Innerwear

I have just had a fantastic pair of trousers made. I bought some really good quality striped cotton, somewhat akin to the material Obelix wears - blue & white striped - and went to the tailor to ask him to make me another pair of trousers. As they only cost about 90p to make it would be churlish not to. The tailor fingered the cotton and said , "Very good madam. Very good quality. I like." I was very proud of my choice. He then chattered in Tamil to his two lady assitants, who were giggling behind their hands. As they usually do this whenever I enter the shop, I thought nothing of it. Pretty soon however, their laughter became almost paroxysmal.

Eventually I asked the tailor to explain. Well, that sounds like an easy request, but actually it took ages, with loads of hand gestures and pointing. "I have this material" he said, "I like" he said again. Yes, yes, but what was so funny.

"I have this as innerwear".

Oh, I get it. My trousers will be the same material as his underpants. Oh well, I thought, it's such nice material, I'm not going to waste it. So I went ahead and had them made. I wore them with pride yesterday. There's no doubt they caused a stir. Apparently, it's not just the tailor who has underpants made from this mateial. This is underpant material. It is not used to make anything else. Except my trousers. So essentially, I have been walking around wearing the Indian equivalent of a giant pair of Y-fronts.

Colds, Dogs and Vultures

Firstly, I just want to say how totally annoyed and aggrieved I feel to have a cold when I have never been so hot in my life. How it is possible to get a cold when one is sweating in 34 degrees C with a humidity of 100%? I think the viruses must have been getting tips from the incontinent mosquitoes.

Secondly, it has been very noticeable how many wild dogs there are around. I honestly don't remember there being as many as there are now. Initially, I thought it must be something to do with the general population expansion generating more waste etc for the dogs to eat. But then I heard that there was a disastrous decline in all three indigenous raptors (vultures) since 1998. Once I heard that, I noticed that I have seen none and remember seeing them all the time. At first this decline was attributed to a mystery virus, but now it is believed to be caused by diclofenac in the food chain. Apparently, it was recently introduced into India and Pakistan as treatment for cattle and has quickly become widespread owing to it being quite cheap. Unfortunately, it is toxic to birds, causing renal failure and visceral gout in vultures. This is believed to be the cause of the decline. There is still some uncertainty, however, as it is also potentialy fatal in dogs which have, as the vultures declined, risen accordingly. Also it is believed to be excreted quite quickly from mammals and therefore the cattle would have to have been treated immediately prior to death. Still it's interesting and sad to see their absence. It is causing major problems of waste removal in some parts of the subcontinent and especially for the Parsees, who instead of burial or cremation, depend on vultures to get rid of their dead.

First Staff Meeting

Was GREAT! Everyone was so keen. Apart from a teensy weensy omission on my revised proposal (ie forgetting to include the overall Director) the report was received well and there was so much enthusiasm to get started and do jobs. As I am the person with the most time, I will mainly be the report writer, minute taker etc. My official job title, apparently, is Convener. Not sure what that means, I'll have to google it. Just done it, apparently it is someone who causes people "to come together formally". So what they are trying to say politely, is, as suspected, that I'm a noisy, bossy, busy-body, English Doctor! Well, at least they give me a proper name for it.

At the meeting we decided many things. The project is going to take place in a village called Keelalathur, which consists of a central village containing 180 houses and the outskirts, called "the Colony" which has 120 houses. The total expected number of villagers is therefore 1500.

Next week we will spend every evening in the village gathering data through "social mapping" which is one of several techniques in a process called participatory rural appraisal. This means that the data comes directly from the villagers. They will assess their own needs. Social mapping works as follows. The village area is divided into smaller sections, one to be tackled each day. The Rural Community Officer, who is a RUHSA staff member working within the community will mobilise several village women called animators to help us. (When I first met these women, I thought they were free-lance cartoonists and was very excited at the prospect of seeing their work - I was wondering if they Indianised Garfield or had their own Kumar and Hobbes). These animators, who know the area like the back of their hand, will itemise every house in each section and will provide us with information about the house and houseold. For example, they will give us indicators of poverty, like housing type, roof type; they will also know names, ages and details of family members and will therefore be able to say whether there is unemployment, dependency or poverty in each house. On the basis of this, we will, over the course of the week, "map" out the village and have identified the most vulnerable within it.

