"Today was an Indian Day"

One night, walking back to our homestay in Dehradun we were laughing about all the now familiar local quirks and Indian-isms. We confirmed with one another "Today was an Indian day"-- to the core. Yet unconsciously my brain quipped the response, "Today was a good day". The overt association between "good" & "Indian" came naturally.

I can say with certainty that since embarking on this journey I can now better understand and perform rest, that I am less perfecting and more flexible, and that I feel euphorically grateful for every comfort and opportunity I've been blessed with. In the words of an American physician I met in Mussoorie, "Life truly isn't fair, and we've been dealt a good hand."

Dr. Gandhi told us he never donates money to charities, but rather incorporates giving into his daily practice. When patients come to see him who are unable to pay he gives his services gratis, even if that means admitting these people to his inpatient service, & feeding and caring for them there for months if need be.

I really took to this concept, and am approaching my future with a similar vision. From here forward I will never be content to allocate philanthopy to a corner of my life, to collect dust & pick up surplus energies of mine on rare occasions. No one who has lived amongst destitute poverty and looked it in the eye can do so. The need is too great, and the time too urgent. Service will instead be for me a daily aim, and with my medical training in hand I feel I have a tangible skill to offer others.

That night as we lay in bed discussing our goals for the rest of the trip, Sadie offered in her true free-spirited way a resolution of all concrete objectives, instead embracing the CFHI mantra, "Let the world change you." Simplicity only rivaled by truth... and so it has.

Mussoorie

7,000 feet up winding cliffside roads lies Mussoorie, a charming tourist destination literally built into the sides of Himalayan foothills. We spent a week there at Landour Community Hospital, a Christian missions facility that serves most everyone in the area.

On my first tour of the grounds I saw: coffee, a flat-screen TV, & TOILET PAPER. That's when I thought to myself-- this must be God's country! The town was formerly a British hill station, so Western influence was palpable throughout.

In the mornings, we would see patients at the hospital, then most afternoons were spent running health camps in nearby villages. On our first afternoon we drove to a nearby Tibetan refugee camp that housed & schooled orphans. I bet we saw 50-some children & teenagers that day. Lots of upper respiratory viruses, skin infections... the usual suspects, but unfortunately, like most places in the region TB is a pressing concern.

It was actually a lovely camp. The children wore well-kept uniforms & played carefree in the courtyard amidst a stunning landscape backdrop. Ironic that such a beautiful project should grow out of the bitter disputes between China & Tibet that tore these families apart. Fitting that these young exiles find refuge in India, who troubles itself with almost no one & embraces pluralism instead of being burdened by it.

The best part of that day was hiking to their hilltop Buddhist temple. From the prayer deck all was silent with just a faint trail of laughing children's voices deep in the valley bellow. Tibetan prayer flags were condensed on this viewing perch and extended downward in every direction, keeping a beat as they flapped in the cool breeze.

Mountains stretched out before us, one after another as far as the eye could see. In that moment I thought I had never seen anything so beautiful in my life.

Adventures in Vickram Riding

 Transportation woes being a staple for Westerners in this country, we have experienced them all: non A/C train, common bus (that was the worst), Agra cab ride from hell, auto 'take-your-life-into-your-own-hands' rickshaw, and hallmark of our time in Dehradun: vickrams.

 

* Premonition-- yep, this ride turned out to be rough *

These colorful carts are obviously built for Asians. The roof is low & seats narrow; meaning to house four people per side which is never possible even for the genetically small natives. What's more, they are colorfully adorned, though terribly worn, & the engine sounds like an accelerating rollercoaster ride. The combination makes you feel like you're at an amusement park & the stark images whizzing past are only actors in a fun house.

One of those first mornings when we were still pretty green we hopped on Vikram 8 & attempted to get to Cafe Coffee Day, site of Darshan Lal Chowk, closest intersection to City Heart Centre. At that time we were still unsture of the name, so as we were pulling away Sadie just burst out "Clocktower!" which is reasonable close, thinking to ourselves "we know where to get off..."

* We didn't ask... *

The driver immediately began speaking rapidly in Hindi, shaking his head 'no' & shooing us off. We got into an English/Hindi shouting match, no other passengers being able to translate, and were finally duped to get off the vickram. The driver demanded payment, we emphatically refused and were left in a cloud of dust in the middle of rush hour traffic.  It was quite the scene-- we still laugh about that day! (And yes, in a city of 1 million we serendipitously got this same driver again, this time going the right direction, and he was great!)

The miraculous thing about it is that the system actually works. The streets are packed like tetris, lane markings are only a suggestion & absolute anarchy reigns, yet traffic still moves, people get to where they need to go, and getting there is relatively affordable. Plus, what better way to meet a new friend than sitting on their lap during a grueling ride in a miniature Indian cart?

Dehradun

The bulk of my trip was spent in Dehradun, the capital city of Uttarachand. It's a bustling, developed area with a little over a million residents. From that first late night we arrived in town after days of traveling, it felt like home.

My first clinical experience in the city was with Dr. B C Ramola in opthalmology at Doon Hospital. Doon is a government care center, and looks every bit the part. The smell of sewage surrounds its walls like a fence; patients crowd in every open space, some sleeping on the concrete hallway floors. Yet dynamic medicine is taking place there, and the providers are passionate about the masses that crowd inside their doors.

Dr. Ramola's "office" was little more than a partially enclosed box with one desk, a few stools huddled together, and what appeared to be a slit lamp collecting dust under its plastic shroud. Patients assembled outside the door on a long bench & crowded the adjacent space as well. It was evident, in classic Indian fashion, that whatever transpired the rest of the morning would be public knowlege.

