Friday, March 23, 2012

Palliative Care in Trivandrum

I am two weeks into my second adventure in India, and things are going fairly smoothly, well, perhaps "smoothly" is not the best adjective to use when describing life in India, but I can tell you my adrenaline is not pumping in full force every time I step out the front door like it did the first few weeks of my last trip here. I have yet to be kicked off the sidewalk by a gang of donkeys, come face to face with a spider the size of a Frisbee, nor have I had to sprint through a crowd a people to hop on a moving train yet, so life is good I'd say. That does not mean I have not had my share of interesting events here though. As soon as I landed in Mumbai, after the 15 hour plane ride, I could immediately tell I had made it to my desired destination, because it took only moments for all of my senses to become fully engaged in my surroundings. People draped in colorful fabrics and patterns filled the sidewalks and stores, and beautiful green trees and palms among brightly painted homes stretched as far as I could see. Then of course I caught glimpse of the hundreds of eyes that stare at me as if I were an alien that had just beamed down from a hovering space craft. Deafening horns from cars, buses, rickshaws, and countless motorbikes blare consistently day and night to let others know you will be run down if you do not get out of their way. From little restaurants cooking up spicy curries- to burning garbage- to the smell of sweat and body odor rising up in the hot sun, there are always an assortment of distinct smells circulating about the busy streets. My taste buds are also always on high alert because no matter how "non-spicy" I'm told the food is, my mouth always seems to be on fire every time I eat. Lastly, I can honestly say I can feel India in variety of ways. The mosquitoes here must have hit seventh heaven when I arrived; I stopped counting the bites after 50. When going out in public, and taking public transportation, there is no such thing as personal space. You have to grab, shove, elbow, and do whatever it takes to get on some buses in which the maximum capacity is only hit when someone is literally hanging out the door of the bus. Today I struggled to avoid having my face smashed into the sweaty lower back of the man in front of me while an old woman shoved adamantly on my right butt cheek in order to get me up the bus stairs. Quite a sight to behold and laugh about I'm sure had I not been the one crammed in the middle.
I am staying in a city called Trivandrum in the state of Kerala which is in Southern India. Northern and Southern India are very different in terms of food, weather, landscape, and culture in general. There are over 200 different language dialects spoken in India, the main being Hindi. Here they speak Malayalam, a dialect that I have yet to pick up hardly at all. I spend most of my time communicating using childish gestures and pointing to things I want/need. For example, when I'm hungry, I point towards myself, rub my tummy and pretend to put food in my mouth. One of many things I'm hoping not to slip up and do when I get back to the US. Many aspects of Kerala are very much different from the image I have of the North. The state has a 100% literacy rate which is certainly not the case in the majority of the country. It is easy to tell people are well fed here too, and the obvious differences in classes are not nearly as apparent as they were before. Today a young man said to me the heart of India is in the North, and I can certainly understand why he said that. The culture seemed to be more vibrant with crowded cities and traditional rural villages, but the disparities among people were also very visible. Here it is easier to see where India is making great advances, and I feel very fortunate to have spent time in both Northern and Southern India. Although Kerala has been a bit more mellow in comparison, this does not mean I have been without challenges. One challenge I struggle with daily is the changing of my clothes. The weather here is hot and humid! Ninety degrees Fahrenheit and 80 percent humidity during the day make for a seriously sweaty Nicole. Every evening it feels like I'm stripping off a full body suit of pantyhose that I had just marinated in for hours. Everyone dresses very conservatively and it is not unusual to see people covered from head to toe even under the blazing sun. I too make sure all my most scandalous parts are covered, e.g. my ankles and shoulders. I don't know what these women are thinking, but the last thing I want to do is wrap a sparkly, itchy scarf around my sweaty irritated neck. I guess the phrase 'pain is beauty' holds true around the globe.

For those that don't know what I am doing here, I'll explain a little. A handful of alumni of CFHI (Child and Family Health International), the organization I went to India with prior, were asked to come here to review a brand new program they are hoping to launch for future students. We are learning about palliative care through lectures and medical rotations as well as giving feedback and insight to CFHI so they can get an idea of what future participants will experience. Palliative care is a medical approach that improves quality of life of patients and their families facing problems associated with life-threatening illness, through prevention and relief of suffering by means of treatment of pain and other problems, physical, psychological and spiritual. Many patients we see have terminal illnesses, such as advanced cancer, and like hospice, palliative care doctors and nurses offer support and relief in the end of life process. There are three other girls in the program, which is a month long. I share a small room containing two twin beds, a table and chair, and a bathroom with one other girl. The other two girls are across the hall from us, and there is a kitchen at the end in a mess hall like setting where we eat breakfast and dinner prepared for us daily. We are staying at a beautiful christian college complete with various fruit trees and massive palms that line the dirt paths that make up this very tranquil campus. After breakfast, we walk for about 10 minutes to the main road where we line up to dash across streets with no traffic laws to catch a bus or auto rickshaw to either the hospital or the Pallium India office. Our days consist of lectures on some days, in which we are taught the intricacies of palliative care, and on other days we do home visits where multiple teams of doctors and nurses set out to surrounding areas to provide free care and medication to patients in their homes. These patients are generally bed ridden, living in poor conditions, and taken care of by family or members of the community if their family has abandon them. Seeing these people remind me how precious life is and how so many things we take for granted on a daily basis can easily be taken from us in a blink of an eye. Yesterday I observed a man in his early forties express his anger and sadness in knowing that just two weeks prior he was able to walk around his home and village freely, and now, and for the rest of his life, he is unable to even get out of bed without someone helping him. He had taken a bad fall at work which left him paralyzed from the chest down, suddenly changing his life physically, emotionally, and financially forever. I have seen many similar stories here, and I cannot help but be humbled knowing I contain perhaps the greatest gift any person can have, my health.
My time here so far has been truly rewarding. We have been learning from Dr. Raj Rajagopal, known as the father of palliative care in India. He has a way of speaking, making the most profound statements so effortlessly on a daily basis. I think of him as my guru. Between the patients and the wonderful people working with Pallium India, I am so grateful to be in the midst of this extraordinary experience.

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