The next week, we then target those identified as being vulnerable and with (Tamil) questionnaires, ascertain the exact nature of their vulnerabilities and what interventions would improve their health and social welfare.

Project Ahoy!

It's very exciting, the first "Action Team" meeting has been scheduled for 2.30pm tomorrow. The plan is to discuss the project and start data collection at the village. I have written a revised project proposal following all the individual meetings, which will be handed out tomorrow. Hopefully, it will get a good reception and they aren't angtagonised by this nosy, noisy, busy-body English doctor (who is she, anyway?)

Bangalore

Have you heard the one about an English Doctor, a Swedish Nurse a Norwegian Pharmacist and an American Student? They all went to Bangalore and saw a tiger. OK so it's not funny, but it is true.

This weekend the four of us, as previously seen starring in "A Loaded Rickshaw", went to Bangalore, which is a three hour train ride up into the cooler Nilgiri hills. It was bliss, too cold for mozzies and I didn't need a fan.

We took the train on friday night and arrived at our Hotel at midnight. It was a nice hotel, the concierge was about 14 and when we asked if we should pay for the rooms, he said no, just a deposit. The deposit turned out to be 50% more than the total room cost for the whole weekend. Which caused a minor uproar. When we asked an Indian friend if this was normal practice, he looked sheepish and said yes because often his fellow country men leave a mild trail of devastation in Hotel rooms. We behaved ourselves very well, apart from a brief spat about the need to pay more than the rooms.

The two main highlights of the trip were having sushi and seeing a tiger. The sushi was truly delicious and, having been slightly protein starved, I could feel my muscles expanding as I ate. The only disappointment was when I ordered a traditional Japanese dessert which turned out to be baked beans and ice cream. Well, not literally the Heinz variety, but certainly some kind of bean topping was on it. It took some serious adjustments of my tastebuds to allow me to eat it uneventfully.



On Sunday morning we got up early to go to a reserve which treats tigers and other endangered species, keeps them in a safari type enviroment, rather than cages and then returns them to their original habitat. Consequently, they take bus loads tourists through the park where there are large free-roaming carnivores. It was amazing.

Any Cream Will Do

Somebody told me that toothpaste was good for mosquitos bites.

Last night I lay in bed rubbing my legs furiously on the slightly abrasive sheets, which had a thin layer of sand on them from the bottom of my feet, quite unable to sleep. There is no such thing as a satisfied mosquito bite. Trying to break the itch scratch cycle is probably the cause of much mental illness in this country.

A knowledgeable Australian, from the northern, tropical parts, had told me that the worst culpritis are not, in fact, mozzies but tiny sand flies which, apparently, instead of biting you, PEE on you. And they have incredibly itchy pee. I cannot think of anything more anti-social than an insect maliciously peeing on you for no gain to themselves, except the amusement, one presumes, of loutish gangs of them hovering over you, laughing themselves sick as you scratch to pieces.

So, as I cursed the hoard of incontinent midges, the thought of a potential solution being as near as the toothmug in the bathroom percolated through my itch obsessed mind. Groggily, and still trying to scratch, I staggered to the bathroom and found my luckily almost new tube of toothpaste. Sitting on the bed, I smeared the whole of my lower legs liberally in slightly astringent, minty fresh, white cream. Astonishingly, the obsessive itch began to subside and I gradually drifted off to the soothing aroma of Colgate Total.

Saying goodbye to Daniel

At present, being in Vellore, there are many more foreigners around and, as they all live near each other, they tend to hang out a lot. Consequently, last night I found myself being invited to the leaving do of Daniel, a Bristol Medical student, whose stentorian English tones I had already heard in the library amongst the more prevalent lyrical tones of the local medical students, but whom I hadn't met. It seemed like a good idea and I asked how long he had been here. Two weeks was the reply. Wow, I thought, that's even better than me at Dalton surgery. I shall have high expectations of having a leaving do every Friday night as I go home for the weekend, when I get back to England.

It was a fun evening in a restaurant on a roof terrace overlooking Vellore, which does definitely look much nicer in the dark. The food was good (I had butter chicken masala and a paneer naan, washed down with a lime soda and Kingfisher Beer), and the company, of which there was an inordinate amount, owing more, I feel, to Daniel's English Public School boy looks, than his length of stay, was good fun. I sat next to three New Zealand students, also on elective, one of whom had had a traumatic time at the barbers shortly after his arrival.

