India travelogue - pics

[Uncle Yuan]

On the outside chance anyone is interested, I thought I would post lightly edited versions of my mass emails to my family (you don't need to read my endearments).  They're going out about twice a week, and I'm halfway done with my trip, so expect another four or five installments.

The first email was quite short and basically consisted of me saying I'd arrived and that my bed was frightful - a thin pad on a platform that was making my back and hips hurt terribly.

#2
Things continue to go well here.  I kind of figured out my bed situation.  I had been propping my feet up on a pillow at night as the heat and travel had been making my feet swell.  It turns out that the extra pressure this put on my back and hips (when I slept on my side) was what was causing all the pain.  Since I removed the pillow I've been sleeping better.  Now my bed is merely horrible instead of being active torture.

But that's really the only down side so far.  Today I went out to a village with the mobile health team – several social workers, nurse, etc, to meet with the Village Health Worker and the various councils (women's, men's, governing).  It was a great exercise in adapting to life at Rural Indian Speed – namely, things happen when they happen.  We took blood samples from adolescent girls for an anemia study, talked with some folks about a project to equip the entire village with indoor toilets, checked on a couple of infants born since we were around last, did some of the requisite schmoozing and so on.

I am also trying to learn Marathi.  I'm not exactly sure why, really, except I really hate not being in on the jokes!!  From what little Hindi I've been able to teach myself the two languages seem pretty closely related – they use the same script, for example.  I dunno, maybe it will help me learn Hindi better.

The food is generally quite good, but odd things cop up every now and then.  Yesterday morning I was rather excited to see cold cereal being served.  (And you all know how much I like a good bowl of cereal!)  Then they served it with hot milk.  It was fine, except the cereal got soggy really fast!!  Shobha (the director) makes it a point to have the Americans over for at least one meal a day.  I suspect she enjoys the company and the novelty as most of the folks she associates with have been with CRHP for 20-30 years.

There is one other American here right now – Bernie (Bernice), who is doing a fellowship before starting medical school this summer.  She speaks pretty decent Marathi – but she's been here for six months already and will be here a total of ten months.

I hope all of you are well!  Write me emails.  Even though it's super slow, I do check them at least every other day or so.  I'll probably focus on group replies.  I timed it the other day – to sign on, read one email and send another (that I had already typed in Word then pasted into the email) took 20 minutes.  So, lots of individual responses will probably not be happening.

[Uncle Yuan]

#3
Happy Saturday!  Things are settling into a bit of a routine now.  Yesterday was a surgery day, which occurs every Tuesday and Friday.  Yesterday's cases where all "feminine" – including an ovarian cyst about the size of a large mango.  Ugh.

Child marriage continues to be a bit of a problem here.  The woman with the ovarian cyst, for example, looked to be about 15.  As she has two children, ages 6 and 7, she is likely older than that.  But I would be surprised if she were much older than 22.  CRHP has made some progress on this front – in villages where they are working the average age for marriage is now about 18, compared to 14 elsewhere.  Girls are also much more likely to get more schooling, although most villages can't support beyond about 10th grade.

The hospital is quite different from what I'm used to.  First of all, it's all wards instead of individual rooms.  And as Papri knows, family is practically required.  Theirs no food services, so families bring food or cook it on site.  The courtyard is always filled with people cooking.  Everybody has at least one family member with them at all times.  There's also a nomadic tribal group in the region, and when one of them is in the hospital, the whole clan comes along!

Today was the animal market in town.  Acres and acres of cows, goats and buffaloes.  Yes, Papri, I took lots of pictures!  The cows all get quite spruced up for market day – freshly painted horns and usually a thick dusting of bright pink dyed powder on their faces and hump.  The buffaloes aren't painted, but they are shaved to their knees.  They also keep a tuft of wiry black hair on their heads.  They look very strange!

I also just remembered why the internet is so poor – just before I left there was a news story about a major telecommunication line in the Mediterranean that was accidentally cut.  It supposedly cut internet capacity to India by half!  And given the amount of off shore contracting that happens in India, it's proven to be a major handicap on the Indian IT sector.

