Ramogi Film City

Oh, the film city. Hyderabad is the home of Tollywood (the Telugu analogue of Bollywood) . Ramogi Film city is an attraction in the area that is half Universal studios, half movie sets– and totally an India experience.

I’ve actually been to the Ramoji film city once before with Jann, Natasha and their excellent friends David and Chad. We had an outstanding time rolling our eyes and clowning around with cheesy characters and movie sets. You can ride the train to “Fun-dustan” or crawl through a genie’s mouth and to arrive in a menagerie of acrylic animals. There are life sized maniquins of Angelina Jolie as the Tomb Raider (complete with pouty lips), Darth Vader and Charlie Chaplan. There are also some really cool topiary gardens, which are my favorite. Its quite the tourist destination, people come from all over Andrah to ride the train to Fun-dustan.

So naturally, when my dear friend Theresa found out that her sister, Selene and her brother in law, James were coming for their first visit to Hyderbad: Ramoji Film City is exactly where she wanted to take them. It is, in fact, the place to be.

She asked me to come along as well, and I was more than happy to oblige. It was a gajillion degrees though (104 F, which might as well be a gajillion), so I was not overly excited about walking around an amusement park. But Theresa is one of the kindest souls I know, and she has been my rock since the day I stepped foot in Hyderabad. I can deny her nothing. Armed with sunscreen, water bottles, a pom for the road, and lots of banana chips (Theresa has got me hooked on banana chips) we were ready to roll.

We took a charter bus to the theme park, and when we got there I marched up to the ticket window to get my admission ticket. Theresa was two steps behind me, taking it all in (this was her first time at a theme park) but when she realized what I was doing she flipped out.

Flustered, she squeaked: “You are my guest! I have to buy your ticket!”

“Please no, Theresa. It’s okay, I’d like to buy my own.” I answered as I shuffled through my rainbow bills. The tickets are 600 rupees ($12) each, which is probably more than a daily wage for a lot of my working class friends here.

Then she started looking really upset as her eyes filled up with tears, and I realized that (yet again) I was breaching India etiquette and truly insulting her. So I reluctantly stepped aside and let her buy my ticket. The moment passed, and Theresea, Selene, James and I set off for our adventure.

Everyone really seemed to enjoy themselves, and I was excited to find another elephant for my collection. (Side note: Have I mentioned my elephant collection? I am making an effort to procure a small elephant from all the different places I visit in India. Its going well, so far I have 8. I’m really far more excited about them than should be considered normal.) We took photos in the topiary garden, experienced a 4-D rollercoaster (you know, its theater that you sit and watch a screen with moving seats? And they spray water at you and blow wind etc), and had lunch at a small café on site, where Theresa also bought my meal.

Coming home, everyone was tired but happy. Selene and James are staying the whole week, and Theresa is trying to come up with some more awesome adventures.

I am still a little uncomfortable with Theresa’s overwhelming generosity today. Theresa’s role at SRH is certainly one of servitude. I don’t really know the details of her salary and all, and she is very well cared for in terms of necessities (housing, food, etc), but I get the impression that her role as xray technician and assistant to Dr. Beine is similar to that of the nuns who live here. Her work is centered around service, not income. This is my Theresa who helps me bargain  my poms down to the lowest cent in the market because she is adament that I should not be overcharged just because I am foreign. My Theresa who would rather walk miles in the sun in spite of her bad back, because it is frivolous to waste a few rupees on an auto ride when “God gave us two good legs.”

I know that she has been saving for the very special occasion of her sister’s visit, and I am touched and honored that she included me. It’s just very difficult for me to accept something so significant when I have so much, and those around me have so little.

I need to think of a way to appropriately reciprocate her kind gesture. I’ll work on it.

gina and Theresa at Ramoji Film City

Idle

My mornings generally go like this:

I wake up, and groggily stumble around my room for my contact lenses and flip flops which I pop in and on, respectively, and drag my way over to my shower. Once in the shower, I turn on the faucet to fill my 5 gallon plastic bucket which I unceremoniously dump  over my head, washing off the nights worth of dust and sweat (have I mentioned how HOT it is here?!) in one big wave.  After some vigorous scrubbing, I brush my teeth (with treated water, of course. No dysentery for this girl.) and find myself a skirt and a blouse off my clothes line worthy of the day.