After dinner, 5 of us, including the Party Boy were all going in the same direction and consequently shared a rickshaw. Sounds easy. The Vellorians do it, but their buttocks are considerably smaller than ours. I led the field, obviously, followed by Malin, who is also quite squishy, and we formed the seat cushions for Ture (a Swedish Nurse) and Triveni (an American Gapper). They said they'd never had such a comfortable ride. Daniel was sharing the seat with the rickshaw driver who had practically invisible butt cheeks but very sharp elbows.

Having previously thought I had already ridden in the Oldest Rickshaw in Vellore, I soon realised there was a new contender for the title. Not only that but it sounded as if the rickshaw driver tried to save money by mixing water with the petrol. The farting noises which emerged from the exhaust were truly astonishing. The imperceptible incline towards our destination must have felt like the North face of the Eiger for the poor phutting vehicle. Then we stopped for fuel which involved piling out whilst the driver put about 2 tablespoons of petrol in the tank. Off we went again. We did eventually make it amid much hilarity. I'm sure they put on these shows deliberately for the tourists. Below is a photo of the group the poor rickshaw driver agreed to pick up. We all, but especially me, look like we have at least one Special Need.



It was a fun evening, apart from one million tiny things. Mosquitos. I don't even want to discuss them. I think they are the only things in India getting a square meal, mostly from me. To misquote someone who said it, my legs feel like a relief map of the Himalayas, only fifty times itchier. How the little bastards get a foothold on my slippery skin, goodness knows, they must be wearing galoshes. Certainly, they wear gas masks, or hold their long probosces as they dive in, because the air was so redolent of DEET that I practically passed out.

A Vellore Trouser Suit

I've been wanting to make that joke since I knew I was coming here and now finally you can see a picture of me dressed entirely in a Vellore Trouser Suit!

I tried to explain to the tailor the hilarity of having a Vellore Trouser Suit post 1970. Strangely, he didn't find it as funny as I, but, being polite, he guffawed with me.

Trip to the Beach

I thought I would put a few photos of our trip to the beach after the tsunami village medical camp. Indian modesty being such that the "ladies" had to swim in all their clothes. Surprisingly, however, despite their best efforts at decorum, a clinging wet sari looks quite seductive!

Clicking on the photo brings it up full sized. I tried to upload them via the blogging website but they only worked sporadically, so now I have done it via the link on the left - ImageShack. I am really happy with them so I am giving them a free plug (no gain to me)!

Family Outings to the Beach Taking a dip

Still signs of the tsunami The Team! Idyll

Vellore So Far

Today I am going to the tailor to pick up the first of my "suitings" which has been made for me. I hope to god they fit. The tailor did have to stretch quite a lot to get the tape round me. Also the material is lovely breezy cotton which will probably shrink as soon as it touches water, which as you can imagine will be as soon as it comes into contact with my body.

Yesterday, I spent the morning packing for my two week sojourn in Vellore, which was very strange. I packed almost everything but left a few things behind in my room to stake my claim on it. I then cadged a lift into Vellore with Dr Stephen who is a vascular surgeon (I don't think they call themselves "Mr" here when they become surgeons). He is a lovely man who spent three years in Adelaide Australia about which he is very interesting. Not least about the wastfulness of the disposible healthcare culture in which we in the west live. He tells me that there are many things which a company will market as single-use which can actually be sterilised/autoclaved and used again. Similarly, he brings lots of equipment which has reached it's sell by date but which is still completely usable, but it is a way of making the company have limitations on their stock and minimising litigation for them. In India however, it has a very useful place amongst people who don't care what the sell by date is as long as it saves their life. It is clear that we are over obsessed with risk reduction in the West and that there is a lot of waste as a result of it.

Sharing the car with us was a young man and his family. The young man was an inpatient at the RUHSA hospital with a kidney infection. Dr Stephen had seen him on the rounds that morning and was concerned about him as he was not improving. In fact, he kept spiking a temperature despite intravenous antibiotics. As a result Dr Stephen felt he should be referred to CMC for further management and investigations. Not having any ambulance service here, he was lucky to be able to squeeze into the back of the airconditioned car with his family (mother and father), all sitting on jump seats in the boot, because otherwise, despite a raging temperature, a canula in his hand and bare feet, he would have had to get on the bus.

