INDIA 2012/13

Page 1

SIX WEEKS IN

INDIA 23 NOV 2012- 8TH JAN 2013

HANNAH GLOVER

DELHI PALAMPUR MCLEOD GANJ AMRITSAR MANALI AGRA JAIPUR RANTHAMBHORE JOHDPUR


B.I. (BEFORE INDIA) FRI 23/11 It’s a well-known fact that all travel novels all read the same; an ordinary thirty-something protagonist unhappy with the monotony life travels to the other side of the world seeking adventure and enlightenment. Usually these characters end up fulfilled, in love, and - I’m assuming - with a large credit card debt. What happens in the middle is usually a blur of strange experiences involving peculiar food, adventure sports and plenty of miscommunication. However, I signed up for a trip overseas for a different reason. It was the opportunity to experience a totally different healthcare system that provoked by interest. If my aspirations of completing a medical degree are any indication of my tenacious personality then it wouldn’t be a surprise that I chose the country with the both the world’s second largest population and arguably one of the worst healthcare systems in the developing world – India (Malawi wasn’t an option). I have realized that in order to be a good doctor, it takes more than a lab coat and an encyclopedia-esque brain. To me, a doctor must possess the ability to communicate with anyone; despite their gender, race, religion or aliment. However communication is more than speaking the same language. It’s about understanding each person and their lives, and then being able to fit within their world. Part of what drew me to the program in rural India was knowing I would be able to spend time learning Ayurveda, an ancient traditional Hindu medicine which is still widely used. In addition, I was hoping to get out of my comfort zone, exercise my communication skills and be able to experience another culture, one that has already become so intertwined in the Australia’s multicultural society.

THE JOURNEY

SAT 24/11

In the days leading up to my departure, the idea that I was travelling by myself started to worry me, despite knowing I was meeting a group of Australians once I got over there. With exams up until right before I left, I decided to leave the mental preparation for the fifteen-hour flight over. I failed to take into account my evening departure, and before I knew it I awoke in Delhi, feeling completely unprepared. As I looked outside, I saw nothing but thick clouds of pollution and I was secretly glad that I still had a eight hour drive to Palampur, situated in foothills of the Himalayas. With our suitcases strapped to the roof, we began our journey, watching the streaks of orange and pink appear with the rising sun. At around 2pm, we stopped to pick up some ‘take away’ curry and naan, which we ate with our hands as we drove on potholed streets through villages and farmland – definitely a messy experience. At the seven hour point we were clawing at the windows, excited to see our home for the next four weeks. However ‘eight hours’ quickly turned to ten, then twelve. We watched the sun set as the landscape changed from flat ground to hills, then to mountains, which meant a journey of constant hairpin bends, a style of driving I know I will have to get used to over the next few weeks. We arrived at Bobby’s house 13 hours after we originally set off. Exhausted, we ate our first Indian meal – dhal, curry, rice and chapatti before collapsing into bed.

COVER 1. A farmer in Samode, near Jaipur 2. The Taj Mahal in Agra 3. Sunset from Mt Triund


ORIENTATION

1. Welcome to India Sign - Amritsar, Punjab 2. Bobby Ji’s House, and our home for the next four weeks 3. Grace, Elly and my bedroom 4. Cows wandering the streets 5. Palampur’s main Bazaar

SUN 25/11

We awoke the next morning to stiff backs thanks to the extraordinarily thin mattresses, however the whimpering ceased once we ventured the terrace for breakfast, only to be met by the magnificent view of the Himalayas. While we waited for the next carload to arrive for Delhi, we set off exploring – walking around Saloh and Arla, the local villages, catching a bus into town, doing a bit of shopping and striking up conversation with the locals in very limited Hindi. The rest of our group arrived at around 5pm, and we all got a chance to get to know each other before dinner. We knew exactly how they felt – keen to shower and get to bed. Needless to say, tonight was another early night, a concept that we were keen to embrace. The next morning we had our orientation, which also included and introduction to Indian time by starting almost 45 minutes late. After the ground rules had been laid out and our questions answered, we went for a drive, where Amit showed us where our placements were and pointed out key landmarks and things we should know. While in the car we also got to chat to Amit about Palampur and Himachal Pradesh where he mentioned that most of Himachal does not abide by the caste system but rather is more strongly ranked by income. He said that most people had some form of income, though the majority of the people were considered to be low or low-middle class, which was an interesting point considering what we witnessed by walking around the villages – most people lived in small but (somewhat) structurally sound houses, many with TVs and satellite dishes. While in the villages, we were constantly swamped by children in neatly ironed uniforms making conversation in English.


I was a little bit shocked by this, as I assumed that education would not be a priority in a tiny village in the foothills of the Himalayas. However, these bilingual children are even more educated than I am! That night at dinner we chatted to Amit about this, and he told us that in Palampur and many other parts of Himachal that children go to school six days a week and learn both Hindi and English, as it is the only way they can secure a well paying professional job.

