The world is shades of grey

   

            Life would be so much easier if the world was black and white and all issues had a simple solution. Instead the world is a broken place and the past two days I have been exposed to some of this brokenness. I’m still processing how I feel after being exposed to prostitution in India so this post will be my feelings at this point and will hopefully make sense.

            We started off our day by learning about the Mukta project that Pravara Medical Trust started to promote awareness of HIV/AIDS to female sex workers (FSW) in the community. They have really done some amazing things in building relationships with the FSW, brothel owners, police, and community to make their job safer. They promote the women getting screenings for HIV and other STIs as well as getting medical check-ups regularly. They also helped them form a community-based organization, which is comprised of the FSW and they are attempting to be their own advocates to police, etc. to make sure they are treated fairly in the community. The aim of the Mukta project is to make being a FSW safer by having women tested and treated for STIs. The goal is not to stop the prostitution, brothels, etc.. Instead the stance is that prostitution is a profession like any other profession and it should be allowed to happen because it is the woman’s choice to be in this profession.

            This is where I struggle and have a problem. In my mind prostitution will never be ok. No woman who feels good about themselves and their body, who values herself would sell her body. She may say while she is a prostitute that she is choosing to do this because this gives her a sense of feeling in control, but it really isn’t a chose. After talking with some of the staff we learned that most of the women are in prostitution because they have no other way of making money. They feel like this is the only skill that they have and way that they can provide money for themselves or their families. Boyfriends, brothers, parents, etc. also may have sold them and that is why they are currently a FSW.

            As I sat in across from women in a brothel I just didn’t know what I should be feeling. We were talking to them and asking them questions like it was any other profession and like this was a totally normal conversation to be having between women in their mid 20s. We drank our pop as women came into the room and left the room, as men walked by peering into the room. We asked them if they ever saw their families and they responded that they sometimes got to go home or else they just sent the money home, but that their families didn’t know that they were FSW. They told them that there are in some other type of business in the city. We sat with the brothel owner (a woman) and she laughed and joked around with us. As we talked about STIs they insisted that they always used condoms even if they were offered more money to not use one, that kissing wasn’t allowed, only the actually act of sex. We finally had to leave because there was a long line of customers waiting so as we left the room we were met by the stares of men waiting to be with these girls.

I just stood and walked out numb and thought how can this be ok? What about this situation and these women’s lives are normal? How can I go about my day with the knowledge that these women have sex with up to 15 clients per day? What can I actually do to change these women’s lives and make them feel valued and worth anything? These are the types of questions that I have been asking myself since spending time with them. We briefly learned their names and ages, but never really heard much of their story. I already have forgotten some of their faces, which is really hard. I want to remember them; I want to remember this experience, because this was in my face brokenness of the world. I just left with a feeling of helplessness, what could I do to improve this situation? All that I can really do is to pray for these women and while prayer is an amazing and powerful thing-in this situation it just doesn’t seem like enough.

For myself to continue to go on with my life I have to find the light in this situation. These women are getting tested and trying to improve their health. Over 89% of the FSW in the city were seen at the Mukta project last year. If the free government condoms are gone, women are coming to buy their own. The women have started to advocate for their own rights and to make sure that the laws in place are being followed. In India prostitution is legal, but solicitation is illegal. So legally the women who are in prostitution shouldn’t be punished, it is the brothel owners that are doing illegal things. If the law is followed then the women are treated as victim, not criminals, which is much better than the US. There are positive things happening even in the midst of all of this brokenness.

            Tuesday we learned more about the community-based organization for the FSW and as I sat their listening to them talk about it I was still angry about the situation. They were discussing how a few brothels in the area had recently been shut down by a raid and how the organization had been working to try and get those brothels up and running again so the women who have a place to work. This doesn’t make sense to me. Why not give these women the opportunity to learn a different trade so they can feel more empowered and value themselves? I know that it’s not as easy or simple as this, but I really wish it were. I do understand that this is a very complicated issue with lots of different players so that is why I sometimes wish it were a black and white issue, but instead it is just a lot of grey.

