Apres moi, le deluge

Cows and cars – the old and the new in India February 1, 2014

This post stems from one of our final assignments for the Global Future Physician course: a 250-word (at least) blog post centered on a single photo from our time in Mysore.  Hey – I didn’t go entirely overboard, my submission was just a hair under 500-hundred, how’s that for some uncharacteristic brevity? 🙂

My phone camera, while mostly adequate for providing a me reference for posterity, didn’t begin to effectively capture the dimension and vibrancy of the sights I viewed in and around Mysore. However, amid the clunky, blurry, badly-lit, and finger-in-frame photos I’ve found some surprising gems, like this one:

Mysore cow decorated with turmeric water to celebrate Sankranti

The photo above was taken on the final day of our three week sojourn in Mysore, along Sayyaji Rao Road and just outside of the Karnataka State Arts and Crafts Emporium, a few blocks down from the Devaraja Market. Not captured at that precise moment in the photo, beyond the parked autos in the background, was the deluge of buses, autos, bikes, motorbikes, and auto-rickshaws darting, bullying and honking past on their way into or out of the city center. While I became well-acclimated after three weeks to the ubiquitous free-range bovines present even in what seemed the unlikeliest of places, including urban palace grounds and improbably-trafficked chaotic intersections and roundabouts, I never lost my capacity for bemusement at the frequent and mostly unrestricted intermingling of (what I would normally consider) rural with the utterly urban. Hence, a goodly number of my photos capture cows, oxen, water buffalo and goats navigating traffic, trash, temples, and such. The cow in the above photo, dyed with what I understand to be manjalthanni (i.e. turmeric water) and managing a rather impressive, if unintentional, color-coordination with the parking barrier, is additionally illustrative of the practice of decorating cows and cattle for Sankranti, or the winter harvest festival, underway at the time.

This photo also embodies for me a theme I found recurrent in different ways, across a broad spectrum of lectures, site visits, observations and interactions during these three weeks: the juxtaposition in India of the traditional and the modern. Lectures on Hindu religious beliefs and Indian literary epics, as well as visits to numerous temples and sacred sites, demonstrated an India grounded in culture and tradition, while lectures on Indian medicine, healthcare, politics and economics, along with field trips to locations such as hospitals and local waste treatment facilities provided a glimpse into an India very much pursuing modernity. A number of our lecturers discussed different facets of Ayurvedic medicine (traditional Indian medicinal practices dating back two millennia), which many Indians use in complement with Western medicine. Other lectures asserted that while there remain some significant gender-based inequities, much of which is borne out of eons tradition and religion, Indians are by and large in favor of a broad range of family planning methods, considered to be rather modern by Western standards.

I can’t claim to have absorbed nearly enough in my three weeks in Mysore (nor do I perceive that 1.2 billion Indians are anything like a homogenous population) to speculate whether or not this coexistence of old and new is an easy, comfortable prospect for Indians. However, I did come away with an overall perception that not unlike the modern autos speeding and darting around, or sometimes having to yield entirely to, the cattle ambling ponderously through the streets (such as my yellow friend above), the Indians I had occasion to meet and observe, both rural and urban, seem to have established a sort of duality between contemporary pursuits and that which is very much traditional.

So about those rabies statistics… January 8, 2014

While we’re doing plenty of mucking about in 80/90+ degree sunny tropical weather (with apologies to the long-suffering Minnesotans back home), sight-seeing and sponging up volumes of info on Indian culture, history, medicine and healthcare while here for 3 weeks in Mysore, India, we’ve also been split into small groups and tasked with completing a group project which will be presented to our classmates, faculty, parents, sigs and whatever other strays show up that evening in February.  Each group is at liberty to choose whatever topic suits them, although it’s generally assumed the topic will to be in some way, shape or form (however tangentially) related to medicine/health care, and it should be centered on some aspect of Mysore or India generally.

However, as has been particularly highlighted, bolded and underscored for us is the point that whatever our project/research/topic – it shouldn’t end up being something we could just basically phone-it-in on or complete by simply researching it entirely on the internets. We should be working to find and make use of local resources, eg the small army of physicians and SVYM staff at our disposal, the SVYM library, local residents, photos/vids/audio of experiences, interviews, etc.

My group’s project started out looking to explore the public health impacts of the out-sized feral/community dog populations  (i.e. acting as rabies and tick/flea-carried disease vectors) and snakes/snakebites on city and rural communities in India. We’ve expanded that topic a wee bit (at least in this data-gathering stage while here in Mysore) to look at other negative public health impacts of human/animal interactions (elephants, jaguars, tigers, etc). However as I found today – the continuing progression/evolution of our group project, as well as the alleys and side ventures along the way, may end up being nearly as interesting as our topic(s) itself.

Dogs snoozing outside one of the main entrances to Mysore Medical College Hospital, where each day approx 50-60 individuals suffering from dog-bites come for treatment.

