June 12: Last Day at the Hospital

Ammini sitting at her desk

For my last day at the hospital I followed Ammini to observe more of her counseling methods and to speak with some of the families that she interacted with. During our breaks we discussed how things needed to be broken down so that members of the community could understand the information. Ammini asked if there was anyway that I could just stay in Gudalur with her and help her talk with families and explain the material to them. We went over more of the pamphlet material and I got all the different topics that I will eventually need to work on and cover. We also spent some time meeting with Dr. Nandakumar to make sure that all the material is on track and that I had all the information that I needed to continue working when I got back to Pittsburgh.
After lunch I spent some time with Mahesh who is the Ayurvedic doctor at the hospital to tape some yoga exercises that we can play for the patients so that they can perform the exercises correctly. It's going to be really cool when the videos all come together. My uncle was coming to pick us up at 4pm so I had to make sure I had everything that I needed and needed Dr. Nandakumar to fill out my evaluation form for my rotation. I really hope that I can manage to make it back here at least once a year because it definitely is a peaceful atmosphere and the people here are amazing to work with.
My uncle was on time to pick us up so we said bye to everyone at the hospital and packed up his car for the 4.5 hour drive home to Sulur. He had brought his niece, Saranya, with him to keep him company on the drive up to Gudalur so we had a full car on our way back. We had to drive through Ooty to get to Sulur so we stopped in Ooty to grab some food and take a small break. I have a strong feeling that he likes to see how fast he can drive because we were definitely zooming down the mountain holding on for our dear lives. I tried to take a video clip of his driving but we kept getting caught behind buses and he felt the need to go around the buses and other cars which scared us because it was dark and they were all hair-pin turns.

We dropped Saranya off at her house and stopped in to say to her family before heading home. We got home around 10:30 where we tried to eat the dinner that our grandmother had made for us but we just ended up getting into our PJs and passing out.

               

June 11: Ellumaram Village Visit

The local area center

We spent the day at a nearby village updating medical histories, passing out medication and screening individuals for sickle cell. The environment here is very different from other hospitals in the country. There are around 28 villages that the hospital caters to comprising around 20,000 individuals. There are 8 area centers that each have 2 nurses/health animators that are there every day and are responsible for seeing the patients that the area center is responsible for. The Gudalur Adivasi Hospital can be very far from some villages so patients cannot necessarily make it to the hospital every time they need medical attention. It is during these times that they go to the area center to receive care and medicine. All of the employees in the hospital and area centers are all Adivasi’s (or tribals) from the nearby villages so the hospital has a very big sense of community and most of the time everyone knows everyone else that is in the hospital. It’s almost as if it is one big family at the hospital.

Walking to the village

                This comes into play with genetic counseling because nothing is very private in these parts. Pretty much everyone in the villages can tell you what is going on with other members of the villages. It is also very common for individuals to marry other members in the same village which is why the sickle cell gene has thrived in these tribes for so long. A big component of genetic counseling here has been to educate individuals about marrying individuals outside of their communities to reduce the prevalence of the sickle cell gene and the chance of passing it on to future generations. The health animators explained to me that more and more individuals are starting to marry outside of the community.

Vignesh (2 yrs) at the v

Today I went with one of the health animators, two lab technicians, and one counselor to a nearby village called Ellumaram. It was about a 30 minute walk from the hospital to the village but it was a nice day so it wasn’t too bad. Each family receives a family genetic card that has all the screening information for each member of the family. We screened about 10 different individuals (mainly children) in the village. The counselor, Rathi, explained to the parent why the kids were being screened but pretty much everyone in this community is aware of sickle cell and that everyone needs to be screened at some point. As of right now around 16,000 individuals have been screened for sickle cell trait. After spending the day at the village we headed back around 2 to eat lunch back at the area center near the hospital and then headed to the hospital. I wanted to finish up some more information for my pamphlets.

