This is another long but disjointed post that certainly marks a change from the sort of things I’ve seen or talked about before. I’ve been having a lot of trouble finding time to sit down and write and as a result I’m not very happy with the outcome – but I owe you guys some stories so here goes. I’ll start with a copy of the written entry I made in my journal on a day that I finally felt I fit in.

Fri 1/30

Up for 30 min run and routine on roof, bkfast (eggs and toast and orange type fruit served with salt and pepper) with Ash, school – 7^th and 9^th grade kids were great and taught me to count in Hindi. Gave them books from the library for tonight and assignment to look up history of the Olympics in two different encyclopedias. Back for snack and over to empty OT and ran into Arun and Swaran – we looked at the physics of wheelies on the net then over to OT for steel rod insertion into a shattered pinky toe, a failed attempt at a shoulder relocation, and a very sick woman with terrible abdominal abscesses and some mad septicemia. Held her arms during surgery, helped intubate, and breathed for her on the way to ICU. Dr. Teresa saved caesarean baby’s life (blue, not crying long after birth, etc) and moved on in an astoundingly automatic manner, and then watched Dr. Sonal close mother. Now I’m doing more smaller tasks – getting gloves, wash, IV bottles, holding here and there, it’s cool to be more accepted and be comfortable with procedures. Haven’t been in OT all week and I love the teaching/OT schedule. Lunch of plain rice and snacks as Kavita is gone until Monday…hope we don’t starve. Played some TT and helped Avinash more on his application. Came back and worked out with Ash, showered and made dinner with a couple bottles of Haywards 5000. A drive to town for some chicken at the seedy joint and ran into Arun’s friend the silversmith! Back for soup and papaya and chicken and peanut dinner…hehehe thanks Kavita. It’s good to have a friend and it’s good to make new memories zpooming through Mungeli in 2 minutes 40 seconds watching movies with Dr. Teresa and learning how to make dentures. Today might be my favorite day in Mungeli so far – done everything I like with people I know and care about.

Since I’m running out of deep insights into life, I’ll try to make do with just talking about my days here. I’ve scripted a nice daily routine: up at 7:20 for chapel, morning rounds, breakfast with Ash (and now the Danes), over to school around 10:15 where I teach class 7 (and sometimes before recess, and class 9 for the last hour, then back to my room to wash up and get a snack around 1:15. The afternoon is often more flexible – I’ll see what Arun is up to, or come and write (happening less and less frequently), or most likely, head over to OT to see what’s going on. I usually end up getting stuck watching the gore until somewhere between 5 and 7, when a few of the nurses and I will go play ping pong for awhile. Then Ash and I have a workout from 7 to around 8:30 before dinner either with a movie and Dr. Teresa (while Dr. Anil is traveling), or down in my apartment before bed somewhere between 11 and 1:30. It’s a good schedule, solid enough for me to feel comfortable and flexible enough to allow some time for the unexpected.

I can’t even begin to adequately describe or tell of all the experiences I’ve been fortunate enough to enjoy in the time since the last post went up. Today itself (Sat 2/7) has been a whirlwind. I was awoken by Felix, a 26 year old German who visited the hospital for three months five years ago and is back for a very brief visit to India and who has become a friend in the past three days. I was sleeping in after an epic evening with Ash and the Danes, Tanya and Habib, which began with a toast to new friends and processed with spectacular conversation about many of life’s greatest issues centered around Habib’s Iranian heritage and his struggles in defining himself in a foreign and often hostile land. We touched on issues of God and the meaning of love and how we interact and relate with other people in this context. O it was awesome and we left with moistened cheeks and swollen hearts and definitely with new friendships formed from drinking in the human waters.

Man I’m afraid I’ve lost my ability to write, even my poorly scrawled 3 am journal entry says it better:

How can I explain the cohesion of hearts, the understanding of a loving bond upon which nations and cultures rely. Here an Indian, a Dane, an American and an Iranian Dane discover each other and find God with tears and joy for one another and for the excitement of times ahead. It’s not about what you believe or what you know, it’s about what you’re willing to explore. So happy – put Ash to bed and about to do the same – nothing like making new friends.

Ahhh this what life is about. So anyhow Felix woke me that morning because he wanted to talk about some disturbing images he had seen the night before and we sat on my bed while he told me of a burn patient who had been admitted the previous afternoon, a middle-aged woman with 100% burns. One hundred percent. He saw her only briefly in the ward but the image still haunted him almost as much as her whimpering cries of pain which kept him up in the night (his room in Ft. Henry being just 20 yards from the burn room in the lower ward). She passed on sometime this morning, but the impression she unknowingly left in her last few hours on this student from a place she had probably never heard of was so powerful that he needed to vent. So wow zip zing zoom welcome to life – my concern for my throbbing head was quickly overcome by the emotional onslaught he spilled forth. And then, not fifteen minutes into our conversation three guys from Orissa showed up on my doorstep wanting to meet me, the foreign guy visiting Mungeli. I hadn’t even put on a shirt yet. This is another topic for another post but Orissa is a state which borders Chhattisgarh that has been experiencing a wave of violence targeted at Christians and carried out by a group of radical fundamentalist Hindus. I briefly referred to this in the hospital tour story with the place where they live inside their walls under protection of arms – that was Dipdipur. Alright fine, you convinced me, now I’ll talk about that.

I don’t understand all the facts but I’ve gotten enough pieces of the story to give a rudimentary account. The violence is carried out on religious lines but was inspired, of course, by social and political issues. Much of this has come from Dr. Vijayakumar, much from Nancy Henry, Anil’s mom, and bits and pieces from other random people I’ve met. I’ve gotten two different dates on this fact so I’m not sure which is true – either back in the mid 80s or just two years ago an important Hindu Swami was killed in Orissa. The Maoists, a communist group, claimed responsibility for the murder, but this was not widely recognized and, in fact, it was blamed on the Christians (who are a tiny percentage of the population) by a small group within the Hindu majority. Now, it’s important to understand that this blaming was done by a radical fundamentalist minority group of Hindus, a group which has been gaining a foothold in Indian politics through representation in the BJP – one of the two major parties – the other being Congress (which currently runs the government). The Indian system of government is taken after the British model, so the party system is a bit more complicated. Basically people don’t directly elect their representatives; they elect parties which appoint their own members to government posts. So anyhow, the BJP is very pro-Hindu, Hindus being the overwhelming majority religious group in India, which opens up a lot of room for this radical minority to push its agenda. And their agenda is exactly what you might imagine – get rid of these other people with their other ideas and use violence as the way to go about it – blah, blah, same old, same old. So this group really just needs some excuse to come in and the assassinated Swami is a great one. But it’s more involved than just this – in Orissa (I’m sorry I can’t be more specific on districts I don’t remember all the names) there are also two groups of people who came into conflict, a tribal group and the low-caste untouchable type Hindus (I’ve also forgotten their names, but bear with me). So the tribals in India are given a lot of help and protection by the government, a lot of which are affirmative action type programs to provide opportunities to these “backward” people. These particular tribals have their own language, and it so happens that the wording of the government aid documents specifies that these privileges are to be given to the people who speak this language. However, many of the low caste Hindus also speak that language and used this to piggy-back on the tribal aid to advance their own positions which, needless to say, leads to resentment on the part of the tribals. It also so happens that many of the tribals are Christian because the earlier Christian missionaries had a much easier time converting these populations. So here my understanding breaks down as to exactly how the tribal/low caste Hindu tensions relate to the eruption of the violence, but I imagine these were also easily twisted into a discrepancy across religious bounds. There are a lot of amazing and horrible personal stories about homes and churches being destroyed, men being pulled from their cars and killed with axes, the rape of a nun in full view of the police, a little girl killed in the streets, a Catholic priest who was severely beaten and thrown in his house which was then set afire who managed to crawl to the bathroom and douse the flames with a single bucket of water. But universally, it seems that this violence is caused by outsiders, young men who subscribe to the radical views who are imported to do the work. The big wave of attacks in the fall was not neighbor attacking neighbor, it was more organized – convoys arrived and cut down trees to block the roads before moving into villages to do their grisly work. But now the national government has sent police units (like our national guard) to keep the peace in Christian areas like the hospital in Dipdipur. Still though, many of the Christians have left to seek refuge in the surrounding states. Anyhow, I admit that I’m not the most reliable source because I haven’t taken up a proper study of what’s happened but I hope you get a sense of the persecution and an appreciation of the amazing perseverance that Christian community in the face of great hardship.

So anyway, three of these guys from Orissa showed up to chat and we ended up having a really awkward and strange time. I invited them in and Kavita made tea and Felix and I sat and listened to their stories, all the while trying to figure out why they actually came. Anyhow I eventually showed them out, apparently without giving them whatever it is they were after. Hah, all this before I’ve even wiped the sleep from my eyes. So Felix and I then went off to school, where he’s been a huge help with his ideas and demeanor with the kids. We finished off three days of lecturing on WWII and the Holocaust with the 9^th graders (quite a change in topic from telling stories about magazine pictures and translating Hindi songs) which was, itself, full of amazing moments that I hope to write about later. Then we walked back to the hospital and started discussing plans for German students to come do their national service (mandatory military or social service either in Germany or abroad – which I think is a fantastic program) teaching in Mungeli. After a quick early lunch I went out with the intention of doing some serious writing to get another post up, but I was distracted by a wonderful chat with Dr. Teresa, Ash, and Felix and then by an extraction case in which Ash taught me how to give nerve blocks. Geeze – it never ends. I just stabbed a guy in the mouth with a giant needle – three times!

