Another week (basically) went by

This week has been a whirlwind. Monday we had presentations with the organization’s entire staff, including the founder who used to be head of India’s biggest bank. I presented for my group, and, like everyone, the founder really pushed back. While it was intimidating and challenging for some people, I found it rather stimulating and helpful. After the presentations, we had the entire afternoon and evening to lounge around the resort at which the conference/presentations were held. After a few hours of lounging around/swimming, I returned to the presentations during which I got to hear about all their new initiatives and the inner workings of such a cutting-edge non-profit. It was so interesting and something that really spoke to me—perhaps nonprofit work or business, or consulting or something might something worth considering.
Tuesday was pretty much dedicated to working on our intervention materials and editing the formal paper. 20+ pages (single spaced) later, we have finished the paper! Tomorrow Nancy will present our work once again, this time to the professors.
Wednesday, today, consisted of a few meetings in the morning, a final edit, and a little work for the non-profit that was not related to my project. After working, I went for a long run and it felt amazing. My workout clothes were being laundered for the past three days, and physical activity was something I was desperately needing/wanting. One of the other guests in the lodge in which we are staying gave me a veshti and white chettai (the formal attire Indian men were who are politicians or at a wedding) to wear for the evening. We all went for a local drink (milk and cashews) at Bombay Sweets, and the to the local convenient store called “More.” It was an experience as all of them had their cell phones out and were constantly taking pictures (yes, don’t worry, I got a few for myself too).
Tomorrow I have the presentations, and then it is our weekend. In short, academically this has been a relatively independent week. Tomorrow a big chunk of the group is leaving to go to a vacation spot, but I think I am going to go and visit a friend in Bangalore for the weekend instead. Perhaps some alone time would serve me well—also it is a great opportunity to see a friend from home who is also there. I think I will leave Friday for that, giving me a day or so to relax here before heading out.
This week has been awesome. In the same way that Mexico last summer was great because I tried all the local food (the Izquites from the street vendors), I have been going to the local restaurants. Perhaps I am lucky, or perhaps I have a strong stomach… or both? While I am still avoiding the “true” street food, I have been trying a bunch of local restaurants instead of going to the expensive and Americanized/ otherized Hotel Sangum food (which is also comparatively expensive). I have really wanted to explore and live life like a local Indian, and I finally have my opportunity to do so. I have met some people from the park where I run/play basketball, some people from work, some friends of the boy whose mother runs the guest house etc…. It has taken much longer than I wanted/expected, but better late than never.
On the same note, I have learned and will continue to learn some basic Tamil, I have learned to eat only with my right hand, and I am feeling a little bit more autonomous rather than an animal who is shepherded around. While I am making strong new friendships, I also value the older ones and the depth and closeness to which I have grown with those in my group.
Its crazy to think that in a little over three weeks I will be home in the US. On one hand, I am very excited. On the other, I really love and enjoy Indian culture. As soon as I find some Tamil music, I can say that I appreciate all aspects of Tamil culture. We are way over the halfway mark, and I think that was the hardest part for me---I know the next three weeks will fly by, especially when we have 4-day work weeks and everyone else in this culture has 6- or 7-day long week.s That’s all for now. Good night!
Josh

¡Vamos a Cholula!

Este “post” es dedicado a mi hermanita Dani en Puebla---le dije a ella que voy a escribir algo en español. Aquí he contestado l la pregunta de, ¿ Como va la cosa por esas latitudes del mundo? Pues, todo aquí es muy lindo aunque no se puede comparar con mi tiempo México. Ayer tuve una presentación grande al jefe del jefe de la organización con la que estamos trabajando. Después, fuimos a la piscina y nadamos por la tarde. Después de todo, hubo una cena y regresamos al lugar en que estamos quedando. Esta mañana todos de nosotros (14) estábamos esperando por los coches por más de 30 minutos. Cuando llamamos preguntando donde están, ellos nos dijeron que no podemos ir a la oficina para trabajar (aunque todos sí necesitan) porque hubo un evento o algo allá. Entonces…… me desperté por ninguna razón y ahora estoy aquí sin algo para hacer.
La cosa que yo extraño tanto del último verano es mis amigos. Cuando estaba en México yo pasé tanto tiempo con mis amigos mexicanos. Aquí no he tenido esta experiencia. Aquí es el grupo de los “gringos”, los catorce, y estamos con algo unido. Yo lo odio. Jaja. En serio, tengo ganas a crear amistades con la gente de India y conocer y valorar su cultura, forma de pensar, vida, y todo en la misma manera que lo hice durante el último verano. Pero “X.” Aquí estoy yo y esto es la situación que necesito mejorar!
Espero que todo sea bien allá y que hablemos tan pronto! Les extraño a todos!