            We then talked to members of the MSM (men having sex with men) community-based organization. We discussed the issues that they are dealing with and trying to advocate for. The main thing that they are trying to do is raise awareness about HIV/AIDS and get the members of their community tested. It is a misconception here that only FSW can get AIDS/HIV so they are working to increase the awareness that everyone is at risk. They also are working to change the laws in India that make it illegal for men to have sex with men. They also asked us about what the gay community was like in the United States and we just talked with them. They also showed us some traditional Indian dancing and had us attempt to dance with them. We weren’t very good at this.

            On the car ride home we were discussing the day and discussing if MSM is the term for the gay community in India or if it is only the term used for the male sex workers. There was some disagreement amongst the group on the meaning because we each had a different interpretation of what was translated to us. My thinking was that MSM was the term for the gay community as a whole, but then I got to thinking about what if it was only the term for the sex workers. Why doesn’t male sex workers anger me as much as female? I think firstly it’s because I identify with the women and I see them more as a victim where I see the men as equals. This may be my ignorance and so I will freely admit that. I also don’t know that much about male prostitution or how they get into the trade. I feel like women are usually tricked into it where the men chose this profession. Again I could be very wrong in my thinking, but I’m just being honest. In talking with the men they said most of them were in the community for the fun and the lifestyle. I never got the impression that they did anything for the money or felt trapped.

            After two days of learning a lot about FSW and MSM these are my feelings. I hope that I never forget the experience of being in a brothel. It scares me because I know how easy it is to continue on with my day and my life and forget that feeling as I left. The feeling of sitting next to women who are selling their bodies and trying to pretend like it was ok and having to leave because there were customers waiting. I will continue to pray for these women and the project that the women will come to understand how precious and valuable they really are. I wish they could just see how much they are needed in the world for things other than their bodies.

Our hearts are full

This afternoon a PhD pharmacology candidate, Suguna,  invited us over to her house to spend time together. Her husband is back home where he works and so she lives here by herself while she is finishing up her schooling so she said that she loves to have visitors over since she gets bored.

It was a wonderful afternoon she fed us some Indian food that she put less spices in for us. She showed us her wedding photos and talked with us about her husband. They seem to be really cute together and really love each other so that was fun to see. You could tell that she misses not being around him.

The highlight of our afternoon was seeing all of her sarees and then she helped us all try them on and we took quite a few pictures of ourselves in them. She was so sweet and was a wonderful hostess. At the end of the day she asked us if our hearts were full because that is all that she was hoping for. She said that it is easy to fill up stomachs, but not hearts. I loved this and we just had the best time with Suguna and we can't wait to go back to her home and visit again!

So many sareers (and this is only a small portion of what she showed us)

Friday Fives

Since I forgot to post my Friday Fives yesterday I am posted them today.

1. Learning more about India and having better conversations with students, professors, and doctors in each of the departments we visited this week. 
2. Eating pizza and french fries for Courtney's birthday
3. Getting to talk to people from home on skype and facebook and gmail
4. Looking through pictures with Courtney from our friendship and having some solid laughter over how ridiculous we are (mainly I am in photos)
5. Getting to level 95 on candy crush

Sorry that some of these are repeats of last week (and very similar to Courtney's), but since we do similar things each week I had to get creative. This really was a good week in India and I'm really starting to like it here and feel like I'm seeing a lot of stuff that I wouldn't be seeing in the US. What are your Friday Fives?

ART and CCL

The past 3 days we split our time between ART (antiretroviral therapy not making things as I would not be very successful at that, just check out my drawings Courtney posted on facebook) and CCL (central clinical laboratory).  Both of these departments gave us the chance to really talk with the people who work in them and have some good conversations about India.

In ART we learned more about AIDS/HIV in India. The treatment is free from government funding for patients who come to the center and this center serves almost 3000 patients. They told us that the state we are in has one of the highest rates of HIV in India. We learned about the regimens that they use here and how they decide the treatment that the patients will get based on labs and side effects. They also sometimes have to adjust the treatments based on what medications the government has given them. The days we were there it wasn't super busy because it wasn't days where patients come to get there CD4 counts so instead only a few patients came. The interns that we talked to were really nice and we discussed things about India-such as religion, food, education, history, etc. We covered a wide range of topics and I learned quite a bit about India from them.