After greeting Gopal, my nightwatchman (“Goodmorning madam!” “Namaste Gopal!”) Uncle (my escort? bodyguard? …he walks me everywhere.) and I head down the path and across the bridge (over a creek that is dried up and full of wild flowers and greenery) over to Sunita’s kitchen for breakfast.

9 weekdays out of 10, Sunita makes Idle for breakfast (pronounced eed-lee).  It’s a traditional South Indian breakfast made up of ground rice and dal.  Dal is a legume that is often used to make thick stews, but for breakfast Sunita puts it, along with rice, into a mortar and pestle type machine and grinds it down into a coarse meal. She mixes this with some oil and water and pats it into flying-saucer shaped cakes.

At this point I should clarify, that there are no ovens at SRH. An oven is considered something of a luxury, and isn’t generally utilized in all the cooking done here or in lower income brackets around the country. So Sunita “bakes” her idle-cakes in this funny little box which is made out of aluminum. It’s a cube about 1.5 feet in each dimension, and the front has a little garage-like pull down door. She slides the trays of idle into the box, puts some water in the bottom, closes the front, puts the whole box over a fire, and lets them steam.  When they come out, they are little white cakes that have a texture similar to taking white wonder  bread, breaking off the crusts and smushing it into a dense bread ball (sort of?). With the idle cakes, Sunita serves chutney, which is a general name for a dipping sauce. The breakfast chutney is made from nuts that seem to me halfway between a peanut and a pine nut. She grinds these nuts down into paste and cooks them with red chilies and oil.  Every morning at breakfast I have to bargain down to two idles (Sunita can be unrelenting and tries every day to give me four) and I get a scoop of chutney. Its pretty hot, so I mix sugar into mine. If you stretch your imagination really far, its kind of  like eating peanut butter bread.

So this morning, when I walked outside to greet Gopal and head to breakfast, he had a package  for me (“Parcel madam!”). Weee! I was so excited and a quick glance at the return address confirmed the package was from my Aunt Clara, so I could assume it was full of fun surprises for the children.

I tore it open to find sidewalk chalk, jump ropes, beads, glow sticks, and a number of books and flashcards. At the bottom however, there were some special treats for me! These treats included some Luna bars, chocolate (melted, still delicious), and a “just add water” pre mix for banana-nut muffins.  A shame, I thought, since I had no way to bake them.  I considered mixing in some water and pan frying the mix into pancakes. But then, I got a better idea.

I walked over to Sunita’s kitchen, mix in hand, and presented it to her. She gave me a quizzical look, and said, “what is?”

“American Idle!” I answered.

Her eyes got big as she scanned the front of the package. A foreign label reading “Betty Crocker” and pictures of bananas, pecans and muffins.  A smile broke out and she repeated “American idle!”

I showed her how much water to add (3/4 of a cup), and we got right to it. She grabbed the pans, we patted in the batter, and stuck them in the box.

After about twenty minutes I had no idea what to expect. Sunita was excitedly telling the whole staff about our culinary feat earlier this morning and invited Uncle, Rubina, Mary, Shobba and Marheswarie over for some “American idle.”

We pulled out the trays and the muffins were totally edible! They were shaped like flying saucers, and a little bit chewy, but overall everyone was thrilled.  Especially me.  Sunita was very excited and told me that she loves “American idle,” and is going to try adding bananas and nuts to her recipe.

So there you have it: American Idle, the breakfast of champions!

India Idle and Chutney (with sugar)
India Idle and Chutney (with sugar)

How to Heal?

Today Thanmi picked up a rock.

The HIV branch of SRH was started three years ago. At the onset, 20 children were brought to live here, and the remaining 10 were added over time. To be admitted, the children need a total of nine certificates including both parents’ death certificates.  Initially, many of the children were brought here by government social workers. They had been orphaned and living on the street. Other children were brought straight from their parent’s deathbed. Thanmi, however, is the exception to both of those cases.

She is 11, and grew up in a village area in rural Andhra. After her father died of AIDS, the people in the village realized that her mother was a carrier of the disease, so they killed her. Stoned her to death. Thanmi was 7 at the time, and witnessed the whole thing.

Its barbaric and horrifying, and the very sad reality is that these villagers made a utilitarian decision. They believed that if they didn’t kill Thanmi’s mother, the disease would spread throughout the village and kill everyone.  So they acted out of ignorance and fear, and I like to hope it was more misdirected utilitarianism than aggression. I’ve turned it all over in my mind hundreds of times, wondering who to blame for the very emotionally traumatized child that has been left behind.