[Uncle Yuan]

#4
So much keeps happening here it's hard to keep track.  After I wrote and emailed my last note I went out to "the farm."

CRHP owns about 60 aches in several different lots.  The largest is a working farm with several families living there.  At this location they grow mostly fruit trees – mango, papaya, coconut, banana, tamarind, custard apple, and pomegranate.  They also have some other miscellaneous crops like potato and chick peas.  They also have about 20 head of cows and buffalo here, and some of the land is used for fodder production.  At the other locations they grow mostly produce – tomatoes, onions, garlic, turmeric, etc.  he first use for the produce is supporting the visitors and residential staff at the main and satellite compounds.  Most of the support staff lives on the grounds, as well as some of the professional staff.  And at any given time they can have up to 50 people here learning about what CRHP does and how they might do something similar elsewhere.

Sunday Dr. Arole was invited to dinner at a local family's home.  The family is a huge and very successful Muslim family whose matriarch's life the Arole's saved many years ago.  Now a couple of times a year they invite the doctor and his family and a sizable handful of guests over for dinner and feeds them to the bursting point.  According to Dr. Arole these kinds of invitations are understood to be collective and it is somewhat insulting to the hosts if you don't bring a passel of friends and family with you.

They also own a farm and we ate there under a canopy they erected for us.  The food was wonderful and, of course, any time you got below half a plate full they piled on more food!  The after dinner snacks were the really interesting part.  One of the boys came up with a HUGE bundle of plants that turned out to be green (unripe) chick peas.  He parceled out handfuls to everyone and we sat around shelling and eating green chickpeas.  Chick peas grow on a low bushy plant like soybeans, with one to two beans per pod.

Then we inspected their fruit trees.  One called an "India plum" was getting pretty close to being ripe.   Once our host heard that some of us (well, me and the other American) had never tried them he called a couple of sons/nephews/who knows over with big sticks to knock some down for us.  An Indian plum is indeed a stone fruit, about the size and texture of a crab apple.

Then it was time for the sorghum.  Sorghum is a staple crop in this area because it can take the heat and needs relatively little water.  It is a relative of corn, and where corn has the tassels sorghum has a seed head.  They roasted the green seed heads in a fire, removed the roasted seeds and served them with chutneys.  They were really good!!

I also had my first experience with Indian laundry.  This tiny old man came by yesterday and picked up my clothes.  The price seems pretty reasonable Rs12 for a shirt or pants washed and pressed (about $0.30) As of this writing I haven't gotten them back yet, but they're supposed to be very good.

Weekdays are settling into a bit of a routine.  Most mornings either have rounds, then clinic, or are trips out with the Village Health teams.  Afternoons are surgery, special projects or teaching sessions with the Villages Health Workers.

I think this will be it for this installment.

[Uncle Yuan]

Today is Valentine's Day – so happy Valentine's day everyone!

Things are starting to heat up here.  Last week was quite cool by local standards, although I, of course, found it quite comfortable.  Mornings has probably been near 50 and days in the 80's.  This week the weather has turned more seasonal with lows in the 70s and highs in the 90s.  The heat is actually made somewhat bearable by the very, very low humidity and an almost constant light breeze.  As a result, it can be quite pleasant in the shade.  The sun, however, is very strong.

Today our village visit wrapped up with a stop at a sugar cooker.  I had stopped there briefly with a group of folks learning about CRHP, but this week was a little more in depth.  The operation is reminiscent in many ways of cooking syrup on the farm.  The cane is crushed my machine and the juice collected in a storage tank.  Nearby is the cooker apparatus, which consists of a large platform built into the hill side, perhaps 20 feet by 50 feet.  At one end of the platform is the cooker itself, consisting of a flat pan perhaps 10-12 feet in diameter and one foot deep over a firebox.  For fuel they burn the dried remnants of the pressed cane.  The pan is supported on rails that run to the cooling tank at the opposite end of the platform.  When the syrup is the proper consistency, which they check by dropping a little into cool water, the pan is rolled to the cooling tank and emptied through a spout in the bottom of the pan.  As the syrup cools and thickens it is transferred to muslin lined pails to harden.  The result is an orange-brown block of jaggery.  According to the owner they can cook a batch in about two hours.