In the CCL we spent most of our time with the head of the lab. He really wanted us to ask him questions about India, the lab, and really anything else that we could think of. We ended up talking to him for quite some time and he told us what he felt were the major public health problems in India. He said that he thought the lack of health awareness was a major issue. People don't use primary health care (and there isn't enough primary care centers around) so when they finally go to the doctor it is too late and their disease has gotten to bad to actually treat. He also said that alcoholism, anemia, and infant mortality are also problems in India.

He was also just a really wise guy and fine to talk with. He gave us 3 keys to living a good life and they are:

1. Anger is a wasted emotion
2. Always be humble
3. Practice patience

I thought these were all some pretty solid things to live by. He told us that the earlier we start trying to live by these things the better our life will be because he didn't start trying to do these things until much later in life.

We also spent quite a bit of time talking about marriage. He told us about how in the cities and more urban areas people marry more for love now and that often these marriages don't last very long because the couples aren't willing to make it work. He told us that the majority of marriages here are some-what arranged where the couple has some say, but not always a lot. He said that he thought that these often worked out better because both people go into the relationship knowing that they will have to make some compromises. He also told us about the marriage practices of some of the tribal people that he had encountered that were pretty interesting. Really the whole conversation was really good and I enjoyed hearing his take on love, marriage, and families.

He also told us more about his time in the army and the places that he has lived and worked. Some of them were really remote. He told us the stories about waiting for helicopters to come get injured people and having to wait for the fog on the mountains to clear so it could land and take the patients away. He was just full of tons of information and I feel like I learned quite a bit about India through talking with him. I know he told us tons more that I can't remember right now, but it was a great time of learning.

We also learned some about how the lab works and how they do the tests. I made a slide with a blood sample and was not super successful at it. The technician told me I needed a little more practice. We also used some of the hematology machines and put samples in to be read. It was interesting to see how the lab works and what kinds of stuff that they do even if I didn't really understand it all.

I don't have any pictures from the lab or ART because I've been slacking at taking pictures when we are at our posts, but I do have a few pictures of Courtney's birthday celebration that I will share so enjoy.

Bangals at the market

Waiting for pizza and fries at the london twist

Pharmacology Department and Weekend

Friday and Monday I was posted in the pharmacology department. Since pharmacy is different in India the pharmacology department is more research based. It would be similar to a pharmaceutical science department or another type of pharmaceutical research degree in the United States. They teach pharmacology to the undergraduate students, have post graduate students who are doing research work, and also help run the research cell at Pravara. Overall, the pharmacology department is a pretty busy place.

The staff in this department were very kind to us and kept us pretty busy, which was nice. We started out by observing them give oral examinations to a batch of MBBS students. They were learning about the nervous systems as well as other body systems and getting quizzed on these drugs, how they work and their adverse effects. It reminded me of the things that we learned in our PDA (Principles of Drug Action) classes. I knew some of the information and also realized that I still need to do some refreshing on my drug mechanisms and adverse effects. I am also glad that I never had to take oral exams because sitting there being asked questions by my professors would have been very intimidating and I don't think that I would have done very well.

We had the opportunity to learn about a PhD students research project with genetics and warfarin. It was very interesting to see how she does the testing and also to see how passionate she was about her research. She really wanted to improve the way warfarin is dosed in different patients to better improve their outcomes and decrease the number of adverse effects. She also talked with us about her wedding and showed us pictures that she had on her computer. It was very interesting to learn more about the customs in India and how marriage works here.

Monday we spent time watching an experiment. They used a guinea pig ilium tissue to run their experiment. They were seeing what affects different concentrations of a drug had on the tissue contraction and using this information to determine what the concentration of an unknown is. It was very interesting to see this type of experiment in person because we did some similar things in school, but we were just given the data and had to figure out the unknown concentration. They also took us to the animal house and we got to see the rabbits, mice, rats, and guinea pigs that they use for experiments and research purposes.