As a whole, the children are amazing, but there are challenges. For example, sharing and waiting one’s turn are difficult concepts for them, but understandably so since they are so counter-intuitive to the laws of survival. Some of the bigger kids had to learn to live on the street, and I can’t imagine it took long for the younger, more impressionable children to pick up these habits.

Additionally, all of the children struggle with the emotional difficulty of losing their family, leaving home, and realizing that they are sick with the same disease that killed their parents. They know they are “different” and sometimes expresses that they feel alienated.  They are generally isolated from the other healthy children who live on the compound with parents who have leprosy, because the HIV children are so vulnerable to the healthy children’s common colds and germs. But overall the orphans are joyful, and they really do a good job of looking out for one another.

Thanmi, however, really seems to have some much deeper emotional issues. She is beautiful and charming, but she can swing so quickly from mania to depression. One minute she is climbing a tree as high as she can, calling for all to see,  and then suddenly withdrawing and displaying angry or aggressive behavior.

SRH has hired a counselor for the children, but frankly this guy is pretty checked out. He doesn’t know the children’s names, so how could he know their histories?  Meera madam has expressed her frustration to me that there are so few child psychologists, and it has been very hard for her to find anyone to work with children who have HIV.  The man she has now is some kind of therapist who usually works with adults.  He observes the children once a week as a group, and engages them in yoga and meditation. That’s all fine and good, but in my mind, many of the children need one-on-one counseling with a specialist, especially Thanmi. The medical and administration staff has really put alot of time and effort to get her the best help they can, but its a struggle.

So this afternoon I was on the playground paying “Amina Katamina” (which is the India version of “Miss Mary Mack” I think, for those of you who played these kind of games at recess) with a few of the girls when I saw conflict a-brewin’ across the yard.  From a distance I saw that Thanmi wasn’t waiting her turn for a game, so one of the other kids pushed her out of the way as she tried to shove herself forward. She tripped and fell on the ground, landing hard on her backside.

I walked towards them to dissolve the argument and referee the game, when I saw Thanmi’s hand instinctively reached for the ground next to her. Her fingers clenched on a stone about the size of her fist, and her eyes narrowed flashing with anger and she raised it above her head. I sucked in my breath sharply. Then I barked out her name.

Immediately she snapped out of it, dropped the stone, and picked herself up. She trotted over to me and started to wimper about  how she got pushed.  I told all the children firmly, “fighting. no.” They all nodded solemly, Thanmi included, and we went on with our game.

I don’t know much PTSD or child psychology, but I do worry about Thanmi.   She is watched closely for signs of hurting herself or the other children. Meera Madam and the whole SRH staff are aware of her behavioral issues and are desperately trying to get her the help shindia 1211e needs.

This poor little girl has been through so much.  And I worry about how she has internalized it. I can’t stop thinking about how when she felt threatened, Thanmi reached for the weapon that murdered her mother and destroyed her family.

They are working on a solution for her. She has already been tried on several medications and hopefully  better therapy soon. In the meantime, she is watched, cared for, and loved. I just pray it will be enough.

Once upon a Holi

Once upon a time there was an American girl named gina, who moved to India for a little while.  She made friends with a bunch of children, who taught her Telugu games and crazy dances.  One day, the children got very excited for a holiday called “Holi.”

“What’s a Holi?” the American asked.

“Holi is when we play colors!” they said.

So gina went to the market with two of the older children to find some “colors”.

On the way, an Indian man stopped the three, “where did you children find this woman?” he asked accusingly in Telugu, gesturing to the white girl.

The children snapped back, “she is our sister.” All three beamed knowingly at one another, joined hands, and walked away.

They found a stand with a cardboard sign reading “Holi colors 5 rupees” and bought packs of bright blue  and pink rice powder, stopped home at Guest House 1 to get some water balloons for good measure, and were on their way.

At the children’s home,gina expected the children to all gather round and paint peacocks and flowers with the rangoli powders. However, 60 little hands reached into the colors bag, and the children started running. But not before *poof* one of them threw a generous handful of colored powder right in the unsuspecting American’s hair.  This was supplemented by the splash of a water balloon to the back of the head.  It was then that she knew, it was on.