Ash is really straightforward with his teaching, and giving nerve blocks is second nature to him now so he also sort of ignored the whole preface thing – this was some mad OJT. So he sat me down next to the patient, an older man with an awesomely full freshman year Conference style moustache to sideburn affair, set they syringe on his chest and went straight into it. He showed me the necessary landmarks and gave a finger waving explanation of the area I was to work in before handing me the syringe with a warning that a mistake would mean piercing an important group of blood vessels and some serious hematoma. Hah! This reminded me a lot of his warning not to get my foot near the tire on our trip to Bilaspur – I’ll talk about that soon! So in I went, stabbing away, and with a little assistance on one of the blocks he was all set for his extraction. Simply fantastically incredible and totally ridiculous – third year med students can’t do the stuff that I’m casually invited to do in afternoon conversation, and that was easily the best experience I’ve ever had with lidocaine… But the best part came when Ash took the next half hour to explain facial nerve structure on a skeleton in the OPD waiting room, and then got carried away and just started talking – bone structures and injuries, muscle attachments, locations of important blood vessels, the beauty of the elbow, where epidurals are injected, ahh it went on and on for almost forty five minutes and I ate it up. We collected quite a crowd of onlookers who watched as the skeleton came to life, his bones now wrapped with a fleshy knowledge of the life construction he used support.

But now to talk a little more about the personages inhabiting these environs, for in addition to the doctor’s starring roles, the Mungeli performance has quite a large cast. There’s Arun in maintenance, a mellow and contemplative type who helps keep me busy on slow days and is my main translational link with the rest of the staff. There’s Raknesh, the goofy compadre who’s next mission is to teach me some basic ophthalmologic techniques and take me out into the surrounding villages on promotional ventures for the Feb. 16 Eye Camp so I can help generate some buzz posing as a foreign doctor. There’s Abejeet, an 11-year-old sixth grader with whom I walk home from school with every day and who enjoys quizzing me on my Hindi numbers and days of the week. There’s Wasim, an eighth grader who also sells me live (or freshly butchered (it’s quite the spectacle – I’m going to try to get a video on my camera next time)) chickens at his father’s shop in town. There’s the other hospital goofball, Lakshmi who works in OPD (out-patient department) and who always busts in the ECG room when I’m working on the computer to give me a brown-toothed smile that’s somewhere between friendly, formal, and how-the-hell-are-you-still-on-that-thing.

Then there are the nurses. Avinash is a ward nurse from Tamil in South India with an exhaustively rapid verbal style and whose written English I’ve been correcting on his B.Sc. (post grad nursing degree) application to CMC Vellore (one of two Christian Medical Colleges in India – the other being in Luthiana, both of which are top 20 med schools in the country). There’s Swaren, a soft-spoken senior OT nurse whose shell I’ve begun to crack with evening ping-pong matches. There are the older, sweatered and saried ward nurses who taught me how to remove sutures and catheters and who belt hymns in Hindi with impressive force in the forum which allows them to transcend their usually quiet demeanors. Then there are the three female OT nurses whose names I’ve forgotten but who patiently allow me around their workplace and who have started to offer smile-tagged waves when they’re not wearing scrubs. One has very pretty eyes, whose bashful gaze mine has caught over more than a few sliced abdomens, and whose subtle flicks I misunderstood during the production of that delivery-seared birth motion.

Then there are the supporting cast, mostly professional servants or laborers, whose roles pepper this experiential production with human masala. There are the saried women laborers whose patchy greetings serve as momentary interruptions to their work of making cement from gravel and sand, digging foundations with spades, and hacking down brush to keep the snakes away. There are the half-dozen members of the maintenance staff who double as chefs, bus mechanics, and watchmen and who bemusedly taught me in Hinglish how to drive a scooter. There’s the peanut lady who keeps me well-stocked with her sand-cooked produce, and who may be the first vendor on Earth to whom I’m a “regular” and who prepares “the usual” without my having to ask. There’s Kavita, whose daily “Good morning, sir” lets me know I’m still in India while the products of her dish and pan remind me why I came in the first place. There’s the little girl at the roadside stand who waves and says hello every morning as I pass by on the way to school, excited to make use of her only English word.

Lastly come the animals. There is hospital pig who’s startled me on more than one occasion rooting around bushes outside the dental department late at night. There are a clutch of stray dogs, one of whom recently became a mother to four adorably flea infested pups that sleep in a pile on the tiles outside OT when their space isn’t taken by the pensive relatives of a patient in surgery. There are the chickens and roosters, owned by Arun’s aging mother (who was a nurse under Dr. Victor Rambo, the eye guy who started the hospital) that are actually a special, and very valuable (and very delicious), breed of poultry. Hahaha while this is only a short list I hope you can get a better feel of the production of a day in Mungeli.

O my, so I really want to tell this story properly, but I also want to get up another post so I’ll keep it short (plus there are videos that are way better than words). On Sunday the first, Ashwin and I went to the zoo and spent the afternoon in Bilaspur. Yeah there’s a zoo – full of lions and tigers (the white variety) and bears. O my! There are also giant pythons and hyenas and leopards and deer and crocodiles and more bird varieties than I can count. The setup of the zoo is more like you would picture an animal preserve, a huge amount of land to wander amongst between different animal enclosures, and I had almost as much fun watching all the colorful patrons as I did seeing the animals. From there we continued on to Bilaspur for a mega spicy Indian style Chinese lunch and some shopping at a supermarket. I was initially really sad to be at a supermarket, but Ash was very excited to show it off (another theme of the trip – I want Indian things, they all want western things) so I ended up buying over a thousand bucks of groceries to stash in my backpack for the ride home. O boy I’ve forgotten to talk about the driving. We rode on his bike, a 180cc Indian made pseudo sport affair with is missing a headlight, part of a rearview mirror, and the passenger footrest on the right side as a result of a slight tumble Sudeep took on his way through Mungeli the week before he left. The headlight is only an issue at night (remember bicycle guy on our way back from Durg) but the missing foot peg meant that I had to either rest my sandal on the side of the bike or share the driver’s peg with Ash while trying not to interfere with the brake pedal. I know that sounds silly, but if I rested my foot in a more comfortable position above where the peg used to be there was a very high risk that it would slip into the chain or the tire and send us end over end to instant death. Hahaha the bumpy roads made the journey interesting – it’s quite fun to be airborne on a bike – as did a couple of cracks at the 100km/hr threshold. Like I said, I’ve got some awesome videos on my camera that do the experience of weaving traffic far more justice than I can here so I hope to get those up when we get home. Did I mention we weren’t wearing helmets? Hah! He also had quite a crick in his neck and was having a lot of trouble with the dust in his contacts, so when it got dark on the ride back our exhausted selves prayed our way in. The whole trip was awesomely dusty and I was almost brown and he was Ash(yer) by the time we pulled in for dinner, again some fun pictures of that on the camera.

This morning (Thu 2/5) I was awoken in the predawn hours by the blasting of my doorbell and a messenger who used sign language to tell me that I needed to go to OT and asking where the Danes lived. So I put on a shirt and jeans and marched over, determined not to be shown up again. The patient was being wheeled in through the double doors as I arrived, a big woman with an even bigger belly, with a baby inside trying his level best to get out. I groggily stood and watched the nurses flit about preparing the table (for night shift there are only two nurses and one doctor on call) as Anil went this way and that barking orders making sure the scene was set for the dual combo of surgeries (another caesarian was just behind this patient) and also feeling the crunch of his need to get on the road to head to Kodikanal, to visit his alma mater and Sheeku Jeetu. So anyhow, he invited me to scrub in and assist, and what person in their right mind would refuse an offer to help slice someone open, poke around a bit, and pull out a baby on the way. So I rolled up my long-sleeve “Come and See” shirt, washed my hands and arms with the OT bar soap, and for the fourth time, worked my way into a gown and gloves. Surgeries with Anil are about as no-nonsense as they can get, to the point that I’m no longer comfortable calling him Anil without that preface that knowledge earns. Anyhow, he’s a furious worker and demands the same of his staff and there were many instances that I was glad to still be wearing my cloak of ignorance. But that only works for so long, because, despite my best efforts, I just keep learning things! This morning was no different, and I’m now probably 10% effective as an assistant. Hahaha twice during the operation, once as I had my fingers fanned out clutching a contracting uterus in the open air and once when I held a pair of babcock-laced segments of fallopian tube, I couldn’t help but think to myself, “This is way cooler than morning practice.” After helping the patient get settled into the ward, I had to stop back in OT to drop off my cap and mask and pick up my sandals. There I ran into Kiati, one of the OT nurses, and enjoyed a few half signed, half broken English answers to questions about assisting technique and instrumentation. She was awestruck that I had scrubbed in without learning the names of all the tools – hah! What a convoluted and inside out introduction I’ve had to surgery! But she’s promised to teach me the names in exchange for some help with her English.

