Last India Update!

Looking back on the past 3 weeks it is hard to imagine where all the time has gone!!  I know it is very cliche to say such things after a long period of an other than usual life event, but I really do know where all the time has gone!  Hopefully looking back on this blog will help myself and others down the road see that our time here was very well spent!

These past few days have been pretty relaxing.  We spent Tuesday helping out Pallium with some data-entry work at their main office.  They are just getting to electronic health records and are all very excited about learning more about them! However,  they patients' entire record is not completely electronic and is just limited to some general demographic data.  I think the big reason for this is not to comprehensively track different pathologies, but rather in order for Pallium to be able to give solid numbers to the people that give them funding from other parts of the world.

Yesterday (Wednesday) we traveled to a beutiful beach in the Kovolam area of Kerrala.  It was in the same general vicinity fo the beach we went to a couple weeks ago, but in more of a touristy area.  There were more European people and a plethora of restaurants, shops, and people selling fruits soaked in rum!  We spent most of the day out there dodging waves, laying out, and taking a bunch of pictures. We got back to the hotel last night around 7 PM and head dinner with the Pallium staff around 8.

We had all of our presentations today (Thursday) over topics of our choice.  Mine was on the various cousines available here in India (of course!) and Ryanne's was over arranged marriages.  Both were great topics and were found as very interesting by the rest of the group!

We received lamps as goodbye gifts from Pallium today and we made them a thank you video on iMovie.  I will be posting it to Facebook when we return to the US and actually have some semi-decent internet.

It is about 6 PM right now and Ryanne and I are just starting our packing! I handed out 10 pounds to candy to children during my home visits so that is 10 pounds less I will be traveling with! Although I did buy quite a few gifts for friends and family....

We are going out for dinner and drinks tonight at 7:30 at a restuarant that is the 7th floor of a hotel with a large rooftop area!  Should be a good time!  Our bus will be departing at 1 AM for the airport and our flight is at 4 or so I think....not sure if Ryanne will write anything before we leave but this is my final post!

Thanks for all your kind words of support and many prayers of safety!  We both talked about our family and friends back home pretty much nonstop throughout our stay and thought this would be a great way to fill everyone in on what was going on with us!

Sunset at the beach!  I made this picture the background on my phone!  

A picture of the barracuda I shared with a few friends for lunch!  It was delicious!  

One of the temples at the tip of India.

Ryanne and I at a fort near the tip of India.

One of the temples had this as their source of fire control!

Ryanne at the beach!

One of the Gods that looked over India.

A temple near the tip of India.

Thanks for sticking with us over these past 3 weeks!  

Pictures!!

The internet is working a bit faster so I thought I would take this opportunity to upload some pictures!

A view from the ferry boat at the tip of India!

Part of the palace in Kerala. The woodwork was very unique.

The first time we saw mountains in India was on the way to Kanyakumari. 

Jackfruit chips! nom nom nom

My first ever coconut! Okay, I didn't buy this. Another student did but they let me try some and then borrow it for the picture. 

Floatation devices on and ready for the ferry boat ride to the big rock!

The coconut man! They cradle the coconut with one hand and use a machete to hack into it. I cringe every time. 

We saw three elephants on the road as we left Trivandrum for Kanyakumari. Jo would yell out "ELEPHANT RIGHT." And we would all try to get our cameras out in time. Obviously, I didn't have much success but it's there! Watching traffic move around the elephant was just like watching cars move around tractors in Iowa. 

A trip to the tip!

I kind of dropped the ball and forgot to update yesterday! Whoops! So I'll fill you in on yesterday and today.

Yesterday, we took a day trip down to the tip of India! We got up and met in the lobby at 6:45 am. The hotel had even made breakfast for us early. Then we hopped on an air conditioned bus and headed out. We made a couple of stops along the way. We stopped first at a Kerala royal palace...super interesting. They made you take off your shoes to tour it which was definitely something you wouldn't see in the States. And that place was huge. It took us close to an hour to do a quick walk though.

On bus trip days, I'm always a little worried that I won't be able to find a restroom if I should need one. The gas stations are few and far between and don't have public restrooms even if you found one. The buses definitely don't have restrooms in back. You just feel fortunate if you get air conditioning. So when I saw a restroom sign at the palace, I jumped on it...who knows when I would find another one and anyone of my close friends and family could testify that my bladder is not the largest. So Angie (another student) and I got in line and discovered that we had to pay to use the facilities. In addition, there was no toilet. It was a squatter hole. Definitely a weirdly fun experience!! Thank goodness we didn't fall in! 

