Pyrexia of Unknown Origin (PUO)

Apologies for the delay in telling you all about Mamallapuram. In my defence, I finally managed to get ill, not in the conventional diarrhoea & vomiting fashion, but in the sore throat, swallowing-like-eating-razor-blades, muscle aches, headache, fever fashion. So the first thing I did after we landed was to accept Charlotte & Arthur's kind offer of a lift home, and then head in to St. Thomas' A&E, which was conventionally manic. Happily, I didn't have to wait long, as my temperature rose from 38 celsius (100 fahrenheit) at booking to 39 (102 ) when they did it a second time, and the nurse even gave a little "oooh" to show how impressed she was. This meant that only the elderly gent who looked like he was having a heart attack and the man fitting in the corridor beat me to being seen.

So they bundled me off to a cubicle, dosed me up with paracetamol, stuck a line in, took an impressive selection of bloods, put a drip up, took throat swabs, and did an arterial blood gas just to complete the set (this involves sticking a needle into your radial artery, and is said to be extremely painful. Mine was fine).

Then I got to go home, feeling a little less sorry for myself. Perhaps I should have gone to Worthing after all?

On poor timekeeping, fictional guide books, untrustworthy hoteliers, and reasons not to eat street food.

9th November (I know, it's very late)
Arriving in Mamallapuram hasn't been nearly as bad as arriving in Pondicherry, but it also shows fewer signs of redeeming itself in the morning. The reasons for this will become apparent later, when I critique the two guidebooks we stupidly believed might have visited the places they were talking about (Jacob, you were oh-so-right).

Before leaving Vellore, we had final meals at the Darling Residency (great name, great food) on Tuesday, at the university canteen on Wednesday (dinner) and this morning (breakfast), and the YWCA canteen. All were excellent. We also tried to pick up our tailoring - Ben and my suits are great and were delivered bang on time; the shirts took daily visits to the other tailors from Monday, when Toyin and Charlotte went to collect their stuff. The discussion then went something like this:

Charlotte: Valakum. [hands over receipt for her and Toyin's trousers]
Tailor: [looking nervous] Ah! [sends lackey running from shop] Please - sit, sit! Tea, coffee?
Me: I'd love a tea. [Toyin demurs as she's a lactard; another runner returns with three cups of sweet, milky coffee. Charlotte is thus forced to drink two coffees and I have to drink a coffee rather than a tea, but hey.]
[we wait some time]
[runner returns with small parcel]
Tailor: [to Charlotte] Please! [Charlotte inspects the trousers]
Toyin: Where are my clothes?
Tailor: Ha ha ha ha! [points hopefully at Charlotte's trousers]
Toyin: My clothes?
Tailor: Tomorrow!
Toyin: You said today!
Tailor: [headwaggling apologetically] Tomorrow for you.
Me: Just checking... [handing over my receipt] Shirts tomorrow?
Tailor: Ha ha ha ha!
Me: Tomorrow? [this being the agreed day for delivery]
Tailor: Ah! [sends lackey running upstairs; he returns in a moment carrying about half of the material Ben and I had left, all completely untouched by scissors]
Tailor: [looking at it] Wednesday for you.
Me: But... [I notice Ben's appalling ochre cotton, which I had avoided purchasing because I have eyes, in the pile]...this isn't for me.
Tailor: [looking at my receipt] Yes.
Me: No - this is for the other one.
[Thankfully, I was eventually able to prevent him making Ben's shirts in my size, so I avoided the ochre monstrosity, and Ben avoided my diagonally-striped peach number.]
Toyin: You said tomorrow, and we leave on wednesday. It must be tomorrow.
Tailor: [further ambiguous headwaggle]
Toyin: So - all ready tomorrow?
Tailor: [defeated headwaggle] Ok - all tomorrow.

How the shirt confusion arose I have no idea, as Ben and I spent about quarter of an hour methodically checking they had everything written down correctly first time, only narrowly stopping short of running a brief test. However, when we arrived the next day, not only had they come through and delivered the goods, they all fitted like a dream, including the ochre (Ben: "Mate - I should have gone for off-white." Charlotte: "It fits very well. And you can rescue that with the right tie.") and the peach (Charlotte: "That looks much better on than I was expecting.")

