vanakkam

July 3rd-6th

Coimbatore, Ooty and More

We rose this morning at 5:00 to catch our 6:15 train out of Chennai.  Morning traffic in Chennai isn’t a whole lot better than the evening rush hour, but we arrive with plenty of time and board, ready for a weekend of traveling.  It’s a six hour ride to Chennai, and I zone out to Coldplay and the calls of ‘Copfee!’ and ‘Chai, Tea!,’ as vendors pace up and down the car.  I ignore them, instead choosing the jelly sandwiches Vaidehi Aunty has prepared.  Tired and a little sore, we arrive in Coimbatore around 1:30 and are greeted on the platform by Chandran Uncle, Malathy Aunty, Narasimham Uncle, and Geeta Aunty, who whisk us off to Narasimham Uncle and Geeta Aunty’s house for lunch and rest.  We’re made to eat quite a bit, which is not a problem.  Let’s just say that the jelly sandwiches were good, but not that filling.  Next time, we’ll remember to bring the peanut butter.

After rest, we pile back into the cars and head to a local cinema to see the Tamil film, Dasavataram, in which Kamal Hassan plays 10 different parts, ranging from a scientist trying to save the world, to an ex-CIA assassin, to George W. Bush…needless to say, it was entertaining.  A lot of the details escaped me (and even Vikram, for that matter; there was a story line neither of us understood), but I could follow the story line well enough.  Afterwards, we went to…Pizza Hut!  The concern everyone for us to eat western foods is kind of amusing.  Talking to Dr. Krishnan, Dr. Venkatesh, even Vaidehi Aunty and Rajshaker Uncle.  Should I let them in on the secret?  I like South Indian food (and North Indian).  After dinner (I finally get to order Spicy Veg.  Small victory, although, it is so very considerate of them to look out for my eating), we return to Narasimham Uncle and Geeta Aunty’s house to rest up for the tomorrow’s journey to Ooty.

We rise much too early for a Saturday morning and, after brief cereal, drive to Chandran Uncle and Malathy Aunty’s house.  We meet them, and all pile into a Toyota Innova, there should be more of in the states, and head out of Coimbatore and into the hills.  We weave back and forth, for km after km.  Finally, after an hour and a half, we emerge and travel on slightly straighter roads.  We reach Ooty around 9:30 and proceed to a touristy boathouse where Vikram and I take a Mickey Mouse paddleboat out on the water.  Next, we drive to the highest peak in South India, but unfortunately, the fog comes in and the view is mostly obscured.  A tea factory visit is the next item on the agenda, as we’re in the heart of tea country.  A cup of delicious chai later, we head to the botanical gardens for a relaxing walk.  Afterwards, we drive a km down the road to a famous rose garden.  Unfortunately, we’ve just missed the season, so not it’s not in full bloom.  Still it’s very beautiful.  Dinner at an Indian-Chinese restaurant is delicious and, after ice cream, we pile back into the car for the drive down the mountain.  We stay at Chandran Uncle and Malathy Aunty’s house tonight, eat dhosas, and get frustrated with the wireless router that we can’t seem to reason with.  Vikram wasn’t feeling well, so we head to bed a little early; I make serious headway into my book and eventually pass out, ready for the journey home on early Sunday morning.

Five am comes much too early, and we sleep through the first three hours of our train ride home.  When we get bored, I finish my book, and we’ve eaten all of the crackers, we start listening to old chorus concerts, having a good laugh.  Vikram’s iPod has all but died as we pull into the station and are greeted by Rajshaker Uncle and Sabbi.  A half hour drive later we’re home in time for sandwiches and checking email, thank god.

A little later, we have a silent three hour drive back to Pondicherry with our driver.  We arrive, tired after a full day of traveling and settle in for a dinner of Mac-N-Cheese.  It’s the simple things in life.  Or maybe not.

June 30th-July 3rd

The Hospital

We begin our studies at Aravind with a packed day of hospital orientation.  After meeting briefly with Mr. Ranjith and talking about the hospital and our project, we attend the general Monday morning meeting of all administrators.  Because Dr. RDR isn’t here yet, Dr. Venkatesh, the deputy CMO, sits at head.  In the first five minutes, I realize how much I’m up against, in terms of the language barrier.  The only reason I follow the meeting at all is because I’m staring at an agenda in English.  After equipment and maintenance issues, an extended conversation about the sisters, the meeting adjourns and we’re left alone with Dr. Venkatesh to discuss our project.  We stumble through our designs, as we’re still unsure what we’re doing, and learn a bit more about the vision centers in the process.

