Saturday, November 29, 2008

He’s Acting Like a Man

To start, I want to say that I am fine and the attacks in Mumbai did not affect me as I was in Jamkhed. But they did have an effect on CRHP and some of its guests, and the attacks will certainly affect India, their international business, and relations with Pakistan (although the extent of the ISI’s involvement is not entirely clear). It is of high concern throughout the country and seems to be one of the largest terrorist attacks in a country that has among the highest number of terrorist attacks per year in the world – although Maharashtra, and especially Mumbai, are not usually the locations.

Secondly, pick up this month’s (December) National Geographic magazine! There is a nice article with photos on CRHP Jamkhed and it goes into detail on the history of the organization and its work in the area and abroad. If you’d like to see it online, click here.

This last month since the course ended has centered on the hospital – the first floor of a two-story building, complete with three wards (male, female, maternal), two operating rooms, an x-ray machine and a pharmacy. To say that CRHP and the hospital staff get by with little funding and fewer diagnostic tools does not do the work justification. It has been an eye-opening experience to watch Dr. Wout and others work through differential diagnoses and work with the patient’s family to provide the care needed.

Each hospital bed is like its own family reunion as a schmorgusboard of relatives, friends and fellow villagers sit on the floor for days, weeks and sometimes months with the patient. If transportation is too expensive or the distance too long, then the family is forced to live in the hospital for the time being. CRHP hospital takes advantage of the extra ‘staff’ in the hospital to put them to work and the family members are in charge of giving meds, bathing and feeding the patient, and informing the nurse to fever and unusual pain. This family-provided service is essential to give the limited number of nurses and fewer doctors the time they need to attend to emergencies, incoming patients or surgery.

At first the hospital was overwhelming and even intimidating. I was struck with the incredible number of patients, the variety of disease, the extent to which diseases disabled the patient before seeking care, and just the overall pain that accompanies the third-world hospital. I had never before seen deformities caused by leprosy (feet curled upward, hands = stumps and face sagged to the point of pain), the shrunken look of tuberculosis (often accompanied by HIV), the miniature size of a baby born at 1.5 kg’s (3.3 pounds), or the ease of peeling off the top layer of skin on a child with third-degree burns. The constant loss of light/electricity during surgery, the lack of oxygen tanks when they were most needed, and the absence of splints, crutches and wheelchairs made it difficult to keep sane with so much need surrounding you.

Eventually these difficulties began to fade as I got into the flow of the hospital and triumphs & remarkable patients came to the forefront. The patients are tough as hell and live with excruciating pain for months before coming to the hospital. Patients walk on fractured hips and broken legs, sit on huge pus-filled abscesses, deliver babies without anesthesia, and work in the farm with a miserably-smelling completely-necrosed foot remedied only by amputation. The joys of the patients and families become our celebrations as most recover from the problem that brought them there and they feel emotionally recharged as they have been afforded the care they need and deserve, often regardless of pay (CRHP raises funds to support poor patients). Patients who get better after receiving malaria treatment, having their cataracts corrected, or delivering via cesarean section will graciously thank you and bring happiness and smiles to the hospital and staff.

We have also adopted a new saying in the hospital – “Stop acting like a man” (comparative to the common phrase acting like a women) – when people are crying and need to toughen up. During surgical procedures or in dealing with pain, it is usually the men who whine the most and demand the most attention. In refixing a broken wrist, men will scream in pain as women grit their teeth and get through it. It has become an ongoing joke in the hospital but for me it has become a rather prevalent theme in Jamkhed and I am always humbled by the strength and perseverance of these Indian women.

Thursday, November 20, 2008

Response, Reflection and the Traveler’s Dilemma

I wanted to post in response to a comment left by Sheila after the last post on the sasu. If you haven’t read her response, then you can find it by clicking here. I appreciate the feedback and do encourage honest assessment like this from all the readers. It’s not easy to write to someone (and especially on a blog) and portray a point that is counter to the writer but I do think it is important and can serve a much greater purpose than simply rethinking what it is that I wanted to write.