In keeping with her luck over the course of the holiday, poor Charlotte was the only one whose tailor let her down. When we turned up on Monday, a full two-and-a-half weeks after she'd given him a dress she'd brought from England specially to have copied, he span her some yarn about the woman he needed to do the work being off sick with chikungunya, and said it could be ready in a week. When we revealed that this was not okay, he told her to call again in the morning. The upshot was that Charlotte, who sorted her tailoring out before any of us, ended up with the dress she came with which the tailor managed to draw on in two places with biro, two silk saris she'd bought to have incorporated into the copies, no copies nor silk dresses, and no time to find anyone else to do the work for her. In the unlikely event that you should find yourselves in Vellore looking for a woman's tailor, do not use City Garments - the owner is a bastard.

Finally this morning we took a bus from Vellore to Kanchipuram which took one and a quarter hours and was smooth as you like. At Kanchipuram we had a slight wait for a 212A. Although the numbering system suggests the bus company have given themselves a minimum of 999 bus numbers to play with, they also have at least A through N just on 212; we almost got on a 212H by accident, which would doubtless have been disastrous. I used the time to play colon roulette with the bus station onion bhajees [this was a grave, grave mistake. Ed.] - the two bullets I put in the gun both tasted excellent, and Ben is the control in the experiment ("Mate - I'm sticking to a zero-tolerance policy on street food"). The second leg of the trip reverted to type, as Charlotte sat down and got someone's sick down the back of her dress, the ride was bumpy as hell, and was made even less comfortable by the fact we had all our bags with us (we bought a ticket for one of them to get the bus conductor off our backs), and by the arrival onto the bus of approximately fifty schoolchildren who swarmed into the aisle and spent most of the journey surreptitiously touching Toyin's hair. All I could think of was (1) whether Toyin was going to snap and begin throwing them through the open door and (2) the immensity of the likely death toll if we crashed.

Mamallapuram itself started off unpromisingly in that the bus station was full of cows and touts, and our hostel turned out to bear precious little resemblance to both guidebooks' descriptions of it as "a charming hotel by a lake and set in gardens which are shared with an artists' gallery and are filled with sculptures. Has a pool." Closer to the mark would have been: "Marble-floored rooms with noisy and erratic fans by a slime-filled mosquito-spawning ditch set in a sandpit full of unidentifiable rubble. Has a pool which is full of six inches of slime and 30,000 mosquitos; beds sized for pygmies; place run by established confidence-trickster." We walked from reception down to the rooms through clouds of mosquitos, and Ben commented "There are a lot of mosquitos here" to which the owner replied brazenly "No, no mosquitos here." The only positive thing was that they were so gorged on the blood of gora that they couldn't fly very fast, and so we embarked upon mozzie genocide as soon as we got into the room. We then discovered that the beds were at least a foot too short for Ben or I to lie down in - and had footboards.

In the morning, however, we went for a very respectable breakfast during which I got sunburn on one arm which was in the sun and Ben got generalised sunburn because he'd forgotten that doxycycline photosensitises you. We then wandered around the local temples, and saw a very good mural of an elephant, which you can see opposite, and the relatively famous shore temple, which should be further up. While there, we amused ourselves by videoing one another doing the headwaggle I have mentioned previously, and I will post links to these at a later date. After that we met up with the Australian members of Team Egg Puff, Jim and Clint, who you can see in the photo below. If you want an alternate viewpoint on Vellore, Clint has a travelogue which is well worth a read. I then went to bed as I'd begun to feel horrendous, getting up only to eat some beautiful fish at a place called Moonrakers which the guidebooks criminally undersold; alas by this stage even swallowing water was rather as I imagine swallowing ground glass to be, but thankfully - as it was the first time I had ordered something genuinely good - I soldiered on.

Our last day in India was spent just outside Mamallapuram at a beach resort (the "Ideal Beach Resort", in fact). I spent much of the day asleep, emerging at sunset to find the other three ensconced on the beach, Ben in a hammock. We then had a last supper at the restaurant with Clint, Jim, and Nok (another Aussie friend of theirs), and had to endure another taxi not turning up to take us to the airport, resulting in our having to book one through the Ideal Beach Resort and getting royally shafted on the price. However, we had left our room key with Jim and Clint, so we got our money's worth!