In town on a Sunday.....

Yesterday I had a pretty intense game of basketball in the morning with Mukesh and his friends. I forgot my water at the guesthouse, so I chugged almost two liters of water when I got back. We had a field visit during the afternoon. While it was extremely unproductive, it is really cool to see the way people from the small villages live. The more time I spend there, the more I love the culture.

            Last night was great.  About half of the group went out with about half of the people working for our partner non-profit and we had a huge dinner at Claypot.  I had a chicken dosai that was delicious with a fresh pureed mango to drink. I even managed to eat the entire meal like a true Indian (only using your right hand).  For dessert, we went to the big Arun ice cream shop and I had black currant and guava ice cream.   It was a great change from the nightly trip to Hotel Sangum.

            It is crazy to think that I have 28 days left before I head home.  On one hand I am ready to be home, but on the other, I am really enjoying Indian culture.  The food, people, and general ambiance is really pleasant (although the temperature could be about 15 degrees cooler).  I would love to come back on a less structured group-oriented program and be able to truly experience and explore deeper into their rich culture.

This morning I went with Eprice and Leslie to the “downtown” area and went shopping—for 70 dollars, I got 2 pairs of nice pants and 2 nice button-down shirts.  We then got fruit and just hung out for a while.

            Tomorrow I am presenting to the ICTPH staff our research/intervention, so I just finished doing a little reviewing for that. In a little bit, I am going to be giving Mukesh another swim lesson.  Other than potentially going the ICTPH guesthouse and having a low-key game night, nothing else is on the schedule. That is it for now.

Josh 

The Long Overdue Post

            Sorry I have not updated this in a week!  Time has escaped me.  To begin, last weekend was awesome. The weather was cool, the showers were hot, the food was awesome, and it was a nice little break back in civilization.  We met some other Americans who were working in the IT Park at a bar on the top of a skyscraper, walked aimlessly through the city, and also saw touristy sites such as the botanical gardens.   The hotel had a really nice workout room and pool so we capitalized on those amenities. After probably what will be/was my most frustrating week in India, it was a perfect weekend getaway!

            When we got back, I promised Mukesh, the son of the woman who is in charge of the guest house, a swim lesson, so Shawn, Leslie and I took him to a nearby pool.  We ate oversized dosas while we waited for the pool to be free and then worked on some fundamentals of swimming.  All in all, it was a great afternoon. Later that evening, Sonia and I paced up and down the street we live on about 20 times having a good conversation.  It was a refreshing way to start off a week, especially considering the week before had been so repetitive. 

            For the rest of the week, Shawn, Leslie and I have been going to the nearby field and playing basketball and running pretty much daily at sunset.  It has been a great way to get rid of some energy. We have gone to the good ol’ Hotel Sangum, the new huge Arun ice cream shop, and other new places to eat.  This past week actually went by pretty quickly.

            As for the reason I am actually here, the work is coming along pretty well. Our field visits this past week were very productive. We solidified our intervention, and I finished my part for the first major paper.  We observed a woman cooking, met with a survivor from a stroke, conducted food audits in nearby markets etc…  Monday we have our first presentation to update our partners in how everything is going. 

            Right now the electricity shut off (again), and Shawn, Sonia and I are sweltering in our cozy (or “Tiny@$$”) room. He poses a very good question: In a country with so much of its economy based in the IT field, shouldn't they be able to have reliable electricity for a bare minimum?   Please feel free to comment!

            I will write more later as the heat is putting me to sleep.

Day 19

           Yesterday we not only had a skills lab in which we learned to take a blood pressure but also a CPR/First Aid class taught by the Indian Equivalent of the American Heart Association: “If you find someone unconscious, just start compressions if you do not feel comfortable checking to see if they have a pulse.”  While, on one hand, it was very interesting to see the differential in the quality of care between the two countries, I, personally, found it to be a complete waste of time as I am an EMT-B and a American Red Cross instructor for CPR/First Aid in the US.   Hopefully a lot of these “activities” will end soon and we can do what we came here to do (i.e. fieldwork) rather than classroom activities where we learn technical skills that are irrelevant to our specific task (and that I already learned).