The fact is that all the things I see and learn here are very complex and India is much more of a new world than just a new country. The culture and history here is something that even if I had lived here for twenty years I still would not understand. The subtleties in many Marathi words spoken in Jamkhed is something that even a native Marathi speaker from a Marathi village 15 hours away would not understand. As such, there are many things that as a person who has not grown up here will never understand. This is not to excuse being culturally-ignorant and making broad judgments but it is to say that my blog is not meant to describe the complex intricacies of Indian culture and life. My blog is a method of reflecting on the experiences I am going through here and displaying my own viewpoint on issues that I am learning about and have not yet before been involved with.


I do appreciate the comments and now realize what I wrote can be construed offensively. “Terror of the Sasu” seems to be more of a horror movie than a cultural commentary and certainly there is more to the sasu than just being a terror on the family. The fact that the sasu lives with her son in the first place resembles the strength of the Indian family and the unity that family members hold from generation to generation. The assistance that the mother-in-law provides in raising the children and caring for the home also allows the wife to work/improve her life outside of the home in order to create a better life within the home for herself and her children. And in some instances the mother-in-law relates to and helps the wife in family life and if there are difficulties with the husband. In my earlier characterization of the sasu, I did mean to make it somewhat dramatic and there certainly is a fine line between being pensive and ignorant. I see how my desire to at times be descriptively-exciting can cross the line into hidden meanings and misunderstandings. But it was the radical difference in the sasu’s role in Indian families versus American families that I hoped would come across in the post.


In my three months since I have arrived in Jamkhed, I have heard and read how abusive the sasu can be to the wife. She can create an unhealthy household with a wife who feels trapped and alone, with very little room to turn and no opportunity to peacefully escape, and a husband who is stuck between choosing between his wife and mother. The sasu’s control on many aspects of family life, from how to raise her grandchild to what rooms the wife is allowed to enter during menstruation is that aspect that I do find terrifying. I also wanted to raise the point that CRHP has done great work in changing this difficult family dynamic. As was seen in that hospital experience, Dr. Arole and others seemed to realize that proper health cannot be targeted without including the mother-in-law in family conversations. Through their work they have created these women’s groups where previously-taboo and stigmatized issues like these can be raised without fear of retribution. And now the wives take oaths to be caring to their future daughters-in-law. It is that remarkable aspect of CRHP that I wanted to come across in the post.


The struggle than many visitors to CRHP Jamkhed seem to face is to continually look at the project with an observatory eye without placing our western and personal judgment on what we are seeing, even after months of being here. It is that aspect that in general is most difficult about traveling, but also what makes it so important and rewarding. Visiting new cultures and learning from other people is a fantastic way to open up your mind to new ideas, new ways of life and different forms of happiness and suffering. Traveling pushes you to be accepting of others and appreciating differences rather than judging them.


And there is a fine (but important) line between being culturally-mindful while also maintaining a critical viewpoint on universal values that need to be held by everyone. It is hard to dismiss things that I find wrong (regardless of where I am) as simply being a part of the culture, thus letting it stand as is. This happens in many cases, whether it is the abundant alcoholism in the area or throwing trash on the ground and out windows. And for me it very much held true in the case of the sasu, where it becomes an issue of the wives rights being trampled on because she is trapped to remain a part of the family. It is also that fine-line that I may at times smudge when I do not give the full background to the situation presented.


I hope this blog serves (and has served) to be both a reflection of what I’m experiencing here in India and add some explanation to some of the major differences of Indian versus American life. I try to convey my viewpoints to display my personal values intertwined with this new and unique culture, while being mindful of universal rights. It is this active dialogue with those interested that I very much love, enjoy and appreciate. And if you have any questions or feel I have offended in future posts, I ask that you also let me know so I can clarify if need be. I do enjoy the dialogue and look forward to more.

Sunday, November 16, 2008

Terror of the Sasu

As if beginning a King Kong movie, there comes as large a force to be reckoned with as Godzilla… the Sasu, or Marathi for mother-in-law. Just saying the word itself sends shivers down even my own spine and I am brought back to her long and painful role in most Indian families. By mother-in-law, I mean the mother of the husband, and by role, I mean her relationship with her son and even worse, with the daughter-in-law. It is the most interesting family dynamic I have learned about since my arrival in August.