The big treat for us was getting to have some fresh cane juice.  They serve it here with some lime juice added, which helps cut the sweetness and makes for a very refreshing drink.  I've had "cane juice" in the US, but it was much thinner, and I suspect it must have been watered.

Yesterday I "took" a class with the Village Health Workers.  I talked about anemia, which due to nutritional concerns is a constant problem.  We've been seeing a fair amount of the hospital lately, mostly coincidentally.  All of these women have been taught about anemia in the past, but it's always good to review.  I did manage to teach them a thing or two as well.  Next week the topic is going to be diabetes, I think.

For several reasons, diabetes is becoming more prevalent in the area.  Some is diet since as people get more prosperous their diet becomes more "western" (which I believe has less to do with copying the west than with a universal urge towards consuming fat and sugar that is a protective drive in conditions of scarcity, but harmful when food is more plentiful).  Mostly, though, I think its just folks being healthy enough to live longer.  By the same token their having more high blood pressure and heart disease.

One thing I find really cool about being here is the birds.  Not only do we have the brown and black crow, but I've also seen parakeets, mynah birds and some other very pretty birds around the compound.  Out and about I've seen parrots and doves (which look nearly the same as mourning doves, but have a slightly different song).  I'm sure the people here are quite blasé about them, but I think it's neat.  My camera is lousy for taking pictures of them though – ther're too small and too fast.  Oh well, maybe a few will turn out!

Time to get this edition to press!  Almost half-way through!

[Uncle Yuan]

Another week has drawn to a close.  Half way done!  My jet lag has long since passed and I finally feel like I can navigate my way around the compound, at least.  Jamkhed remains a bit beyond my comfort level, I'm afraid.  Which I really ought to not let intimidate me, I know.  Well, getting over there gives me a goal for the next two weeks.

I've been getting more involved with teaching the staff.  This Monday the Village Health Team has asked for information about high blood pressure.  I spent several hours yesterday typing up a handout that is detailed enough to provide useful information without being overwhelming or too technical.  The one aspect of preparing is not having a good sense of the level of understanding of my audience.  All of these people have been working in healthcare and public health, some of them for 35 years.  Yet, none of them are trained medical people.  Dr. Shobha has been very helpful in this regard.

My big experience this last week was being something of a VIP at a village meeting (unbeknownst to me).  CRHP has a program that will put running water and a toilet in every house in a village as long as the whole village is willing to meet the requirements.  EVERY house must agree, for one.  If even one homeowner holds out the project can not go ahead.  Then every household must come up with 1000 Rupees, which is an awful lot of money – the better portion of a family's monthly income.  Or more.  Finally each household must find a 2x3 meter space on the periphery of their home for the new bathroom.  The village must also arrange for a squad of masons and provide their room and board if necessary.  CRHP will then provide the bricks and mortar to build the bathroom, a water tank for each home, a water tower for the village, a toilet (squat style), pipe to install central water for the village, two taps for each home (kitchen and bathroom) and pay the wages of the workers.

One of the principal problems is getting the village to come together coherently.  India is notorious for its many, many political parties and their divisive politics.  They can make the Republicans and Democrats seem like best of friends.  The political tone can vary dramatically from village to village, with one village is stuck in grid lock and personal cronyism while the next one over is very cooperative and goal oriented.

Anyway, this village (whose name I forget), was ready to sit down and have a town meeting about the toilets.  They asked Dr. Arole (senior) to mediate.  This village was the first village that CRHP started working in and is widely known for its unusually cooperative town council and cohesive town spirit.  This was immediately obvious as we drove into town – the downtown was a tight coherent market square, spotlessly clean and kept up.  There was NO litter anywhere, the streets were swept and clean and trees and flowers lined the street.  I've been in a good handful of villages in the last two weeks and this place looked like no downtown I've ever seen in India.  My experience is that an individual home or facility may be nicely kept, but the common space is a filthy dirty mess.  (I asked if the village had simply spruced up for guests, but I was assured that this was its normal state.)

