while I caught my breath between exclamations, and gave me a tiny smile of satisfaction with that raised eyebrow. And then turned and kept on walking.

We made it to the kitchen and I ran in breathlessly, “Sunita! Mary! Ohmygosh, Uncle just killed an ENORMOUS SNAKE! Did you know we had ENORMOUS SNAKES?! He was AWESOME!” They girls all needed a minute to try and figure out what the heck I was saying. They looked at uncle, who casually shrugged and reported in Telugu that he had ninja-killed a snake, no big deal.

Then turning back to my breathless, fully adrenalized self, Sunita said in broken English, “Of course we have snakes. This is India. Why do you think Uncle walks you everywhere for months and months? And carries his snake-killing stick?”


So there you go. Uncle: my very own Snake killing bodyguard. Thanks, Chief Sir.

Shobba and Uncle, the snake-killing Ninja

Dining out: American style

Well, I came up with a plan. And though I found the whole evening to be rather silly, Theresa is happy and I have to count it as wildly successful.

I have been branching out in Hyderabad little by little. Jann and Darryl have taken me to some pretty spectacular Indian restaurants inside the city. I’ve been discovering some amazing dishes, and have learned that the paramount of Indian refinement is in service. And when I say service, I mean, service. You come up to a fancy restaurant and there is someone usually wearing a crazy hat who is there to open the door for you. A separate someone to seat you. A separate someone to pull out your chair. A separate someone to pour your water. Another someone to take your order. Two other people stand there while you eat, refilling your plate from family style serving dishes in the center of your table, as needed. Its overwhelming, to say the least.

So I figured: this is a good plan. I will order a taxi and take Theresa, Selene and James out to swanky Banjhara Hills and we will dine at one of these super fancy Indian restaurants. And since this time I am the host and they are my guests, they will have to accept my hospitality (and the 8 different waiters), and that will be wonderful.  Awesome.

Its been hard for me to meaningfully and appropriately show my appreciation for the amazing people here in my India life. The small and thoughtful gestures of inclusion, compassion and warmth really make all the difference in the world for me when I am so far from home. So many days I desperately want to contribute back. But there’s language barriers, and sensitive etiquette I don’t really understand all the time, and class concerns or whatever—and at the end of the day, I certainly don’t want to alienate anyone. So I smile a lot, and make an effort to communicate my very genuine gratitude. So THIS! This is an opportunity that I was really excited about. I don’t really get out a whole lot, and its not very often that there would be something in Hyderabad that I could expose Theresa to. Very pleased with myself for being such a savvy American, I called for a driver to pick up our foursome that evening, and told Theresa to ready her favorite sari because we were going out in style.

Theresa was very excited about this, and was all a flutter about our special outing. I had mentioned three of the different fancy restaurants I knew of, and gave a brief description so she could help me decide which would be best suited for Selene and James. Then, with a shy tilt of her head and a slight fluttering of her fingers she asked, “do you think we could go to that special American restaurant everyone talks about?”

It took me about 2 seconds to realize she was referring to TGIFridays. Oh yes. Potato skins and red polyester waiters and cheap beer. That TGIFridays.

Now, you may remember me referencing that TGIFridays is the new hotspot in downtown Hyderabad. Really. That’s where the Tollywood stars go to see and been seen, and I see it pictured in background of the entertainment section in the newspaper. Its young and hip and very popular.

My grandiose idea of Theresa being waited on hand and foot by a small army of waiters, was rapidly deflating. But seeing the excitement in her face, and the opportunity to share something with her that was exciting, glamorous and so familiar to my western upbringing—how could we go anywhere else? So yes. I called TGIFridays and made a reservation for 4. Theresa was thrilled, and immediately went to tell Selene and James about our very exciting evening so they could all get ready.

A few hours later our cab arrived and the four of us headed into the big city, specifically into Bhajara Hills, which looks like downtown Los Angeles. Even though its only a 40 minute drive away, its like a whole different world from Kukatpally. But that’s India for you: some of the world’s most advanced technology and universities, and some of the world’s most destitute poverty and ignorance. But I digress, back to the story.

So the cab pulls up to the plaza where TGIFriday’s is (for my Clevelanders: think Legacy Village or Crocker Park), and I lead the way. Theresa and Selene were giggling like schoolgirls and James asked if we could take the moving stairs. Apparently, it was a very big deal when the escalator was installed and James, Selene and Theresa  had  all never ridden one. So that was exciting.

We got seated at the restaurant, which looks exactly like every TGIFridays ever. Lots of rock n roll paraphernalia on the walls, Cricket games shown on mounted TVs, Beatles playing over the sound system, servers dressed in familiar red polos with black pants. They were even giving out helium balloons at the door. Three menus unfolded and I watched as Theresa and company looked over glossy photos of very foreign looking dinner entrees. Finally, Theresa said to me, “will you order for all of us?”

Uh, sure. Obviously there are no burgers on the menu, and I didn’t want to make Theresa, James or Selene uncomfortable by ordering something that you would eat with silverware (other restaurant patrons were using silverware, and looking very much like my mom on the rare occasions she tries to use chopsticks) In the end, I ordered smoothies with colorful umbrellas, mozzarella sticks, potato skins and quesadillas. I picked out chicken fingers with fries, popcorn shrimp with onion rings, and some fish and chips. How’s that for American gourmet?!

Theresa was just tickled. She kept asking me to talk about what all the different foods were, and then asked me if I ate them at home with my family and if this is what we did at Christmastime. I gave up trying to explain that we don’t typically gather around a giant plate of French fries for special meals at our table and just went with it. So after I would talk about one of the dishes, Theresa would tell Selene whatever I had just said (Selene doesn’t speak English) and then ask me another series of questions. Then I ordered ice cream brownie sundaes for dessert, which were a huge hit, naturally even though the spoons were a minor obstacle. Oh ice cream, how I miss you.

When it was all said and done I had the enormous remainders of food boxed up so Theresa could take them home. Then when I paid the bill Theresa made a motion to contribute and I smiled her and explained that she and her company were my guests and she just beamed with appreciation. I hailed a cab and we headed back home, Theresa excitedly recapping dinner the whole way.

Its really become the common theme for my life in India: nothing ever plays out the way I think it will, but everything turns out just as it should. Even though Theresa only had one waiter, I am definitely considering tonight a smashing success.

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Theresa, gina, James and Selene at TGIFridays, Hyderabad