In the evening I finally schlepped my rucksack to my new home, and carried it up to the third floor where I am staying. Ulike at RUHSA, I have both corridor mates and a view, see below:


One of my corridor mates is a new girl like me, she is from Washington, and has just completed her pre-med degree. She has rather sensibly decided to come out to work in India in the hospital, interestingly also with Dr John on his TB program, in order to see whether medicine is for her. I guess it will be a real make or break scenario. It was great fun listening to her youthful enthusiasms, which seem highly focused without any direction, which is a combination only the young can get away with. It rang many bells for me, thinking about all those years ago when I was last here, except she is clearly more organised than I am even now! Funnily enough, it didn't make me feel old and nostalgic, just happy that people still wanted to leap off the diving board into life.

Anyway our bubbly, enthusiastic conversation came to an end as she wanted to go and find some water, having just arrived and having none in. I shut the door and had just pulled down my trousers in preparation for using the western loo - I didn't actually need to go, I just wanted to sit on it and croon - when there was a knock. Clutching my trousers, I opened the door and she was standing outside looking a little distracted.

"I'm feeling a little..." she said as she looked around behind her. I realised that she was about to faint, but unfortunately I couldn't get out of the door (which opens in 2 halves and therefore is very narrow) and hold my trousers up and catch her. She dropped like a stone to the floor banging her head on the concrete. It was horrifying. When she came round, she said, I'm so glad you're here, as you are a doctor. Yes, well, I shan't be putting that little incident on my CV, that's for sure. Luckily, she's totally fine apart from a bump and a bit of a headache.

Eating at the Tsunami Camp

Here is a picture of our lunch at the tsunami camp which I tried to post before. In the foreground is the mighty busdriver who, with crackly tamil songs and soundtracks screeching just above his left ear, drove for hours and hours and hours. In the background, bending forward is Malin, the Norwegian pharmacist who works for Pfizer and is on loan from them to the CMC as a dpnation of expertise. She, myself and a couple of others are going to Bangalore this weekend.

Two weeks in India

It's amazing to think I have been here two weeks. It's extraordinary how the initial wariness and nervousness of being somewhere totally new and strange (apart from some remembered familiarities) gradually eases into increasing boldness about exploring one's environment. As mentioned I am staying at RUHSA campus which is in the heart of the countryside. It is a small area with many low buildings scattered along its dusty paths - hostels for students, visitors and young doctors; residential houses for staff and their families; offices and training rooms; a hospital; a little shop with a public telephone; a post office and a canteen for anyone who needs sustenance.

There are lovely, lovely people who live & work here, they are so helpful, welcoming, smiley, hospitable and friendly. The most important person on the campus is the Wonderful Immanuel for whom nothing is too much trouble. Whatever you ask of him, however obscure and seemingly impossible, he sorts it out. I have told him that he has set such a standard that I am going to try and find increasingly impossible tasks to assess the limits of his brilliance. Personally, I don't think he has any limits, but I've warned him he's going to get some serious challenges now! Mr Handy Anandan has already been mentioned. He sent two electricians in today to earth my plug, which I was very glad about as my laptop has now stopped giving me electric shocks everytime I touch it.

After the pair of barefoot Sparks had finished earthing my room they moved on to fix a light outside on the passage. They asked if they could plug their drill into my socket. Of course I replied, turning away to continue what I was doing. When I turned back I realised that "plug in" was not an accurate description of what they had done. The drill, which I could hear whirring away in the backgroud ended in two wires which they stuffed directly into the two bottom sockets. Amazingly neither did they fall out nor kill anyone and they finished their work and went away happy at a job well done.

The doctors here are also lovely, so keen to talk about their work, which they all feel very dedicated to. They are all committed to delivering the best possible service to this little rural communty and are full of new ideas and projects to improve things. Dr Rita, who will be instrumental in the project I am working on, is about to start cervical and breast cancer screening in the villages, which is non-existent so far and people are presenting late with uncurable disease. The training officers who will be the main source of expertise and enthusiasm for the project are absolutely amazing. They have had so much experience with delivering services to the villages from healthcare to economic projects. Again they are bursting with ideas of what we can do further.