THE FIRST DAY

TUES 27/11

Last night we had our official welcome dinner at Palampur’s only vaguely upmarket restaurant – ‘The Lounge’. Where we tucked into plenty of curries and naan bread, while also overdosing on Lassis and Gulab Jamun, the traditional Indian dessert that consists of a fried ball of milk concentrate, soaked in rosewater syrup. They also offered us a mouth freshener at the end of the meal, which looked – and tasted – like potpourri. Definitely something you have to try once and only once. This morning we started our first day of placement. For the first two weeks I am at the Kaya Kalp Ayuverdic Centre, which is supposedly one of the most pure and well regarded centres in India. The third week I will be at Dr. Kalayan’s Outpatient Clinic in town, and the last week will be spent doing community work in schools and villages. Getting to the centre was not as easy as we expected, where we had to walk-bus-walk-bus-walk. Knowing we were running quite late, Amit picked us up in town and drove us to the centre, where they didn’t blink an eyelid at our terrible punctuality. Once we were there we were introduced to Dr. Ashutosh and given a tour of the centre. Kaya Kalp was much larger than I imaged, with a double story treatment block and several accommodation blocks set within a beautiful garden

with a backdrop of the impressive Himalayas. The hospital has departments for naturopathy, panchkarma, physiotherapy, yoga and acupressure, as well as a kitchen and dining hall for meals (cold clear cucumber soup– delicious!). We started off by reading up on Ayuverda in their small library. It is definitely far from typical western evidence based medicine, and very different from what I have leant at uni. Grace and I found many parts of it absurd and inquisitive, particularly what they believe is the origins of disease, a disruption between the three doshas, vata, pitta and kapha. It will definitely be interesting to see how a diagnosis is made and how they treat illness. We left the centre at around 1pm with some books to study and headed home for lunch. Ventured into town later in the afternoon to pick up some supplies, where we accidentally stayed too late and had to get home in the dark, definitely not an experience I would be overly keen to repeat.


AYURVEDA

WED 28/11

Today was an early start, leaving the house before 8am. Two bus trips and plenty of walking later, we arrived at the Ayuverdic Centre. We started the day by watching a panchkarma treatment on a 68 year old woman with osteoarthritis. The treatment invoved forming clay rings on her knees, which were sealed and filled with hot oil, which was changed every 5 minutes for half an hour. The woman was lovely and spoke great English. We chatted the whole time about life in India, ayuverda, yoga and the treatment of her ailments. It has become pretty obvious that this Ayuverdic centre (I’m not sure about others) mainly treats fairly affluent patients from throughout India and the world, mainly for chronic health conditions and rehabilitation. The second treatment we watched was a naturopathy treatment for skin and hair conditions, such as eczema and acne. The treatment consisted of a face and hair pack containing mud and medicinal herbs. It’s really interesting observing treatments and I feel like I am learning a lot, however I feel like I’m not able to give back. I was kind of expecting this, especially when I will only be here for such a short time. Hopefully in community week we will feel like we are making more of a difference. The last treatment we saw for the day was a knee and back mud pack followed by a massage with herbal powders (Udhulana). This treatment was designed to reduce obesity, by mobilizing fat and assisting the lymph drainage, while also working within her Kapha disposition. The evening consisted of yoga, dinner and chatting with the rest of the volunteers.

1. Treatment block at Kaya Kalp 2. The magnficent Himalayas 3. Fresh fruit and vegetables on every corner


RAINY PALAMPUR DAYS

THURS 29/11

Today we awoke to the sound of rain, definitely not a plesent sound since considering the plummeting temperatures and the long walks ahead of us. We arrived to placement sodden and cold where we watched a shirodhara, pouring of a constant stream of oil onto the forehead. Shirodhara is designed to alleviate stress and tension and boost the immune system. After this we had a lesson in acupressure, where he taught us about different pressure points on the hands and feet, as well as the main ideas about acupressure and how they relieve pain and disease. We headed back to town for another three-hour lunch break before coming back to the centre, where we met the loveliest guard eve, who was joyous to meet foreigners and test out his English. Like many other people we had met, he was keen to talk about God, though we weren’t sure which one he meant! Its definitely strange being in a country where there is such a large focus on religion and faith, especially compared to Australia. I guess a lot of religion in both Australia and India is instilled during childhood, however in India it seems to be much more prevalent and definitely more of a celebrated part of their culture.

A REGULAR DAY

FRI 30/11

Another day at the Ayurvedic Centre, This morning we watched an oil massage on the legs used to treat a rash and nourish the skin. Following this we had a chat to Dr Ashutosh, where he taught us everything from Ayurvedic philosophy to the meaning of life. If felt very fitting to be learning about these things overlooking tranquil gardens with the snowy Himalayas as the backdrop. After this we headed into lunch at ‘The Golden Dragon’, another resturaunt serving Indian, Chinese and ‘Continental’ meals. Back at the Ayurvedic centre we studied in the sun while we waited for D. Ashutosh and Dr. Malvika. We are getting quite used to the relaxed nature of Palampur, and are enjoying quiet nights and slow paced days – definitely not two things that are seen as a priority at home. Its definitely nice to be able to relax after coming to India straight after uni exams and feel like we are becoming quite Indian in our outlook towards time.


