Wednesday, March 21, 2007

RUHSA Update

Including Sri Lanka and travelling with Mum and Dad, I have been away from RUHSA in one way or another for about month so when I got back there was a lot to catch up on. In order for Mum and Dad to meet as many people as possible in the short time they had, we organised a special lunch in the canteen for everyone involved in the project and of course, we went to the village to see the centre and meet some of the oldies.

Pleasingly, there has been quite some progress since my last visit. The main improvement is the addition of a temporary kitchen in the corner of the backyard. The women from the self-help group were no longer having to carry heavy pots of rice and sambar on their heads for a mile from their houses to the centre. This temporary "kitchen" consists of a concrete sheet leaning against the side of the building, propped up by two bamboo poles. I had a moment of concern when I heard the roof was asbestos, which is clearly unethical, but when I made a fuss everyone said no, no it's not asbestos it's concrete. So who knows whether it is or it isn't, but they assure me it's not, so let's hope so.

Underneath the sheeting, on the ground is a makeshift firewood stove which can cook one pot at a time. A woman is crouching down, building up the fire with sticks they've carried in as bundles on their heads and stoke the flames by blowing down an old plastic water pipe. From this raw, crude scene emanate delicious smells as the sambar gently steams to one side and the rice boils on the fire. Another woman is chopping onions, chilli and coriander to add to the pot.

Water is a huge problem for us, as Keelalathur is a drought-prone area and the government supply is insufficient. There is a 30 foot well with not a drop in it. At present we are having to buy water in pots for cooking, eating and washing from a private supplier. A final solution to this conundrum has still not been found. We are aiming for a kitchen with a working tap, but I'm not sure how we will achieve it.

As the steamy aroma of lunch wafts through the building, about 26 elderly people are sitting on mats occupied by reading newspapers, chatting, playing games with beans on a board marked out on the floor in chalk, and doing simple jigsaws. I look closer at one of the jigsaws. It is a health education puzzle. I feel it may not be in the hands of the intended target audience. As I watch, an elderly lady, with grey hair and a thin sari, shakily makes a picture of male genitalia with a condom on, bearing the legend in English and Tamil "Safe sex protects from HIV". I hope she takes note.

Whilst they wait for their lunch, Kalaimanai introduces my parents to the group. Everyone is smiling, their hands together in front of their faces, touching their foreheads with their fingers. Vannakum to Dr Arabella's Amma and Appa. There is a marked difference between the Indian and the English sexagenarians. Certainly, no-one would feel the need to start a feeding program for the visitors. Then the most amazing thing happened. One of the gentlemen stood up and spoke in Tamil. Kalaimanai translated. He was asking us if we would like to join them for lunch. How incredible is that? They are so comfortable and settled in the centre that they now regard it as their own. Being asked to share their food was an extreme honour, which we had to decline as it was the day of the special lunch at RUHSA and we were expected back, but I was deeply touched and excited by the implications of that invitation. We will have my last lunch in India together at the centre, which is fitting.

In a flurry of Vannakums (which means hello and goodbye) we take leave and go back to RUHSA. Vimala, the lady in charge of the canteen has outdone herself and prepared a delicious lunch for us. South Indian food is very different to that found in flock-wallpapered curry houses in England. Rice is the staple and not light, elegant basmati, but stocky, slightly sticky grains which absorb the spicy sambar, a thin, lentil gravy, heavy with curry leaves and the occasional floating drumstick (a woody stalk plentiful in the area). Rasam is even thinner, called South Indian Firewater, almost a soup not a sauce, with a delicious, tart, coriander and black mustard seed flavour. Again, curry leaves float on the top, lonely for the company of other vegetables. There are overflowing dishes with carrots, chopped and cooked so they are still slightly crunchy, with onions, sesame seeds and chillies; spinach with coconut; a deep yellow potato masala, speckled with black mustard seeds, and delicious chicken lightly covered with a rich fiery tomato masala. There are two other types of rice, fried with peanuts and curd rice with pomegranate seeds. And of course poppadums. As we tuck in, I think of the elderly at Keelalathur, slightly shamed by the amount of food in front of us, but glad that they at least have something to eat at lunch.

Now Mum and Dad have left, I have been able to concentrate whole-heartedly on completing my role here at RUHSA. For the last few days, I have been compiling and updating the medical records; picking up important issues and discussing them with the other doctor on the team who is arranging referrals and investigations for those who need it. For example, the lady with a thyroid nodule will see the surgeon in a week's time; several people with high blood pressure will get regular check ups and medication. A couple of men with persistent coughs will have sputum samples to check for TB. Some have been cleared already, which is good.

On Saturday, I took everyone’s photo for their medical records. This is an unusual solution to the fact that unique identification is difficult for people who have no date of birth, address or last name. All things we take for granted in the UK. Interestingly, one lady did not recognise herself in the photo, which makes one think – if she has no mirror, how would she know what she looked like?

The final jobs include developing a questionnaire for evaluation, compiling all the meeting minutes and writing a report on the months I have been here. In addition, in my last 2 weeks, I am visiting a women’s refuge in Bangalore, going on a four day trip to the mountains and trying to meet up with Justine, which I think is going to be impossible, as she has not been in contact for weeks. She’s probably staggering around Kerala looking for vodka and samosas, oblivious to the ringing of her phone.

I have some concerns about the project once my bullying presence leaves, because each time there is a meeting, I go in thinking that we are all in agreement, but everyone is astonished by the plans when I recap the last meeting and we rehash the same ground until everyone agrees again. Between meetings, which don’t really happen when I’m not there, people carry on with their own ways not really working as a team. It’s as difficult to get a consensus on action as it is easy to get a consensus on saying yes, yes to shut me up. However, Mathew, who will be the driving force once I’ve left, and I, have drawn up a tight, manageable and logical schedule for the next 10 months with dates for reports and evaluations for which he has taken responsibility. I have his mobile and his email. I will be calling. He is scared. Very, very scared.

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