Week 6 Update

The internet has been down the past couple of days so I haven't been able to post any updates, but it's back to working now for the moment so I can. Here is an update of the things that I have been up to the past few days:

Monday:
We were posted in the family medicine department. This was probably one of my favorite departments because the interns and doctor really took time to explain what they were looking for with each patient as well as what they thought the patient had and the treatment options for them. It was also apparent that the doctor really cared about each of the patients that he saw. He took time to really examine each of them and talk with them about what was going on, which is something that I haven't seen in all of the department. He also talked with us about different diseases, medications, and health care in general. He was very interesting to talk with and I wish that we would have been posted longer than just the 1 day and am hopeful that we may fit another visit into our schedule.

Tuesday:
Today we were posted in general medicine and so we started off the day by going on rounds. This was an ok experience, but they really didn't talk to us much about any of the patients so it felt like we were really just following a group around like lost puppies. We found out that a lot of the general medicine patients are in the hospital for things like organophosphate poisonings, snake bites, and things like this. In the afternoon we were in the outpatient department for a little bit and just observed the interactions between the residents and the patients. We also spent some time in meetings. In the middle of our day all of the international students met with staff from CSM as well as the Vice Chancellor of Pravara to give feedback on how things were going. Then in the afternoon we went to CSM for Ben's presentation on his time at Pravara since it was his last day. It was really fun to listen to him give his presentation and see his view on how things went. It seems like his time here was really short even though he was here for 4 weeks, and I wish I would have gotten to know him a little better. In the evening we were invited to the guest house with the staff from CSM as well as the vice chancellor for a meal. It was outside and had multiple courses. The food was really good and I ate way too much. It was also great to chat with the students from the other universities and get to know them all a little more.

Wednesday:
Today we went to a rural area nearby called Bhandardara where we visited 2 rural health centers in the area and a mobile clinic. We talked with the staff at each of these locations about the types of patients that they typically see and got tours of the facilities. The staff were all great and really seemed to care about the patients that they saw. The patients that are mainly served by these locations are tribal people and people that are very poor and don't have a lot of access to health care. I was really impressed with all of the things that they are able to do at these sites with limited resources. They really make the most of what they are given and really don't waste much. At one of the clinics we made friends with a dog that Courtney named Bill. He followed us around the village and even followed our car for a bit when we left. I also made friends with a little boy and got him to smile at me as well as play with my watch and look at me without crying so I'm making some progress with the small children. The area that we went to was also really scenic and was surrounded by mountains so it was really pretty as we drove around. On our way back we were also able to stop at the dam that is nearby and take pictures around it after doing a little hike in my sandals.

Tomorrow I'm posted in surgery and then on Friday we are headed to New Delhi to go see the area as well as the taj mahal so I'm pretty excited about that.

Dinner on Tuesday night

It was a red top black leggings day

With Bill (the dog)

My new bff

Making Friends

We have actually started to make some friends from the departments that we have been in so far and this weekend we had the chance to hang out with some of them and had a lot of fun.

On Saturday we went over to one of the professors from the pharmacology departments house and had mutton biryani. It is a traditional Indian dish made of spices, rice, and lamb. It takes about a day to make and they special order it from a person in Loni. When Courtney and I were in the pharmacology department the guys were appalled that we hadn't eaten it yet or even heard of it before so they said that we all had to eat it sometime. It was really good, probably one of my favorite things that we've eaten so far in India. It was quite spicy so it was best when we mixed it with some curd (a sour cream/yogurt type thing) and it actually ended up tasting very similar to a chipotle burrito bowl (which I have been craving recently) so that was really good.

We ended up just sitting at his house and talking for quite some time about a lot of random topics. One of the Indian guys knows quite a bit about America so we talked about America for quite a while. I think he knows more about America then we do, which is fine. We all also just joked around for awhile and they made fun of us for a variety of things. It was a great afternoon and I am so glad that they invited us over and made sure that we had this traditional Indian dish.

Saturday evening Courtney, Jill, and I went over to one of the ophthalmology resident's (Tanvi) room and talked with her for quite some time. It was really nice of her to invite us over and just chat about life with her. We learned more about India and the marriage customs as she is engaged to be married in January as well as her plans for after she is done with her residencies. She is a really awesome person to talk with so we had a great time just having some girl time.