TREKKING AND TRADITIONAL MEDICINE THURS 6/12

Lots has happened since my last entry! On the weekend we went trekking up the Himalayas. We left early and arrived in McLeod Ganj at around 8am, where we began out trek. The first part was quite difficult with lots of uneven rocks, steep climbs and the adjustment to the pace of trekking. After a steady 4 hours of trekking we stopped halfway for lunch before finishing off the last 3 hours of trekking – definitely the hardest part of the trek – steep climbs, thin air and ground covered in slippery ice. But arriving at the top made it all so worthwhile – not only the view but the sense of personal accomplishment. We sipped chai and took in the view, followed by a snowball fight, definitely a memorable moment for a few of us as it was the first time we had really seen snow. Somehow I ended up at the receiving end of snowballs, from alliances and enemies alike. I managed to exact my revenge on both Bobby and Steve with the help of a little girl power and then the battle was over. We soothed our frosty hands on warm mushroom soup while we watched the sunset and the towns below light up. We started a bonfire, which was definitely needed given the below freezing temperatures. The rest of the night was spent around the bonfire chatting, eating curry and watching shooting stars. When we could not stand the cold any longer, we retired to our cabins, constructed of thin pieces of wood and windows with no glass, where we spent a very cold evening huddled together. The next morning we ate breakfast and geared up for the trek back down the mountain, which only took two hours but resulted in the most painful legs and feet. We spent the afternoon exploring McLeod Ganj, a picturesque small village on the side of a mountain, home to the Tibetan Government-in-exile. The streets are bustling with monks, backpackers and street stalls, selling

everything from prayer flags to pashminas to the humble ‘Free Tibet’ T-Shirt. We were all amazed by the range of wares, and spent hours attempting to barter, although the sheer exhaustion of the past few days meant that we were an easy target. We finished the trip with a leisurely trip and then the bus ride back to Saloh where we were ecstatic to be reunited with running water and toilets! The rest of the week was spent at the Ayurvedic Centre, which has been getting quieter now that winter is fast approaching. We finished up our acupressure classes and celebrated our newfound knowledge with some Gulab Jamun. We watched more Panchkarma, including basti (clay rings filled with oil) on the back, knees and elbows, as well as countless massages with oils, pastes and powders mixed from innumerable numbers of herbs. We also watched a few naturopathy treatments, including massage, steaming and hot towel wraps. The rest of the week was spent doing yoga with Rup Lal or having intense philosophical or crazy medical conversations with Dr. Ashutosh, or just chatting about hairstyles and the latest trends in henna tattooing with Dr. Malvika. I definitely feel like I am really starting to get along better with the staff and patients at Kaya Kalp, with many stories and jokes being shared despite the cultural barrier. Its definitely comforting to be able to know our way around and be friendly with the staff, especially to see them so excited about foreigners that have come to learn – definitely makes us feel like less of a burden on their system!


1. Our group about a third of the way up the mountain 2. Prayer flags guiding the way 3. Picturesque pine trees 4. At the top - Cannot believe I made it! 5. Myself, Grace and Elly at our lunch stop 6. Sunset from the top 7. Chai at the top - a lifesaver 8. The fire - the only thing saving me from certain death


GOLDEN TEMPLES AND DANCING IN PUNJAB SUN 9/12

Friday was spent again at the Ayurveric Centre. It was definitely a slow day which was convenient since Grace & I had a “meeting” in the afternoon, as we knew there would be not much on with Dr. Ashutosh and Rup Lal away. The naturopathy ladies were keen to try a few treatments on us, which resulted in Grace getting a relaxing foot massage, while I got what was called a ‘hip bath’. Needless to say, it was an experience that can be looked back and laughed upon, but as a small Indian lady was literally washing by butt, I could only laugh to myself and justify it as a cultural experience, albeit, a humiliating one. With a renewed outlook on Ayurvedic medicine, we spent the rest of the day observing treatments, and helping out where possible. On Saturday, we set off to Amritsar, which is in the neighboring state of Punjab, around 7 hours drive away. The car trip was uneventful and seemed like a constant stream of potholes, crumbling buildings and tea stalls, with local weaving through the crazy traffic on car, foot, bike or donkey. At around 1pm, we arrived and checked into our hotel, had lunch and changed into our amazingly colourful traditional kurtas before heading off to the Bagah border crossing ceremony, which is held on the Indian-Pakistani border. I will say now that the only piece of advice that my mother gave me before I got on the plane was ‘Don’t even think about putting a foot across the Pakistani border.’ I’m not going to lie, I was keen to do exactly that. However once confronted with the watertight security and the seven foot tall (not including ridiculous hats) men with guns, I quickly decided to follow my mother’s one piece of advice and stay well within the boundaries of India. Being foreigners, we were ushered into the ‘VIP’ section – a narrow strip of seats designated for whingy tourists, a type