Our project took a turn for the investigative-journalism today when by happenstance Dr. Sumanth lecturing this morning about public health mentioned in passing the incidence of rabies cases annually in India as 221. That number surprised me, as the stats on the number of annual cases/deaths from rabies in India which our group has been discussing (acquired online from NIH, CDC & WHO’s websites, no less) was estimated to be consistently around 20,000 annually (or 0.2 lakhs, as I’ve learned).

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Physics and fiction January 8, 2014

Oy – found that so much was packed into the weekend that I needed some time to just savor it all, to let it percolate and kick around in my brain without diving straight to writing. Trying to get back in gear today in capturing some impressions from yesterday’s field trip, and there were so many – I could barely scribble them down fast enough.

Actually though, first thing’s first: I had the time of my life riding in the back of the van from Mysore to the Vivekananda Memorial Hospital (and back again). I found myself giggling like a ridiculous child on a roller-coaster every time the van bottomed out in a hole – tossing us around like rocks in a tumbler, or each time we passed (i.e. near-missed by improbable millimeters due to government by some local laws of physics entirely different than those which govern U.S. traffic) lumbering cows & oxen, trotting flocks of sheep, bounding goats, strolling adults, darting children, lurching buses, ambling bikes, or small trailers/rickshaws piled comically high & wide with straw (or some reasonable facsimile thereof) at 100km/hour. Seriously – people pay for rides like this at amusement parks.

This vid clip isn’t from yesterday, there would have been no way to capture vid without the pic being so jostled about that you would either be unable to see anything, or you would incur your own motion sickness by-proxy. This snippet is from our drive to visit Bhara Chukki Falls, via paved and mostly smooth roads; however it’s an ever so brief glimpse of what driving is like here. A few rules of thumb:

1. everyone drives on the left, except when they don’t;
2. the middle line is (or any lines are) superfluous;
3. no speed limits (that are enforced) – everyone drives as fast as their particular vehicles go, or that road conditions allow for;
4. everyone passes anyone at anytime, regardless of oncoming traffic;
5. horns are used nearly constantly as a courtesy/heads-up: eg. “hey I’m going 100 km/hour and passing your flock of sheep on the right.”

Also note – the lower left of the windshield has a sticker with the number 60 on it, which reads: “60 km/hour is the electronically-controlled limit of this vehicle.” Ahahahahaha.

I’m incredibly grateful to the universe that I don’t suffer motion-sickness under such conditions as we traversed yesterday. Even more grateful that I’m able to read under such lurching conditions as the travel time allowed me to nearly finish one of the books I have on loan from the SVYM library. The book, “A Hundred Lamps,” is a collection of seven stories/excerpts “from the works of some of the best known authors of Hindi literature,” each story highlighting snapshots and facets from the lives of Indian physicians and medicine.

The stories touched on a number of topics and historical settings about which I’ve learned over the past week, including (most coincidentally to the fact that I only learned yesterday for the first time some history and background about India’s tribal peoples) a story about a small town/village called Dhingar Gaon which lay in proximity to a large tribal population. The story related the pending advent of a paper mill, slated to decimate the surrounding forests and displace the tribals, as had happened in other areas in the name of “progress.”

Each story varied in its time period and setting, allowing glimpses of India’s history, politics, culture and religion to be seen and understood in the context of characters and the narratives spun around them. While I’m a lover of non-fiction of all sorts too, this book captures why I love fiction – particularly historical and speculative fiction. It allows history, sociology, philosophy, and all manner of topics to be explored via narratives, making what can be otherwise dry topics more engaging and relate-able.

I set out to highlight some of my observations on our school and hospital visits yesterday, and look at the alley down which my reflecting has taken me. More on the visits themselves in another post!

For the love of a calf January 7, 2014

To be cross-filed under both “things I didn’t need to go to India to find/do” and “animals always trump anything/anyone/anytime anyway” is this befriending of an ox calf when we stopped to admire the view by the shores of a reservoir on the way to our last stop on yesterday’s field trip. Along the flats (not sure if they’re actual flats, not sure if I know what flats actually are – but I’ll call them flats), the local folks had their cattle and oxen pegged out to graze (I assume, hell do I know about local agriculture). This ox calf who was most near to us had a tree branch all caught up in its bridle (or, ropey head-harness thing).

We were advised while here most definitely to not touch/approach dogs due to their feral state (feralocity?) and on account of their being rabies vectors. I figured my risk for rabies-via-calf was low, and as our faculty grown-ups didn’t attempt to stop me, I approached said adorable snuggly calf and fished the branch out of its face/bridle. It was a bit jumpy/shy to start, but once the branch was removed, it was all friendly lovey-dovey (or possibly desirous of me merely as salt-lick?).

