Ommmmm

This weekend, we went up to Dharamsala in northern India, which was aMAZing. Dharamsala is the home of the Dalai Lama, the Tibetan government-in-exile, lots of maroon-robed Buddhist monks, and even more European hippies. It kind of reminded me of the Himalayan version of Boulder, Colorado. A lot of people come and stay in Dharamsala long-term to study yoga, meditation, and Ayurvedic/holistic medicine. Dharamsala is absolutely beautiful (and about 50 degrees cooler than Delhi!) - huge mountains with tiny houses perched on the side, colorful prayer flags strung up between homes and across streets, and some seriously awesome people watching.

The view from our hotel

Prayer flags strung over Dharamsala

Walking down one of the streets in McLeod Ganj

Rainbows over the valley

On Saturday, we hiked some steep trails between the tiny towns of McLeod Ganj, Dharamkot, and Bhagsu. The views were spectacular, and each of the towns were very cute with lots of shops selling Tibetan crafts and the latest in hippie-chic clothing. Unfortunately, the hike made us all very aware of just how out of shape we've become after 3 weeks in Delhi, where our only exercise has been staying as still as possible to avoid overheating. We ate at a couple different Tibetan restaurants, and it was a very welcome change to not see the words "curry", "Tandoori" or "dal" on the menu.

Me hiking with "Smokey", the random dog who herded us along on our hike (until he was scared off by some very vicious monkeys)

Nancy and I taking a chai break

Sunday we visited the Dalai Lama's house, Dharamsala's Buddhist temple, and a museum about the Chinese invasion of Tibet. There was a big rally of monks and Tibetan refugees at the temple because it was the birthday of the Panchan Lama (the Dalai Lama's right-hand man), who China has allegedly been holding captive for the last 20 years. There were speakers, posters hung up all over, and a group of people participating in a hunger strike.

The rally to free the Panchen Lama

The Dalai Lama's living space is small and understated. The temple is also pretty small, but very ornately decorated. You could peek in the side and listen to the monks sitting on the floor chanting. The temple is lined by prayer wheels - these gold cylinders with prayers enscribed on them that you spin clockwise to send the prayer out into the world. There were lots of people prostrating and praying outside the temple, it was a very neat sight to see.

The museum of recent Tibetan history was pretty sobering - kind of like a mini Holocaust museum. Our waiter at one of the restaurants we ate at told us about he had walked for 24 days across the mountains to flee from Tibet in 2006. He had grown up under Chinese rule, and was very happy to get to talk to Nancy in Mandarin, but also said that he would unlikely ever be able to go back to Tibet, and would probably not see his family again. Really sad.

Me, Emily, and Nancy with our Tibetan waiter

Sadly, our mountain vacation had to come to an end, and we took a very cramped overnight bus back to Delhi. We were welcomed back to Delhi by the undeniable stench of human feces, and a view out the bus window of dozens of men squatting next to the river, doing their morning business. A few seconds later we drove by the brand new Jetson's-style Delhi Metro. Call me crazy, but I think proper sewage and sanitation would come before state-of-the-art public transportation on my list of priorities. It's been a very educational experience being in Delhi for so long, but I am eagerly anticipating moving on to greener pastures at the end of this week.

Taj Mahal

This weekend we went to Jaipur and Agra, both of which, like most things in India, were awesome but a huge, exhausting hassle. Everywhere we went, we were mobbed by very aggressive vendors and beggars, who do not take “no” for an answer. Jaipur is called “the pink city” because all the buildings are painted pink, and the city has a cute vacation-y feel to it (minus the beggars). There are lots of elephants and camels being used for hauling stuff around, and monkeys and peacocks everywhere. We went to the City Palace and Amber Fort, both of which were beautiful, and ate dinner at this place that felt like the Indian equivalent of colonial Williamsburg – they had lots of traditional food, dancing, snake charmers, elephant rides, etc. It was a little cheesy, but fun.

Jaipur - "the pink city"

Nancy and John riding an elephant


Seeing the Taj Mahal for the first time was truly an amazing experience. However, once we got up close to go inside, it was a completely different story. We happened to go on the one day a year that entry to the Taj Mahal is free, so it was super crowded with very hot, very sweaty people. It was over 120 degrees outside, and we had to take our shoes off to walk on the marble ground, which may as well have been made of hot coals. Overall, totally worth it, but it probably would have been a nicer experience on a different day.

Me at the Taj Mahal

Nancy and John at the Taj Mahal

This week we have been doing a little bit more clinically-based work. We went to an outpatient free clinic, where the doctor we shadowed saw 100 people in less than 3 hours. He literally did not spend more than 3 minutes with any patient. Very little history, no physical exam – just got the chief complaint and wrote a prescription. He did have very good follow-up, but I was really shocked by the whole practice – it would never fly in the US.

