Kerala here I come!

Hi folks,

You're probably wondering where I have been the last few days. Tuesday night Manipal University changed a server, and we've been without internet connection ever since. What's more I had a draft of my MPH project proposal due to my advisors today! I did the best I could on my proposal, and it has been sent off. I was a gnat to the IT fellas here, and they just left my room - finally I have internet again!

In just a few minutes we're boarding the bus to the Mangalore airport to fly to Kerala for a very long weekend! I won't have internet access there, but hope to post some great stories and picts to the blog next Tuesday, January 19 when I return (also my 31st birthday!).

Community Diagnosis Day 2 and Neglected Diseases

This afternoon we took part in our second community diagnosis. The home we visited was very different from the home we saw yesterday. Today's home had only one room, with a kitchen outside. Five people live in this home, including a one-year old infant. Today we received a more thorough explanation of what occurs during a Community Diagnosis visit; these things are examined: locality, family composition, family history, occupations, health status, living conditions, and assessment of surroundings. That data is collected and can often be helpful in identifying health potential issues for families and communities. For instance, if a large area where water pools is discovered, health workers can educate the family on the importance of covering or draining the water so as not to give mosquitoes a place to breed.

This morning's lecture was was also very interesting. Dr. Lobo introduced us to a category of disease I had never heard before - neglected diseases. These diseases kill fewer people, but cause disabilities and deformities that cause heavy economic burden and great misery to the victims. This class of diseases is neglected because they have low rates of mortality (causing death), they are not globally distributed (they are focused mostly in tropical nations), and because they primarily affect the poor who have little political voice or power. Neglected diseases include leprosy, dengue fever, Japanese encephalitis, yaws, and filaria just to name a few.

The mother-in-law at the home we visited today rolls beedi cigarettes. Often referred to as "poor man's cigarettes," they are popular in South Asia. Beedis are unfiltered, and composed of tobacco leaves. Beedis are hazardous in homes because generally women are the ones who roll them, and those women often have children nearby or on their laps. Women who do this work are more prone to certain types of cancers. When you purchase beedis, you have no guarantee of the conditions in which they were prepared, or what contaminants might have found their way into them in the home where they were prepared. The way this industry functions makes the American tobacco industry look . . . almost like good guys.
Mother and child.

The situation for dogs and cats here is very different from what I expected. There are a lot of street dogs and cats, but it also appears that many animals have a home they tend to stay near. I have seen plenty of dogs wearing collars, and many animals linger near homes in clear anticipation of food. India is a developing nation that is unable to supply safe water and sanitation to much of its population; clearly veterinary care and sterilization of cats and dogs is low on their list of national priorities.

There was a mama dog at the home we visited today; this puppy is hers. Though not yet afraid of humans as most wise street dogs are, this puppy is smart and scrappy enough to know that the family garbage pile, only 15 feet from the front door of the home, is a good place to find a snack.
Same puppy. He was almost stuffed into my backpack and whisked off to the US.
It rained this afternoon, which is highly unusual outside of the monsoon season. This is how the family we visited collects rainwater. If left uncovered (and often they are) these pots of water will become vectors (breeding grounds) for mosquitoes who will then spread malaria, dengue fever, and Japanese encephalitis to humans.
Village food stand.
This little boy is from a family with means. Their home has all indoor facilities. His father owns a business that deals with cable television, which is big business here. I have seen satellites mounted on roadside shanties.
This is the coffee shop located in the student center here. Many of you know that while on this trip I have also been researching and writing my MPH project proposal. This has meant a lot of early mornings and late nights. I can get a delicious latte for 42 rs, or just less than $1.
These are the postcards I have been handing out. When we come across children it is nice to have something to share with them. Even if the recipient is not literate they can enjoy the photos. If you are traveling abroad in the near future consider taking a stack of postcards. They will make you very popular!