The plan for our project is to start with an appraisal of the needs of the village we are going to set up the community centre in, which is called Keelalathur. The team so far consists of myself, Matthew A who is extremely experienced and has been at RUHSA for many years, but is far from running out of ideas; Selvakumar who is a psychologist and who is keen to increase mental health provision, a subject after my own heart; Dr Rita, as previously mentioned, who is a community Medic and who has a postgraduate degree in epidemiology and her junior Dr Shrikanth; Jumbulingam who's also phenomenally experienced in fieldwork and a couple of others, whose names I have shamefully forgotten. I am really looking forward to our first "staff meeting" which will take place next week as both myself and Matthew are away for a week.

As well as the local staff there are 8 Australian social work students who are doing a project in the surrounding villages based on the WHO's Healthy District template. They are all lovely people who have a great sense of responsibilty to their work here. I have only got to know a couple as they are all quite busy, but Romi, who has just shaved her head completely - something she has always wanted to do, hurt her foot last week so has been around more than the others and so I have been able to spend some time chattng to her which has been great.

I am currently in Vellore having to be online several times a day for my MSc in International Primary Care which started today so I have left my rural idyll and am in the hustle and bustle of central Vellore!

Thank you to those who leave comments, because although I feel like I'm writing this extremely sef-indulgently for myself, it is nice to know what people think if they are reading it. Of course I don't know who they are from usually, so they are probably unknown internet surfers with a special interest in worms!

Workmen

Today, Mr Anandan who should be called Handy Anandan insisted that I should have my door fixed. Every day he comes by, swirling around my room searching out and describing defects in a rolling, liquid language scattered with many 'super, super's and 'tomorrow coming's. A few days ago he noticed my door stuck. "Carpenter, carpenter, tomorrow coming" he promised. Well today they did. Three of them. One to carry the tools (in an old hessian rice sack), one, whose girth was less than the door's breadth, to hold the door as the third, who easily had the smiliest smile, wielded a saw of Fisher Price sharpness and cut an enormous triangle of wood from the underside of the door. He was obviously the head carpenter, because not only did he not have to carry the tools, but he actually got to use them. The great news is that my door no longer sticks. The bad news is that there is now a cat-flap for mosquitoes, who don't even have the bother of pushing open a flap to get into my room.

The Project

It seems as if things are finally taking shape now. Last week I met several people, including someone from the UK charity which contributes to the hospital and the rural project, as well as the newly appointed director of RUHSA (Rural Unit for Health & Social Affairs, the department in which I am staying and working) and a lot of talk was talked. Obviously I contributed. But now there is a firm project which is about to get underway.

To give you a little bit of background (skip this if it's boring - there will be no hilarious exploits on buses over the next few paragraphs), RUHSA was set up as an independent Unit in 1977 to serve the social and healthcare needs of a specific region or "block" in Vellore district. In it's early days it set up agricultural projects, small holdings, self-help groups where women could generate their own income and therefore independence and a small hospital with 70 or so beds was built with outpatient, casualty, inpatient and surgical capacity. The block is divided into 39 Panchayats or village groups with a total population of around 120,000. RUHSA built peripheral service units (PSU) scattered throughout the region from where healthcare and other economic or social projects could be administered. Each PSU was presided over by an RCO (Rural Community Officers) - who along with their volunteer army of Health Aides and Family Care Volunteers, formed the bridge between RUHSA services and the villagers.

In 1985 RUHSA became a part of the Christian Medical College in Vellore, which despite it's name serves a mainly hindu population. It was started in 1902 by an extraordinary American woman with the fantastic name of Ida Scudder, who whilst staying with her parents as a young woman realised the need for female medical professionals. The story, as told in a radio interview by her in 1959 which I listened to on tape, goes as follows.