Despite being billed as a meeting to discuss whether to go with the toilet plan (or "scheme" as they say), everybody jumped on almost immediately.  The meeting soon turned into a bit of a celebration.  All of the attending dignitaries received a ceremonial coconut, including me as the special visiting American medical student.  (Papri will have to explain the significance of the coconut.  I asked, but the best I could get from anyone was that a coconut is the traditional offering to the gods.)

When we got back to CRHP I gave the coconut to Shobha's cooks who make an amazing fresh hot coconut chutney that we ate for a snack with hot chapattis.  Yummy.

[Uncle Yuan]

Sunday evening I had my latest cultural outing.  The senior Dr. Arole has been living and practicing in Jamkhed for about 35 years.  In that time the town has grown from maybe 3,000 to over 20,000.  As I've outlined before, this is due in no small part to his work in health and economic development in the area.  As a result he is something of a local dignitary.  He enjoys telling the story of a young Muslim man who perhaps 20 years ago was essentially run out of town (mostly by his family) for a series of criminal actions (most falling in the realm of misdemeanors).  After several years he decided that he'd had enough and was hoping to return.  He approached Dr. Arole and explained that he was ready to become a "good fellow" and would he be willing to use his influence to ease his way.  Dr. Arole agreed and over the years the young man has become quite a pillar of the community.  He is now a successful businessman, and among his businesses is the Rajanikant Arole Hall, a large rental hall.  He also started a charitable fund named after Dr. Arole which he uses to support local children's health and educational programs.  ( dunno, but I'm guessing he was grateful for Dr. Arole's help!)

Anywho, this last Sunday he was presenting a concert to raise funds for his charity (named after Dr. Arole) at his hall (named after Dr. Arole) and he asked Dr. Arole to be his guest of honor.  And as I indicated last week, it is understood that such invitations include a large retinue.  So I wound up at a Very Indian Pop Concert.

Anyone who has seen a Bollywood movie knows that singing and dancing go together like dal and rice.  (Aunt Yuan insists that the average Indian cares more about a movie's musical director than they do about the film director.)  And if you've seen a Bollywood movie you also know that while actors do the dancing (dancing is a vital part of the resume of any established Indian actor), they only lip synch the songs.  Indeed, while the singers are never featured directly in the film, they are credited and as famous in their own right as the actors.  So, a Very Indian Pop Concert  featured three very good singers (a woman and two men) who were introduced and sang a song, and who periodically returned to the front of the stage for a number, but who spent the bulk of the show sitting at the back of the stage and singing for one of about eight different professional dancers.  From the point of my cultural perspective it was a very unusual experience.  Enjoyable, but unusual.  I was told later that the show was rather more dancer oriented than usual because the crowd was not responding to the singers as well.  They sure did respond to the dancers!!

Tomorrow I'm heading to Aurangebad for a few days.  Dr. Shobha is a featured speaker and presenter at a conference on rural health and economic development.  It's actually an international conference (I can't remember the name of the organization) and will have delegations from across south and Southeast Asia.  Dr. Shobha has wrangled fees and accommodations for me and the other two American students here.

Which brings up the new American: Peter is a pre-pre med student here doing a one month post bach program.  He arrived yesterday from Tamil Nadu, another sate in southern India, where he'd been visiting a cousin who works there.

Now, I am excited about going to the conference, don't get me wrong, but I am also excited about going to spend a few days at a western hotel!  Real beds!  High speed internet!  Real beds!  Stand up showers!!  (I really don't mind the bucket baths, but a stand-up shower sounds so wonderful!!)  And did I mention real beds?  I will be sharing with Peter – I hope he doesn't snore.