A couple days a weeks Dr. Ramola does cataract repair surgeries. I felt a little funny walking around the OR in flip flops! So much for the compulsive sterile technique I've learned. Lots of patients get shuttled through on these days, receive a life-changing operation & are incredibly grateful. It's humbling to think that for under $100 USD you can restore someone's vision, livelihood, independence, etc.

One morning this sweet elderly woman who came in for follow up after her surgery kept looking a me & muttering phrases in Hindi under her breath. On her way out the door, she waved her hands in some precise gesture & patted me on the head. It was so pure & sincere. After having a similar ritual performed on him, our Medical Director, Dr. Gandi remarked, "this is the only profession where you get paid AND blessed." How fortunate we are.

1...2...3... Chapati !

Alright, so tonight was Round 2 of my chapati-making attempts here in America. Still a fail, but better than last time. I don't think you can get them to puff up without use of an open flame. Chapati is basically Indian flatbread, a staple at just about every meal, in every home!

* Mrs. Mehta & I making chapati *

I decided that Indian food & I are a match made in heaven-- I love spice, starch, legumes & veggies, and I've never been that into meat. So we're perfect for each other! In addition to chapati, white rice is standard, usually along with some curried vegetable mix & dahl, which is a non-descript term for pulsed lentils, peas, or beans.

Other local specialties I sampled include samosas (a fried, stuffed pastry), pakora (dense, doughy fried bread ball with various fillings), rava dosa (a savory, crispy South Indian crepe), gulab jamun (a fan favorite in India, tastes like a soggy donut hole soaked in syrup) ... and so much more!

* Chili-spice & citrus fruit-- a surprisingly delicious duo *

I know there's a fried pattern going on here, and truthfully we stuck with those choices a lot because they were safe... but peelable fruits at least were still fair game.

And who can begrudge the lack of clean water when you can be drinking a beverage with "300% more oxygen"? Frankly, we should have just let our COPD-ers go & thrown them a bottle of Oxyrich. Forget that mountain air, my lungs had this bottled water to thank.

Visit anyone in the early afternoon & expect to be served chai & some sort of snack. That was one

of the strangest things to get used to: tea time. A magical hour... or two... in the middle of your day where everyone enjoys chai & just relaxes or takes a nap. How amazing is that?! And we aren't talking Celestial Seasonings black here, chai is made over an open flame with loose-leaf tea, milk, sugar and whole spices.

* Rinku: master chai wallah *

Sigh. Back to my world of PB&Js enjoyed over a stack of research papers. But just wait, chapati. I'll master you yet!



Patti

My first week in India I spent in a rural town in the Himalayan foothills called Patti village. What a paradise! Lush with life & unmistakenly Asian. It's amazing how peaceful this area, only 45 minutes outside the chaotic city, is. The medical clinic is nestled amongst the surrounding hills, in the middle of a rice paddy field.

My favorite memory from this week was when our whole crew trekked 3 hours to run a health camp for a small hilltop village nearby. The view was absolutely stunning. Wild herbs & flowers grew tall on the sides of our rocky path, and more than a few times we'd have to step aside for a pack of mountain goats or cattle to pass.

Even so, about midway my body started protesting. I think Dr. Paul summed it up best when he quoted a former student who said of the hike, "This is heaven, but right now I want to die!" Fortunately, we all made it to the top & were welcomed warmly by the local residents, who brought us chai & guava picked fresh off the tree-- I don't know if it was the long hours hiking in the sun, but I swear that fruit was divine!

They also showed us their village temple where this little guy had staked out with his mother. He could say "hi" and "bye", and had learned to shake hands! How adorable are Indian children? So well-behaved too. I think I could be a pediatrician here...

A Little bit about Me...

My name is Morgan Fulmer and I'm a second year Physician Assistant student at the University of Iowa. I have always had a strange fascination with India, so I was delighted to hear that my program offered International Medicine credit for rotations completed with Child Family Health International there. I enrolled in the Rural/Urban Himalayan Rotation and spent October of 2011 at various sites in North India.

I had a few friends who had worked with CHFI abroad and had good experiences, and receiving a scholarship was a huge help, as the cost of a graduate education is already staggering! One of the things I love most about CFHI is that they operate with a less than 10% overhead cost, leaving a huge portion of program fees going directly into the local communities with limited financial resources or access to healthcare. In some cases, entire clinics--the facility, medicines/supplies, & providers-- are maintained by CFHI. In rural areas, the organization trains "Health Promotors" that return to their respective villages with crucial knowledge of basic disease treatment.

In essence, this organization covers two objectives in its mission: provides students with a global health experience while financially & medically benefitting local communities. Everyone wins!

Technicolor World

My favorite quote about India comes from Keith Bellows, editor of National Geographic magazine:
   
      "When I first vistied, I was stunned by the richness of the land, by its lush beauty and exotic architecture, by its ability to overload the senses with the pure, concentrated intensity of its colors, smells, tastes, and sounds… I had been seeing the world in black & white and, when brought face-to-face with India, experienced everything re-rendered in brilliant technicolor.”

Everyone who has lived in India can attest to what Mr. Bellows described. The intensity of sights, smells, sounds, & tastes couldn't begin to compare with anything I had experienced before.

Ctiy streets are flooded with masses of people, colorfully adorned in various styles of clothing, and snippets of conversations in Hindi, Garwhali, and many strange tongues reach your ears. A Hindu altar may share a street corner with a Punjabi restaurant with a Sikkh owner. I suppose that's part of what attracted me to this place-- the diversity of languages, religions & microcultures all blended harmoniously into the whole.

I quickly came to understand that this program would be teaching me a lot more than medicine. It felt as though I had stepped into a time machine: while my life at home stayed unchanged in its constant routine, a whole elaborate plot now began to take place within and around me in India.