of people we weren’t happy to be seated with. Despite the pandemonium, the border ceremony was a highlight for me as it was a place of contrast and chaos. The juxtaposition of obnoxious tourists against the amazingly welcoming locals definitely highlighted all of the things I hate about Western nations and all the things I love about developing countries. As the music started, I was the first to flee from the overcrowded tourist section and join with the hundreds of locals dancing to Bollywood classics. Looking back, it was definitely one of those moments where I absolutely fell in love with the country, the people and the culture. It was amazing to hear the roars of laughter and joy coming from both the Indian and Pakastani sides of the border – a strangely comforting experience given the civil unrest in Kashmir, just a few hours drive away. Once the music stopped, the ceremony started, which was crazy despite not being able to see much. Gates were opened and closed, flags raised and multitudes of guards performing John Cleese inspired marching. After the ceremony, we all gathered back in our van and headed to the Golden Temple or Harmandir Sahib, a Sikh temple with more visitors per year than the Taj Mahal. By now the sun had set and the temple was beautifully lit, and reflected onto the water surrounding it. It was amazing to walk around the temple and see hundreds of people deeply engaged in prayer, meditation and chanting. Thinking back to Australia, where a typical Saturday night would most likely be spent at the pub, the contrast was unbelieveable. Steeping inside the temple itself was a truly humbling experience, with three floors of gold, marble, gemstones and intricate carvings. On the first floor, there was a traditional band worshipping, the second floor had dozens of people reading Sikh texts, while the third was a place of meditation, where you could view all of the temples surroundings. Coming out of the temple, we received Halva, an offering and a gift from the Gods, although most of us were confused and reluctant to take it. Once


we had left the temple, a few of us had made the observation about how different it was to the Australia, a country with such limited history, culture and a heavy dismissal of religion. Even in Australia, religion is highly correlated with ethnicity, with Hindu, Muslim and Islam religions mostly isolated to migrants from Asian and Middle Eastern countries, while religions such as Christianity and Catholicism are mostly isolated to Caucasian populations. I am well aware about the extreme mixing of cultures through globalization and cultural assimilation and I am aware that these ideas don’t apply to everyone. But I can so easily see how this culture would be a shock to Australians, just as Australian culture would be bizarre to the average Indian. Even in Australia there are so many contrasts within ethnicities that someone could visit a nearby town and experience culture shock. I guess this was one of many reasons I was excited about this trip and ready to be shocked! So after a multitude of cultural experiences for one day, we decided to head to KFC for dinner, only to be surprised by their extensive vegetarian menu, which is appropriate considering the typical Indian diet, however I cant help but think that Kentucky Fried Chicken would be an off-putting name… maybe they should try Kentucky Fried Chicken and Vegetables – KFC&V? The next morning we headed downstairs for breakfast – eggs – an Indian standard. After this we headed off to the memorial from the 1919 Jallianwala Bagh Massacre. This was definitely a strange experience since none of us had actually heard of the massacre! Perhaps it is an example of our narrowminded schooling system or perhaps it stems from our ignorance of other cultures! According to the museum and Wikipedia alike, the Jallianwala Bagh Massacre was a major influential step towards the end of British rule in India. The memorial was peaceful, yet it showed with great detail the struggle that the people faced. After this we headed back to the Golden Temple to have a look during daylight,

definitely equally impressive and absolutely filled with people. We managed to squeeze in a bit of shopping, but we quickly got fed up by the pushy salesmen and the lack of selection (never thought I would complain about too many shoe shops!). The one thing that struck me as we were walking through Amritsar, was the amount of people on the streets that were crippled with deformities from polio. I remember both researching and writing my pre-departure report, where many articles praised the efforts of the government and NGOs for their work in eliminating polio. However its clear that the debilitating scars of polio still remain, and impact on the people’s ability to work and provide for themselves, rendering them at the mercy of tourists and worshippers who pass them by. As we began the long, bumpy trip back to Palampur, I had time to think about the diseases and disabilities that I had come across over the past two weeks. It was definitely a realization that health outcomes go beyond the statistics and that money has great power in influencing health standards.


WEEK THREE

1. The girls outside the Bagah Border Ceremony 2. Elly and I dancing at the Border Ceremony 3. Guards at the Border Ceremony 4. Golden Temple at night 5. Thyivia and I at the Golden Temple

TUES 11/12

As Dr. Kalayan’s Clinic is closed on Mondays, Grace, Steve and I went off to the Ayurvedic Centre, where we spent the day watching treatments, such as a stomach basti and massage, as well as a mustard pack done on Steve’s knee. We also spent ages chatting to Dr. Ashutosh about the similarities and differences in Ayurvedic medicine, particularly about how a diagnosis is made. Its quite interesting that in Ayurveda, there are some parts which are highly scientific, like pathology, and some parts which are completely based on spirituality. It is particularly interesting to see Dr. Ashutosh talk about Ayurveda as he is so enthusiastic about it and really believes it works. However even Dr. Ashutosh knows that some people take it too far, and that like Western medicine, you have to be realistic with what diseases you can treat. After speaking with the patients and staff at Kaya Kalp I genuinely think that there is evidence that Ayurveda works – stroke patients that are regaining control and osteoarthritis patients who are ecstatic at their pain relief. However I’m still not entirely sure whether it is the magical medicial herbs that have realigned their doshas, or more simple things, like continual physiotherapy, gentle exercise and use of heat therapy. However I think that it doesn’t matter what system is used – the main priority is that the patient feels relief from their ailments. However it is clear that Kaya Kalp is not serving the wider population and this this therapy is reasonably expensive, even if they do offer substantial discounts for seniors and those living below the poverty line. Today I spent the day with Steve at Dr. Kalyan’s Outpatient Clinic in the main town of Palampur. The clinic is tiny and is usually open six days a week from 9-6, with a two hour break for lunch. Dr, Kalyan is the only doctor, apart from a medical student, Aditi (nicknamed the protégé). The clinic also has a small diagnostic facility, where they do X-Rays, ECGs and Ultrasounds.