But all these happy stories are also tempered with the sad. I got pretty attached to the septicemic abdominal abscess patient I told you about earlier, so I checked up on her a few times after her surgery and the next morning on rounds – it’s interesting the connection you feel after breathing for someone. Though I didn’t understand all the science behind her case, I couldn’t help but appreciate how fragile her grip on this life had become. Later in OT the following day, I was sad to hear from Dr. Teresa that she had “expired”, an interesting term that reminds me of a conversation with Stoyel and Coach outside the market on the evening of commencement day – the issue of parting is too potent to deal with time and time again, so we mask it behind a benign term, a term designed to function without connection, to sever the link of caring effort with a distant finality that plainly says – your work here is done.

I came here to see, but can see no longer in the original way. It’s been fun helping the Danes get settled and to remember the feeling their faces betray of the exhaustion constant stimulation in a new environment brings, but it’s also been a bit of a shock to be shown just how settled I actually am. Ahh I don’t often like talking about myself in the public forum, but for lack of a better perspective I’ve been given my own lens through which to filter existence and project experience, and I can’t help but make this trip a bit about me. I’ve come to realize a few things about myself in the last few weeks, but I’ve realized them in that subtle way where you feel you knew them all along, you just had to reach your hand into your experiential chest to grasp the forms that reignite the spark of familiarity. In a concrete recognition of my strategic obsessions, I’ve found that once I learn the parameters of a system and understand the tools at my disposal my talent is in drawing the connections necessary to solve problems, and my satisfaction comes from putting each tool to its most efficient use (that and creating things; for while my training is in numbers, my passion is in letters, and I find another type of satisfaction in unleashing the Muse (even though my sentences are often run-on and I employ commas and hyphens under different rules)). I’ve seen here how these are valuable capacities in a surgeon, and perhaps explain why I’ve come to appreciate surgery in a way I never thought I would. Who knows where things will go, but if I ever do become a surgeon, I’ll definitely buy a sweet sound system for the OT to blast philharmonics over diced up patients, and this one won’t be donated to charity after we scrub down the theatre with Ajax.

Well the ECG rat has started his 7:30 tour of the periphery, and I must be off for a workout and dinner. It’s been an amazing ride these last few weeks, I really hope to get up another post in the coming days if time allows, but that will probably have to be my last in India. I’ve arranged to visit a friend in Ahmedabad this weekend and I probably won’t return until the 17^th, which won’t allow much time to sit and write with all the goodbying that must be done. So this is likely the end of the blog’s voluminous postage – I do hope you’ve enjoyed the stories even a tiny bit as much as I’ve enjoyed living them. I look forward to these coming days with melancholy excitement as I live in the keen awareness that the end of this journey is drawing near.

I guess now is also a good time to explain the Indian educational system as all this “Masters in surgery” nonsense is really confusing until you understand how it works.  In India everything up to 10^th grade works the same, they just call things by different names (primary instead of elementary, medium(roughly) equivalent to middle, and high is pretty much the same).  In 10^th grade they take a standardized national exam which starts deciding the rest of their lives.  In 12^th grade they take another which determines if, and where, they will be able to continue further studies.  Then it’s three years of career-focused education (engineering, medicine, teaching, etc) which is essentially our version of college but more intense and professionally oriented.  After that the med students do their residencies and are given the “Doctor” title, but not an M.D.  They are referred to as “graduate” doctors and can then continue their studies for what are essentially specialties like surgery, orthopedics, neurology, OB, etc.  So this is where the “Masters” come from, some specialties, like surgery, carry that title while others, like the medicine guys (M.D.) carry their own.  Hopefully this makes some sense. 

So anyway, I’ve been having loads of fun, and will take this post to share a couple of the cooler things.  First off, I’ve electronically introduced you to one of the X-ray techs, Arun.  His lowly underling (kidding of course) is the hospital jokester and one of the resident alcoholics.  For the moment his name has slipped my mind but I know it starts with an R, so that’s what I’ll call him.  Anyhow, one afternoon I was hanging out in X-ray and he sheepishly invited me to meet his wife, a schoolteacher in a village school five km away from the hospital.  After canceling a previous invitation for that blood and boot fest I told you about in the last post, I quickly assented to spend my free afternoon with him.  The bike ride was spectacular.  Though my passenger technique is still a work in progress, I have learned after years of teaching frightened kids to relax in the water that the same approach is fundamental to the bike.  It’s interesting to experience the dangerous dichotomy from the other side, trying to be smooth when I’m quite literally holding on for dear life.  So we cut through the wind on a sunny afternoon road, dodging construction trucks and bull-drawn hay carts, rattling over bumps and carrying on broken conversation at the start of a language-catered hosting session only to be found in India.  After about three km we took a red dirt side road for two more km, blazing past clucking hens and blue-horned cattle, beeping our way around saried women ambling across the path toting sparkling metal pots full of the evening’s water.  We arrived at the school, in a village of clay shingled houses where the walls gently bow outward, seemingly weary with their existential task of containing the noisy patter of child life. 

We entered one of the buildings and passed into a cool room where I was offered a chair, the plastic deck chair type that is here often reserved for the guests of honor.  I was introduced to his wife and two of the other teachers, family again.  He then took me through the school rooms where his artwork was on display, painted upon aged plaster walls, a map of Chhattisgarh, a diagram of the solar system, the physics and anatomy of the eye, a tiger, a peacock, and a lotus flower, a group of smiling children.  He was again sheepish as I complemented his skills, and hurried me back to his wife and a waiting cup of welcome water, which I warily pretended to sip, remembering all-too-well the wicked effects of bowel overestimation.  Then it was across to another building where 126 students were taught by three teachers in two rooms, and we thought RMES was cramped… While none of the teachers spoke English, this being a Hindi Primary and Medium school, they were extremely welcoming. And happy.  After a few minutes of joking conversation, we were back on the bike waving goodbyes to a dusty farming village and as a clutch of disheveled kids vanished behind our red veil of dust made motion. 

Being more comfortable on the bike now, I took some time enjoy the sights and smells which are no longer culturally jarring, but systems that I’ve begun to understand.  We plowed through gravelly Mungeli streets and stopped for a drink, he being unfortunately lashed to the bottle, and a pair of boiled eggs served with chopped onion, cilantro, and chili powder, a manifested realization of something he always says with a laugh, two pegs, two eggs, and two legs.  I also realized something else after a conversation the previous night over a dinner dual wielded in piled pots from Ash’s kitchen to Ft. Henry – India doesn’t grow hops.  Their beers, Kingfisher and Hayworth’s 5000 are malt liquors, and taste like college.  Anyhow, after our brief stopover we zoomed through the narrow alleys crowded with pedestrians, pigs, bikes, and trucks, to visit the man who is sponsoring the February 16 eye camp in Mungeli.  He is a wealthy shop owner in his sixties who introduced himself behind heavy steel rimmed glasses as the son of his father, as his own son explained that the camp will be held in memory of his grandfather, whose picture stood garnished with flowers at the entrance to their store. 

They invited us to sit, but R had other plans and we were again on the bike for a short drive to meet more family – a brother in law who owns a print shop cum mobile phone recharge center just across the street from the peanut lady I’ve come to love.  Another brief introduction to the liquor store owner and we turned another side street to meet an uncle in his bicycle repair shop, this time not bothering to destride the bike.  Then we made our way through a street past the vegetable lady who sells more farm fresh produce than you can carry for Ru 100 (about $2) before stopping outside a faded yellow gate.  He shouted “Mickey, Mickey!” and we waited a few minutes before making the handheld introduction (they shake for a long time) of his cousin, a teacher, who speaks beautiful English.  From there we turned a corner to his street, stopping over briefly to make the acquaintance of another uncle whose daughter I’ve started teaching in the ninth grade class at RMES.  She gave a bashful, toothy grin when I voiced my recognition as her father sternly nodded.  Then we were over a bump and stopped at his “mini house”, a six room affair with an attached garden and a ninety nine year old grandfather whose blue eyes startled me almost as much as his steely handshake.  Then we drove through another dusty field I’ve come to recognize across from the school to visit the home of his mother-in-law for some spicy snacks and tea.  They are a Muslim family where the sheer, flowing gowns of the women catch the afternoon doorlight as in sh’Allah farewells are offered to a fly-buzzed room of half-naked children and an alcoholic uncle whose couch I briefly shared as a foreign ornament to the masked stares of his cousins around the kitchen corner.  Then it was no-hands ride up the street to the hospital where R dropped me at my gate with a proudly humble downcast smile and invitations for repeat visits.  There’s nothing like getting some dirt under your nails in a new world-walked home, and there’s nothing like Indian hospitality.

Ash has since warned me about getting in with that crowd, but my visit here is brief, and as a guest I’m graced with the privilege of living outside many of the traditional social regulations.  I’ve tried to make friends everywhere, and I still can’t get over how easily a smile translates in Hindi. 