She was sitting at home one evening looking after her mother who was unwell. Her father, a medic was in the back. There was a knock on the door and Ida went to answer it. A Brahmin stood outside.
"Please memsahib, my wife is very sick, please come and help".
Ida said she would fetch her father but the Brahmin was horrified that a man would attend his wife who was in labour. He implored her to come, but she said she had no skills and could not help. Dejected he left. Ida returned to her seat feeling useless.
An hour or so later, there was another knock on the door. A
Muslim man stood outside.
"Please madam, please help my wife who is very sick", he implored, when she opened the door.
Again she said that she had no skills but she would fetch her father. Again the man said that only a woman could attend his wife. Once again a disappointed and unhappy man left her house with no help.
As she sat feeling desperate for these women, a third man came to the door with the same request. Again she could not help. All three women died.
Ida felt that she had been shown the path to her future. She returned to the States, enrolled as the first female medical student in her university and graduated aged 30 in 1900. She returned to India, despite having promised before her revelation, that she would not stay in such a dirty, dusty, hot and barbaric country, and set up roadside clinics delivering healthcare to villages, initially on foot and then using a one cylinder Peugot, the first car of its kind in India. She soon built a hospital and set up a medical college initially catering for female graduates only - the first male students were accepted in the late 40's- to ensure that the women of the villages could have ongoing access to healthcare. It is now a vast internationally reknowned hospital, one of the best in India, with 1900 beds (including rural units) and three community departments of which RUHSA is one.

Many of RUHSA's early projects are self-sustaining and therefore they have withdrawn. The hopsital is still running and seems very busy. The main focus now seems to be training and development, both of healthcare students and local people in health care matters. Consequently the PSU's are a vastly underused resource. Some are in a ruinours state. The project therefore is concentrating on one of the better PSU's and, in conjuction with consulation with the village, is going to set it up as a community cetre to serve the needs of the poorest of the poor, some of whom don't even get two meals a day.

The first stage therefore, is to go to the village and do a participatory rural appraisal, where we assess the needs of the pooorest of the poor and then we figure out a way of improving things.

If you've stuck with me to the end of this, thanks for your attention. If you are interested to know more about FOV and CMC there are links on the left. I will keep you posted about how things progress. It is really interesting to see social care developed from scratch and I will learn an enormous amount. Exactly how useful I will be to them, I don't know, but I'm keeping that quiet.....

Moving on to Trains

It is lovely at RUHSA campus where I am staying, it is in the middle fo the countryside with a railway track running along side- it's almost like being at home. Certainly the quality of the road to my accommodation is familiar.

Unfortunately, the train track is actually a little closer than at home - ie about 50y behind my bedroom window and obviously they go all day and all night. Their philospohy of driving is pretty much in tune with the bus drivers as their main method seems to be to drive with one hand on the horn. Now unlike autorickshaws, which sound like Elmer Fudd going duck-hunting, (apart from one extremely pleased rickshaw driver who had managed to affix what sounded like a foghorn to his diminitive vehicle), trains have sirens which sound like concorde breaking the sound barrier. I can feel the vibrations in my nostril hairs. Trains also, rather amazingly, have about 40 carriages and so the noise goes on for vast lengths of time. Luckily for me I sleep very deeply, but I have been having peculiar dreams where I am persistently being put inside a tumble drier with some concrete blocks, while a football crowd is in full voice outside.

Tsunami Camp

Over the weekend, I have had an extraordinary time. On Friday night, I was picked up by minibus and along with 12 others - nurses, doctors, pharmacists, social workers - was driven 6 hours to a town near the south coast which was hit by the tsunami in 2004. I hadn't been told much about the trip; someone asked if I would like to visit a tsunami village and, not wanting to pass anything up, I agreed. What began to dawn on me over the course of our 6 hour bus trip, was that we were going to a medical camp and that I was one of the functioning doctors. The thought, I must say, was fairly daunting.

As we bounced along the road, I garnered what information I could. We would drive to a town called Sirkazhi, where we would stay overnight, then the next morning we would drive out to one of the villages affected by the tsunami where we would set up a free medical camp for the locals. They expected three to four hundred patients over the day. There were 2 nurses, Frederick & Preethi, three doctors (including myself, who with the female nurse would be expected to see most of the women), two pharmacists, including 2 observing foreigners one, Tammy from Indiana, US and Malin, from Oslo, Norway and several social workers who would organise the flow of the clinic.

We arrived at our lodge at 2.30 am. I shared a room with Preethi, who gave me a crash course in Tamil, in case I had no interpreter. I can now confidently ask if you have a pain and where it is, but am unfortunately unable to understand the answer.

The next morning we arrived at the village and this is the clinic. It was open and you can see that there is nothing between the village and the sea, which lies directly in the distance, as it is completely flat. Luckily it was shady and breezy, but apart from that it was beyond basic.