Sunday night all of us went back to Tanvi's room and we brought pizza from the London Twist and she made us pasta. The pasta was so good especially since we haven't had any while we've been here. We spent a few hours in her room just chatting again and talking about all sorts of random things. It was a really great evening and so I hope that we continue to hang out with her during our remaining time because she is so sweet and just an amazing person to talk with.

What the biryani looked like 

Pasta and pizza

Rural Health Center and Mobile Clinic

Thursday and Friday we spent our time learning more about the outreach that the Center for Social Medicine at Pravara does. We spent Thursday at the mobile clinic. We rode in the clinic bus to one of the villages and parked there for the morning. Patients would come on the bus and talk to the doctor and then be given medicines at a low cost to treat whatever they had. There weren't a ton of patients since it was raining and the villages didn't know that we were coming. We took a lunch break and then a nap break while we were parked on the side of the road. The nap break lasted an hour and everyone (2 nurses, driver, doctor, Courtney, and I) all slept for at least a little bit of it. Then we drove to the next village and parked there and saw a few more patients before we called it a day and drove back to Pravara. It was nice to learn a little bit about the mobile clinic and to see how it functions. We found out that most of the month they go to places where there are migrant workers and they do HIV/AIDS screening tests because this population has a high risk of HIV/AIDS and then the other days are when they go to the villages. In the villages the diseases that they mainly see is a common cold and things like that. If the patient needs more investigations done then they are referred to the hospital in Loni for those tests to be done. We also learned a little more about the doctor and her family and she shared pictures of her son with us so that was fun.

Friday we rode the shuttle bus with some interns and residents to one of the rural health centers. It was also a rainy day so there wasn't a lot of patients to be seen, but we did talk quite a bit with the doctor and the intern. We learned how the rural health center works and that there is one for every 50,000 people in the area that Pravara is located. The patients then are able to go to the center and have all of their primary health care needs and some basic lab tests done here and if they need more specialized care then they are referred to the hospital in Loni. They do a lot of prenatal care visits and prescribe all the prenatal medications for the mothers in the area. They don't deliver babies at the rural health centers though, so moms are to go to the hospital around their due date to give birth. In the afternoon the lab technician showed us how to perform the HIV screening test and we were each able to do one of those tests with the blood samples of patients. He then also showed us how to do the hemoglobin test by hand and so we each tested each others hemoglobin. The highlight of the day for me though was when one small child actually looked at us and made faces back at us. I can't remember if I've posted this before but most of the kids here are scared of us. When we smile at them they look away or run to their parents pretty much as fast as they can. This adorable little boy though came right up to us and played with my watch, copied my facial expressions, and hide behind a curtain and then would pop out to look at me.

Villages covered by the Rural Health Center we were at

Testing Courtney's hemoglobin

Getting my finger pricked

Courtney testing my hemoglobin

Friday Fives

1. Going to Suguna's house and hanging out. It was so nice to look at wedding pictures, chat, try on sarees, and have a home cooked meal. 
2. Getting to skype with Erin. I sometimes forget how much I love to talk with her and so it was so nice to catch up on life with her and Courtney. The only thing that was missing was some nachos and juju juice from Jethros and it would have been perfect.
3. Great conversations after our time in Nashik. Talking with my mom after the first day really helped me process some things and then on Tuesday night Courtney and I had a really great conversation about the things that we saw as well as other issues. I like having real conversations with people that help me figure out my beliefs as well as how I'm feeling.
4. Shopping-going to Nashik on Sunday and buying some more clothes and food as well as going to the market on Wednesday and buying some stuff. Getting to go shopping always brightens my day.
5. Receiving packages. On Saturday I got a movie in the mail that Chris ordered for me. Then on Wednesday I got a call that Courtney and I had a package at the post office so to go ride a rickshaw there. We got there and had a character for a driver-he spoke really good English and then just said some crazy things so we laughed most of the way there. Once I got to the post office we found out that there was a package for Courtney and one for Wing Lee (sounds very similar to Emily) so we picked them both up. Courtney's parents sent tons of food so we won't be going hungry.
6. Bonus since last weeks Friday Fives were a little on the slacking side. Making collages with Courtney. I love cutting up random things from magazines and gluing them together. Courtney's not as much a fan so I appreciate that she did it with me and we made a collage for the other person.

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?