So, In addition to hospital observations, general maintenance and computer work with Arun, and frequent travels, I’ve also started teaching English at RMES.  My favorite kids are the 10^th graders, five girls and three boys who break down in stitches every time I (mis)pronounce their names, but whose English has already improved remarkably.  My least favorite group is the 8^th grade class, four obedient girls and about ten wild boys who are the first people I’ve encountered (other than in Agra) who have tried to swindle me.  But here they don’t care for my money, just the time I keep them chained to their desks.  They love to play this game at recess with a balled-up stocking in which one person grabs the ball and throws it as hard as he can at anyone in sight.  Then someone else picks it up and does the same thing.  It’s endless, and the only point is to enjoy the power of holding the ball and the chaos of running away – seeing this game made it a lot easier to understand Indian commerce.  These were my main classes for awhile, but they like to move me around a lot.  I’ve also been with the sixth and fifth grade classes for one period each and the seventh graders have been whining so I may have to set them straight tomorrow.  The younger guys are challenging on many levels and seem to hold all the right cards – in the classroom, they sit on the powerful side of the language barrier, they command mighty numbers (30 to 40 for the younger ones), and they wield attention spans short enough to cut through well-planned lesson (not that I’ve sacrificed any of those yet, but it sure sounds good).  Luckily, I’ve been able to conceal my severe lack of knowledge in grammatical structure by playing games centered around the noun and the adjective, but after these arsenals run out, I can only hope the verb will hold them at bay long enough for friendly reinforcements to arrive with adverbs and prepositions. Hahaha you really have to have a patient sense of idealism to serve on the fronts of ESOL. 

But anyway, I was late to school today, something that hasn’t happened since high school when 4 am wakeups made wolfing down sweaty second breakfasts more important than the first thirty seconds of Mrs. Jackson’s French class.  Haha and there’s another common cord between this memory and that – today I got up early for a workout.  I’ve tried a few times to be active in Mungeli, but after an autumn bout with pneumonia I’ve been hypersensitive about my lungs and have been picky about the air I choose to gasp instead of breathe.  Mornings tend to be best, immediately before or after (or during) chapel before the canteen cookstoves light up and while the damp air holds the dusty road at bay.  It’s easy to get in some calisthenics anywhere – pushups, abs, and the old leg circuit I thought I’d left in Sarasota – but I’ve been craving some aerobic work, and, since the biggest pool in Mungeli is my tin bath bucket, that means finding a place to run.  A couple weeks ago I was overcome with desire to exercise and went across the street to a dusty field for an evening jog.  Silly me – the air was bad and bumpy tracks in the dark are hard to navigate, especially when being pursued by packs of potentially rabid stray dogs.  So Ashwin found a new place to run – the roof of our building.  It is certainly not an ideal circuit, for starters its only 20m x 8m but its also contorted around the edges which requires some tricky footwork around a particular bend and also has a clothesline on one end whose cables hang at just low enough to catch a neck at the upbeat of a running stride.  But there are no dogs on the roof (though a group of monkeys make the occasional visit they haven’t caused any problems yet).  Luckily, two decades of lap swimming have helped me master the zone-out, body-does-one-thing-mind-does-another technique so running up there is pretty easy as long as I change directions every so often to give my legs an equal share in the continuous turning work.  But anyway, after a few days of gorging ourselves with dinners and movies (Ash and Teresa have been teaching me how to make Indian food) while Anil’s been away for meetings, I was looking forward to a relatively long and relaxing run.  Hahaha there’s a great ceramic wall-hanging in the Henry’s dining room that reads “We Plan God Laughs” which is such a perfect summation of the Indian experience, and this morning was no exception.  Just as I was getting into my stride Arun called to say that Anil needed photographs of all the hospital construction sites for his meeting with an architect friend in Bangalore this afternoon.  Hahaha I’ve also learned better than to jump to for summons like this, so I gave it another 10 minutes before heading down to take the snaps.  Long story short, it took forever to upload the pictures and I didn’t make it to school until 11:30, recess hour.  But today I went laden with an Encyclopedia, a gift from Teresa for the library (which is still annoyingly unused and hurting for a system of implementation – a juicy job for the next group), and I soon found myself sitting in the entranceway surrounded by teachers just as eager to thumb through the book as the kids in my next class.  It was an incredible moment that actually brought tears to my eyes – this group of teachers at the table to my left huddled over a volume packed with secrets they’ve never seen, screaming kids swinging around the playground visible through the window bars beside them, and the older girls walking hand in hand through the dusty yard towards the doorway in front of me.  These were people I’ve come to recognize, people whose names I’ve learned and whose homes I’ve visited.  I came as an outsider to see their piece of the world and I came as a 22 year old kid on a year off after graduating college to learn what I could from a small hospital in rural India.  And here I found myself in a worn out schoolhouse in a worn out wooden chair fighting back tears as I saw so plainly the unwrapping of a gifted moment whose reality revealed a gentle understanding of the blessings I’ve received and whose perception shone through with a love I can’t explain.

About two weeks ago Anil invited me on a three-day trip Anil to tour seven mission hospitals in the region with Rev. Dr. James Vijayakumar, the Global Ministries area executive for Southern Asia.  While it was often fly-on-the-wall observation, there is no better way to learn a game than to be present when the pieces move, and I really got a sense of the big picture in India, in the Christian community, and especially in the mission hospitals.  I could write a volume on just this weekend but for the sake of the blog I’ll just summarize.  We saw many places and met many people, toured established hospitals built up by Anil’s parents, withering hospitals awaiting their time to die, modern and misguided hospitals where the ICU was made as an income stream, deteriorating hospitals in need of fresh leadership, and persecuted hospitals where Christians live inside their walls under the protection of arms.  It was an incredibly educational and unbelievably exhausting journey through the various manifestations of Christian goodwill.  Seeing all these things, I couldn’t help but think about India’s numerous problems.  The biggest and most pervasive issue is corruption.  It seems that everyone will take a skim off the top if they can get away with it, and therein lies another major issue, the inability of the government to enforce its own rules.  This vicious tag-team stagnates development like you wouldn’t believe. 

In the same sense, here in rural India, it is incredibly easy to see something that’s been drilled into our heads since childhood as the American Dream, in a different light.  In a nearly feudal societal structure where caste still very much determines the means to life’s end, those born to privilege are the sole holders of opportunity.  And nearly everywhere, it seems, even in the Christian mission hospitals, that gift of opportunity is hoarded for self-promotion and lorded over the miserable masses.  So coming in as an educated and (by local standards) relatively wealthy foreigner, another childhood mantra is stunningly apparent to me:  the power of one.  It’s like the general/governor system in Total War, for good or for ill one well-equipped individual can make all the difference.  The real sticking point is the rare combination of visionary leadership with a focus on serving others.  It is a broken system that was never whole; its fractures swallow the masses while the fortunate stand securely on the pillars of surname. 

So how can India repair itself?  That’s the real question.  There is no easy answer, but I can think of a linked issue on a smaller scale:  how can we change the Mungeli culture of last-second caesarians and walk-off deaths?  The cause of the first question is a result of the second and the cause of the second is a large portion of the reason the first is an issue at all.  A roundabout comment on a convoluted situation, but I think I found another analogy that works:  a big bowl of spaghetti and meat sauce.  The spaghetti noodles fall this way and that, tangle here and there, and intertwine where they may.  The sauce poured on top is filtered by the weave of pasta so that most of the meat and much of the sauce stay on top.  So we can think of this spatial representation of Indian society – the noodles being citizens, the sauce education, the meat wealth.  The noodles on top are covered in sauce and meat, but as we move down into the bowl the meat soon disappears and the sauce coating becomes thinner until, soon enough, the bed of the bowl is just a steamy mess of smothered noodles.  That is how today’s dinner is served, and how the noodles with meat and sauce prefer things to be.  The noodles with sauce but no meat will struggle their whole lives through for a chance to touch some, but gravity is not in their favor.  Even if a lucky few do chance to catch a smaller crumb of beef that fell between the cracks, they spend the remainder of their lives hoarding it over their peers.  Now there seem to be three obvious ways to remedy this situation, all of which are the responsibility of the central government.  The first is to cut everything up with a fork and knife to spread the sauce and meat around, but that experiment was done last century and just makes the entire dish cold.  The second is to eat the whole bowl, but Pakistan doesn’t seem that pissed off yet.  The third is to make more sauce, and this is the solution I’ve gotten from every piece of Indian spaghetti I’ve asked.  Education for the lower classes, not just to open the doors to new careers and a higher standard of living, but on a shockingly fundamental basis – to teach people that there are consequences to their actions, to awaken rudimentary analytical processes, and through this, to empower them to hold their elected representatives accountable – for the problem of enforcement can easily be blamed on the government, but in the same way the problem of corrupt government can easily be blamed on the people in whose name the it rules.  Education will lead to a new way of thinking about life, and again I’m talking about the immediate and tangible differences that come from literacy, not from the luxury of tacking on some extra initials behind your name.  Education in Mungeli is something that RMES tries to provide so these children can grow up to a better life.  But there’s the rub, the haughty pivot – “better.”  It’s easy to say that squalor and hunger are bad but it’s less easy to say that power and wealth are good.  But again, that is my judgment on our own social structure – shouldn’t they have the chance to form their own opinions?  Our negligence of humanity’s lethal poverty is not the same as killing outright – it’s like choosing not to save the defecating baby.  Isn’t it better to lose the baby in the midst of the attempt?  The end result may be the same, but the difference is the mental-emotional framework of action grounded in compassion.  There is need and you have the means to a solution.  A solution, one solution, but it is the one we know, and I believe it is, in fact, better.