Polio Mop-Up and Community Diagnosis

Drying laundry in the front yard.
Altar. These red alters were in the front of nearly every home in the village. Sometimes significant plants are placed atop the altars to celebrate a holiday.
The chalk marks used by the health workers to indicate whether children dwell in the home, and whether they have been vaccinated.
This is how the kitchen fire is fed outside of the home. As a result of this method of cooking many women and children (because children might be held while a woman prepares a meal in the kitchen) experience respiratory problems. You can often tell where the kitchen is located in a home by looking for concentrated areas of blackness on the roof.
This man was out sweeping his porch this morning.
Transporting firewood.
Huxley and Mr. Poot's Indian cousin.
A very happy doggie who relaxes on a chair. His owner is the man I photographed pulling the wood.
One of the village women. She was kind enough to let me photograph her even though she was in her nightclothes. I think that she is very beautiful.
Grazing calf.
This child was vaccinated this morning. The child is wearing eyeliner, which is a cultural tradition, as well as the "beauty marks" you see on the cheeks of many Indian infants (of which she has one).
This is to ward off evil spirits.
Signs like these are a Christian tradition in India.

This morning we went to a village with local health workers. The purpose of the visit was to go house to house to determine whether the eligible children from that home had received the polio vaccination yesterday. The health workers marked each home to indicate whether there were children, and if they had been vaccinated. For a handful of children the vaccine was administered today on their front porches. This particular village had a lot of animals hence the photos.

This afternoon we did our first Community Diagnosis. We went with university faculty who work in the community to meet with a local family to discuss their health, any issues with their health, and their family planning. The family we met with makes about 3K rs/month, or 100 rs/day (about $2 per day). They were a little unusual in that they have more resources than many other rural Indian families might like land that they farm, a well, animals, and a solid structure home. They are Christians, and have only two children, which is also unusual. Both of their children are in private school, and the parents do not intend for their children to be farmers when they grow up. Among their cadre of animals were chicken, chicks, dogs, puppies (6 days old), cats, and cows. They were very kind to host our group and speak to us about their family.

Mangalore and Shree Gokarnanatha Temple

2 "elephants" greeted us at the entrance to temple grounds.The main temple.

This was also on temple grounds. One of these statues was in each of the four corners of a pool below and there were colored spotlights - this reminded me of Las Vegas. It was so neat but unexpected on temple grounds!




Something I am very quickly learning about India is that you will be fed everywhere you go. This was our morning snack at the polio clinic - upma. It was delish! The white half was salty, and the yellow half was sweet. Generally you got a little bit of each a bite. The upma's are wrapped in banana leaves to help them retain some of the oil, and the leaves are wrapped in newspaper. Probably yesterday's edition of The Times of India. I hope that we learn to make upma in our upcoming cooking classes.

Today was another touring day - this time in Mangalore. We went to a water park, shopping mall, a professor's home, and finally to a temple. Highlights included:

- Waterparks are different in India. No-one wears just swim trunks or bikinis. All of the men wore shirts and shorts, and many women went down the waterslides fully clothed. No cameras were allowed in - so no picts.

- We checked out the mall in Mangalore. I discovered my new fave store, FabIndia - check them out at www.fabindia.com. I treated myself to a bargain new bedspread which makes me love my room (update - I have been burning a lot incense and it finally seems to be getting rid of the ant spray smell).

- We had lunch at a restaurant at the mall. It was actually GREAT Indian food!

- One of our professors here, Dr. Lobo, lives in Mangalore. He invited us all to come to his home. It turns out that his home was built by his family many years ago, and feels more like a museum than a house - truly amazing to find a place like this in India. In typical Indian fashion, Dr. Lobo's wife put out a huge spread of desserts for us to enjoy. Unfortunately we had just eaten a very large lunch. We all loosened our waistbands because to have had no dessert would have been an offense.

- Even though it was getting late we decided to go by a temple. We were all so glad that we did! We visited Shree Gokarnanatha Temple, which was redone in recent times. I couldn't find any information about it in my guidebook, but it was amazing. It was a brightly lit and lively place at 8PM on a Saturday night. Admission to the temples is free, so you will see families, tourists, priests, school groups - all kinds of folk meditating, praying, observing. There were live musicians in the main temple, many prayer services, and the smell of the incense in the air . . . it was an unforgettable experience.

Because of insecurity with regard to vaccine effectiveness (re: temperature control issues) and the fact that children with incidence of diarrhea (very common here) will not properly absorb the vaccine, they opt to vaccinate children every year from ages 0-5. I wonder if they will ultimately discover adverse effects from this practice like increased risk of cancer or autism from vaccine preservatives. India's public health system is very far away from looking at the effects of environmental exposures; for right now the policy is that preventing polio is priority one for these children. In the US you are vaccinated once as a child, and then possibly again as an adult; I received a polio booster shot just before this trip because India has a high incidence of the disease.