We also were set up with an NGO called Sahara, which has a number of different projects, but mainly does work with injection drug users and street children. It is a very interesting organization because it is run by former addicts who have gone through rehab at Sahara, and have stayed on to help other people get back on their feet. We went to a drop-in center where they had a needle exchange and oral substitution therapy, and were treating abscesses. We also went around different parts of Old Delhi and saw where some of the drug users were living – by the river, under overpasses, etc. There is an enormous population of IDUs here, and it was so sad to see so many otherwise-healthy men whose lives have been totally ruined by their addictions. Interestingly, we also walked by the section of the river where funerals take place – the bodies are cremated in large bonfires on site, then the ashes are floated down the river with garlands of marigolds.

The funeral part of the Yamuna river

Today both Nancy and Emily came down with a case of “Delhi belly”, so I went on my own to a small inpatient facility for HIV patients. They admit people who are being started on antiretroviral therapy, as well as patients who develop opportunistic infections, the most common being TB. We rounded on a lot of really interesting patients, a few of whom were, unfortunately, in the end-stage of the disease. In the afternoon, I was allowed to go around with a translator and talk with a few of the patients and hear their stories, which was really great, and exactly the kind of experience I was hoping to get here in India.

Smelly Delhi

I've developed quite a love/hate relationship with Delhi. It's a city of extremes - rich and poor, traditional and modern, beautiful and filthy. People are extremely welcoming and willing to share their life story with all the gritty details, but a lot are ultimately trying to rip you off or run some kind of scam. There is so much beauty here - parks and mosques/temples/tombs dotting the city, stunning clothes and jewelry - but also so much that is unpleasant to look at - slums, garbage everywhere, air thick with pollution (supposedly a day out in Delhi is equivalent to smoking 2 packs of cigarettes).

A tomb in Lodi Gardens, in South Delhi

We took a bicycle tour of Old Delhi over the weekend, which was like stepping back in time. We rode through a maze of tiny roads and alleys, dodging people, flower carts, kids playing cricket, and cows (one of which Nancy crashed into). We went through a spice market, which sent me into a 20 minute coughing fit, and ate a breakfast of mutton at a cute little restaurant (I think I prefer pancakes). Overall, though, it was an awesome experience, and I wish I could have gotten some better pictures.

So far this week, we have been going around with an NGO called Sulabh International, which does sanitation stuff - placing public toilets in

the slums to decrease disease there, and installing toilets with underground tanks in private homes so there is no need for scavenging. Scavengers (aka "untouchables") are the lowest caste of people in the villages, whose job it is to go to people's homes and manually clean out their dry latrines, then carry the excreta in buckets on their heads to dispose of outside of town. They are treated as pariahs by the community, are sick all the time, and make next to nothing. I can't think of a more inhuman existence. Sulabh runs a trade school to teach the

scavengers how to be seamstresses, beauticians, and electricians, so they can earn a living outside of scavenging. There is also a school for the children of scavengers, who are often excluded from public schools. Tomorrow we are going to a village called Alwar to meet with a group of former-scavengers who have gone to school and are now living and working as part of their communities.

We went into a slum yesterday. The living conditions are pretty appalling, but the people who live there were so nice and happy to show us their homes. The kids were so cute, and each demanded that we taken their pictures.

A Delhi slum - 1000 people live here

Some super-cute children living in the slum

Today our program was cancelled because India decided yesterday that today would be a national holiday - like a snow day for the whole country. Completely insane.

This weekend we are going to Jaipur ("the pink city") and Agra to see the Taj Mahal. I am very excited to get to take the signature "I'm really in India" picture.

Talk to you later,

Tricia

I'm melting

Hi,

We arrived back in Delhi last night. It is so unbelievably hot here - 110 degrees right now and supposed to go up to 116 later this afternoon. There are people riding bicycles and doing work outside like everything is fine, but I feel like I'm going to keel over at any minute. Apparently the traditional way to prevent heat stroke is to eat raw onions and drink lassi (a cold milk drink), so we may have to try that later today.

The rest of our week in Chandigarh was really great. On Thursday we went to another small village and met with a dai (traditional birth attendant), a nurse/midwife, and several pregnant women from the village to talk about their approach to antenatal care, delivery, postpartum education, breast feeding, and childhood vaccinations. India is trying to phase out home deliveries, which obviously have much higher rates of complications and maternal/fetal mortality, in favor of "institutional deliveries" which occur at small birthing centers with a nurse or at the general hospital. Over the past several years, there has been amazing success here in decreasing delivery complications, increasing exclusive breast feeding rates, and increasing the number of babies receiving immunizations. Everything they are doing is pretty much by-the-book in terms of WHO recommendations, and it's great to see these models in place and actually working well. Each place that we went in the villages, we were given a traditional Indian welcome - the women would dot us with a bindi, throw some flower petals on our heads, and put a lei of orange flowers on us - so that is what the picture is.