An epic battle ensued. Blue versus pink, the children all clutched their packets of colors for dear life, and took off across the yard.  Corners were staked out for ambush, balloons were launched as soon as they were tied off, and pink and blue children ran shrieking everywhere. The American girl ran through the whole thing with a stupid grin on her  face as she was “colored” from every possible angle.

In the end, balloons were popped, colors exhausted, and everyone posed for pink and blue photos.

Happy Holi to all, and to all a good night.

The End.

Closure

This afternoon I was tap-tap-taping away on the computer in the HIV office, entering data and listening to James Taylor on my ipod–when she walked in.

My little buddy’s mom. The first time I met her, she was admitted to our ward about two weeks after I got here. She is HIV positive, had TB and was very very sick. Additionally, she is a widow and had her little son staying here with her since he had no one else he could stay with.  I got to be very close friends with this little boy, and was feeling personally invested in whatever would happen to him following his mother’s imminent death.  Then one day I came in, and they were gone. Discharged very suddenly. It was very difficult for me, emotionally.

rangoli

But now she’s back! I almost shouted in my excitement when I saw her being examined by Dr. Sugumma, but instead I waved.  She gave me a tired smile back, and nodded. I ran into the hallway to see if my little buddy was waiting outside, but she came alone.

She is terribly weak. I didn’t think she could get much leaner than the last time I saw her, but today she is gaunt, wasting- her skin hanging over her angular bones. Cachexia, Dr. Sugumma calls it. Her worn face has aged decades in the past few weeks. Two of the nurses gently helped her into the ward and put her into bed. I didn’t want to ambush her, and she fell asleep immediately.  I was burning inside to know what happened to him. Where is he? Is he safe? But I had to wait.

While she was sleeping, I was pacing around the office like an animal. There was no way I could sit in front of the computer screen with all my pent up anxiety. Rubina saw my distress and suggested “go home gina. Wash your face and eat one of your pomegranates.” As always, Rubina is terribly sensible and peeling a pomegranate is one of my favorite ways to kill time.

I walked home, and started peeling my pom when my eye caught a recent package sent by my mom. She sends me lots of care packages full of little treats and toys for the children. This most recent package contained several prints of the photos that I email home to her. Her idea was that I could hang up the HIV children’s pictures in their home.  I immediately started tearing through the photos. Amid all the smiling, dancing, cheeseball pictures of the orphans, there were two photos of  him, my little buddy.  One flying his kite on pongal, and the other of him standing next to his mother grinning over Rangoli paints.

After some time I walked back to the ward. Not only was she awake, but  she was waiting for me.  I sat beside her bed and she laboriously explained what happened using her broken English, my broken Telugu, and alot of gestures.

She had finally relented and got him tested. He is HIV positive, which is really the confirmation of what we had feared. She had held off for so long because she hoped that after she died, someone from her family would take him in. Unfortunately, as she continued to get sicker, and everyone refused her, she realized that she had to do something. He’s been admitted to an HIV orphanage with a good reputation in northern Andhra. There he will be safe, and  receive good medical care, schooling and food.  Her eyes welled up with tears while she told me that she knew she was being selfish trying to keep him by her side through the end of her life. She knew that as his mother, she had to do what was best for him. So she prepared a place for him to go, and said goodbye.

I produced the photos of her son, and immediately we both began to cry. I promised her that I would send the photo of the two of them to him, and gave her the photo of him flying his kite.

She eventually fell back asleep, clutching his picture to her heart.

 

kirtick

Back in Action

Well, it took 15 days, two hospital visits, a suite of blood tests, a truckload of anti-pyretics, and more naps than I believed humanly possible: but I am finally feeling better! Hooray!

I am back in action. I went into work today and left the lizards to have run of the house.  I am collecting more and more lizards everyday who are seeking refuge from the heat outside.  It is getting to be incredibly hot.  Today the high was well over 90 degrees, and there is no air conditioning on campus! I’ve been drinking inordinate amounts of water, which seems not to hydrate my internal systems, but rather my clothes via my pores (grooooss!)

Very little excitement on the clinical front today.  Madam only saw a few patients, and they were all very run-of-the-mill follow ups. So that meant lots of data entry and database cleaning for me. Data scrubbing is painful, because it entails going through the pages and pages of data, line by line, trying to figure out what the patterns are and where the outliers come from. And in a retrospective study from a smaller HIV clinic like this one, there are more outliers than are really appropriate for a strong statistical analysis. So that doesn’t really work so well.

I know, its super boring. Medicine is so much cooler.

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