To the left of the "clinic", behind the Ambassador Classic, under the rusty corrugated iron is the "waiting room". Luckily, for some reason there were nowhere near 300 people to be seen, which was a great relief to me, as any of you who know about my time keeping skills in surgery can readily understand! As it is I still managed to fairly rattle through them compared to in the UK, but my colleagues saw three times as many as I. It was quite fascinating work. There had been an outbreak of chikengunya here, which is a viral disease transmitted by the Denge mosquito which breeds in standing water overnight & bites during the day. The disease presents as a high fever followed by two weeks or more of nasty myalgia & arthralgia. Although it is not fatal, for people who have no access to analgesia and whose existence is hand to mouth on a daily basis, being disabled by pain can impede your means of surviving.

A lot of the problems are psychological as you can imagine, but these are issues which the emergency camps are totally unable to deal with. The very worst cases do get referred to the hospital, but local counselling for what must be an enormous number of people suffereing from post traumatic stress disorder and depression to name but a couple, is absolutely not available. I was told, that the best we could do would be to give them some multivitamin tablets, so they had something to take away and to reassure them. It was as you can imagine very difficult. Everyone I saw weighed 35-55kg maximum (approximately the size of my left thigh I think). All were clearly malnourished and anaemic, what I really wanted to give them was a square meal and some clean drinking water.

After we had seen about 170 people, we stopped for lunch. This was a packed lunch of extraordinary dimensions. We had more food between than probably the whole village had. Each of us was given a carrier bag inside of which were two banana leaf bundles one containing fishand the other rice. There were 4 little plastic bags tied up with cotton with different masalas and sambas - curry sauces. Before luch, there was a pot of water with which to clean our hands. It looked really clean. When I went to wash my ricey fingers afterwards (having eaten lunch with our hands), I noticed three wiggly mosquito larva and a dead mini tape worm. I have been racking my brains to try and remember exactly how wet my fingers were when I started eating.



The clinic was much less busy after lunch and as my interpreter did not emerge, the other two doctors saw every one.

On the way home we sang tamil songs, stopped off at the beach and swam in our clothes and then drove home arriving at 3.30am on Sunday. it was exhausting, but amazing. I hope to go again and be more useful next time.

Anymore fares please...?

I thought you would like to see what I meant about the buses here, and this isn't particularly full. the last one I was on had someone hanging off the back on the outside. But see those windows? When I'm sitting down, the top of the frame comes to my chin. That's the scale I'm talking about!

A new month

Why is travelling in India so hilarious? Each trip is so full of extraordinary events and sensations that I feel totally overwhelmed before I've even started. Today, intending to go to Vellore by the previously mentioned early morning bus from the campus, I staggered off my double layer of ryvita - otherwise know as mattresses - at a truly hideous hour. I then forewent breakfast as it was not immediately forthcoming, chatted briefly to the manager of RUHSA about the fact that my crappily cheap mobile phone has gone on strike - not only will it not allow me to use the original sim card despite having both reception and credit, but it also won't let me use an Indian sim card either - and then hung around waiting for the bus. I don't know how in God's name I managed it, but I missed the arrival of the honking, dust-raising, people-laden, jingling, clanking rust bucket completely. Luckily someone was on hand to rescue me and he kindly volunteered a poor unsuspecting passer-by to give me a lift on the back of his moped to the nearest bus stop. The gentleman looked at me and then at his tyre pressure and valiantly suppressed his dismay. I tentatively sat sidesaddle clutching the handholds fearfully. There were some truly terrifying lurches as he put his feet on the pedals and prepared to move off. The moped grunted and wobbled off at 3 miles an hour, a single flicker of my eyebrows seemed to be sufficient to set it off balance, but astonishingly, no doubt thanks to the skill of the driver who clearly felt that stopping for anyone or anything would be a Bad Idea and so wove his way expertly through the other traffic and around potholes, we made it to the bus stop without event. It was the most hair-raising 200 yards of my life. Until I got on the bus.

Obviously, it is exremely funny to be roughly three times the size of everyone else, but when you have about 150 people crammed into one bus, it becomes a pantomine. I had 2 saried bottoms resting on mine, one on each of my buttocks, and we all three swayed and swirled in rhythm. Some poor girl was trying to text on her mobile but she was eye level to my boobs which yet again invaded someone else's space. Although space is probably not the right word. In all honesty, I don't really think you've experienced intimacy until you've been on a local bus in India, forget about sex, it's a million times more intimate than that. And with a lot more people.