Coming home for Christmas

Tomorrow I leave RUHSA for a last weekend in Bangalore before flying home to the UK for Christmas. I am really excited at going home and also really happy I am not leaving India for good. It’s a luxury to be able to spend enough time living in a foreign country that you get to go home for holidays, whilst knowing that you get to go home to stay eventually as well.

My suitcase is full of nothing but presents. I have packed no clothes at all, as currently I am only wearing "summer" clothes. Of course, in fact, it is winter here with a few concessional chill Christmas breezes-only somewhat cooler than the hairdryer-hot wafts of high summer. It is a lovely ambient temperature during the day, around 25 degrees, but for the average South Indian, these are arctic temperatures. The fleece and balaclava salesmen on the roadside are doing a roaring trade. Many an Indian scooter rips by with entire Indian families, of course, perched on them, all wearing vile puce coloured fleeces zipped up to the chin with a cheek-and-chin encasing balaclava hat and, if male, a lunghi. I feel like yelling out as they pass to forget the headgear, which looks ridiculous, get a pair of trousers and pair of socks on and even out the overall body temperature, but in reality, as a friend of mine pointed out, being warm-blooded animals, this whole charade should be unnecessary. My theory is that they are trying to recreate the 100% humidity and 40 degree heat of summer, inside their clothing.

Over the last few days I have been enjoying cycling up to the village to continue with my medicals. Vellore district is on the plain beyond the Deccan Plateau which spans almost the width and length of South India and makes the ride pleasant rather than arduous. The bike, like Mum’s school one, is a Hero with no gears, so despite the practically imperceptible undulation of the land, I still find it difficult for my legs to keep up with the pedals. I have attached my rickshaw hooter to the front, which affords much entertainment for both me and the school children, bus loads of men, passing rickshaws, solitary walkers and cows at whom it is a necessity to honk. Occasionally, during particularly enthusiastic knee activity, I accidentally hit the hooter for extra fun. Seeing the Indian countryside passing slowly by as I, comparatively speedily, cycle, is wonderful; the sinuous punk-headed palm trees bordering the brilliant green glistening paddy fields, where a figure with cloth-wrapped head and loins, bends tending to the young rice shoots.

As I pass by the rope-making village, I see the whole process of creating rough, strong hemp rope from insubstantial piles of brown fluff. The village consists of a row of several houses set below the road. At the extremities of the long spaces between the huts, fixed to the ground, are iron hand-winding frames with a central cog. Four hooks are evenly placed around the wheel, making a square, and rotate faster in the opposite direction.

The first strand grows magically. A woman, holding a basket of raw fibre under her right arm, keeps the rotating strand taut, feeding it the mahogany candy-floss, while walking backwards slowly away from the winding machine. Yesterday, a white-haired, slender lady, very gracefully wound the handle, never breaking pace or seeming to find it an exertion. Dotted around the work yard are huge mounds of raw hemp, on which a teenager or two lolls lazily, watching their mother and grandmother working industriously.

Once the smaller strands are formed, four of them are attached to each hook on the machine’s wheel. Another family member, far away at the edge of the village, holds all four strands attached to a hand hook which also revolves, in rhythm with the twisting of the rope, whilst the handle remains still and stable. A man, needed for his strength, winds the machine handle and all the strands dance separately yet synchronously, intertwining themselves into a recognisable single strand of perfect rope. On the road side, from the branches of the Neem trees, half-coiled like Kaa the python trying to leave his tree to snack on Mowgli, hang their finished handiwork for sale. It is a beautiful spectacle.

Arriving at the village today, I had to do a home visit. It was a little different from those I did in Kirkby or Dalton. We walked through the village on and beyond the tarmac to a sand track weaving between palm-roofed houses. Outside one, in the blazing sunlight, the old lady I came to see was seated on the ground, a sack on her lap to protect her legs from the sharp-edged, dried leaves she was weaving deftly, despite arthritic hands, into more thatch for her house. Mobility was impossible for her because she had fallen a couple of years ago, and despite probably having fractured her neck of femur, was unable to afford surgery. She has been unable to weight bear or move without being held by two people since then. She is the sole carer of her achondroplastic, staturely challenged, 40 year old son, who, having limited marriage prospects, has remained single. No new generations are available to help with the burden of care.

Home visits in India, unlike the UK, are a popular and well-attended spectator sport. Confidentiality is impossible when there are friends, relatives, neighbours unashamedly listening and contributing to the old lady’s story. Whilst they are not missing a detail of her complex medical history, they manage to find out whether the funny white doctor is married ("No." "Why?" – How do you answer that?). It has been an extraordinary experience doing these medicals, requiring quite different skills from those utilised at home. It is amazing how much of a barrier there is between a doctor and patient who can’t communicate directly. In some ways too, there are surprising moments of connection, through non-verbal means. When, via the interpreter, I asked if the lady had any problems moving her bowels, she tutted, shook her head and rubbed her knees furiously. I patted her arm and said, "I know exactly how you feel, my knees are killing me too." We laughed.

Sometimes, though, I know the interpreter hasn’t understood why I’ve asked a particular question and asks a different one. The subtlety of nuance and impression revealing important cues crucial to understanding someone’s health beliefs are mostly lost. Sometimes, the interpreter is embarrassed asking certain questions. I find it difficult not to be able to broach difficult topics delicately myself, framing and leading into the sensitively-phrased questions according to the patient’s response. Having an interpreter brutalises the consultation process.

The great bonus in doing these home visits, is that I am a walking, talking sandwich board for the project and there is a palpable interest in what is happening. By paying attention to the more usually neglected or ignored elderly, we have, I hope, elevated their status, and will encourage them to continue to engage with us. A potential problem to be overcome was the shame of someone coming to the clinic and showing the rest of the village that they were not looked after by their families. The level of interest being shown to us as we wander through the village suggests, at present at least, that people want to come and join the program. We shall see in January if that’s the case.

Back at RUHSA campus, there is a suggestion of Christmas, despite the un-seasonal weather. In the hospital yard is a huge, familiarly palm-roofed crèche, surrounded by seated saried and lunghied patients, staring inquisitively at me as I take a picture of it and the "Christmas Tree" (straggly, wilting fir branch with one star on the bowed top). On the ceiling of the outpatient clinic, where brisk-walking nurses in their regulation plain, sky-blue, crisp saris, ferry trays of equipment and notes to and fro, are strung rows and rows of coloured twisted crepe paper and tinsel. The other day, I even heard ‘Hark the Herald Angels Sing’ wafting through the coconut palms. Hindu sandalwood-striped foreheads and Muslim embroidered hats mingle easily amongst the Christian decorations.

So today, I start my journey from RUHSA’s tropical Christmas to a more familiar celebration with my family. Last night, as is my long-held, intractable habit, I was up until 4.20 am, packing and generally footling (in reality writing this posting instead of packing). I am very much looking forward to getting home, although, it would also have been an amazing experience to spend Christmas here. I can’t wait to see everyone and hear what has been happening in the four months since I left. Most especially I am looking forward to being greeted only by people who know me; no random shopkeeper or passing giggling school girl will ask me for my "good name, please, Madam". I will enjoy being anonymous and not an unintentional source of constant entertainment.

Hopefully, for the next 10 days I will be laughed with not laughed at.