After the palace, we stopped at a fort on the coast. There were some cool views of the ocean up there but we were soon on our way again to the tip!

The tip of India is at the town of Kanyakumari and is also called Cape Comorin. You can watch the sun rise and set at the same place! The town was packed because not only is it a popular tourist destination, it also is an important location for Hindus. The temple of an important Hindu goddess is in Kanyakumari. This goddess is said to have protected a famous swami (yogi) from harm and high winds as he meditated on a rock in the sea for three days. This swami then went on to become very influential in India politics and culture. It was the 150th anniversary of his birthday and many monks and Hindus were coming on a pilgrimage to the famous rock. We were actually able to go out to the rock by taking a ferry boat and the views were spectacular. 

One of the best things about the day trip (and India so far) is in thanks to our new friend, Dr. Annie. She introduced Adam and I to something called jackfruit chips. The jackfruit is the largest fruit in the world and is native to India. They fry pieces of jackfruit much like banana chips. And let me tell you, realllll good. We bought a some more today. And I tried my first coconut yesterday too!!

Today, we were all a little tired from the trip yesterday and Jo decided to start class a half-hour later! No complaints here. We had an interesting day of class today on a variety of topics ranging from complementary medicine to end of life care and more. After class, we all relaxed a little bit. I really need to get going on my final presentation but I have found that I am just as good at procrastinating in a foreign country as I am back home. Tomorrow we will be trying to help Pallium with some data entry with the hope that it may help them quantify what they do and have done. For example, if they get all of their records onto a program, it would be much easier to say, "Okay, we helped this many patients with this condition last month/year. The average age of our patients is blank." Jo thinks this could be helpful to their fundraising efforts. So hopefully we will be able to give back to them a bit. 

Adam just ordered me an ice cream, so I had better go help him eat it before it disappears! :)

I'll try to post some pictures later...the internet is not being cooperative right now! 

Less than one week left!

As Ryanne mentioned, today was a day to recuperate from the very busy week we have had!  We spent today sleeping in until around 7 or 8 and then went for a nice run through the city.  We were a little worried about it at first because of the morning rush hour and the sun already being up.  We were able to break our previous record for distance so far here in India at a little slower pace (I blamed the sun, Ryanne blamed my laziness).

After getting back, we spent the morning going through the photos that we have taken since we have got here.   We did this because we have a big presentation due next week over a topic of our choice (something about India, of course).  I am doing a food presentation (who would've guessed?!) and Ryanne had some great pictures of food I may be using for mine!  I will let Ryanne tell you what she is doing hers over...it will be very interesting!

Tonight we may just be hanging out and getting room service.  I got the three Ocean's movies for us to watch before we left (11, 12, and 13) because Ryanne has not seen a single one of them!  We just have 13 to watch and will most likely end up doing that tonight!

We have an exciting day planned for us tomorrow!   We will be traveling down to the tip of India!  We will even stop and visit a temple or two along the way which will provide some great picture opportunities as well!

This was our last weekend here and surely a very relaxing one!

One of our favorite things to indulge in here!  The small seeds taste like black licorice and the sticks are toothpicks!  They are used to freshen your breath after a very spicy meal

The salads that Ryanne loves! Where is the lettuce?!?

A grandpa with his 5 year old grandson.  The grandson has down syndrome and a seizure disorder.  The grandparents spent most of their week taking care of the child because the parents worked 16 hours a day.

Yogurt!  Served room temp and without fruit!  Very different than what we know of in the states!  

Who needs silverware?

Yesterday and today were both home visit days. Yesterday (Thursday) my group along with a student from UC-Berkely went out to a rural area. The Pallium team consisted of two nurses, one physician, and one driver. We probably went an hour outside of the city. There we did five home visits to visit patients suffering from cancer, diabetes, hypertension, etc. One really interesting thing our team did was a bereavement visit. A former Pallium patient had passed away three weeks away. We went to check in on his wife and see how she was doing. We did not stay long but while we were there, everyone stood and prayed silently for the patient's family. It was a really powerful moment. I'm not sure how many faiths were represented in that house but I would venture to guess at least several!

At that same house we noticed that you could just barely see the ocean through the trees. They invited us to climb up to the roof of a neighboring house to get a better view. We really couldn't see the water any better but we had a lot of fun climbing up a narrow staircase on the outside of the house. There was no handrail and a deep well was just waiting down below! Just a little scary.