I'm still finding medicine an interesting endeavor here.  Every day is some new twist.  I only recognize about half of the drugs they use in the hospital here, for example.  Partly this is because there are newer, more effective drugs that are only available in the US or are too expensive for CRHP.  But this is also because some perfectly good drugs have been supplanted in the US by drugs whose only virtue is that they are new, thus expensive and still under patent, thus profitable, and thus heavily marketed by drug companies.  And of course, lawsuits take a heavy toll on how medicine is practiced in the US.  They use a lot of gentamycin here, a very, very effective antibiotic.  It also very rarely causes kidney failure (almost always reversible) and very, VERY rarely causes permanent deafness.  As a result, hospitals in the US are scared silly of it and never, ever use gentamycin as a first line treatment.  In fact, it is only given as a last resort and then only under very close supervision (daily kidney function tests, for example).

Dr. Shobha is also willing to sit on an appendicitis for a day or two, something that would never happen in the US.  Partially this is a logistical decision.  While she is a competent surgeon, there is no anesthesiologist on staff at the hospital.  Thus Dr. Shobha would have to manage both the surgery and the anesthesia – and abdominal surgeries require general anesthesia which is much riskier than the epidural for a cesarean section, for example.  Therefore it is generally safer for her to stabilize the patient and wait until the surgeon and anesthesiologist arrive on Tuesday or Friday.  But the delay is also due to the fact that most appendicitis can be very safely managed for a couple of days with fluids, antibiotics and pain medications.  This is rarely necessary in the US where every hospital has surgeons, anesthesiologists and OR staff on call 24 hours a day.  It is an interesting example of how one can deliver good medical care in a way totally different than how it is practiced in a modern western hospital.  And totally outside my own training and experience in a modern western hospital.

[Uncle Yuan]

I got back last night from a brief two-day outing to Aurangebad.  Dr. Shobha had been invited to appear on behalf of her father at the Asian congress of the International Association of Agricultural Medicine and Rural Health.  Since she had this clot of American students hanging around she graciously agreed to let us join her.  The conference dealt with the Millennium Development Goals, a series of eight goals designed to reduce poverty, infant mortality, increase the status of women and children's access to education and so on.

The conference itself was quite interesting and some of the speakers were quite good.  Some of them were . . . not.  For the most part I think this was due to the fact that very few of the presenters were able to present in their native language (all presentations were in English).  More than one person dealt with this by putting their speech, verbatim, on PowerPoint and simply reading the slides.  Still, there were some excellent presentations and the folks there were all very dedicated to development in their countries.  There were delegations from Korea, Japan, the Philippians, Australia, and of course India.  There were also a few Europeans there who were either doing work in Asia or where members of the IAAMR in Europe.

The conference was held at an amazing hotel with large and beautiful grounds.  We stayed about two blocks away at a hotel that was "merely" nice.  I meant to take a picture of the pool rules at our hotel, but forget.  There was some great Indglish – "Person who are know to have any common cable diseases are prohibited from using pool," or "Spitting or blowing of the noice is prohibited."

Aurangebad is the launching point for day trips to the Ajanta and Elora caves.  The caves are actually rooms dug into a cliff face – some the size of a tennis court – with carvings dedicated to Buddha or various Hindu gods.  They are an amazing display of engineering – especially considering they were created in 300 BC.  I had seen them in our previous trip to India, so I focused on the conference.

Aurangebad is also known for its cotton and silk weaving.  On a tip from a rickshaw driver I found my way to a local weaving shop with some amazing silk and wool weaving.  I went back, dragging my group, and we did a fair amount of shopping.  It was rather frustrating since I did not bring money with me to do any really serious shopping and they had such beautiful things.  I do feel a little guilty about the rickshaw driver.  He was trying to talk me into going with him when he told me about the place but I didn't have the time.  It was close enough to walk and I later went myself.  He caught us there when he was delivering another group.  I hope he was able to talk the shop owner into whatever kickback he would have gotten for bringing me.