So, the answer to your inevitable question of whether I hiked all the way to India just to befriend a calf: a solid yes. My cousin on facebook asserted that clearly I should be pursuant of a career as a veterinarian rather than a physician. My response to that: it’s exactly because I’m a super weepy bleeding heart hippie over animals that I couldn’t deal with being a veterinarian. But serve as doc for humans? Somehow I find that prospect utterly palatable and doable. 🙂

Of lectures, palaces, temples and trash January 3, 2014

My postings have been few and far between this past year, but for the next few weeks while I’m traipsing around southern India, this is going to be mainly a travel/documenting/lecture-logue. Not terribly interesting for the wider world, but a useful means for me to capture, sift & sort some of my comings/goings and thoughts thereof. </disclaimer>

Today’s morning class/lecture/discussion started with our daily debrief from 8:45-9:45 where we have the opp to reflect as a group on the previous days lectures & activities, questions, issues, etc. Today’s debrief session was broken into small groups, mine led by Dr. Susan Pleasants, one of the two U of M faculty (along with Dr. Mike Wootten) heading up this earnest rabble of future-physician wannabees (myself included). Our debrief conversations covered a variety of topics from yesterday’s lectures on corruption in India and food security presented by Dr. Balu. After our 10:00 tea break (daily breaks in lectures at 10:00am and 4:00pm for chai tea and biscuits), we settled in for a lecture from Dr. R S Rajan (who, in addition to being a retired cardio-thoracic surgeon, is also a retired brigadier general in the Indian navy) providing an overview of the Indian healthcare system.

Among much other new knowledge sponged up from the lecture, I was pleased to gain from Dr. Rajan’s lecture further insight into Ayurvedic medicine, as well as clarification on what I’ve been able to learn so far about it. He described briefly the origins of Ayurvedic medicine and how it became, and continues to be, the holistic approach it is for treating the health of an individual in the context of their life and specific circumstances.

Dr. Rajan asserted that while Ayurvedic medicine is not useful for addressing emergent/acute or surgically-needful conditions (eg. appendicitis, bone breaks), and that although most Ayurvedic treatments haven’t been scientifically assessed for their efficacy, it can be (although not always is) practiced in line with the principle of “primum non nocere”or “first, do no harm.” Dr. Rajan shared one instance where an Ayurvedic remedy has been found to be clinically effective. The Ayurvedic remedy for high blood pressure Rauwolfia serpentina (aka Indian snake root) was found to contain the compound reserpine, and in the 1950s was shown to be effective in managing high blood pressure and in synthetic form remains in use today.

After class and then lunch (all super tasty vegetarian meals here at the Swami Vivekananda Youth Movement hostel!), we headed out for a field trip to visit Mysore Palace and the Chamundeshwari Temple.

Mysore Palace

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Canis indianis? December 31, 2013

It’s 2:30 on Monday afternoon where I’m at here in Mysore, India, (hey wait no it WAS 2:30 pm on Monday when I started this post, then due to circumstances and classes and misbehaving internets it is now actually 1 hour into 2014!)  for a three week study abroad course through the University of Minnesota. (I time traveled 11 & 1/2 hours into the future in the process of getting here; also too, who knew there were time zones of half hours? I did not!)

If you know me, you probably aren’t all that surprised that one of the first things I took note/care of in making my way in/through my new surroundings were the populations of free-range dogs. The view out the bus windows during the middle-of-the-night ride from Bangalore to Mysore showed a landscape scarce of humans but frequented by stray/feral canines. My initial impulse on seeing these canines so apparently abandoned and disconnected from the direct human contact, companionship and intervention that I’m used to States-side was to feel downright troubled, concerned, earnest, bleeding-heart and more than a little judgmental along the lines of “wtf – why don’t they do something about this – it’s dismal, callous and cruel to just leave dogs to fend for themselves and bereft of human companionship?”)

Exploration of the area around the hostel this morning also revealed an abundance of alternately lounging and meandering, tongue-lolling feral dogs.

Strays dogs in Mysore, India

As I’ve had the opportunity so far to observe them singly, in pairs, in small packs, interacting with each other or just existing as part of the landscape, it occurs to me they actually seem rather self-sufficient and generally getting along quite well being semi-estranged from humans; they certainly don’t seem sad-panda at not being, er, lapdogs. In fact, the canines I’ve observed, including two I just watched trotting through the adjacent lot, overall seem well content with each others’ company and minding their own business.

There’s obviously much more to this issue than a quick cursory “oh good – they seem fine and happy, so all is well, my conscience is off the hook”, and certainly more to consider in terms of overall good/benefit (or lack thereof) to the health and well-being of humans and dogs in having such roving bands of feral canines be the norm in heavily populated ares.  However, it does give me at least initially pause to consider caution in knee-jerk projecting my American sensibilities of human/canine relationships onto this area & culture.

Tumbling onto the scene in southern India, particularly in a learning opportunity like this, prompts all sorts of ponderings and observations, which indeed are legion in my neural muck presently.  But go figure that my first thoughts go to the animals.

Happy New Year from the other side of the globe. 🙂