           

The family genetic card; Lakshmi measuring the weight of the babies, Another Lakshmi recording down all the information

Reena, Kala, and Sakthivel having their blood drawn by Rathi for their sickle cell screening 

    We were going to go out for dinner but Anna and Hayley were sick all day so Nicola, my sister and I went into town to get one last mango shake since we were leaving tomorrow and picked up some dinner in town and went back to the hostel to eat with Anna and Hayley. Some of the others back at the hostel were cooking up some snacks and it ended up being on big party when we got back. There were around 20 different people that were in and out of the hostel all night and we had a great time just chilling and getting to know everyone that was there. 

June 9th: Auto Rickshaw Ride in Ooty- Cows, People, Buses and much much more

Anna, Hayley, my sister and I crammed into an auto to take us to the railway station from the Rose Gardens. We wanted to buy some train tickets for Anna which didn't happen but this was our ride.

June 10: Theppakadu- Elephants, peacocks, bison, monkeys and deer

Nicola, Akshaya, Myself and Anna in the back of the jeep

Theppakadu reserve forest is part of the Mudhumalai National Park and Wildlife Sanctuary. It was about 45 minutes away from us and we wanted to visit to see if we could possible go on an elephant ride and drive through the forest to spot some animals. The wildlife sanctuary is also a tiger reserve but it was highly unlikely that we were going to see tigers. Another medical student, Nicola, had arrived from England the night before so she joined us on our trip to Theppakadu. We had a pretty relaxed morning since the four of us were still tired from our adventures the day before so we didn’t head out to the forest until around 1pm. We had arranged for a jeep to take us and drive us around and bring us back afterwards. Jeeps rides are always nice in this area because the scenery is gorgeous. You pretty much drive through forests/jungles no matter what direction you travel in.

This monkey was quite comfortable

Two deer facing off

We got to the reception center around 2pm and went to see if there were any elephant rides today but unfortunately they only had one elephant that was feeling well enough to give rides and there were people from the morning groups that were still waiting. We decided to grab some lunch and go on the van safari through the forest instead and then drive around to try and spot some elephants afterwards. We saw a ton of monkeys while we were walking around. We couldn’t buy tickets for the safari until 3pm so we had some time to kill. We ended up getting some parceled lunches and ate them outside of the reception center waiting for the tickets to go on sale. We got in line when people starting lining up but the concept of standing in line and waiting your turn does not seem to register. It happens everywhere but the sheer number of people that tried to cut in front of everyone with stupid excuses about what they weren’t waiting in line like everyone else was astounding. Fortunately we managed to get tickets and waited for our turn on the safari. All in all, the entire safari took us about 45 minutes. It was a rather boring ride because we only saw deer (which we have plenty of in Pittsburgh) and one lonely elephant at the end that Hayley was pretty sure was tied to the tree just so people could see one elephant during the ride.

                I think our driver saw that we were disappointed at the lack of animals that we had seen because he drove us past the border to the neighboring state of Karnataka to the Bandipur Reserve Forest to see if we could see elephants there. This ended up being awesome because we saw a ton of elephants there and a ton on our way back. We got the reserve just as the elephants (there were about 4 or 5) were being led away but immediately across the street there was a mother and baby elephant that were drinking water from the pump. We were the first ones there so we got out of the jeep and managed to get a nice group picture with the elephant and get really close before a crowd started forming. We were less than three feet away from the elephants which was definitely an awesome experience. We just kind of stood there and watched the two elephants take turns drinking water. I wish it was possible to bring a baby elephant back home or to own one in general. We couldn’t hang around for too long because we were trying to make it back to the Theppakadu Reserve to see the elephant feedings at 5:30pm but I think seeing the elephants definitely put all of us in better spirits and we were excited to head to the feeding. Even better for us, the sun was starting to go down so more and more elephants were starting to come out into the open. As we continued to drive back we stopped to see another pack of about six elephants that had ventured out near the roads and were giving themselves a mud/dirt shower. Eventually we made it back to the Theppakadu reserve to the elephant feeding camp and got to see about another eight elephants as they had their feedings. There were also a ton of hogs and peacocks that were roaming around the feeding camps.