            I think the hardest part of creating an intervention is how simple it must be—I think much more on a systems level.  While all of my ideas have incorporated some sort of community-wide messaging that is complimented by both a school-based intervention and a women’s group-based intervention, they would prefer for us to focus on a small aspect—perhaps only targeting one group.  As a result, I think our intervention will be a gender-specific (i.e. targeting men and women separately) push to get people to be more active. In other words, I think we are going to push for friends (as couples do not interact in the public sphere) to go for walks in the mornings and promote this heart-healthy behavior.

            The reason for not pursuing a diet-based intervention is simple—even if you change the recipes, the ingredients are the same.   Moreover, Naan/Rhoti without as much ghee or Sambar without as much salt simply does not taste as good—and there is no way to convince people that a “silent killer” such as hypertension is lethal and worth sacrificing their delectable meals that have been passed down from generation to generation into average bad-tasting “healthy” foods.

            This weekend Shawn, Sonia, Eprice, Dessa, and I are going to Bangalore!  It will be a nice and needed vacation!  Hopefully I will get to see Joan who has been in Bangalore doing research at the Institute of Management.  We are staying at a hotel with a pool, so I am super excited to be able to go swimming—after all, it IS summer!  We are taking an overnight sleeper bus tonight to Bangalore, so more to come on this end!

***

            Currently I am on a sleeper bus heading from Thanjavur to Bangalore.  They are mini beds on an air-conditioned busà So much nicer and cooler than the train we took from Chennai to Bangalore. If you ever plan on traveling in India… I highly recommend KPN travels!  My field visit this afternoon was not ideal—out of a catchment area of over 1,000, the community health worker only knew 7-8 people with pre/diagnosed hypertension, none of which were available to talk. In short, for a disease that is allegedly affecting 30-40% of the population, we did not really gain much information…Oh well.

            I just had the most insight and productive conversation with Sonia, however.  To preface, this week has been a very hard week for me. Ironically, it was the first week I felt truly comfortable and ready to explore India.  In other words we spent one week in Chennai and one week in Thanjavur, and I think that I felt like I was finally returning “home” when we got back from Pondicherry on Sunday evening.  Saying that, this past week was a lot of background information and skills labs  (taking blood pressures, CPR etc...)  on information I had already covered in previous course and life experiences as an EMT etc… Yet, what I came to realize was that it was not reviewing the same information that upset me so much but rather the fact it took so long.  When our class was supposed to be only one hour, it repeatedly went on for two and a half.  All in all, a class that was on the schedule from 10-11 became a 9:15-2:00 activity (and one day which was 8:30-4:45), and I felt that my chance to explore India’s rich and vibrant culture was taken from me.  I felt like I was part of a herd who was blindly shepherded from place to place without any ability to take advantage and appreciate my environment.  What Sonia so kindly reminded me was that, while this week was lost, there are still 5 more weeks to go!  Therefore, stop dwelling on the past and just be even more proactive in the upcoming weeks.   Thanks to everyone for listening to me complain this week J 

And for you readers out there: Yes, this means exciting shenanigans to come!

           

            In other news:

           

                        Wishing Hannah a speedy and healthy recovery—you are in my thoughts and prayers!

                        Good luck Dad on the Marathon!

                        Happy belated birthday to Max and Jim!

Day 16

On our way back from Pondicherry we did not take the National Highway but rather back roads.  Despite the bumpiness and the aggressiveness of the driver, it was an amazing way to see the country.  We drove on paved roads and dirt roads while seeing monkeys, goats, cows and so forth. We passed through big downs and small towns, green area, rice fields, and drove next to a damn. For the first time of this entire staged and organized program, I felt like I was seeing India for what she truly is. 

            One of the things that stood out to me the most about our time in Pondicherry was way the caste system still manifests itself in contemporary Indian society.  For a grand total of 222 dollars, our driver drove us from Thanjavur to Pondicherry, slept in the car (a Tata Wingate), and waited around the city for the 72 hours we were frolicking around to pick us up whenever we pleased.   As a result, I felt that the least we could do would be to take him out for a nice dinner one night as I noticed he was constantly chewing tobacco to suppress his appetite (I presume to conserve money). After insisting that he join us that was accompanied by the peer pressure from the other nine persons who were with me, he reluctantly agreed.