The hospital in Mungeli is the only real corporate producer to be spoken of in the town, and it is the key to unlock the heavy gate of progress.  This hospital exists because a missionary doctor named Rambo thought caring for the needy was important.  Today it is the nucleus of betterment in Mungeli, providing higher quality care at less than half the cost of hospitals in Raipur, regular employment for both staff and day laborers, opportunities for career advancement through sponsorship of nursing and doctoral students, and education to the area’s children through RMES.  Establishing infrastructure and education are the first steps towards sustainability.  But to sustain here there must be a reason to come back.  Why would the educated choose to work here?  Even nurses only stay out of obligation.  Life is hard, poor, and small; nearly a monastic existence of medical labor and Christian reflection.  And here is the main problem in the mission hospitals – the lack of dedicated doctor-leaders who are willing to take responsibility for others at the price of irrationally high opportunity costs.  The solution to this problem is also not easy, as it requires irrationality towards popular social virtue, a trait that pops up maybe once in a million. 

On his last day in India, Rev. Vijayakumar delivered a wonderful message at morning chapel in Mungeli.  He spoke about a passage in Revelation in which the crystal waters flow and the servants of God wear His name on their foreheads.  One of his most important points was one that we’ve all heard before, but, at its core, is really the fundamental challenge of being a Christian.  He asked us whose name is written on our foreheads, because all of ours say “prestige”, “success”, or “comfort” from time to time.  It is easy to get caught up in life to the point of enthrallment, a term I’ve grown to love since it’s meaning was explained to me by a Kenyon professor in a course on Paradise Lost.  Enthrallment is enslavement, but it is not an imposed dominion, it is our own willing submission to something that is unworthy of our devotion.  But looking deeper there is more:  the control of our desires and our attempt to life God-centered lives really is our true, and really only, means to express love within our gifted structure of free will.  But after facing that, there is more: these words are of our own penmanship, not in the sense that we directly put ink to skin, but in the way we script our lives.  His name is worn on our faces for others to see, and it is obvious but not overbearing; it is a brand and not a banner. 

Here I’ll change course and talk a bit about my experiences at the hospital.  First though, another observation: the power of touch.  Removing sutures, sitting in crowded cars, eating with my fingers – the proximity of life creates a different sort of connection, one in which life here is very personal.  This is no less true in OT, and one I first found to be almost overwhelming…  The next few sections are written mostly in diary immediately after I had the experiences.  I could easily flush them out but for desire to get up another post I hope you enjoy them as they are.

A patient came in complaining of chest pain, his X-ray showed his left lung was completely filled with fluid.  Sudeep sat him on a stool and made an incision in his side to feed in a soft plastic tube which became the outlet of a spectacular foamy cascade of 3 liters of yellow fluid.  It looks like dehydrated urine and splashed on my open toes.  That was shocking.  Just up the hall I went to check on a moaning woman who I thought was in labor, but her legs were covered with abscessed injections and the surgeons were working their fingers in her wounds in search of puss. 

Chest tube guy has been here for about two weeks and I often see him walking around outside, tube in tow.

Rushing around one morning round we ran into Sudeep who had a difficult case to discuss with Anil.  A 29 year old woman, pregnant with her fifth child, one previous caesarian, ready to deliver but only dilated 1.5cm.  We headed over for a visit to the ultrasound.  After some time, Anil probing her insides, it struck me that there were six people in the room, but no, there were actually seven, one of us still hidden in our first nest.  Three of us, two of her family and myself, were staring blankly at the ultrasound display, not understanding the grainy images rolling around inside her belly.  Here too the language barrier held me at bay, Anil and Sudeep consulted in serious tones, Sudeep filled out some paperwork and questioned the family members who were no more nervous looking than any others I’ve encountered, Anil called in a nurse with some gloves and performed a digital exam and again consulted with Sudeep.  Then he turned to me before talking with the family to let me know that there were only six of us after all…                                                     

So just stepped out of OT where I was invited to observe a laparoscopic removal of a kidney stone, unfortunately it was too compacted to extract so a stent might help the patient do the job on her own.  Towards the end of the surgery a woman came into the other OT screaming and shouting and thrashing causing a big scene.  She was pregnant and her baby was due and was also forcing her blood pressure to dangerous heights, pushing her into an hysterical deliria.  Six nurses and attendants fought with her wrangling extremities while Sudeep calmly and cleanly went about his work – he had the baby out in thirty seconds.  I’m not sure exactly why, perhaps because of the baby, perhaps something to do with her BP, perhaps because she was so difficult to control, but they used local anesthetic to take the baby and then had some difficulty sedating her afterwards because with her uncooperative demeanor they weren’t able to get a main line IV, instead opting for her hand, which being a perfectly constructed agent of acceleration (think Frisbee throwing) was also not an ideal site for an injection.  Be that as it may, she needed diazepam so Sudeep would be able to properly close and wow, it was chaotic bloody mess.  Eventually Anil and a couple nurses managed to make it happen and it fell to me to hold her bloodied and writhing arm to prevent her from ripping out her IV catheter.  The most important thing is that she and her baby boy are ok, but wow – I’m still kind of amazed at what just happened; that was A.W.E.S.O.M.E. 

I went home for lunch that day and, for the first time in my life, washed someone else’s blood from my hands.

On the 21^st Sudeep again invited me to get my hands properly dirty and I scrubbed in to “assist” him in a hysterectomy.  Again, he explained the steps he was taking and answered my questions along the way, assigning me small tasks during the surgery to keep me engaged and actually help, too.  At the end came the kicker as after watching thousands of stitches he figured I would be able to put in one of my own.  When he told me to come on the other side of the table to finish the last stitch it was like being called onstage at a rock concert, total tunnel vision and a nest of butterflies, the forceps and clamp felt unfamiliar and so did piercing flesh.  But with a little instruction I was able to complete a stitch, and thanks to Sudeep’s willingness to teach, will never forget how to make that suture.  Being inspired by this intense personal engagement, I spent the whole day in OT.  Dr. Sona explained a hernia repair and I got really excited, to the point that I’ve borrowed an anatomy book to start learning about the things we see every day.  Surgery is like the ultimate puzzle, you have to take things apart in such a way that after you’ve rearranged some of the pieces, you can put everything back together again.  It’s also an amazing performance of well-planned execution, my favorite part of which is before the first incision when all the doctors fold their gloved hands and take a few moments to pray over their patients.  Later that afternoon came another experience, which at the time was more bewildering than anything, but in hindsight is top 5 coolest things I’ve ever done.  Sudeep and Anil had me scrub in for a caesarian.  In this case, racing to get the baby out, I was keenly aware of how out of my element I was.  I understand all the basic protocols well, but the job of an assistant is to task manage equipment so the doctor can focus on the patient, and I am still quite inept when it comes to which clamps are needed when, which needles are used on which tissue, and how to properly pass instruments.  So, of course, for this one there was another, real, OT nurse assisting.  Another element that made standing at the table a little more difficult is the fact that all the nurses speak only in Hindi and choose to use subtle head nods or looks with their eyes to point out the important things I need to be doing.  This mode of communication feels very casual compared to their intent so that I often totally fail to grasp the fact that they are talking to me!  Also, Sudeep is a gentle guy and speaks softly, but speaking softly with what I hear as a strong accent, behind his mask where lip-reading is right out, I sometimes don’t understand all of his instructions either.  Hahahaha seriously, how do they let me in there, I can’t believe it either.  But surgery is also very intuitive, there’s obviously a huge knowledge barrier as to the what but a little less with the where, and less so with the how.  Open in layers, manage blood supply and enervation, deal with the issue, close in layers.  It’s really neat again to have this perspective, totally on the outside of the theory, but able to recognize, and even perform, some of the practice.  Anyhow, I was actually assigned real tasks during the caesarian and stood with my hand on the patient’s belly as Sudeep extracted the cord-bound baby.  The feel of that birth-motion is forever burned in my mind.

End of diary section

Ahh heres another fun story – how I became the third victim of the roads.  Anil, Teresa, one of their uncles, their two pugs, and I made a trip to Durg a city southwest of Raipur, to partake in a family celebration of two matriarchal birthdays.  I was already feeling a bit woozy that day and was napping when Anil called to say we were leaving (this woozy feeling later developed into a three day challenge of my intestinal fortitude), so I quickly wolfed my lunch, a pot of ramen-type noodles flavored with tomatoes called Maggi, and headed out.  About fifteen minutes into the drive, just as we passed beyond the craterous roads of Mungeli I got a wave of nausea accompanied by some serious worries.  But I managed to suppress it and was fine for the next half hour of rocky country roads.  At that time we had taken the dogs out of their cages to roam around the back seats, and one of them, Bozo, was squirming on my lap and continually poking me in the stomach.  This was the uncomfortable first factor.  The second was a fully-cranked, almost violent guitar riff on an album of Santana’s greatest hits.  The third was one bump too many.  These three combined for an incredibly fast and overwhelming wave of nausea that was more than I could contain, and before I could even properly alert Anil, I sent three fantastic streams of ketchup-flavored Maggi juice all over the floorboards.  Hahahaha there’s nothing like meeting half the family with your clothes covered in your own vomit, and also nothing like watching your president’s inauguration from India, in an acquaintances’ relatives’ house with your clothes covered in your own vomit.  I must pay respect where it is due:  Barb and Nancy, well done, it was only afterwards that I realized the window control button was literally under my thumb. 