Another part of our time in the pharmacology department was to visit the research department and learn about the proposal and approval process at PIMS for research to be conducted. As I don't have a lot of experience with research in the United States it was interesting to hear how it is done in India and to see the emphasis they try and put on research projects.

The people in the pharmacology department were also just wonderful to talk with. They told us places that we should go eat and things that we should eat at each place. They even wrote down the names so it will be easier for us to find them (hopefully). They also talked with us about tv shows, books, and movies and what they have been watching. They have seen way more American tv shows then I have I think.

This weekend we stayed in Loni and did a few activities. We met with Center for Social Medicine and discussed how things were going and got to see our tentative schedule for the rest of our time here. It was really nice to see what departments we would be going to as well as the rural health centers and mobile clinics that we would be going on. It makes me more excited for the time that I have left in India.

We rode a rickshaw to the post office and mailed some postcards to people at home. Hopefully the postcards will make it to people eventually, but only time will tell ;) We also tried out a couple of different restaurants in Loni. One is called the London Twist and has pizza and french fries (along with other things) but we ate that for dinner on Saturday night.

Sunday we went to the ophthalmology department's CME on cataract surgery in the morning. They had a nice program to open the day and then we listened to a couple of lectures on cataract surgery techniques. As I do not know too much about the eye I wasn't totally sure what was going on, but it seemed to me that they are doing some great things in the advancement of cataract surgery in India. I also decided that I would never be able to do surgery on the eye after watching some of the videos.

I'm really starting to enjoy my time in India and am enjoying all of the people that I am getting to interact with. Everyone here has been very gracious hosts and for that I am very thankful.

Riding in the rickshaw

post office sign

Friday Fives

Friday Fives are something that Courtney and Shelley do every Friday. It is where you think about the past week and come up with 5 things that you enjoyed and were positive things to your week. When we got to India and were wondering how we would survive the next 8 weeks we decided that we would start doing them here.

I've still been struggling lately to really enjoy India. I tend to really dwell on the things that aren't going well and how my expectations of this experience aren't being met instead of thinking about all of the things that I'm enjoying. Thinking about the 5 things that I've really enjoyed is somewhat helping me see the good in this experience when I sometimes think it was a waste of a rotation to be in India.

I would encourage you to also come up with your Friday Fives (feel free to leave them in the comment section if you'd like):

Here are my Friday Fives:

1. Being in the radiology department and getting to see ultrasound after ultrasound. Being able to actually identify the parts of the growing baby was amazing.

2. In the pharmacology department today a PhD candidate showed us her wedding pictures and explained somewhat about weddings in Indian culture.

3. Being able to purchase food that is somewhat familiar to me when I need something from home. (oreos, kit kats, and chips plus appy fizz)

4. Traveling last weekend and being able to see sites around the area as well as shopping

5. Being able to skype and chat with my parents (plus Isaac for a bit), Chris, and Carina

Here are a few random photos from India so far that I don't think I've yet posted on the blog:

We never thought we'd be excited to eat sodexo, but the KFC had this sign when we walked in

I'm pretty much an expert on ultrasounds now....

We spent the past 2 days in the radiology department and I would have to say it was one of the best experiences that I've had in a department (besides watching the surgery). We started out with one of the doctors showing us an overview of the department. He showed us the CT, MRI, X-ray, and ultrasound machines and told us about how they all worked.

Once patients started arriving we observed each of the machines and the residents in those areas explained a little how they worked. If there was an interesting case in another area a resident would come get us and bring us there. They did the best job I think of really explaining what was happening and making us feel somewhat involved and not just in the way.

I really enjoyed seeing how each of these machines worked since I’ve never had any of the tests done nor actually see them performed in real life. Some of the interesting things we saw were: a young man with a brain tumor so they mapped it out on the CT scan so they knew where to target the radiation, a CT assisted biopsy of the lung, a ultrasound assisted biopsy of the abdomen, and some MRI scans of cancer that had spread to the brain and had multiple malignancies.