Entering the clinic, the lack of privacy was immediately apparent. Most of the patients waited in Dr. Kalyan’s office, with the remaining patients gathered in the waiting room, where everything could still be seen and heard. According to Dr. Kalyan, today was particularly busy and I spent most of the day watching the constant stream of people, some cases translated for me and others spoken in rapid Hindi. Dr. Kalyan was still keen to test my knowledge, where he asked me many questions, everything anatomy to pathology to physiology, with the odd general knowledge question thrown in for good measure. Luckily, I’m pretty confident with my science knowledge and was able to answer most of his questions (thank you subconscious) and even coming up with better answers than Aditi. I knew I had won him over when he handed me his penlight (actually a small torch) and translated his patients’ symptoms. I shone the light into the patients mouth to be greeted with an oozing white infection. Suppurative Inflammation? He nodded. Caused by pathogen invasion and triggering neutrophil infiltration? He nodded and asked me what kind of pathogen. Bacterial or fungal? What kind of bacteria? I was at a loss, when my subconscious kicked in and I thought back to dreary 8am pathology lectures. Streptococcus? What kind of streptococcus? I know there are six… Strep viridians, strep pneunoniae… He stopped me, smiled to himself and then said ‘Don’t worry, it’s a fungal infection’. He chatted with the patient in Hindi and then scrawled on a piece of paper for an anti-fungal medication. To anyone else, that exchange would have been dreary, kind of gross and just weird. But to me it was an absolutely amazing experience to be able to put my knowledge into practice and feel the rush of medical practice. It totally confirmed my career choices and reassured me that even with the communication barrier, I would still be able to make a difference, whether it be in the next two weeks or further on into my medical studies and career. Another trip highlight.

CHAI WITH DR KALYAN

FRI 14/12

I spent the rest of the week with Dr. Kalyan, with him even asking me to come in earlier and stay back later. It was a great experience just to watch him work and chat about the clinic, the patients that come in and the limitations he faces. Luckily it quietened off as the week progressed an gave us time to chat over sweet cups of chai, we chatted mostly about medicine, but also chatted about other things, like how he believed in Communism, and loved parrots for no apparent reason. We saw dozens of patients per day, with every possible ailment, including the flu, bronchial infections, hypertrophic cardiomyopathy, broken bones, ligament damage, cholecystitis, stroke patients, and many many many cases of diabetes. India’s alarmingly high diabetes rate is exacerbated by their lack of treatment and control over the disease, therefore allowing it’s comorbid symptoms to manifest, such as delayed healing and wound infection, blindness, loss of sensation in feet and hands, cardiovascular disease and kidney diseases. There was not many drugs prescribed for diabeties patients, with most of them being advised to eat a healthy diet and exercise. Most of the patients had their blood glucose levels tested infrequently, mainly due lack of finger prick testing, which required a vile of blood to be laboratory tested, a costly and time consuming process. Surprisingly, I saw very few cases of ‘third world associated’ diseases, like malaria, hepatitis and tuberculosis. This could be due to the diagnosis facilities available, and the need for more specialist care, likely in an inpatient hospital. For a doctors office, Dr. Kalyan’s was sparse, his only medical instruments was a stethoscope and a manual sphygmomanometer (blood pressure cuff) and his torch. Medical records and prescriptions were written on a piece of paper, which most patients brought in for their consultation. I don’t think


I saw a single box of gloves, antiseptic or bandages, but I’m assuming most cases requiring this kind of treatment would be dealt with at the nearby Karan Hospital. Dr. Kalyan said that most of his patients were very poor, and often he gave them medical care for free. I didn’t get a chance to ask the price of a typical consultation, but I know at the nearby hospital, consultations start from 50 RS ($1 AUD), which seems to be fairly reasonable. On Wednesday, Steve, Michael and I got the chance to spend the afternoon in Karan Hospital, to have a tour and see some procedures. Over the past three weeks, we have heard many horror stories from the nurses, of unhygienic conditions, lack of anesthetic and lack of supplies. Stories of endoscopies performed without anesthetic, severe domestic abuse going unreported and gaping wounds treated with nothing but iodine and a boiled-but-secondhand bandages. The hospital is quite large, and performs up to three major and three minor procedures each day. We were able to observe two cholecystectomies (gall bladder removal). It was reassuring to see the procedure done minimally invasively, however there were a few differences in the way the procedure was carried out. Patients walk into the theatre in regular clothes, usually while the previous patient is still being operated on, and they are woken up just as stitches are being put in. Considering some of the things we had seen thus far, hygiene was okay – Dr. Karan changed gloves between surgery (boiled not fresh) but the rest of the surgical team didn’t (however they did not have much contact with the patient). None of us were required to scrub in, and instead of providing coverings, everyone swapped their shoes for sandals – not exactly hygienic. The surgery was one I will never forget, especially with the Dr. Karan answering his phone midway through surgery! Tonight we are heading out to the Golden Dragon for Meg’s Birthday Dinner, where we are all going to dress up in our Indian finery, which

should be fun! Tomorrow morning we are heading up to Manali, another long drive, but hopefully there will be snow at the end of the journey!