After the celebration as we were making our way through the darkness outside of Durg, we were chatting and laughing about the chances of another epigastric incident when we came upon a man splayed out in the road alongside his bicycle.  We stopped and turned around to check on him, he still had a pulse and was breathing, and Anil called in to the police.  This was a personally risky move, because often when accidents are reported the police will assume the person who called is the responsible party.  In this case, however, they had already been alerted and were on their way.  We waited around while darkened pools head-drawn blood thickened on the tarry asphalt, and we were about to move him off the road when a bike arrived with two men and a flashlight – the police.  After some debate with Anil, the three of them decided we would bring him back into town to a government hospital.  So the seats were folded down to make a temporary bed and the policemen lifted the injured man inside.  Everyone squeezed in around him and we made our way to supposed safety to the haunting rhythm of a deteriorating airway.  At the hospital the police ran in for a stretcher onto which we placed his wilting form, and while they hurried him in to a doctor I wiped his blood from the seat-back with a handful of Teresa’s tissues.  On our second trip out of Durg that evening, Anil adopted his passive tone, which I’ve learned to interpret as strained, exasperated, upset, helpless and is used all too often when talking about other healthcare centers.  The doctors he left the accident victim with were nearly inept and entirely unwilling to take responsibility for his care, immediately referring him off to a ward where he would be assessed and referred to two other hospitals before ending up in Raipur, if he survived that long.  

From a conversation I’d had earlier that night with Dr. Joseph, an ophthalmologist who we met on one of our hospital tours in Deepdipur, I learned that applying to medical school in India is quite different from the process in the States.  Admission depends entirely on one exam.  GPA, extracurricular activities, exposure to healthcare, and, perhaps most importantly, motivation to become a doctor, mean nothing.  You take an exam, receive a rank, and the top ranked people are admitted until the number of allotted seats are filled.  There are no essays, no drawn-out applications, no interviews.  And the education is similarly non-personal.  The whole thing feels a lot like a class at Tech – you get your gtg number you sit in lecture, or not, you learn the material, or not, but as long as you perform well you are rewarded.  This system has its merits, but when it comes to healthcare, and especially difficult or risky cases like our bicycle accident guy, Indian doctors seem more likely to wash their hands of a life than risk tarnishing their reputations by losing a patient in the attempt to save him.  The major prestige professions here are engineering and medicine, and from what I’ve gathered so far during this trip, many, if not most, of the doctors here look at their profession simply as a prestigious way to make money.  Speaking as someone currently going through the application process in the States, the painfully obvious missing factor in all of this is care.  The medical incentive structure here is misaligned, and the way to fix it is at the beginning – screen for students who would become good doctors, not just those who have a good grasp of theory.  It seems so easy.  Too easy.  For change means upsetting the entrenched elite of medical education, who are happy with their own prestigious positions and not at all inclined to disturb the festering mire of the normal.  Sill further back comes this idea of normalcy, the ideas of honor and prestige, the societal focus on education, and the cultural focus on self.  As I took off a vomit-stained shirt (that white collared shirt you left me, Nancy) now streaked with the blood of a man I’ll never see again, I realized that all these factors play their role in creating the uncaring physician. 

Something that’s been ever present in my mind over the past couple weeks is the privilege of perspective, and how it is quickly it retreats behind normalcy’s steady advance.  I’ve realized I find it more difficult to see great things as great or amazing things as amazing.  I just watched a sixteen year old girl have an abortion, yet somehow it was almost routine.  Perhaps I’ve been desensitized…perhaps, but life and death happen, and here is a place that stands in between.  I know this post is a bit more reflective, perhaps even pessimistic, but life is not performed in a rosy glow on the far side of the world.  Gravity still applies, the plants are still green, and people are still just people.  It is good to come and see something different.  It is good to shake up perspectives and think about the way we live our lives, for it is too easy to hide from ourselves, and each other, in the cloak of the other, promising that things will be better with distance, change, or time.  But being alone in a foreign land, it is hard to hide from yourself…

For us then, it was back to our place for breakfast, usually eggs and toast with hot water for instant coffee and then off to work on an activity until lunch hour around 2:30. Molly and I spent one day working with Annkita’s computer trying to update software and connect to the internet so she could complete her tenth grade project, a movie on rural healthcare. While Tadd turned his attentions to the accounting office, Barb, Nancy, Molly, and I spent the next two days painting the outer façade of the hospital and attempting to learn snippets of Hindi much to the toothless bemusement of our gawking local entourage. Being trained more in skills of the mind than skills of the hand, we were less than clean (though in our defense the paint was so thin it was like brushing water) but after a few coats and a few touch-ups the hospital entrance now shines in fire-engine-red glory.

Early one morning, as the 5:30 Call to Prayer sent its invitation drifting through the dampened air, my jet-lagged mind spent some time thinking and reflecting. As the dewdrops give form to the intangible fluid, anchoring their place tips of grass they do not choose, playing their part in their own cycle of life, some amorphous ideas coalesced in my mind while I was scratching my mosquito bites in the epic hours. The previous day the Muslim TB woman was taken out of the ICU by her uncaring husband, who no longer wanted to foot her bills and had completely washed his hands of her imminent death. Later in the evening, the young burn victim was also taken by her family and by this hour had surely passed beyond her physical agonies. I was frustrated to confront this bitter failure of care and I started trying to wrap my head around the issues. The best I could come up with was a question to myself, “How I would handle Japanese encephalitis were it to strike now?” I would pray and I would trust. How does the burn patient handle her state? She probably prays in the way she knows and trusts those she has been taught to trust – it is what she knows and in her state perhaps she was more comforted by a family-nested death than potentially life saving care in an invasive and foreign environment. If someone doesn’t want to be cared for, what can you do? I asked Anil later that day and he gave the same answer I found: nothing. We can want but you cannot force reception. It’s kind of the reverse of an old Coachman adage, “Nobody can make you feel inferior without your consent.” There is nothing but energy intensive education that may change their minds.

One afternoon we also manned the game stations at the Rambo Memorial English School (RMES) New Year’s Fair, the setup for which was a classic epic of culture clash. We were told to arrive for setup at 10 am, but knowing how things work, Nancy and Molly didn’t show up until noonish (Barb went to OT with Anil, Tadd was doing accounting, and I was content to paint). But there was nothing to do and no one who understood English so they returned for a lunch break. We went back between one and two, as the fair was supposed to start at two and we wanted to be ready ahead of time. Silly us. We ended up doing some more sitting around until about 1:45 when the guy we were supposed to be working with rolled in and told us that we were meant to have all the supplies for the games. This was a huge and frustrating surprise because we were told that he would have everything we needed the previous day at the end of a 40 minute meeting conducted almost exclusively in Hindi. Anyhow we went panicking around the hospital trying to drum up a ring toss and five balls but a stop at Ft. Henry and a quick word with Theresa proved to be our saving grace: she had all the supplies from the previous year’s fair in storage. So, we went back to the school and set everything up by 2:30, just as the kids were arriving. We may have been a little under prepared materially, but we were decidedly under prepared mentally for the dizzying onslaught of orderless excitement that greeted us. The kids threw their game tickets at us with reckless abandon, pleading and squabbling amongst themselves for position. Ahh it felt like Agra all over again…they learn to fight but they also learn how to accept not getting what they want, for when all the prizes were gone, even those who didn’t win walked away happy.

That night I spent some time trying unsuccessfully to get the blog pictures up. As I was clicking away on Terry’s computer, Barb, Nancy, and Molly came over to say that Anil had called us in for a caesarian along with Shaiku, Parveen, and Annkita. Having children in the OR or OT (operating theatre) as they call it made the show into quite a spectacle. Their innocent and curious commentary made half of the procedure a continuous chuckle, and it was refreshing to see stoic procedure undercut by wonder. But even as the Renaissance, the Reformation, and the 60’s have shown, after discovering we must categorize to understand, and this inevitably leads to another establishment. We were privy to the reason behind the establishment of OT methods as the doctors labored in their furious formality to extract a dying baby, who was passing stool in his final panic mechanism, a feeble instinctual attempt to clutch at a life he did not know. “Not good,” Anil’s words tersely described a situation we didn’t understand as the mother quaked and moaned. In the end, the baby and the mother are ok and, after our harrowing structural lesson, we were left with an emotional treat: an image of Shaiku and Parveen touching the soft hands of a fresh life, still specked with gore from his first brush with death, a death prevented only by generations of knowledge manifested in the right place at just the right time by the sweaty team beside them, routinely closing up another patient.