 Yet, what stands out to me is the way in which the people of India (or at least the once with which I have interacted) understand that they are poor and that there are always poorer and so they will do whatever they can to help spread the wealth.  For example, the driver stopped and bought flowers from a poor child on the side of the road on the way back not because he needed the flowers but because he wanted to help out a fellow citizen.  Similarly, the bravery in which a 6-year-old girl—especially in such a patriarchal society—approached a big 10-person van and conducted a business transaction with a 30-year-old man was breathtaking.

***

It is now 10:25 on Monday evening and I have a terrible confession: I cannot count… there are actually 40 days left from today before I head back to the US.  While it is not that important of a point, I figured I would clear the air.

            As for the reason I am ACTUALLY in India, the coursework has kind of reached the nadir. Truth be told, I am a little frustrated/disenchanted with the work.  Hopefully it will pick up soon.

 I have come to realize (and I can only speak for my group) the work that we are doing is not as valuable as I understood it to be.  Despite the fact that cardiovascular diseases are the biggest problem that community worker’s are facing, they only affect 30-40% of the village.  Out of that percentage, people that have a blood sugar of 120 are included. Therefore, I wondering if it is as truly bad of a health issue as it has been made out to be.   More specifically, it seems that the common treatment is giving patients pills and telling them to come back in a month in a half to get their blood sugar checked—there is no advice about changing one’s lifestyle.  If this really is this case, it seems more to me of a problem with the training doctors receive in medical schools and the doctor-patient relationship rather than an uncontrollable health issue.  Moreover, as a public health official, it is ludicrous to think that we can enter a village and have them change their lifestyle.  Therefore, I think the best idea would be a school-based intervention informing children about risks and helping them minimize and eschew risky behaviors.  More to come on this topic as the intervention develops (Also feel free to leave comments!)

While I do not mean to be comparing this experience to Mexico, I saw patients with blood sugar levels over 400 and no running water or electricity who are subsistence farmers. When comparing their living conditions to those of the people in India who have electricity, carved wooden trim on the exterior of their home and tile floors, the Indians look like they are living like Kings--it is hard for me to think that this is really the most pressing public health issue in this region.

Finally, there is not much to do in this region.  Our schedule seems to be class from 10:00-12:30 (even though the syllabus only says 10-11), lunch, and then either heading back to the guesthouse or a field visit depending on the day.  On Wednesday they scheduled a “BLS” class [more commonly referred to as First Aid and CPR in the United States]—considering I teach this class in the United States, I feel like this will be just stalling/killing time.  In the evening people like to go to a hotel for drinks, and an occasional fruit run might fill in all the time in between. Other than that, there is not much (anything) to do.   If anyone has any suggestions of what I can do (besides read) PLEASE feel free to let me know!

***

In other news:

HAPPY (BELATED) BIRTHDAY SHAWN! Shawn (my roommate and only other male companion) turned 23 on Saturday.

On the same note, Dessa’s Birthday is tomorrow So HAPPY BIRTHDAY DESSA!

 I bought a book to teach me Tamil. While my Tamil lessons have become more sporadic, I want to keep pushing and studying so I can have a broken/basic conversation by the time I leave!

            Father’s Day is Saturday so if you have not bought a card yet and sent it to your dad, make sure to do it soon (sorry dad, yours will be via email)

Day 13

Where to begin?  While each day feels like it is going by rather slowly, time on the whole is passing by super quickly--only 37 days until I leave to head back to the United States! This weekend was a perfect getaway to break the monotony of Thanjavur (there is just not really anything to do there).

This past week we had another field visit and then to skills labs where we learned how to check for problems related to oral health as well as oral cancers.   I think the most interesting part of the academic side of things has been to see how interconnected all the different teams' topics are: Child and Maternal Health, Cardiovascular Disease, Oral Health, Cancer, and GI. I think the potential collaboration between groups and their solutions could create a systemic change that is all interconnected.  Saying that, our individual teams need to start working together and make a lot more progress before collaboration is even in the picture. As my team has been assigned CVD, I think the hardest part for us will be creating a successful culturally appropriate intervention rather than identifying the determinants.