At the feeding camp

Pretty cool trick 

                On the way back we ended up spotting a ridiculously large bison and another elephant that was carrying tree branches across the road. It would be our luck though that the cable for the gas pedal ended up breaking so we had to pull over on the side of the road as the driver attempted to fix it. We were kind of worried because it was already 6:30pm and it tends to get dark by 7pm and we didn’t want to be stuck in the middle of the forest after dark. The road that we were on gets shut down at 9pm everyday and doesn’t open up until 6am the next morning because the elephants and other animals wander the area freely. After awhile though the driver just gave up and pulled the cable through to the front of the car and held onto the cable with his other hand to drive the car. Definite props to him because he was steering with his right hand while operating the clutch and holding on to the cable with his left hand. We had him drop us off in town because we didn’t want to worry about the jeep going up and down the hills on the side roads leading to the hospital. 

Ridiculously large bison

We were meeting the others from the hostel (Sophie, Rahul, Vivek, and Mohantu) for dinner so while we waited for them to join us we decided that we needed to introduce Nicola to the amazing mango milkshakes at Lulu Bakers. Hayley decided to be adventurous and try a pistha shake with chocolate ice cream but the rest of us were not planning on messing with perfection and got the usual mango milkshake with vanilla ice cream. 

Mango Madness

The parotha guy

Sophie and Rahul found us just as we were finishing up so we all decided to head to Gudalur mess for dinner. The Gudalur mess has some of the best parothas that I have ever had. The other food is kind of questionable but the parothas end up being worth it. The five us had egg parothas that were amazing but with the exception of my sister the rest of us were falling us asleep while sitting at the table. It wasn’t that late but all the traveling and riding in the jeep seemed to be tiring us all out and Anna and Hayley were not feeling well to begin with. We somehow managed to stay awake till the other half of the group finished eating before heading back to the hostel. I walked back with Sophie and Rahul while the other four crammed into an auto. The walk back was super nice and refreshing and apparently the auto broke down three-quarters of the way to the hospital so the other half of the group had to end up walking part of the way anyway. It doesn’t seem like our group has much luck with vehicles this time around. It was back to work for the next day so we all decided that going to bed early would probably be the best bet. 

June 9th: Ooty: Botanical and Rose Gardens

In our new clothes :) 

We decided to be adventurous and take the town bus to Ooty. It’s about a two hour bus ride up the mountain so we ended up catching the 10am bus. It was pretty crowded at first but the conductor on the bus made sure that we got seats. It was actually a really nice and refreshing ride. At one point a drunken guy got on the bus and was being rude so the conductor stopped the bus and kicked him off. The guy was basically breathing down our necks and the smell of liquor was so strong. He definitely swaggered off when he got kicked off.

Sitting on the engine of the bus

                When we finally reached Ooty it was half past noon so we decided to go grab some lunch. We went to the Nahar Hotel where we had one of the best lunches ever. Paneer butter masala and palak paneer with butter naan. It filled us up so much but it also energized us to start our trip. Our first stop was the tourist office. We wanted to see if we could book tickets for an elephant ride in the national tiger reserve in Thepakkadu. Unfortunately we couldn’t book tickets the day before but the rangers at the office were super nice and gave us a map of Ooty and Muthumalai forest.

The view from the bus and our amazing lunch

From the tourist office we headed to the Botanical Gardens.  We ended up making a pit stop at a Café along the way that had these amazing Choco Balls and they were only Rs.15. We also went to the Modern Store which apparently is the place where you can get pretty much anything that you are craving from peanut butter & nutella to SPAM. It was interesting because they had all these different types of Riesling and zinfandel but when you took a closer look you realized that everything was “de-alcoholized.” This was also the one spot where you’ll pretty much find every foreigner that is traveling in and around Ooty. The store was pretty close to the garden so it was an on the way stop to pick up some Kleenex.