On our final day as a group, we went over to the school for morning activities (morning formation is probably a better description) sans Tadd, who had unfortunately fallen ill during the night. The uniformed children lined up by grade and, led by their upper class prefects, performed an elaborate nationalist ritual of salutes, chants, and songs that put the Pledge of Allegiance to shame. We then setup the new school library, a single bookshelf enclosing five boxes of books held under lock and key, and took a tour of the school classes. I think we were all initially very unimpressed with their educational structure – particularly with the fact that it is an English school where the teachers can hardly form coherent sentences, but after being around the area a bit longer and getting a sense of daily life, even that palsied touch of knowledge is the best bet these kids have of a better life. We toured the school with Rev. Sona, a minister, retired teacher, and now principal of the school (in typical small-town fashion, everyone here has at least three jobs). We wandered through bare rooms packed with children who stood and issue well-metered greetings of “good morning sir” and “good morning ma’am”, politely rehearsing for the strangers peering in on their worlds. But, at recess the kids ran wild, their white teeth and eyes flashing against sun-browned skin. Their starched attentions turned to dynamic hoards chanting, clapping, tussling, and throwing pebbles. They are good kids. A group of young ones, not more than five years old, stood at a distance, being not yet able to navigate the playground’s physical or social structures they played in smaller ways amongst themselves. One moment, in particular, stands out in my mind – a little boy with peek-a-boo shoes throwing arches of red dust into the crowded air, a chaotic creation which framed well the playground tangle of child-motion.

In the midst of all this activity came a question Nancy asked as she was thinking about our time here, “How did you serve God in India?” The answer to that question is tricky. Before leaving I had a talk with my brother about the formation of habit, a point that I lifted from many poolside lectures at Kenyon. The idea is that we don’t suddenly become someone new without making it happen, or without allowing it to happen. Daily life here has its differences, but they are differences to which we slowly allow ourselves to be come accustomed. When the glossy feeling of newness wears off we find that life is, yet again, just life, and each day is just another day. In this sense it can become easy to wonder, how did I serve God?

“Come and see” was our invitation, an invitation with many layers, but centered on the connection between us and them. We have done many things in India– eaten her foods, shopped in her strange markets, choked down her dust, wandered amongst her monuments, shared smiles and unspoken understanding, seen new life brought forth, and watched neglected life slip away. We’ve formed relationships, which however temporary they may end up being, have left impressions that are sure to last a lifetime. We were given a short window of opportunity to laugh and cry and wonder, and to construct with our individual gifts something with bettered the life of another. So how did we serve God? In the same ways we did at home, for action is our tool but shaping a humble and contrite heart is our true service, a service which knows no bounds within any activity and which requires no place to perform. Come and see – an invitation as welcoming as you allow it to be.

Around 9 o’clock we received word that a tiger show had opened and we rushed to the central complex to buy tickets.  By the time all was settled, we had about 50 cars and an hour wait ahead of us, so we settled in for a breakfast of boiled eggs, toast, and fruit along with a few amusing encounters with a family of nearly domesticated monkeys.  At one point during a group restroom break the kids were left alone in one of jeeps and were accosted by a grumpy monkey searching for food.  They managed to frighten him off, but not before he left a little calling card on the driver’s side door handle…  Before long we were off and formed yet another orderly line along the road next to the elephant pickup/dropoff area.  The tiger was barley 30 meters from the road, which called for a code of silence which was actually enforced quite strictly.  On our turn we mounted the beasts by ladder for a gentle, rolling ride through a gully and up a hill to a big shrub in which the tiger lay, patiently contemplating the best means to extract himself from his observational predicament.  I was on an elephant with the kids, but they put me to shame with their mature excitement as I was bounding around twisting this way and that to get a look and a picture of his regal eyes gazing at us from his woody chambers.  Suddenly, the tiger decided he’d had enough and made a break for it, leaping over a few fallen trees trying to make his way back into the forest.  But our elephant guides were well-versed in tiger trickery and, after a brief and exhilarating chase, had him subdued again in an exposed patch of sun.  You better believe it was snap snap from there and I hope you’ve been able to see some of the great images we captured of a magnificent animal (I’d put them up but I still haven’t figured out this silly photo feature).  On our way back to the hotel I had a funny realization:  that elephant ride was the most organized and efficient system of transportation we’d had so far in India.  I guess economically (come on, you knew it was coming…) the incentives are well aligned for the park officials to get the maximum number of viewers of the maximum number of tigers because you better believe they make maaaad bank off the foreign tourists (our rates were 3x higher than native rates).  The drive back to Mungeli was again well-packed and bumpy but this time also laced with a slew of 70s and 80s dance tunes and an absolutely fantastic display of sleeping power by Shaiku, who’s unbelievably limp body was draped across my lap, his head smacking against my knee in a mirrored response to the road’s concavities. 

Being New Year ’s Eve the Henrys naturally put on a grand party for the staff and their visiting family and guests.  Again, our staunch American manners had an interesting time adapting to the relaxed nature of the gathering, without being chaperoned we grappled with terse social interactions, overly conscious of cultural taboos.  Hahaha but the food was excellent, BBQ chicken wings, German potato salad, and some kind of awesome fruit pudding, an obviously welcoming (and appreciated) gesture to appease our blander palates.  Anil played a fine host, flitting around the house, carrying the party with him, but the best way to engage strangers is to give them an activity, and fireworks being left to the kids, we soon found ourselves corralled around the karaoke machine.  Unfortunately for our tone-deaf group, the Henry clansmen are massive musicians and the rules of etiquette required our participation.  But Tadd did us proud, belting out renditions of classic rock songs that I didn’t realize had reached India, and closing with a group performance of YMCA much to the other guests’ amusement.  We left a little early, citing exhaustion, but in hindsight I wish we had stuck it out for the ball-drop.  In fairness though, we went down hardly bothered by the ripping explosions that speckled the wee hours of 2009.

(after writing this next section, I realized its incredible cliché, but I think the cloth image works, so just let it happen) The next morning, as I lounged on my bed after our first proper night’s rest in too many days to remember, I admired the wonderful designs on my sheets and spent some time thinking about the beautiful and intricate things we create, putting tangible form to an expressive desire.  Our journey through India so far had been a whirlwind of sightseeing and entertainment, a tourist trip which, while exciting, was not the sort of experience I had expected.  I know I was not alone in wanting to get into life at the hospital and start giving back.  From there my thoughts progressed to the relationships among action, beauty, and purpose, a theme which continued through the New Year’s church service where familiar ritual was shared in a tongue we did not understand. As the women of the congregation stood taking communion I was taken in by the intricate beauty, sharp colors, and flowing forms of their saris.  The superb quality of their dress stood in sharp contrast with the surrounding conditions, where rustic simplicity is the rule.  Expanding this idea further highlights a broader, seemingly contradictory, condition I’ve discovered in life, where it is often necessary to go back to our physical and emotional basics to find true spiritual refreshment (a lesson I call the Walden theme after living through it in the Smokies).  Our so-called pilgrimage was for exactly this purpose, and it was marvelous to behold in that special moment.  But recognition of truth is only the first step in crafting a life, as learning to distinguish the worth of threads is only the first step in producing a precious cloth.  Submission to truth is our true purpose, and we must learn this trade from a master before we can hope to ply it ourselves. Discipline and hardship become our allies as we become comfortable being uncomfortable, unlearning self to make space for love.  After submitting to simplicity and opening our worlds we are finally made worthy to take our turn at the loom and with aching fingers and sweaty brows to pass the shuttle in rhythmic labor, and by finding joy in the outcome, coming to find joy in the process – weaving an intricate pattern with our devotional threads to create a design with our lives, our sweetest silk, which will be pleasing for God to behold.

The trip to the park, as they call it, is another three hours over exceedingly rough country roads.  In lieu of detailed descriptions of potholes and kettleholes and cauldron holes let me just say that if you’re ever planning for some extended off-roading, I highly recommend Indian tires.  We made this trip in Anil’s land rover type jeep, and because India’s craziest driver navigating some of her worst roads wasn’t enough of a challenge for our delicate American sensibilities, we also packed in 11 passengers to make it a little more interesting.  I hope there’s a picture of this somewhere but it was the five of us plus Sheku and Jeetu (twin boys about 9) and Annkita (daughter 16) Henry, Shashi and her boys Vishal (12ish), and Parveen (10ish).  It was pretty awesome.  And absolutely uncomfortable.  Our only bodily movements came every few kilometers when Anil would misjudge the road ad our heads would meet the ceiling.  On this long trip we grew weary and cramped.  Eventually, we climbed a few hundred feet to a plateau where the park is located and stopped at a gate to register our presence with the authorities.  We all grew excited and hoped the hotel door would soon fall under our headlight’s crooked glow.  “How much further” we asked, worried that our tired bodies would grow moreso. “Fifty kilometers” came the reply, for there were five such gates and even more difficult roads ahead, and we sighed and groaned in our minds.  “O! it could be worse,” say the children, “I’m happy we’re past the first gate”; “I’m happy we’re not two inches from home”; “It could always be worse…”  From the mouths of babes these words crumbled my imperially-erected fortress of self-servitude:  here was a perfect practice of patience. 

Sometimes though, sitting quietly is not an option.  On our windy way between the fourth and fifth gates we played a wild game of tailgate chase with some other visitor who refused to let us pass them.  For some reason, I associate this interaction with the journey of the Rebel Alliance through the bowels of the first Death Star in Star Wars: A New Hope, and our spectacular chase ended in a similarly epic fashion.  Anil managed to pull past the offending vehicle, but almost immediately afterwards Nancy doubled over and made her sister proud, leaving a second taste of her foreign lunch as a treasure for some lucky warthog.