1. Dr. Kalyan and Aditi in Dr. Kalyan’s Office 2. Kalyan Clinic from the Main St 3. The Operating Theatre at Karan Hospital


MANALI

MON 17/12

On Saturday morning, we headed up to Manali, a small town in north Himachal. The drive was around 7 hours of constant hairpin bends through the beautiful scenic mountains and rivers. We stopped for lunch in the Naggar Valley, where we visited the gallery of a famous Russian painter and enjoyed copious amounts of chai as we adjusted to the freezing temperatures. A couple of hours later, we arrived in beautiful Manali, which was absolutely covered in a thick blanket of snow. The scenery was incredible, it definitely felt like we were in Switzerland, not India! Checked into our hotel and then went for a stroll around Old Manali before settling down to dinner and relaxing by the fire. The next morning we ventured out to Solang Valley for a day of winter sports – skiing, snowboarding and paragliding! We watched our van attempt to make it up the hill to pick us up, but the lack of chains meant it would just keep sliding down the hill. Watching a large van slide down the hill doesn’t exactly inspire confidence, however Bobby assured us that once we were all inside it would slide so much – great. We all slid down the hill (literally slid – the road was solid ice) to the van and piled in for the journey that I was confident would be my last. We began the trip with Amit telling us not to worry as we had the best driver in Palampur. And we needed him, since we had to drive to Rohtang Pass. According to Wikipedia, Rohtang Pass means ‘pile of corpses’ due to the high death rate on the road. I was saying my prayers. Halfway up the infamous road, we got bogged in snow. Thirteen of us piled out of the van and tried to push, with many of us getting distracted by the amazing view and the abundance of fresh fluffy snow. Crowds of locals soon gathered to watch a group of white people in ridiculous snowgear bought at the last minute from Palampur’s small selection. Once again the camera phones were out, and we were glad to be source of amusement.

After an hour or so of pushing and we were finally free – lucky since the cold weather had been too much some of us, with Elly fainting into the snow. However Elise and Bobby took the lead, and before we knew it we were all pack on the van with Elly wearing layers and layers of jackets and socks. Halfway back down the pass, six of us decided to try and hire a jeep to take us to Solang, while everyone else headed back for shopping and lunch. Amit managed to wrangle us a good deal of a jeep and driver, however it meant that three of us had to sit in the back of the jeep. Hilarious considering the amount of snow falling. We arrived at Solang after a rickety journey, where we hired ill-fitting skis and ski scooters to take us up the mountain. It was Michael and my first time skiing, and I quickly learnt that I was one of those people who should never ever participate in winter sports. After an hour and countless falls later, we had a quick but my needed lunch and then took the gondola up to the top of the mountain for some pictures and chai. The snow on the top way so powdery, that if you took one wrong step you would be neck deep in powder, which would require assistance to get out of. We decided to head back into town, with Michael, Alana and I in the back of the jeep this time. It was snowing quite heavily, but it just made the trip so much more memorable. We stopped and picked up a lady in traditional dress who spoke no English and just stared at us and took pictures with her camera phone. We got dropped off in New Manali, where Grace, Alana and I set off for some serious shopping. The few shops along the way had no electricity and stacks of interesting wares that we hadn’t seen before. We stopped at a lovely little leather goods shop with yaks outside. The owner offered us chai as he showed us his beautiful handiwork. As per usual, I couldn’t resist his charm and bought two bags. We headed back to the hotel with copious bags in tow, where we settled into another night of chai, dinner and chatting.


The next morning we ducked back down to the nearby shops to pick up a few things and to ensure we got a photo taken on a yak before we left Manali. We were all pretty sad to be leaving, as we all had an amazing, memorable weekend here. We drove for a couple of hours, where we stopped along the Beas River to go whitewater rafting. Luckily it wasn’t snowing where we were, but it was still freezing cold. We were all hyped up and ready to give this a go, knowing that we would likely be regretting it soon. We hopped in two rafts and began our 14km trip, where I lost all sensation in my feet after about 500m. It was actually ridiculously fun, with some of us dunking our heads in the freezing water and Rach and Michael even jumping in. About 10km into our trip, the guide told us to be silent. We were confused, until he quietly explained that fire and the gathering of people on the shore was actually a cremation. It was definitely a weird site considering death is such a taboo topic in Australia. India has many different traditions regarding death, with bodies being displayed in the family home before being cremated and spread into the Ganges River. Cremation for Hindus is a major tradition, and the idea of not cremating a body is unacceptable. However I wasn’t expecting it to be so public. Freezing, we got changed and headed back to Palampur to organise our community week!