Today was another day of home visits. My group accompanied two nurses and two physicians to an outpatient clinic in Trivandrum called TIPS. We met the founder of the organization while we were there. Apparently his organization serves many people in the area. They come in to receive their medications for free and be seen by a doctor. In addition, tea, lunch, and activities are provided for the participants. Today was supposed to be a day for cancer patients to be seen but we saw saw other illnesses including psychiatric conditions, hypertension, and diabetes.

The doctor from Pallium today was simply outstanding. I asked her how long she had been practicing medicine. She told me 45 years. A rough estimate of her age would put her somewhere in her seventies and she still works hard everyday and appears to love her job! Talk about dedication. In addition, the Indian work week is six days, not five. Monday through Saturday. I honestly don't know if I have the energy to do what she does despite our fifty year age difference.

At the end of the morning and after we had seen 25+ patients, the TIPS volunteers served us a traditional Kerala meal. It is completely vegetarian. There was boiled rice, sambar (a lentil based topping for the rice), avial (a thick mixture of vegetables, curd, and coconut), achar pickles (very spicy), and paayasam (a sweet rice pudding). The meal is usually served on a large banana leaf during important events such as weddings. It was so good!! I even liked the spicy pickle. They were really happy that an American liked it and insisted on sending some home with me! I also tried to eat with my hands which is the typical way of eating in Kerala. No one really bothers with silverware here except tourists. Silly Americans. I gave it a shot and made a mess but I think the doctors enjoyed watching me eat. Adam has been doing it for a couple of days now and is getting pretty good at it! I still have some catching up to do!

Tomorrow is a free day for us!! Yahoo!!!. That means sleeping in and hydrating for me. It's so crazy how quickly the time is going by. In one week I'll be back home in cold, icy, snowy Iowa.

This man is a local movie star! I've been told that there is a film business for each of the local languages and I believe this guy is the leading man for the Malayalam industry! 

A typical roadside store in both rural and city areas. They sell fruits, drinks, juices, ice cream, chips, and sweets.  But no one seems to sell Diet Pepsi (don't even try for diet coke!). 

The view from the roof of the building we climbed up. Didn't see a lot more water but we all got a little (okay, a lot) scared when we saw this!

Beautiful scenery on the trek to a home visit on Thursday. Banana trees galore. 

A typical Kerala meal. I can't remember what the top left item is - perhaps something with curd. The top middle is avial. The top right is the pickle. The rice on the bottom is topped with sambar.  The paayasam hadn't been served yet. 

Another Day of Home Visits!

It's Wednesday evening at about 5:15 PM and Ryanne and I are just unwinding after a long hot day of home visits.  

I began my day today in an outpatient clinic about 45 minutes outside of Trivandrum.  They actually used a small room that also doubles as the town's "library".  Because it was kind of a slow morning, one of the doctors took my group out for chai before patients began coming into the clinic.  There outpatient clinics actually serve more than just the pain/palliative patient population.  They told me that many patient come in with slight coughs or small cuts that just want to talk to somebody about that.  These patients usually just talk with one of the nurses there and are on there way pretty quickly!  There were about 8 patients that came into the clinic this morning and after all was done we set out on home visits.

We kept pretty much the same routine for our visits as we did last week (small introductions, ask the patient how they are feeling, check on the family, changes in medications, etc) and I began to realize just how efficiently these teams can operate out in these rural areas.  They are able to do so much with so little, and still give the patient as much time as they need.  I think all four of the patients that we saw today had a stroke within the past two years or so and are paralyzed entirely on one side of their body.  Not quite as intense as we saw last week! 

I actually took some pictures this time so will put those below!  

Ryanne and I are going out to eat at a place called "Black Pepper" tonight!  Should be pretty good!  

An example of just how adorable EVERY child is here in India.

           

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The small library the doubled as our outpatient clinic.

Grandmother and Granddaughter

The man that had the art of chai making down very well! 

The world's largest fruit in the world's largest democracy!  The Jack Fruit!  

Another day, another dollar

Today was another day of class. We had a doctor from Pallium speak to us about communication skills, focusing on communicating bad news to patients and their families. It was very interesting because in the United States the patient is given all of the information and can choose to withhold that information from their family. However, in India the reverse is true: families get all of the information and choose if the patient should learn the truth. It was very enlightening.

Adam and I didn't do much after class today...being abroad can be tiring and I think we just needed a relaxing night in. We read a little, watched "Ocean's Eleven," and ordered room service.