Earlier in the trip Vishal had been babbling away about scientific and literary nothings, exercising his curious mind.  At one pint he stated, matter-of-factly, “There are there things I don’t like about India:  roads, mosquitoes, and litter.”  His mother, gently nudging him back from the negatively analytical, quietly asked, “What are three things you do like about India?”  “Everything else” came the response.  There is such life here, such vibrant beauty in the lyrical laughter which fills the dusty corners of our journey.

Our hotel, like almost every other property in India, was a walled compound containing supporting facilities and a large gazebo where meals were served.  The rooms were Spartan but the company was excellent.  We spent the evening with a fire and a bottle of wine, fighting back sleep’s heavy onslaught with conversation, stories, and a generous does of chiding, for children and flames are not always the winning combination you might imagine…  Anil explained the plan for the morning – a 5:30 wakeup to lad into open-top jeeps for a chilly ride over to the park gates where we would line up to have our papers checked before the official opening around 6:30 or 7.  We would surely enjoy a pleasant fauna-spotting ride through the jungle, but the main reason everybody, tourists and natives alike, goes to the park is to spot a tiger.  The rangers and guides have a unique method for putting their wild beasts on display:  before sunrise a contingent of expert trackers sets out astride elephants in search of a tiger, and upon finding one, they box him in (tigers being somehow pacified by the presence of an elephant) and set up a “tiger show” which involves an orderly procession of elephants shuttling viewers from the nearest road to the pinned tiger.  These shows require supplementary tickets, which are only available after a tiger is secured, so our chances of seeing a tiger would depend on our timely admittance to the park, the opening of at least one show, and our ability to negotiate the queue for tickets – wow what fun!  Excited by the prospect of the show but utterly drained from another long day, our bodies wanted rest and we soon grouped off for a few hours down before a bell-clanging wakeup in the bible black predawn.

Up by 5:30 we dressed and gathered in the hotel’s upper lobby in what was becoming our stereotypically punctual and ineffective MO, as our entire crew was not assembled and loaded for at least another hour.  Our safari day began like any other, cold and crowded.  We piled into two jeeps for a windy ride through the park, each of us as clenched in our own thoughts as the throbbing fingers in our jacket pockets.  Roving through dense forests in dampened air, I was reminded of Smoky Mountain treks, except here warmth was not to be found in boot-tossed stones, and we received yet another lesson in physical patience.  But soon enough our earned reward revealed itself as the rosy-fingered tips of dawn stretched across a misty veil of jungle plains to shake us from our achy stupors and invite us back to the gentle unfolding of our own Odyssey.

After a few hours and a few failed attempts at catnapping we narrowly avoided a vicious pileup that surely would have taken our lives thanks to the skill and intuition of our driver.  Often on the roads in India large trucks will pull off to the side of the road with mechanical problems or because the driver wants a nap.  But occasionally they stop right in the middle of the road.  When this happens with little daylight and near zero visibility on the highway, one wonders how accidents aren’t more common.  Anyway, our driver slammed on the brakes and stopped us inches from a truck and became very agitated, quickly reversed a few feet and pulled around to the side of the truck to shout at the driver.  Not 30 seconds after we first hit the brakes another truck with a human cargo of commuting women came barreling through the fog and smashed into the truck we had narrowly missed.  Ah, how quickly disaster strikes!  The mangled cars were less than half the tale, but our driver didn’t keep us around long an soon moved up to enlist the help of other travelers in sorting out the wreckage.  So, we were spared and moved on, bobbing and weaving our way to Agra.

The Taj complex is remarkable in its symmetry and in its details, which are so elaborate and prevalent that it is difficult to fathom the process of its creation.  I’ll spare the touristy details to someone more qualified.  But we enjoyed a guided tour of the complex, many photos, and some clean restrooms before being taken on a wine and dine sales trap to a carpet manufacturer and a stone engraving/inlaying shop.  The company that Anil’s agent arranged our transport with apparently has some deals with tourist herders in Agra, but we eventually managed to escape.  At this point we were beyond exhausted and craved only a bite to eat and a horizontal surface.  We found both back at the YMCA and took a much-needed 6 hours to recuperate. 

At 3 am we met our driver again for a foggy trip to the airport, a characteristically relaxed navigation of security, and a flight to Raipur complete with vegetarian-option in-flight breakfast.  For the first time in days we landed in sunlight, and, recessing down a movable staircase were treated to cool, fresh air and birdsong as the light morning mist lifted.  We were expecting someone from the hospital to meet us, but imagine our surprise to find Anil’s cheeky grin outside the terminal doors.  He had driven the ambulance down to pick up his sister-in-law Shashi (again sp uncertain, sorry!) and we were only a few convenient hours away.  Ah such gracious hosts, and such driving!  Anil is apparently a little crazy even by Indian standards and wow, on straight roads, I don’t think we ever traveled forward without accelerating or braked without crunching into our neighbors on the benches in the rear compartment.  But there we found ourselves, careening down a narrow country road dodging oncoming traffic by margins well within the centimeter scale as Anil delivered his cacophonic symphony of motion.  On the way in we stopped to visit a village church, the first in the region, which is in the midst of repair planning to fix up some cracked supports and happened upon a tree whose name I’ve forgotten which lent us a bitter snack for the rest of the bumpy ride to Mungeli.

Being conscious of the value of this internet time I am tempted to gloss through and give the highlights of our trip so far, but I feel that wouldn’t fulfill this purpose or do justice to the experience.  Instead, I will try to write well, when I can, and try to give a proper account of our exploits.

On the 27th of December our group departed a foggy Atlanta on an evening flight bound for London.  Waiting on a runway queue we watched the planes before us shake and roar into takeoff their lights soon enveloped by the silent southern smoke.  Unbeknownst to us then, this farewell was to become our theme as we seem to constantly discover and depart new places in mist.  After eight hours of pleasant British service we arrived at Gatwick around8:30 or 9am local time, passed through coustoms, played a game of which-luggage-is-ours, and made our way by bus to Heathrow, a pleasant drive through picketted pastures where homely ponies took their breakfast as our bleak stares passed them over in the sun-lashed morning fog.  We were tired, but only in the sense of having a poor night’s sleep and, by all accounts, were still quite functional.  In Heathrow we met up with Nancy’s sister, Barb, and departed for Delhi.  I was fortunate to find myself in a window seat with two amiable companions who were heading home for the holidays.  They were excited to learn of our first trip to India and were happy to help break the experience in with stories and tidbits of wisdom to lessen the impact of the shock which lie across the threshold of our runway.  One comment they made really resonated, and I have tried to use it as a filter to understand the many cultural differences we are faced with each day, they said – In the States we develop systems around our concept of convenience, while in India the underlying mindset is, “What is life without challenge?”.  But if this is so, as it seems to be, it is a compassionate challenge rather than the competitive sort we are used to.

From our arrival in Delhi things, as they say, hit the fan.  hahaha ok maybe I’m being overly dramatic but it was certianly a struggle to navigate life after another long, fairly sleepless flight, and exhaustion hit like a train wreck as we stood on a curb beside a sand bagged bunker surrounded by luggage while we waited nearly half an hour for our driver to retireve his car from the parking lot.  The soldiers staitoned there quickly shouldered their arms and retreated behind their walls to muster a leering defense against our unconventional assault on their sensibilities.  The sentiment was soon repaid as the moment our driver arrived we were accosted by half a dozen willing hands to carry and load our bags in exchange for a few battered one-dollar notes, the residue of our lengthy and partially failed attempt at currency exchange with the National Bank of India.  But soon enough we were off into the morning’s third hour and a fog as thick as pea soup (this is the first time in my life I’ve had occasion to use that line, couldn’t pass it up).  But really, visibility was 20ft max, as we were introduced to India’s unique style of automotive transportation.  It’s funny, but the best description we’ve gotten of the roads came from Vishal, the son of Anil’s sister-in-law, Shashi (forgive sp), “In the US we drive on the right side.  In India we drive on both sides.”   Though in those wee hours and poor conditions there were few drivers out, we enjoyed our freedom of the road with all the tremendous beeping and sudden stops and starts one would expect from a system where traffic lights are optional and the only presiding rule is that the biggest car wins.  I enjoyed myself immensely, though the others seemed less impressed…  In any case, we made it to the YMCA where Anil had arranged our lodging sometime around 4am and awoke the staff to request the fulfillment of our reservation’s implicit promise of restrooms and beds.  But here, our challenges began, as the reservation in question did not exist, and because their reservation system (a big book with names and dates and father’s names and addresses and passport numbers and signatures) did not update until their 12pm check in/check out time, it appeared that our reservations for the following night were also nonexistant.  Needless to say our already frazzled nerves began to fray, though in hindsight, perhaps this was the most characteristic introduction possible – here were four dirty travelers who bust down the doors at 4 in the morning demanding a service which all the records say they did not deserve – any normal city hotel manager would have us back on the streets as soon a look at us, but our kindly host worked through the issue at great length and eventually arranged a room for us to store our luggage during our trip to Agra and the Taj Mahal. 

At this point in our journey I wasn’t sure whether to laugh at the absurdity our plans or cry because they meant at least another 10 hours before we could sleep (in actuality it turned out to be more like 16), but the gauntlet was laid and the only way to the other side was to pass through, and so we dropped our bags, brushed our teeth, and jumped back in the car.