We learned that most of the time patients don’t come to the doctor especially the radiology department until something is really wrong. They said that for the most part they don’t have to use a lot of contrast because the scans show up pretty clear when there is a problem since the growths are usually rather large. They said that in the US it is more common to need to contrast to pick up the problems since they are typically smaller masses.

We spent quite a bit of time in the ultrasound part and watched as mother after mother had an ultrasound done on her baby. It was really amazing to see all of the body parts and we were able to identify them as time went on. I wasn’t quite as good as Courtney, but was still able to pick out the body parts. We really aren’t experts, but now if the ultrasound is in position I can pick out quite a few body parts. We also learned how they measure the femur, head circumference, and abdomen circumference to determine gestational age and if the fetus is growing at a proper rate. We also discussed more about how it is illegal to tell the patients the sex of the baby and the professor/doctor we talked with showed us a powerpoint on this and really explained more about it.

They also were very concerned about what we did for fun, if we liked the food, and if we were enjoying our stay. They gave us some tips on places that we should visit and also some restaurants that we should try out. They were all really surprised that we ate in the mess hall because many of them said that they didn’t even eat there. These types of conversations have been common in most of the departments that we’ve visited, but they just seemed to be more interested in our answers and really gave us suggestions on things to do.

I've been slacking on my picture taking so I don't have any to add to this post so I apologize for that and will try to do a little better next time ;)

Thoughts on India after 2 weeks

Life in India has become some what normal now. We have our routine down: get up, go to breakfast, go where we are posted, break for lunch, go back to our post, then hang out in our rooms until supper, and then eventually go to bed. At times it feels like I've been each much longer than 2 weeks, but other times it seems as if I just got here and still have no idea what is going on.

I have pretty much accepted the fact that for the majority of the time I will not know what is really going on. We still haven't had our program clearly laid out for us with what is expected of us and I'm not thinking that will come anytime soon. I have decided that I am ok with this and I will continue to go to the sites where I am directed and get my schedule one week at a time. For those of you that know me well you know that I like to have things planned out and pretty organized. This is helping me to realize that it is fine to not have things all planned out and that I will survive it.

The past two days Courtney and I were posted in the skin department. The resident did a good job on the first day juggling seeing patients, giving and oral exam to students, and explaining things to us. He is actually the first person so far that explained to us what each patient had and what they were going to treat them with. I am not an expert on the skin or dermatology so some of the things I had no idea what they were or how we typically would treat them in the US. The main treatments that I knew about were ones that I have tried for acne and my keloid scar. The skin department doesn't see a whole lot of patients so there is a lot of sitting around that is done. Courtney and I occupied our time by playing candy crush, 4 pics 1 word, she drew, and I finished Ender's Game. The residents in the department spend their downtime studying for their exams so we don't really want to disturb them too much and we don't have a ton of questions about skin.

This sort of sitting around understanding only part of what is going on has become very common for us. Part of the reason for this is because it seems like most of the departments don't really know what to do with us since pharmacy is so different here in India. All of the doctors and residents that we actually talk to and have longer conversations with have been pretty awesome. They do a great job at talking with us and explaining how things in India work and for that I am very thankful. Most of them also seem very interested in how things in the US work so we explain that side of things as best as we can.

The other big adjustment that I had to make was learning to like the food. I still wouldn't say that I really enjoy eating, but have come a very long way in the past 2 weeks. I now can eat the food without feeling like my mouth is on fire. It is hard to get used to eating 3 pretty spicy meals a day and not having a lot of sweets. Luckily I brought quite a bit of sweet things from home with me so when I need that fix I have something in my room. Since there is always some type of bread product at all meals I have also been enjoying that. A store nearby sells a drink called appy fizz (sparkling apple juice) and so I've really been enjoying drinking that as well as getting some chips on occasion when I need something a little salty.