Soon afterwards, we’re led through the out-patient services, free and paid, through the individual units, meeting many of the senior ophthalmologists.  Without going into incredible detail about the procedures, I have to say that the Aravind Eye Health system seems to be the most organized and efficient hospital I’ve ever seen up close.  Despite a lack of IT integration into the general patient care, something that the US has only seen in the last 10-15 years, the hospital manages to see an incredible volume of patients at minimal cost without sacrificing the quality of care.  Vikram and I can’t help but turn to each other every few minutes and remark about the efficiency.  ‘You don’t see this in the US.’

We take our lunch this first day in the Doctors Mess:  chapatti, rice, mixed rice, daal, and a lentil dish.  Eating Indian style looked like more of an adjustment than it turned out to be.  After lunch, we’re given a tour of the in patient services, the highlight of which was definitely scrubbing up and going into the OTs while surgeries were going on!  An incredible experience, to say the least.  One really interesting aspect of admissions here at Aravind is the selection of services:  patients choose the options based on how much they can pay, if anything at all.  For example, patients in the free hospital are have little choice in pre and post op accommodations and fewer amenities/comforts, but they receive all consultations, medications, and surgery for a nominal fee of Rs. 750, or less than US $20.00.  For the level of care, this is incredible, considering that most ophthalmic procedures are elective to begin with!  On the paid side, patients will pay more, from slightly more than the free side price to around Rs. 30,000, or US $650-700.  I feel like this kind of system would run havoc in the US, but here, it works.

Another interesting note thus far would have to be about the Indian relativity of time.  Not that I am the most punctual person in the world, but we’ve arrived everyday at the hospital around 8:30 and we’re left waiting until 9:00-9:15 at the earliest.  Once, I believe, Mr. Ranjith has been ready for us at around 8:45.  Meetings, including that first board meeting, rarely start when they’re scheduled.  An ophthalmologist we were supposed to meet with on the second day we don’t meet until the fourth.  We don’t sit down with the director of the vision centers, except for an informal conversation we have when we meet him ourselves.  It’s not particularly frustrating, but once again, it requires an adjustment, a change of pace.

On our second day in the hospital, we spend most of our time observing Dr. Sivananda, the ophthalmologist staffing the hospital’s vision center room this month.  He’s engaging and inquisitive about our work here, and our education in the US.  Everyone here seems to be curious, at least all of the medical personnel, about how healthcare works in the US, how medical education works there, etc.  Dr. Sivananda alternates between consulting patients via the computer, something I’ll surely be talking more about later, and seeing live patients in the room:  can you say efficient?

We’ve had a few running jokes our first week in Pondicherry.  First, the AC unit for our room.  Supposed to come on Monday…then Tuesday…the Wednesday…finally, it was coming on Thursday.  It arrived, only for us to discover that the breaker needed to be replaced.  Oh, well, guess there’s next Monday.  The other running joke has been, ‘Okay, tonight we’ll go into Pondicherry.’  Ranjith has supposed to have taken us every night until Wednesday, when we finally went into town for dinner.  Each night, it was the same.  We’d get a call, or run into him and he’d say ‘I’m running late.  We’ll go to Pondicherry tomorrow?’

Wednesday, our third day in the hospital, we finally ventured out:  twice!  After a morning spent in meetings with Dr. Krishnan and in the computer lab, we finally were able to go to the vision center.  This is the first day something has happened when it was supposed to happen since we arrived.  Well, sort of, because, unfortunately, there was a mix up and we didn’t leave on schedule because of a disagreement between supervisors.  When two of the supervisors got out of the van, one of the sisters asked, jokingly, if we could go now.  After we were finally underway and 4 km out from the hospital, we received a phone call.  There had been another mix up.  We were supposed to have taken three patients who were participating in a genetic study at the hospital to their villages along the way to the vision center.  Once again, we end up sitting on the side of the road, waiting for about a half an hour for another van to come, bringing the patients, so we can drive them 5 km down the road.  Twenty-one km later, we arrived at the vision center.

To briefly describe the vision center, picture a 16x8 room with smaller 10x8 rooms branching off of that used for patient counseling, examination, and restrooms.  A small cubby hole serves as patient records.  For limited space, this seems to be a quite functional work environment, due in most part, to the efficiency of the sisters who manage it daily.  We sit and mostly observe, talking a bit to the ophthalmologist who has accompanied the team today to do routine post-op checks.  Later, she shows us the well kept patient logs, which only need to be databased for analysis.  After seeing a few patients and familiarizing ourselves with the set up, the team is ready to return to the hospital.  This time there are no stops, except to let off those who live in villages along the way.  We get back around 6:00 and, surprise, we’re actually going to Pondicherry tonight!