And as much as this story is about the mother-in-law, it is also about the Indian bride, who is not fully accepted in her husband’s home until she produces a male child. When he is born, she is so grateful that she indulges her son to excess (the simple dichotomy between bearing a male versus female child is evident when you see newly-born sons cuddled up with their mother while newly-born daughters are left alone on the other side of the room, distant from the bitter mother). As the boy grows up, he remains close to the mother and distant from the father and a very close-knit relationship forms between mother and son. When the son is married, he is now given to another woman, and the mother often becomes very jealous and envious of this new woman in her son’s life. Since the wife often moves in with her husband and his family, tension is instantly created between the wife and mother-in-law, with the sasu giving the wife hell for everything. The situation deteriorates so much that the son is placed in the middle of the fight, forced to choose sides on many arguments. To maintain the loyalty of his mother who has spoiled him and nurtured him his whole life, he often sides with her, estranging even more his wife who has left her family and now feels alone in her husband’s house. She is often desperate to gain the acceptance of this new family, especially the mother-in-law. And what better way than to bear a son?… so the cycle continues.


In my diploma training course, a 26-year-old Indian wife living in Chennai told me she was desperately trying to move out of her house and find a job away from her husband. They had been married for three years after being in love for eight, and had a two year old daughter. They were an atypical couple because not only had they married out of love (rather than arranged) but he was Hindu and she was Christian. “The love was very strong,” she said. Everything changed after two years of marriage when the husband’s father died, leaving his mother alone. She became ravenous, lonely and manipulative, making unheard-of requests of her son and blaming the wife for the misfortunes of her family. The sasu forced them to change their house to meet Hindu customs, including prayers to Hindu Gods and practices like not entering the kitchen during the period of menstruation. She began to control her son, often taking much of the money that he made and turning him into an argumentative husband. Everything changed and eventually she got so tired that she moved out of the house and in with her parents. Still madly in love with the man she met before his father died, she is confused and angry, hoping that he will soon return to his senses and ask for her back.


Another example occurred while making early-morning hospital rounds with Dr. Wout. A child was admitted the night before with abdomen discomfort, high fever, and trouble peeing. After a physical exam, we realized he had phimosis, a problem where the foreskin at the end of the penis does not retract, thus causing the inability to pass urine and accounting for much of the pain. Wout told the mother that he would simply need a circumcision to correct the problem yet the mother looked terrified and on the verge of tears. The surgery was scheduled but it hit the fan when a woman came storming into the room, yelled at the mother, made a huge racket and started screaming at her and put the mother again in tears. We asked what was happening and the woman began to scream in Marathi at Wout. We came to understand that she was the mother-in-law and didn’t want her grandson getting surgery. Wout re-explained the case to the mother-in-law and the dire need for surgery to remove the pain. With a very doubtful look in the eyes of the mother-in-law, and tears in the mother’s, they both agreed. When we returned to the ward three hours later, the child was gone and her family had packed up and left with no return.


In educated, uneducated, rural, urban, rich, and poor families, this same trend is seen again and again. A wife who has to put up with a difficult mother-in-law becomes an angry sasu herself. For the hospital and for CRHP, it means that the sasu is an essential piece to the puzzle. If we are to provide care or an operation to the child or wife, we must also recognize the influence held by the mother-in-law and include her in that decision. If the Village Health Worker wants the mother to join the women’s group, then a conversation has to be held with the sasu before she is allowed to join. Due to that influence, a major goal of these women’s groups has been to educate mothers to not be so difficult as their sasu was, and most have taken pledges to be different, and they have. They hope to set an example for all to follow.