Which reminds me – walking!  Many folks in India do walk to get from one place to another, yet the notion of choosing to walk when there is another option seems unheard of.  When the rickshaw drivers accost you it is certainly because they want the fare, but they also seem genuinely perplexed that one would *choose* to walk.  I've noticed that even around the CRHP compound (which you could walk across in 10 minutes) the doctors Arole will drive much more often than not.  I suppose it is a sign of affluence – not having to walk.

I seem to have stumbled on to a laundry rivalry!  My normal arrangement is for 1:00 pm Sunday with this tiny little man with a huge smile (but few teeth).  This morning at 8:00 I answer my door to a younger woman here to pick up my laundry.  1:00 is actually a rather inconvenient time and we've missed each other more than once, so I figured "my" laundry guy sent his daughter-in-law for an early pick up.  So I was quite surprised when he showed up at 1:00 looking for my laundry.  Come to find out there is this woman who hangs around the compound looking for foreigners and doing their laundry.  She has the reputation of being a bit of a trouble maker and frequently tells folks that Dr. Shobha has sent her, a frank lie.  In fact she has been told numerous times to stop this practice.  Plus I guess she is not that good a launderer.  Shobha is trying to get my clothes back and then get them to my regular laundry guy.  I felt so sorry for him when he showed up - he has a bit of a walk to get to the compound, and today it was all for nothing!

I hope to get one more letter off before I leave.  My flight home is early Saturday morning in Bombay.  This is a bit of a logistical trick as Bombay is something like 300 miles away and I need to get to the airport at 6:00 am.  I may end up leaving for Bombay Thursday evening, spending Friday doing some last minute shopping, then to the airport from the hotel.  We'll see.

[Uncle Yuan]

Things have been fairly routine since returning to CRHP last weekend, but things still continue to surprise me.

The hospital employs four or five ayurvedic doctors.  These individuals basically have a four year degree in ayurvedic medicine, something that enables them to make a living and practice medicine of a sort.  But by the standard of "modern medicine" they are not much more than under trained medical assistants.  Without impugning their model of health care (which I honestly feel has its merits) they are ill trained to care for the often critically ill patients who come to the hospital.  Ayurvedic medicine is best used for health maintenance and perhaps the treatment of chronic disease.  Dr. Shobha seeks to increase their training through on-the-job experience and the occasional training session.  Like the one I gave yesterday on the evaluation and treatment of chest pain and heart attack.  As an example of their training, only one of these doctors had been trained in CPR!  (We'll leave aside the discussion of the expertise of a fourth year medical student, with no training in Advanced Lifesaving, in the field of evaluating and treating heart attacks . . .)

Another example – A couple of days ago we admitted a man with fairly advanced heart failure.  Heart failure essentially means, for any one of a number of reasons, that the heart can not pump enough blood to sustain the body.  One effect of this is that circulation to the kidneys is reduced and the body begins to retain fluid.  Most often this fluid settles in the lungs making breathing very difficult.  I stopped by to examine this man and noted that he was using his abdominal muscles to help him breathe – a condition called "accessory muscle breathing" and a sign of extreme shortness of breath and only a short step away from respiratory arrest (where the body becomes too fatigued to continue breathing).  I recommended they get a blood oxygenation reading on him and consider starting oxygen if it was poor.  It was going to take them awhile to scare up an oximiter, so, being only a student, I left them to carry on.  I stopped back a couple of hours later with Dr. Shobha to find the patient's situation even worse: he was sitting up in bed with his arms pushing against his legs – an even more advanced state of accessory muscle breathing (bracing the arms allows the neck muscles to pull up on the chest cavity).  Yes, they has taken his oxygen level – it was 75% (normal is 98-99%).  But, no, they had not started oxygen.  Checking it then we found that it was 68%.  We did get him on oxygen and he rapidly improved, but it was obvious he was sicker than we could manage here so we transferred him to a larger town with a more modern hospital.