A standing bus ride, an auto and a half mile walk, we arrive at a restaurant in the old French area of Pondicherry.  Curiously, Pondicherry was originally a French territory, and remained so all through British rule and up until the 1980s, or so says Ranjith, when it was turned over as a union territory to the Indian government.  It’s not much, except to say that I can read street names and menus finally.  Also, not unexpectedly, we see the highest concentration of Caucasians thus far, and the gentle whisper of Romantic and Germanic languages fills the candlelit evening air; a momentary respite, it would seem from a barrage of the unknown.  After dinner we walk along the beach, listening to a subdued Pacific’s waves crash up against the shoreline.  An auto and bus ride later, we’re back at the hospital, for sleep and another early morning.

Thursday, the last hurrah of our first week, begins in earnest, with meetings and more time spent in the computer lab, our new home.  The second vision center trip has been moved to Friday, but as we’ll be in Chennai, unfortunately, we can’t make it.  Our AC unit finally arrives today, and as I said before, much to our chagrin, the breaker needs to be fixed.  ‘Come back Monday,’ we tell them.  It doesn’t need to be fixed before the weekend.  Back in the room, we pack for Chennai and a weekend visiting Coimbatore and Vikram’s Aunties and Uncles, the same ones who met us in Chennai those first days.  This time we will journey to them, and then together visit Ooty, a hill station in Tamil Nadu.  But before we get there, a 5 hour bus ride, an hour and a half of which was Chennai traffic, we arrive in Chennai, tired and sore at Vaidehi Aunty’s house where we’ll spend the night.  After a brief rest, it’s off to Pizza Hut for Indian style pizza, which isn’t all that different, except people take Pizza Hut seriously in India.  And it’s cleaner and spicier.  Good combination.  True to form, Rajshaker Uncle thwarts my efforts to order Spicy Veg and insists I order a chicken pizza.  One of these times, I’ll win…

June 26th-29th

The First Few Days

In the haze that is these first few days, I’ll try to hit most everything. Friday was spent buying Bata sandals, now my favorite piece of India, thus far at least, and traveling around Chennai. I had my first auto(rickshaw) ride, which was an experience, to be sure. A little unnerving, but, like most everything thus far, exhilarating. Later, after a lunch of idly, steamed cooked rice ‘dumplings’ and sambar, we rested for a bit and then ventured across Chennai to Malathy Aunty and Prakash Uncle’s house, where we met several people and were again presented with gifts. We then drove over to Malathy Aunty’s showroom where Vikram played the bamboo flute, much to Malathy Aunty’s delight. We went to Prakash Uncle’s office where we chatted for a bit about India and our project. It was interesting, some of his insights, regarding the structure of ‘health camps’. How free health camps met little success until a marginal price was attached to the consult/medicine distributed, thus rendering the service now worthwhile. I guess that the stigma that something that’s free is of an inferior quality doesn’t know borders…Interesting, nonetheless.

On our way out to dinner at Cream Centre, a nice vegetarian restaurant in Chennai, we drive to the beach and I get my first glances at the Pacific. The wind and an approaching storm put a quick end to our Frisbee tossing, and we jump back into the car. It was crowded then, but if it’s anywhere near as crowded as Prakash Uncle says it will be on Saturday evening, then I don’t know crowded. Clearly, I don’t know the first thing about crowded.

A word about driving in India: don’t do it, if you value your life, or have an indecisive bone in your body. I’m not nearly brave enough. I could get used to the opposite side of the road, but the constant weaving, suicidal, unending battery of honking cars, trucks, busses, two wheelers is a bit too much. I thought it was interesting, in a culture that prides itself on hospitality, how driving could be so fatalistic, so inconsiderate. Vikram was quick to point out, though, that the ‘rudeness’ is a strange form of courtesy. Honking to make your presence known, to prevent accidents and whatnot. I’ll buy that to a degree, but you don’t drive as if there’s no one behind you and no one of consequence in front with a lot of politeness. Prakash Uncle put it best: ‘If you can drive in Madras city, you can drive anywhere…well, not really. If I were to drive anywhere else, they’d lock me up!’.