One thing I wanted to mention was our trip to the beach on Saturday. About half of us contributed money and we paid a taxi bus to drive us to one of the popular beaches which is 19 km away. The driver also stayed at the beach and gave us a ride back!! Talk about service. The beach was so pretty and the water was perfect! One thing that was a little different was the swimsuit attire. We were the only girls wearing two-piece swimsuits. Add that to our "bright" skin and I felt like we stuck out a bit! But it was really fun and we hope to go back again before we leave.

The beach at Kovalam. 

Add caption

A message found on many walls in Trivandrum. Apparently, writing this ensures that no one can place "bills" or posters on your wall in the hope that your wall won't turn into this:

A houseboat, more class, and a birthday!

These past two days have been quite busy for Ryanne and I!  Yesterday we took a four hour bus ride along with our group to Lake Alleppey, which is about 140 kilometers north of Trivandrum.  It was a very bumpy ride that included our first stretch of Indian highway driving.  This made the driving within the city look quite calm (with highway speeds for a bus heading up to 80 km/hour).  After arriving at the lake we boarded a large houseboat and were served a mango fruit juice while we pulled away from the dock.  We traveled around the lake for the next six hours where we saw a bird sanctuary, ate a delicious lunch, and played a few games of cards. Most of us were quite tired, with bad sunburns, once we hopped on the bus to head back up to Trivandrum.  We stopped for dinner on the ride south at a nice lakeside resort where I had one of their specialty dishes, a chicken curry on top of a fritter...to me it seemed like chicken on a pancake, DELISH!  We got back to our hotel around 11 PM last night and slept in until about 9:15 this morning to make it to class at 10.  We must have been absolutely exhausted from such a long day in the sun and 8 hours total on an uncomfortable Indian bus.

Our class this morning was one of the best so far.  We had one of the doctors from Pallium India speaking to us about good communication skills for much of the day.  The man was very bright and was able to not only teach great communication skills, but do it while crossing into the context of another culture.  This seems to be an ongoing theme for us here in India within our home visits and lectures.  We may be able to do a great job caring for patients within the comfort of our cultural setting, but how would we do things differently in another culture?

It was one of our friend's, Taylor, 21st birthday today.  We went out for the most American meal possible, pizza, for dinner as a group (and brought our professor along too)!  We got a her a couple of Hindi dance music cd's, a very nice cake, customized birthday drinking glass, and a bottle of Bacardi!  She posted on Facebook slightly after that it was one of the best birthdays she has had!

We have lecture again tomorrow (Tuesday) followed by 3 days of home visits.  It should be a great learning experience getting home back into the home visit experience after just one day of it last week.  We will be sure to post all the latest and greatest exciting things from the other side of the world!

                Here are some fishermen we passed on our boat ride on the lake!

Here is a picture of a whole line of house boats traveling through one of the canals to get to the lake.

The delicious lunch prepared by the boat crew.

The Pallium Experience

Shout out to Miss Spencer Ann! Today she turns 26 and I wish that I was able to spend time with her on her birthday.

As Adam talked about yesterday, we got to go out on our first day of home visits yesterday. Talk about a reality check. Several of the patients I met had dirt floors that had been packed in with cow dung. They slept on simple wooden or metal bed frames, often without any real mattress. One patient's family had even attached wheels to a plastic lawn chair to create a makeshift wheelchair. But these people were incredibly warm and welcoming with just their smiles! One family even gave Adam's group flowers!

Pallium India sees patients for a number of reasons besides pain, including diabetes, cancer, and hypertension. One of the doctors we were with told me that Pallium India received 1,300 new patients just in the year 2012. This does not include patients from previous years who are still participating in the Pallium program. Can you imagine? The craziest part is they do it all with six physicians and less than thirty nurses. Holy buckets. In addition to nurses and physicians, Pallium India uses social workers to take care of the family as a whole, whether it be by providing a commode for in the house or providing a soap-making kit to help bring some income to the household.

Today was another class day. Because Pallium's Dr. Raj had some unexpected things come up, he was not able to teach as much as they had planned. So Jo stepped up and taught for probably three more hours than she had planned on! After class today, one of the social workers brought in some jewelry made by one of the patients. A 50 year old, paraplegic woman earns a living for her and her family by crafting earrings, bracelets, and necklaces. She was recently featured at a Kerala art festival. They brought in samples of her jewelry and we were able to place orders for what we want and they should be ready in a week and a half! It is great to get real Indian jewelry while helping one of Pallium's patients....needless to say, I felt justified in my purchases and kept adding and adding to my list! Whoops!

Another thing about India is that tea breaks are important to the culture. Everyday we have had class, we have had tea breaks both in the morning and in the afternoon. It's serious business here. Both breaks are 30 minutes and they offer chai tea, coffee, regular tea bags, cookies, and small appetizers. I could get used to this.