1. The view from Rohtang Pass 2. Grace, Rach, Michael, Meg and I at Rohtang Pass 3. Snow Angels with Alana 4. Riding a Yak! 5. Ski Scooter with Michael 6. Whitewater rafting adventures


COMMUNITY WEEK

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So on Friday afternoon, just before we were about to leave for Manali, Bobby gave us the rundown for community week. Unfortunately, we would have liked this information slightly earlier so we had time to… plan? Nonetheless, we were thrust into the world of health promotion on Tuesday where we headed to the Tea Gardens, which has many villages with migrant labourers, many of which are very poor. We gave out toothbrushes and stickers to the kids, and gave out iron, calcium, folic acid, paracetamol and condoms. It was interesting to see the amount of pregnant women who were there, many still in their teens. I guess this is attributable to their culture plus the lack of birth control, but it was still as bit of a shock! We also tested blood pressure for pregnant women and the elderly and advised them of any lifestyle changes they should consider. I couldn’t help but think about the prevalence of diabetes, and I feel like it could be beneficial to try and get a fingerpick blood glucose level tester to further assist in monitoring sugar levels as this is a major contributor to high blood pressure and many other disorders which could be easily prevented. We also got shown around the gardens and shown how tea is made – pretty cool if you drink as much tea as I do! On Wednesday we headed to the Rotary School, where the Elly, Alana and Meg had been working with mentally challenged children trying to provide stimulation and improve speech and swallowing. We played with the kids for a couple of hours before dividing up into groups to read to the kids, teach them to brush their teeth and wash their hands. Grace, Michael, Steve and I were in charge of hand washing, where we used our best Hindi (Hands! Dirty! Clean!) to demonstrate how to wash your hands. The kids loved giving it a go and holding their hands up to show how clean they were. Elly, Alana and Meg had mentioned earlier in

the trip that the kids hated washing their hands in winter because the water was so cold. We were hoping to be able to give them some large packs of antibacterial hand sanitizer, however it isn’t readily available where we are, but is useful to pass onto future groups doing similar work. In the afternoon we explored a nearby Hindu Temple and a Buddist Monastry, both of which were very interesting but very different – its amazing that they can live together so peacefully. Thursday was spent out at a nearby village where we set up a dental camp. On the rooftop of somebodies house, Bobby, Thiviya, Elka and I set up a makeshift clinic where we extracted teeth of the villagers. Bobby was doing all of the extractions (most of them were so rotten that they could just be pulled out by hand) while Elka, Thivya and I were in charge of loading up lignocaine, sterilizing instruments and giving out ibuprofen and antibiotics after the extraction. I remember talking to a friend who is studying dentistry about why she wanted to be a dentist, and she told me that she thought it was something that could be relatively easily fixed, and could really make a difference, especially in developing nations. Setting up the clinic, that was exactly what it felt like, and it definitely gave me a taste for dentistry. Given the dental care that we had seen both at the camp and throughout the trip, I could definitely tell that extractions were very common, and often a fix-all measure, resulting in people with very few teeth. Definitely got me thinking about how we could prevent dental issues, however I think it is attributable to lack of money and dentists, and the sheer magnitude of India’s population. The rest of the group was playing with the kids or giving out medications and condoms to the villagers. For me, the village camp was the most successful and fulfilling day of community week. That evening Steve, Michael and I went to visit Aditi and her family out in Salayana where we ate a delicious feast, got henna tattoos, and chatted with her family. Such a lovely evening filled with jokes and


laughter – definitely something that breaks any communication boundary. Unfortunately, I finally succumbed to Delhi belly on Thursday night meaning that Friday was spent resting up. Luckily it happened at the end of the trip, so I only had to miss one day of community week – could have been much worse. Recovery was pretty fast, and by Friday Afternoon Elly and I headed up to Arla to get more Henna tattoos. The rest of the group went to a local public school, where they taught dental hygiene, first aid and hand washing. Apparently it was pretty difficult, as the kids weren’t engaged when they were talking in English, and our Hindi is pretty limited! The evening was spent packing for our departure tomorrow afternoon. We’re all pretty sad to be leaving after our group has formed such a tight bond and we are all so attached to living in Palampur – I’m definitely not ready to leave! On Saturday we headed off to McLeod Ganj again to do some last minute shopping before getting onto the bus at 6pm. Loaded up with bags of scarves trinkets, jewellery and tea, we boarded the bus and embarked on our 12 hour turned almost 16 hour bus trip – once again we were cursing Kingfisher Airlines for going into liquidation mere months earlier. As we climbed off the bus in smoggy Delhi, we were bombarded with taxi drivers. Before I knew it, Elly, Elise and I were in a van and off to my hotel. Luckily, my mother had organised a hotel for me with super early check in, so we were able to shower and sleep straight away. Bliss. That afternoon we all met up again for McDonalds in Connaught Place where we all said our final goodbyes as most people were heading home and others heading off over other parts of India. It was definitely hard as I had formed some pretty great friendships with people from all over Australia – hopefully we’ll be able to organise a catch up at some stage! Heading back to my hotel, in the dark and by myself was ridiculously scary to say the least. I was so used to sleepy little Palampur and Delhi is

so big and nasty! Luckily I spent the whole trip (I think it was the scenic route as my hotel was definitely not 30 minutes drive away) on the phone to Thiviya so she was sure I was safe – an absolute lifesaver! Tomorrow my parents and Brother arrive for another two weeks worth of travel around India – pretty excited to see them and explore some new places.