Saturday began with hot milk and Honey Nut Cheerios, a new experience, but not a bad one at all. The milk here is very sweet, different than in the US. Adjustments are okay with me, though. After more driving in Chennai and a visit to City Centre, a shopping complex, we made our way outside of Chennai to see a Hindi movie, Thoda Pyar, Thoda Magic. Although we didn’t have subtitles, we followed the movie pretty well. It was quite good. We tried Indian pizza for the first time, ironically at US Pizza. It was good for fast, movie theatre food. Dinner at Vaidehi Aunty’s house, chapatti and aloo gobi, was much better, in my opinion. An evening trip to Spencer Plaza, the big mall of Chennai, I walked out with a new watch for next year. Being approached by shopkeepers was the confirmation I was waiting for: everyone has been staring it me. I haven’t minded thus far, but it makes you feel a bit uncomfortable, like you’re either that interesting or encroaching, invading. Everyone who I’ve been introduced to has been incredibly warm and welcoming, but everyone on the outside stares as I pass.

On Sunday, we prepare to make the trek down to Pondicherry (Pudhucherry). After much consulting, packing and repacking, we’re ready to go. A harrowing drive through the countryside later, Rajshaker Uncle gets to Pondicherry and eventually to the beautiful Aravind Eye Hospital complex. There we meet Mr. Ranjith and get settled into our flat for the month. From the first minute, we realize that we have too much space, but it will be quite comfortable. Vaidehi Aunty and Rajshaker Uncle take us out to GRT for dinner and basically forced Non-Veg down my throat. It was delicious, but the Naan Vikram was having looked incredible.

After dinner and goodbyes, we were finally left to ourselves, ready to begin our work in Pondicherry.

June 25th-26th:

Departure

We left Pittsburgh today at around 12:30 PM and began what is sure to be a whirlwind trip to India. I have to say, what nerves I might have had in the car on the way to the airport dissipated about two minutes after take off and were replaced by a calm that I cannot explain. Maybe it was the prospect of journeying to a land I’ve dreamt about for so long. Maybe it was my best friend sitting a few seats behind me. Maybe it was the intoxicating pull of freedom: intellectually, emotionally, and spiritually? Regardless, I think that whatever this month has in store, I’ll be able to appreciate its many forms, tastes, experiences…

Journey

Newark Airport: arguably the most cruel, inhumane place on the planet. If ever there was a more screwed up airport, in design and actuality, someone let me know so I can never go there. Just a few thoughts: don’t make people who have a connecting flight to catch go through security again. Don’t design your gates so only one 747 can fit in a gate at one time. Don’t place all of your shops, food establishments, etc, on the opposite side of security. That just seems silly! Are they trying to lose money? If they are, they’ve succeeded. I know not to buy overpriced airport food there next time. Or go there for that matter.

Our plane was delayed, hence to confusion and frustration. We were scheduled to take off at 5:40. At nearly 8:10, we finally board and are delayed yet again by a plane traffic jam. Once we’re actually in the air, it’s better, but I worried about the connecting flight, for which we had a 3 hour layover and had all ready been delayed two and a half hours. After chitchatting for a few minutes with the lady to my left, we settled in and prepared for the transatlantic leg of our flight. This is the furthest I’ve ever traveled from home. Am I scared? No, I’m excited beyond words.

After reading, drifting in and out of a movie, talking to Vikram and dozing for at most 15 minutes, we landed in Frankfurt. I’m less than impressed with the airport, but there’s a lot of construction going on. We were both incredibly tired and I’m a little irritable. There’s a moment when I think I’m going to lose it, when we’re being corralled out of a sitting area and made to stand in line, but I pull it together. Not worth it. But checking the boarding passes means we’re that much closer to India and very close to our next flight. Which it turns out was much nicer…Airbus does it better. If only my stomach wasn’t turning over on itself…

Arrival.

They’re not kidding when they say the heat will get your first. At almost midnight, Indian time, we arrive at Chennai Airport and in a haze plod our way to customs arrival. After standing in line for what seems to be an hour (and in actuality was 45 minutes…), we learn that we could have chosen any line. Too bad only one said in big letters “FOREIGN PASSPORTS.” After an uneventful passing of the passport, we make our way to baggage claim, where miraculously, both of our bags are safely there! As we turn the corner and make our way outside into the smoldering, heavy night, we’re greeted by smiling waving faces: Vikram’s aunts and his uncle, soon to be known by name and loved like my own family. After hugs, gifts, and awkward hellos, we make our way to the cab and pile our stuff in, departing for the hotel.

One not so benign car ride later, we arrive at the Raj Palace, our home for the brief time in Chennai. It’s nearly 1:00 am when we’re finally settled. At around 2:00, Aunties and Uncle leave for the night and we’re left to our own devices. Snapping on the TV proves an interesting endeavor, though eventually we settle on 9XM, a Hindi music video station we will watch much too often in those first days…exhausted we pass out onto our soft beds. Here at last, and all I can think about is sleep.