Choco Balls and the De-alcoholized Wine

Looks it's Gudalur

Onto the Botanical gardens which are gorgeous. We enjoyed walking around and seeing all the plants and flowers. Anna and Hayley were a tourist attraction themselves and had quite a few people come up to them and ask to have their picture taken with them which was kind of annoying especially since most of the people coming up were in their 20s and 30s. They weren’t really comfortable with it and we kept saying no but people kept coming up to our group throughout the day.

                After leaving the botanical gardens we decided to go to the Rose Gardens which according to the signs were only 1 km away but we quickly learned that either the sign lied or we took the longest most roundabout way of getting there. We really had to use a restroom and saw a Dominos along the way so we decided that we’d go in there buy something small just so we can use a decent bathroom. Probably one of the downsides of traveling in India is that it is hard to find a clean bathroom anywhere. The Dominos menu looked pretty interesting but we were all still full from lunch so we just continued on walking towards the Rose Garden. After a number of twists and turns and walking down random alleys and walking up steep hills we finally reached the rose garden.

                The roses were definitely gorgeous but the garden probably would have looked better if the roses were planted closer together. We went through the garden taking pictures next to pretty roses and wandered around until we needed to get to the bus station. We wanted to catch a bus around 5:30 so we would be back to Gudalur around 7:30-8 but we just missed the 5:30 bus and the 6:00 bus never came so we were stuck waiting until 6:30. Anna and Hayley wanted to get some jasmine for their hair so we did while waiting. We spent the other 50 minutes staring down all the random people that were looking at groups and refusing the people that came up asking to take pictures with Anna and Hayley. None of us could understand why so many people wanted to take pictures with Anna and Hayley. What were they going to do with the picture? Frame it and say that this was the day they took a picture with a white person?

In the Rose Gardens

Finally we got on a bus and managed to get two seats. Since the previous bus had never came this bus was overcrowded and people were majorly pushy which none of us really were willing to put up since we were so exhausted. In particular there was this one lady that somehow managed to push both me and Anna simultaneously until Anna gave her a nice little shove which stopped her from leaning onto her. She went and sat on the lady behind us instead but Anna and I couldn’t wait until she was off the bus for good. We finally made it back to Gudalur around 8:30 and took an auto back to the hostel. We spent some time talking with the people that were in the hostel before we all excused ourselves to go to bed. Although we only went to two places in Ooty we had a really good time exploring together and just hanging out.  

June 8th: Working in the Hospital and Back Into Town

 I spent the majority of the day putting together a rough draft of the video. It’s actually to really cool to be putting together these videos. I have to make myself think about the Adivasi community and what they would be interested in and how to make the material understandable for them. I finished working on the Sickle Cell Pamphlet and spent the morning making a rough draft of the video. We are making three separate sickle cell videos, one to introduce the topic, the second to explain the mode of inheritance and the third to explain the various treatment/management plans. Putting together the first video made me think of the potential of these videos and I’m really looking forward to coming home and working on them more in depth. I really hope that these videos turn out well because I think they have the potential to help a lot of people if done properly.

                After finishing the sickle cell pamphlet I worked on a diabetes booklet. There is actually a pretty high population with diabetes so teaching them about proper diet and how to prevent or manage diabetes is very important. I’ll be visiting tribal villages on Monday so I am looking forward to speaking with various individuals to learn about their knowledge of various subjects. I will also be following the health animator/counselor that works with sickle cell families to see how counseling is done.