Through this I learned two things, both indicative of the challenges of practicing medicine in rural India.  First, although they may be named "doctors", these individuals did not have the clinical training to recognize the signs of respiratory distress nor to interpret oxygen saturation levels and treat accordingly.  (I was initially intimidated to be working these doctors because I assumed that like all Indian trained professionals that they would be scarily proficient.  Dr. Shobha had assured me that I was already better trained in critical care than they were, and I am sorry to say that she is entirely correct.)  This becomes a rural health issue because, like in the US, it is extremely difficult to entice physicians to come to the hinterlands to practice when they can make so much more money in the cities.  As a result, the hospital recruits who they can and struggles to train them on the job.

The second lesson is that even rudimentary therapy like oxygen is expensive and difficult secure.  The hospital obviously does not have central oxygen, but I was surprised to learn that what oxygen they did have (in tanks) had to be fetched from Achmadnaghar, a four hour round trip.  There are no gas delivery services to Jamkhed!!  This explains their practice of very minimal oxygen use, even when clearly indicated for heart attack and asthma patients – it's too precious to use in any but the most absolutely critical of cases.

Today CRHP is starting their twice yearly artificial limb camp.  They have a special shop were they construct mostly artificial legs for amputees.  Like everything else here the project is a model of ingenuity and frugality – piles of sheet tin and scrap metal are crafted into custom fitted prosthetic legs.  While not beautiful, the limbs are simple, rugged and durable.  In the next week over 150 amputees from all over central India will travel to Jamkhed to be fitted.

Also appearing for the artificial limb camp is a swarm of teenagers from church in Japan.  Each camp the church brings a group of volunteers to learn and work.  The chaperones have made this trip many times and are good friends with the staff here.  It is also gratifying to see these teens support the stereotype of the Japanese tourist.  Dr. Shobha's Siamese cat must have had his portrait taken 800 times last night!

Tomorrow, Friday, I begin the long journey home.  Eight a.m. I catch a ride to Pune with Dr. Shobha who is going for business.  From there I will take a shuttle to a small hotel Mumbai where I will spend the night.  Four a.m. the next morning it will be a rickshaw to the airport to make my 8:00 am flight – first to Frankfurt then to Chicago.  In Chicago I will take care of Customs, then a quick commuter flight home.  Home, with a nice comfortable bed!!  (Oh, and family too, I suppose . . .)

[stumpy]

I have enjoyed reading this thread, too. Thanks for posting it. I hope you have a safe journey home.

[Uncle Yuan]

Home!  A day late, but home.  My flight from India to Chicago was delayed enough that by the time I cleared customs and etc at O'Hare I had missed my connecting flight to Minneapolis.  So I got an all expenses paid night at Holiday Inn O'Hare and a flight home this morning.   I'm glad folks enjoyed my posts.  I hope to get my pics organized over the next few days, then I'll get a few up.

[Dweomer Knight]

Very fascinating read.  Can't wait for the pics. 

DK

[Tried looking up Jamkhed in Google Earth.  It found it but you couldn't zoom the image in very much.]

[Alaric]

I've enjoyed reading about your exploits and misadventures, as well.

[BlueBard]

Glad to have you back, UY!

[Uncle Yuan]

I finally got around to uploading a few pictures to my image service.


This is the CRHP main building.  The main floor is out patient offices, the upper is administrative offices.  You can see the maternity ward to the left, but most of the rest of the hospital is behind this building.


This was my room, with the dreaded bed.  There was no closet, dresser, wardrobe or even wall hooks - which was a drag.  Those cheap plastic patio chairs are EVERYWHERE!


This is the Intensive Care Unit - which basically means they monitor the patients here more often.  The hospital has no central oxygen or telemetry, but they can haul out a heart monitor or oxygen tank if needed.


Moses is the master of the artificial limb workshop.  It's amazing watching him tailor a leg to the patient.  It can take quite a bit of cutting, hammering and shaping, but he will custom fit every limb made during the workshop.


The cattle market - like our fairs the cows are washed, clipped and looking their prettiest.  But in India they also get make up!