Dr. Senil walking to a home. The log to the left was the old "bridge." The cement one is new.

Dr. Arun working on a chart. 

The flowers Adam's group received. He brought them back to the room for me!

Dessert at one of the best places in Trivandrum, ZamZam.

Pallium nurses walking to a home. 

A few pictures

First Home Visits!

It is 7:45 PM, and Ryanne and I have just returned from eating dinner at ZamZam.  It is a delicious place that serves mostly contemporary Indian food.  I had the butter chicken masala, while Ryanne had the mushroom masala...we split a side of naan (which is my favorite).  Both were quite spicy and took quite a bit of white rice to get both dishes down.  Luckily for us, this restaurant has a vast selection of unique ice cream treats to cool your palate after dinner.  I enjoyed a mango sorbet sandwich and she had some extravagant contraption of layered ice cream with what looked like graham crackers sticking out of the top (delish!)

We may have been so hungry during dinner because today was our first chance to go out into the community with Palium to meet with patients.  I spent my time with a physician, nurse, and a social worker in an a little rural area about 20 kilometers north of Trivandrum.  The first patient we met suffered a stroke a few months back and was paralyzed on his left side, had uncontrolled diabetes that led to multiple missing toes, and a few other diseases that pretty much left him bed ridden.  We met with him and his family and they chopped up down coconuts off the tree and we had some very delicious coconut with the family.  I brought a  huge bag of candy along and passed it out to some of the village children and you would have though they had just received a bunch of new toys they were so happy!  I forgot to bring my camera on this trip but will be sure to do so on future trips.  The next few patients brought us to a much more densely populated section.  The second home we came to had a man with a few different kinds of cancers and spent his entire day just laying in his bed.  However, the problem is that his bed is made entirely out of WOOD (no cushion/mattress whatsoever).  The Palium Care team brought a soft egg shell type foam and some sheets for his back to make him at least a little more comfortable.  In this home, the family made us freshly squeezed orange juice while we carried out our cares.  Home visits number 3 and 4 were rather short and I wasn't able to help out a whole lot because the home was so small, there was no more room in the area the patient was at.  

One thing stood out to me more than anything today actually getting out into the community.  As very very little as these families had, they always made an effort to find some way to show us gratitude and to make us feel comfortable in our home. I really wish I would have brought my camera just to give these words justice as to how poor these living conditions were....there will be three more home visits and I will be sure to document the rest with pictures!  

Tomorrow is another day of lectures, Saturday we will spend helping out at the hospice clinic, and Sunday we are going on a day long boat trip as a group!  Should be fun!  Hope everything is going great back home!  I think Ryanne and I know are going to alternate days posting to the blog so be sure to expect one new post everyday!  

Things I've learned

Things I've learned so far in India:

As Jo says, "The lines are merely suggestions." Seriously, most of you would freak out if we drove in Iowa like they drive here. Little regard for traffic lights and lines, pedestrians cross at their own risk, and enough honking to give you nightmares. We have seen three people on one moped so often I doubt I will ever be phased by seeing two football players run around on one back in Iowa City.

When they say spicy, they mean spicy! Adam and I tried to prepare ourselves for Indian food by going to Indian restaurants beforehand but we quickly found out that you can't really prepare for this. Apparently, Kerala, India is considered the spice capital of the world. And they've earned it. But the food is so good, you just have to fight through the pain!

Rickshaws are more scary (and more fun) than any rollercoaster at Adventureland (and that's saying something!). They are doorless tricycles with a backseat that can hold up to three passengers besides the driver. There are literally so many rickshaws, you don't have to look more than thirty seconds to find an available driver.  They weave in and out of traffic and I can never decided whether to laugh or cry.

People here are so kind. Many people come up to us each day just to say good morning, ask us where we are from, and wish us well. Some even ask for pictures with us (Adam is my arm candy). And while it was startling at first, I feel very welcome in Trivandrum.

-Ryanne

Adam and I ready for the New Year's Eve party!

Jenna getting wrapped in her saree. You can't see it now but workers and bystanders were circling around to watch!

A craftsman at the exhibition sale. This is a hand-carved piece done onto several  slabs of wood. I think he said this one took him 4 days. 

A view from inside a rickshaw. It is hard to get a sense of the traffic here from a picture but hopefully you can see just how close together everyone is and how the lines aren't exactly being followed. 

A new bus from Hewet-Packard to Pallium India. Teams will take this bus out to home visits. It is equipped with some awesome technology and even a shade awning.