       
It was raining for the better part of the day so after we finished up at the hospital we spent part of the evening sitting outside the hostel watching the rain and the construction workers. They provide us with pretty good entertainment. We wanted to enjoy the nice weather before heading back into town to grab another milkshake. :-D We also decided that since it was the weekend we would head to Ooty tomorrow to explore a bit. It’s a pretty big tourist attraction and since Hayley and Anna had never been there and my sister and I hadn’t been since 2006 we thought it would be a fun adventure trying to explore on our own.

                After our amazing milkshakes we came back to the hostel for dinner and ended up just hanging around with the others in the hostel before heading to bed to prepare for tomorrow. 

June 7th: Hospital, Shopping and Mango Shakes

Some Adivasi women outside of the hospital

 The day here doesn’t start till 9 which is nice. Mala is the cook at the hostel and she makes the most amazing food for all us. We all eat breakfast together around 8:30 before heading down to the hospital for our day’s work. After breakfast I met up with Ammani and Sheila to go around the hospital and see what has changed and what I would be doing. The hospital is currently under construction. Additional wards are being added and separate buildings are being built for an operation theater, post-natal ward, blood bank and another guest hostel. It’s amazing the changes that are underway from last year.  I truly believe that this hospital has managed to find every kind-hearted, dedicated, loyal Indian in the vicinity to work for them. Everyone is so nice and helpful that is insane. Even all the patients are sweet and friendly. This hospital is definitely a gem that is hidden away in the Nilgiri Hills but I’m glad that I have been able to work with them and hopefully be somewhat helpful.

The additional wards that are being added on 

         Ammani and I spent the morning going over all of the educational material that they currently have in the temple. My project will be to take the current presentations, spruce them up, translate them into Tamil and make them into a pamphlet and then also make an educational video in Tamil of the same topics. Dr. Nandakumar is quite excited about this project and talks a mile a minute about the potential of the project which is kind of entertaining. He has designated individuals within the hospital as the “audio visual department” and I am to work with them to make these videos. Apparently I should not have majored in Biology but I think we are all learning as we figure out this project. The educational videos will be played not only at the hospital but also at all the local area centers when patients come to visit. The topics range from Sickle Cell, stroke, diabetes, hypertension, epilepsy, nutrition, sanitation, personal hygiene, rules and regulations of the hospital to whatever else the hospital thinks is important for patients and families to learn about.

            I’m excited to work on this project but I just need to figure out the logistics of everything. Dr. Nandakumar knows that I won’t be able to get everything done immediately but he wants to me to continue to work with the hospital in any capacity possible even after I graduate which I would love to do. I already want to try and come back at least once a year if possible but we’ll have to see what happens with the job search next year.

            For lunch we go back to the hostel and eat with everyone once again which is nice. The hostel is a 10 second walk from the hospital so we can always go back and forth during the day if we need to. After lunch I spent the rest of the afternoon going over the information on my own and updating things as needed and translating everything.

Deciding whether she wants the blue salwar or the green

              

           Akshaya spent the day with Anna and Hayley following them around on their medical rotation. But we all agreed to meet up at 4pm to go shopping for Anna and Hayley. They had tried going shopping for clothes previously but couldn’t get the sales reps to understand what they wanted. The walk into town was nice and refreshing and we spent a good bit of time at the store but ultimately we were successful and both Anna and Hayley found a couple of salwar sets that they liked. 

They had some pretty interesting hats at the store

The best milkshake ever!

While the store was making the necessary alterations we headed over to Lulu Bakes to get some amazing mango milkshakes. I was introduced to the milk shakes at this bakery during my last visit and had to have more this time. They are by far the best mango milkshakes that I have ever had and everyone has agreed.We also picked up some sweets to try out to see which ones we liked. 

                

We picked up a few mangos after getting all the clothes before heading back to the hostel in an auto. After showing off the clothes that had been purchased and eating dinner we settled down to watch A Walk to Remember before bed since Anna and Hayley had not seen the movie before. A Walk to Remember is still probably one of my favorite Nicholas Sparks books/movies. 

Our new friends :) Anna and Hayley