Currently I am in Puducherry (spelling varies considerably).  It used to be a French colony and is a really fun city.   Today we wandered around the city, went to an Ashram, the beach (you cannot swim.. but it is a nice coastline), meandered through the streets, lighthouse, and so forth.  We found this fancy hotel/restaurant and had steak/lamb/fish for lunch--I had the snapper. We are going to its sister restaraunt for Shawn's birthday tomorrow (it is a rooftop restaurant overlooking the ocean).  The amazing part of being here is that four people had drinks, main course and desert for about 50 American dollars.  Saying that, because everything is so cheap, we sometimes forget how little what seems like so much here is. I am highly considering returning here for another weekend trip.

Tomorrow we might take an organized tour of the city or perhaps just walk around and visit the specific spots we want to... time will tell. As much as I want to take the organized trip, it is also our weekend and I would love to relax and try meditating or walking through the lush green park in the center of city. I just went for a workout in the hotel's (very limited) gym, and am getting ready for drinks as we watch the sunset and then dinner in a bamboo hut.  On that note, I must go, soooo I will write more soon!

Day 9

     Two days ago Mukesh led some of us on a tour of the temple---it was amazing to see the architecture and colors that still exist from over 1000 years ago.
       Yesterday's lecture was focused on India's healthcare system.  Exploring the differences between their flawless plan for universal care and its implementation was very interesting.  During the afternoon we went on field visits in which we got to see a sub-clinic, a primary health center, and a ICTPH health facility.  Walking through the communities, talking to the people, and being privileged to see their everyday life helped narrow down potential interventions we will propose (my group is focusing on CVD).   Afterward, we came back and went to the center of town and tried to orchestrate a group weekend trip--trying to figure out transportation when you do not speak the language can be difficult.  Afterward we returned back to the guest house and had our typical dinner, rice, rhoti, and veggies.   Once the guest house dinner was over, a few of us--especially Shawn and me--went to the hotel for chicken.... I miss my protein.  When I got back, Mukesh and I did a little work on the computer.  
    This morning I got up at 6 to exercise and am about to go to class!  More to come!

Day 6

Here is the update. Yesterday’s class was very interesting. We discussed not only the role of technology in making health care more efficient and comprehensive but also the importance of governmental structure.  The latter half of the class reminded me much of the Sened’s political science class from last semester.  

            During the afternoon we went on our first field visit. Even though everyone was in shock as to the poverty and underdevelopment of the community, it was much more developed and had a much higher population than the communities from Mexico last summer.  Nonetheless, it was very powerful. We saw the school, the primary health center, the water tower etc… 

            When we got back to the guest house, we went for a walk to the bakery.  I bought Ladu, Sonpapadi and Golojalab (spelling)?  They were all very tasty… but the pomegranates from the fruit market downtown still prevails.

            After that, we hung out on the balcony on the third floor of the guest house. We were serenaded by the nearby multi-day wedding.  After dinner, Eprise, Shawn, Dessa, Sonia, Whitney and I went to a hotel and had a drink during which we ran into the entire ICTPH staff dining.  We had some quality conversation and it was a really good time.  Ironically, we were not allowed into the bar (since women do not usually drink here and had to drink in the restaurant.

            This morning Mukesh, Shawn, Erin L and I went to play basketball at a nearby court.  Afterward we did some real work, went downtown for a bit, and am back at the guest house.  It has been a good time

            Other highlights include that Shawn, Eprise, and Allison are finally going to get their luggage!  I also took some pictures and will post them soon.  More to come, but that is all for now.

Work finally begins!

So today is Day 4 and I am officially over Jet Lag—I slept for almost a full night. Yesterday was a great day.  The food was awesome—and was very filling! We tried all of these new foods—most of which I cannot remember the name of—but it was a great mix of spicy and sweet.  We saw the ICTPH headquarters, met the staff, and saw where we are going to be based out of etc…  Everyone and everything seemed very nice.   During the afternoon we went downtown and went shopping—we ate sweet limes, jack fruit, oranges, pomegranates etc… it was so nice to finally eat some fresh fruit!  After dinner I just hung out at the guest house.  The temperature also finally dropped last night (with a very sprinkles of rain) and it felt delightful.  Thanjavur is MUCH nicer than Chennai and I am really excited to be here.  Actual work is finally about to begin!  More to come (as will pictures…. I need to get on taking some!)