On Friday we went to a drop-in center for MSMs (men who have sex with men), and talked with a group of guys who were hanging out at the center. India is a pretty horrible place to be if you are a gay man - they endure lots of harassment from the community, and violence and rape from the police; they do not come out to their families, have arranged marriages to women, and have to essentially lead a double life. The men at the center were involved in peer education about condom use and HIV testing, as this population has a much higher rate of HIV infection. I felt like they were incredibly brave for doing this kind of work, because even coming into the drop-in center puts them at risk of abuse from the neighbors. It was a really sad situation, which does not seem like it will change any time soon, until the traditional male-dominant values here start to shift.


While in Chandigarh, we got to do some sightseeing as well. We went to a fruit and vegetable market and bought some really delicious papaya and this brown fruit that kind of tasted like a pear and was also very good. We also went to a rose garden, and did some shopping at a bazaar. The bazaar was comlete sensory overload - it was packed full of people, fabrics for sarees and kalmeez salwaars (the pants/dress outfits that women wear), jewelry, and western-style clothes (t-shirts, jeans), and was so hot and noisy, with salespeople grabbing you from every direction to come look at their stuff. Luckily we were with Sanjay, our program coordinator, and Pooja, one of the Indian girls from our guest house, who helped us negotiate some good deals and keep from getting lost in the maze of shops.

This weekend we are just hanging around Delhi. We are doing a bicycle tour of Old Delhi very early tomorrow morning (before the traffic gets crazy), which is supposed to be great.

Later!

Chandigarh

This week has been really amazing so far. Nancy, Emily, and I woke up at 5 on Monday morning (no easy feat when 9 1/2 hours ahead of Columbus time) and caught a train to Chandigarh, which is the capital of the states of Punjab and Harayana in northwest India. The Delhi train station was quite an adventure - it is enormous and very crowded, even early in the morning, with lots of children and old people begging, and quite a nauseating smell (I don't think Oma's "constipation in the station" song has made it to India yet). The train itself was pretty nice, and Chandigarh is a very nice town, with much less craziness than Delhi.


We are working with an NGO called SWACH, which oversees a number of projects addressing HIV/STIs, adolescent health, and antenatal care/safe deliveries. It is quite an impressive organization - very well run and sustainable, with a very knowledgeable and enthusiastic staff. On the first day, we visited the general government-run hospital in Chandigarh, where people can get free care, labs, and medicines if they are willing to queue up at 6 in the morning and wait all day. We got to tour the lab facilities and blood bank there, and learn about how they are testing for HIV and screening blood products - remarkably similar to how the US does it.



SWACH's HIV prevention efforts are targeted to female sex workers, and in the afternoon we got to meet with a group of women at a drop-in centre who have been taught how to educate their peers about condom use and getting tested for STIs. We had a very candid conversation with these women, during which they answered all of our questions about their efforts in the community, their profession, and the issues they face. It was absolutely amazing how open they were with us, and how much they wanted to teach us about their lives and struggles helping to support their families.


Today we drove to a remote village called Yamananagar (try saying that 3 times fast - or just once for that matter), and visited the adolescent health site. We got to meet with a group of adolescent girls and educate them about menstrual health - something that is not taught in schools or at home. Also a very open and candid session, which the girls really appreciated, and which felt very rewarding to be a part of. We ate lunch at the home of the village leader, who told us all about life and culture in rural Indian villages.



We are staying at a guest house with a family and 8 other Indian girls who are in Chandigarh for work or school. We eat family-style dinners every night, and it has been very nice getting to know people here. Everyone is extremely friendly and welcoming - at times a little too forceful with serving us chai and seconds/thirds/fourths of meals - but overall great.


Hope all is well!

Tricia

We're alive!

Nancy and I arrived safely in Delhi last night. We had a horribly bumpy flight - I think I've seen too many episodes of Lost to be able to tolerate much turbulence - but survived without crashing into the Atlantic or Iran. We were picked up at the airport by a man with our names on a sign, which made us feel very important, and taken to the flat we are staying at in South Delhi, along with 3 girls from the UK who are here doing various volunteer projects.

So far, my impressions of Delhi are that it's very hot, very crowded, and has the most unbelievable traffic I have ever seen. There are no rules, no lanes, pedestrians/bicycles/cows wandering wherever they want, and the group of us, getting honked at and practically run over every time we step out the door. Hopefully it just takes a little getting used to. For getting around town, we take auto-rickshaws (rickshaws attached to motorbikes), which I would wager about as scary as jumping out of a plane. We are doing some sightseeing around Delhi this afternoon, and then leaving tomorrow to do a week of rural medicine in Chandigarh.

Our apartment and view in Delhi