Tuesday, November 4, 2008

Mumbai, Bombay… whatever you call it, it is certainly not Jamkhed

To catch a little break from Jamkhed and have a mini-vacation, Wout (Dutch doctor), Thomas (Dutch med student), and I caught a ride to Mumbai last Tuesday. The contrast between rural and urban life in India is amazing and easily visible as large farms are replaced by huge buildings, billboards change from wishing a friend happy birthday to selling a pair of jeans, and the poor who sleep in huts change to the poor who sleep on the concrete sidewalk. The cows still exist in both places, as do the dogs, but there are less of them. The rickshaws (hand-pedaled mini-taxis) and motorcycles still own the road but in Mumbai women riding on the back sit straddling the motorbike rather than both legs off to the side… a big difference in meaning. Mumbai is big, loud, very crowded, more modern but expensive, and dirty dirty dirty, but a great way to get away for a couple days. Jamkhed is a more peaceful and supportive place to live for the year and leaving for Mumbai I did expect the draw I felt taking me back to this little town.

After checking into our budget hotel in Colaba, the main tourist area and center of south Mumbai, we found ourselves with a myriad of restaurants to choose from and every restaurant we chose was fantastic. Indian food made locally is just so good that we ended up eating it for breakfast, lunch and dinner. Each restaurant has its own specialty; all filled with tons of sauces, different red, green and brown spices and tons of oil that often forms the top layer of the dish. But when mixed with chicken, spinach, cottage cheese or goat that sucks in the spice, and then mixing with garlic naan delivered steaming and very crusty, it is an amazing experience for your mouth. And your stomach does not miss out either, as it gurgles non-stop for a couple hours after a good meal, crying for relief. Every meal we stuffed ourselves until we were uncomfortably full and almost regretting it, but the next meal we’d do it all the same again.

The highlight of Mumbai was one morning when we woke up very early to catch fishermen unloading heaps of fish onto Sassoon Docks, a 90,000 square-yard dock at the end of south Mumbai. Hundreds of huge, brightly-colored wooden fishing ships that had arrived at 2am after fifteen days at sea lined the docks with their uniquely-designed flag flapping in the wind. Beginning at 5am, fisherman unload tons of fish off the boats to their fishwives on land who carry it to their little open space on the docks where they auction it off to the thousands of buyers who equally crowd the docks. The scene was chaotic and equally exhilarating as we tried to walk through this mass of people, ankle-deep in fishy water, unable to stop and stand for a second without forcefully being pushed from all sides by fisherwomen rushing to buy the freshest catch. These fisherwomen were amazing – hired by a family or restaurant to buy the freshest fish at the lowest price, they would weave through the crowd, coming within inches from the edge of the dock, while carrying a 50-pound wooden basket on her head filled with fresh and dripping fish. They would rush by, yelling at other women and making their way to the vendors auctioning off the fish. Once a new load arrived, the bidding war would begin as buyers yelled out prices for fish, ranging from tiny shrimp and mackerel to medium sized catfish and pomfret to large sharks and even octopus. After an hour and a half we found ourselves pushed out of the chaos back onto safe land, reeking of fish and wide-awake as if we’d slept 12 hours the night before.

At the end of the five days, the easiest way to get home to Jamkhed was by train to Pune and then by bus or car from there. The train ride was almost as exciting as Sassoon Docks. Since we were only able to buy confirmed tickets, we did not have seats on the five hour train ride and from the hundreds of people standing in the traincar there was no way we were going to find a seat. Fortunately, I sneaked my way to the entrance door of the car where I was able to sit with my legs hanging off the train and the wind blowing in my face. The view was amazing as Maharashtra state is hilly and green and we passed along many small little towns and over mountains and through forests and I had a front row seat for the whole thing. At times the pushing amounted to me almost falling out of the train but with a tight grip onto the handrail the five-hour journey was completed with gusto.

Election, election, election… Everyone I met in Mumbai asked me about the election and even in Jamkhed people understand its significance. And while they don’t know the policies and understand each President, they do comprehend that America’s relationship with India and other countries is at stake. And before I am ever able to state my opinion, every person I speak with, from the Africans to Nepalese to Indians, is pro-Obama. Why, I ask? “We believe what he says, and he has good things to say.” This election is reaching more places than just North America and I can only imagine the tense and exciting feeling in the states. Let’s hope it ends up as well as it can.