St. Mary's Island

The shoreline on St. Mary's Island. We came in on the tender on the other side of the island, where it was more sand/shells than rocks.
The vegetation on St. Mary's Island.
Their attire indicates that these young men are in training to be Hindu priests (not sure if priest is the right word).
Great view of St. Mary's Island from the boat.

Today we had a most deserved break from school work - we went to St. Mary's Island! We took a bus to the fishing town of Malpe (pronounced mall-pay) where we boarded a boat. I must tell you that the smell in Malpe was like nothing I have ever experienced. Nothing. And the flies. Oh my the flies.

Once we boarded our boat it was a 45 minute slow and scenic ride to St. Mary's Island. We pulled a rather large tender behind us; they were tethered to us by rope and the engine of our boat was really laboring under the large effort. Once on the island we strolled around at our leisure, mostly near the water. We were disheartened with how much litter there was in the area where we came ashore, but on the other side of the island it was a near pristine paradise. After our outing Dr. Howard treated us all to lunch at The Woodlands restaurant in Udupi. The food was so amazing!! I think we all ate too much but I simply couldn't leave it on the table. We split a breadbasket full of naan (there was butter naan, my fave), I had a lime juice (so good!!) and I had the tastiest butter palak masala. 13 of us had lunch, and there were many appetizers and juices. The Woodlands is a very nice restaurant. Our bill came to around 1300 rs, or about$26.

Sri Krishna Temple

Elephant at the head of the parade. I hope they gave him a nice snack afterwords!
Krishna Temple - it dates back to the 1300's. The temple is surrounded by 8 maths (monasteries).

It is hard to tell from this photo, but this is not a human - it is a very large statue.
Part of the small parade/procession.

We had an exciting little add-on today after our field trip - we went shopping briefly at Big Bazaar (I got some clothes), and Dr. Howard treated us to Sugar Cane Juice. Our next stop was the Sri Krishna Temple. It was an exciting time to visit the temple as preparations are underway for a big celebration next week. Today there were many visitors to the temple, and we were able to walk through as well. I snapped some good shots outside, but photography inside is strictly prohibited. We left our shoes outside (we paid 1/2 rupee for someone to secure them) and shuffled through the maze of the temple barefoot just like everyone else. A little boy behind me kept smiling up at me, so I gave him one of my Baltimore postcards (many of us brought small items to give to the children we encounter). A few minutes later I realized that the boy, his father, and two brothers had tracked me down to get postcards for each of the other brothers. I'm not used to being so popular.

Visiting the Temple was a tremendous experience. I was hesitant to partake in everything because I wanted to respect someone else's place of worship and ceremony, but I was encouraged at every turn to take part in the rituals. There was bell-ringing, viewing of statues, touching of icons, and some kind of liquid that was ladled into your hand; first you smelled it, then you put it on your head. When we came out of the temple we heard gun shots and music; there was a small ceremonial procession headed our way. There was someone very famous in the procession; I don't know who, but all of the Indian girls in our group knew him, and were calling their moms to say that they had seen him. The trip to the Temple was just stupendous; I am afraid of cheapening the experience by trying to describe it more, so I will leave it be. I hope that you enjoy the photos.

District Hospital

Katrina and I enjoying Sugar Cane Juice outside of Big Bazaar.
No-one here has dryers, so the linens used in surgery at the hospital are laundered, and hung out on the lines.
Dr. Howard with the housekeepers in the tuberculosis wing. I'm wondering where their masks are??
These are some samples of positive HIV screening tests.
This man was a greeter at the District Hospital. He asked us to take his photograph. He enjoyed seeing his photo on our cameras.

This afternoon our field trip was to the District Hospital, which is two levels about the PHC in my last entry (we went to the hospital in between them - I will cover that later). We received a very thorough tour, and learned a lot about how the Indian public health system manages HIV/AIDS. We visited a women's AIDS ward, and saw a seclusion facility for people with highly contagious tuberculosis (we didn't get too close).