1. Kids at the Tea Gardens 2. Thiviya and Elka teaching children to brush their teeth 3. Playing with the kids at the Rotary School


DELHI

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My family arrived in Delhi on Sunday evening to commence the next part of our journey. Monday was Christmas Day, which seemed to be a decent excuse for a public holiday despite them not celebrating it at all. Christmas was largely overshadowed by the protests surrounding a rape on a bus in Delhi only a week beforehand. On Christmas day we stopped briefly at a McDonalds where we got chatting to a man with a broken arm. He was part of the protests, which were against sexual abuse, which is painfully prominent in India. His arm was broken in several places and a finger torn off when they were beaten by the police. We talked for almost two hours about how India was largely moving against the rape culture, and the changing role of women in India. It was amazing to hear an Indian man stand up for women’s rights and speak of thousands of other men who were also passionate against the acceptance of sexual abuse. Even walking down the streets of Karol Bagh or Connaught Place, there are a hundreds of people always gathered in protest, not something you would see among Australia’s apathetic population. Things like this are so pivotal in the changing landscape of India and other developing nations and its easy to see how dramatically reducing sexual abuse will lead to the empowerment of women, creating a more democratic society and less unnecessary injuries using India’s precious medical resources. The nurses told stories of horrific assaults they had witnessed in Karan Hospital, where there would be investigation into the circumstances, therefore permitting and almost encouraging violence against women. I understand that change is a gradual process, and I am definitely hoping that India continues to move in a positive direction. 1. Clean hands at the Rotary School 2. Supplies at our makeshift dental clinic 3. Bobby setting up the dental clinic


AGRA JAIPUR RANTHAMBORE JOHDPUR

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The two hour train trip to Delhi turned out to be eight and a half hours. I wasn’t surprised about this at all, but my family sure was. As a self confessed disorganized person, I can definitely emphasize with India’s perpetual lack of punctuality. The two days we spent in Agra were mostly touristy – visiting the Taj Mahal and the Agra Fort and being harassed by rug makers. Another six hour drive and we were in Jaipur, also known as the pink city. Jaipur was our first taste of Rajasthan, the state known for being quintessentially India. Unlike smog coloured Delhi, Jaipur was vibrant, and still contained all the charms of India in a city. Our three days in Jaipur were filled with amazing experiences – visiting Samode, a rural village, where we played cricket with the locals, made bracelets out of tree gum, gave candy to the local schoolchildren and went shopping while riding camels – another thing crossed of my bucket list. We also toured the Amber Fort on an elephant, visited the water palace and did a lot of shopping! We brought in 2013 Bollywood dancing to a traditional Rajasthani folk band in Ranthambore. Ranthambore is a very tiny town located next to Ranthambore National Park, popular with tourists for its wildlife, in particular the almost extinct Bengal Tigers, which we were hoping to see. New Years eve ended quickly, as we were off to our bed (in tents despite being around -5 degrees!) before our early morning safari. The next morning we watched the sun rise, wrapped in thick woolen blankets as we headed out on Safari. We were told the chances of seeing a tiger were small, despite having 52 tigers in the national park, the last sighting was nine days before. However around 20 minutes in, our guide enthusiastically but silently jumped up, pointing at the bushes. Against all odds, there was a mother tiger and her cub. After about 15 minutes of watching them feast on a deer

carcass, drink from the lake and play, we were bombarded with other vehicles that had heard there was a sighting. Our guide was hysterical and told us, with great enthusiasm, that the first sighting of the year was a great honour, and that the Hindu gods will bless us for the next year. Our same guide was just as shocked when we returned from our third and final safari having seen tigers each time, telling us it was the luck that the gods had given us and that we were going to have a great year! After three days in Ranthambore, we drove back to Jaipur to catch the sleeper train to Johhpur, where we spent two nights in an amazing fort in the middle of the desert. The place was extravagant, and we spent most of the time riding camels or horses and relaxing. We also went out to some of the villages around the town, including a small fully sustainable eco village, made up of four generations of extended family. This was challenging, as it was the first time that I had seen poverty up close. I had become quite used to people begging on streets, children selling you things and driving past slums, but it was the first time I had entered someone’s home. Their small cow poo huts were small and contained few belongings. The village was mostly self-sustainable, but even seeing their small amount of livestock and vegetable garden, it was obvious that their lives were basic. Thankfully, the owner of the Fort we stayed in is providing schooling and medical care for the villages in the surrounding area, hopefully breaking the poverty cycle or at least alleviating them of debt and suffering. On our last day in India, we travelled into Johdpur and visited the Johdpur Fort and the Blue City. We spent the last of our rupees on gifts and souvenirs, before flying to Delhi and then off to Singapore. Six weeks in India had inspired, challenged and moved me. I know I’ll be back soon.


A.I. (AFTER INDIA)

Back in Sydney, I want to be back in India.

1. A foggy day at the Taj Mahal 2. Amazing architectire at the Agra Fort 3. Buying jewellery while riding a camel! 4. The Amber Fort, Jaipur 5. Elephants at the Amber Fort 6. First tiger sighting of the year 7. Early morning light 8. A lady in the village near Johdpur 9. Johdpur, the Blue City 10. The fort, near Johdpur

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