I've also decided that washing machines and dryers are great things to have. Having to wash clothes by hand in a bucket takes quite a bit of effort and I'm never really convinced that I am actually doing a good job of cleaning them. There is a strange washing machine here, but I'm not entirely sure how to use it and it kind of weirds me out so I will just continue to do laundry in my room once a week and hope that by the end of my time here my clothes don't smell too bad from my lack of washing abilities.

The other situation that I should probably update you all on is the creature situation. After posting about my lizard friend I am happy to report that there have been no other sightings in my bed. I have however seen more lizards in my room, but as long as they don't try to sleep with me I am ok with that. I did have a flying cricket attack me one night right before I was going to bed so I didn't really appreciate that, but I successfully killed it and haven't seen any more in my room since that time.

At this moment in time I am still really glad that I came to India and have the opportunity to learn more about another culture. Even though it hasn't been the clinical experience that I was hoping for the people are great and I am learning some things about myself as well as the country of India. I think I am also glad that I am here for 8 weeks because I think I will continue to learn more and adjust to life here and if I was only here for 4 weeks I would just be getting settled when it would be time to leave. Would I like to live in India long-term? No, at this point I'm thinking 8 weeks will be plenty of time.

What laundry day looks like

1st time breaking out the rain jackets

Weekend Trip to Aurangabad

This weekend we took our first trip outside of Loni to the Aurangabad area. It was fun to get out of Loni and see more of India and now whenever people we interact with ask us if we've been anywhere else in India we can say yes. I also took lots of pictures this weekend so I have only a small amount that I'm putting on the blog (still quite a bit). So if you'd like to see more sometime just let me know and I can show you. I will also probably upload more on facebook at some point.

Our weekend started off early Saturday morning at 6 am when our driver came to pick us up. We then headed to the Ellora caves, which are "caves" that are carved out of rocks with structures and such. They were really neat to see and it's really hard to believe that they were built so many years ago since the work is so intricate. This is also when we got the first taste of what being Americans or white means in India. We got asked tons of times to take our picture with random people. We obliged at first, but then as the weekend continued we just said no. We all decided that we would not be ok being celebrities and having random people come up and ask to take a picture of you or else just take pictures of you just standing around.

Group in front of the first cave we went into

Our backs were sweaty from all the walking so we looked really cool for a little while to air out

Then we headed to the Ajanta caves next. These are similar caves, but have a lot more paintings on the walls rather than carvings. I personally thought that these were better and enjoyed them much more. A lot of these caves were dark and had lights in them so it was a little harder to take pictures (especially of the paintings on the walls), but I still got quite a few good ones.

Sign when paying for our ticket. Don't worry I had my epi-pen and Heather was my lookout for bees since I never seemed to see them

Then we headed to Aurangabad and went to our hotel for the night. For supper we ate in our hotel, but they had American food on the menu. I ordered pizza and it was so good. It was also really nice to sleep in a comfortable bed with a normal pillow.

Sunday morning we got up and headed for Bibi Ka Maqbara, which is the mini taj mahal.

Then we headed to the Daulatabad Fort. This was a really cool place and I decided would have been a great place to take seniors pics. It included lots of stairs though so we were pretty tired by the time we made it all the way up the hill and back down.

The structures on the left side of the pictures towards the top of the hill is where we climbed to

After this we were a little tired of outdoor activities and walking around since that is what we had been doing the past 2 days so we headed to the Prozone Mall, which was like a typical American mall with extra security. We had to have our bags searched and go through a metal detector to get into the mall and then at most of the stores you had to check your bag before you went in and then pick it up when you were done. That part was a little strange, but otherwise we had a pleasant shopping experience. It was nice to be at a place that seemed very familiar and for lunch we even had KFC (which I made everyone, but myself that a picture in). It was also a little strange feeling since it almost felt like we were in the US, but then knew that we were in India. I ended up buying some shirts and some sarree fabric that I am hoping to make a blanket out of.

After our shopping experience we headed back to PIMS and got unpacked. I'm glad we went for our weekend trip, but now I'm feeling tired and like I'm not really ready to start our week tomorrow. I feel like I need a day to recover from all of this excitement.