On arrival at the airport, Toyin and Charlotte plumped for a samosa each to tide them over until the flight left (at 4am); they are both still suffering the after-effects now. For my part, the flight back was deeply unpleasant, as I was running a huge temperature, had constant muscle aches and headache, had to drink lots of water to stay hydrated even though it hurt, and was forced to watch Stormbreaker or whatever that film about the teenage spy is called. Whatever it is called, it was rubbish. Only sickly Ben, with his zero-tolerance policy on street food, has survived unscathed.

All in all, though, India was a great success, and unlike Charlotte, Toyin, and I, Ben is getting neither first-hand experience of antibiotics, nor the benefit Charlotte's got of her consultant discussing her case with the entire firm ("Guys! Charlotte's had D&V for ten days now, and the microbiologists have given her cephalosporins. What would we give her?"). It is reassuring to see how literally some people take the description of medicine as "the caring profession"...

Hope you've enjoyed reading - normal intermittent service will now be resumed, probably after exams.

Correction & CHAD

I must make two corrections to my last post - first, I suggested that the reason Toyin and Charlotte didn't have a wonderful hot shower while we were in Pondicherry was that their shower wasn't working. It turns out that they actually just didn't try it because "it looked a bit rusty". Second, I forgot to mention that the legendary Shankar also revealed (under direct questioning) that Toyin doesn't count as gora - rather, she's kala, which I believe is Tamil for black. Logical though this is, it means we've had to drop the moniker "team gora", so we've replaced it with "team egg puff", in honour of one of the more curious-sounding CMC snacks.

CHAD (Community Health And Development) is the community arm of CMC, and it's a very interesting model. Although it's technically part of the main hospital, it's on a different site and runs along very different lines - they have their own outpatient clinics (which are even busier than the ones in the main hospital), their own wards, their own labour room and so on, and they only refer patients on to CMC proper if they don't feel they can handle them. From that point of view it's like a secondary referral centre in the UK (or a district general hospital), but it also does the primary care work which is done back home by GPs. This involves looking after about 120,000 people in the various villages around Vellore.

They've done this in a very interesting way - they essentially assimilated the traditional birth attendants, who were already part of the community, and paid them retainers to be part of the community work done by CHAD. Straight off the bat that gave them a lot of local knowledge and direct access to these communities. They then send nurses out to the villages every week or so to check up on any people who are pregnant or have illnesses (TB, HIV, etc), and to keep track of what's going on, and send doctors out every month to run clinics. They then refer anyone needing a higher level of care on to CHAD back in Vellore, and the really tricky ones get referred on from there to CMC.

At a practical level, what this means is that they know just about every person in every village "personally" through the birth attendants, and they know how to find people when they need to and vice-versa. It means they have an enormous amount of trust and goodwill built up in that community. On top of that, they got a visiting guy from NASA to satellite-map the entire area for them - and have all those people mapped to where they live on the map. They then plot the incidence of diseases and so on on this map - the example they gave was that if they had a number of cases of diarrhoea in a village, they could go down to the level of detail that would tell them if there was a drain linking the houses affected, and act accordingly.

Bloody impressive, basically, and something which the NHS would probably kill to be able to replicate in any number of South-East London council estates.

My own trip out to the villages was in the back of a van; we did the rounds of the expectant mothers, bereaved, and ill in the morning, and were fed a lot of dangerously brown-looking peanuts (the main crop round here) which tasted a little as I imagine wet wood to. We also visited some of the creches they run for kids whose parents are working the whole time - the teachers had the classes singing for us, and Toyin drew a blue sheep-like thing for one of them which totally baffled the children even when she began saying "Baaaa!" hopefully. The creches are entirely free and aim to ensure literacy among the local population, social interaction, and above all nutrition - they weigh them and so on - and are yet another impressive aspect of the program. In the afternoon we went to one of the rural clinics, which were insanely busy, and took turns examining pregnant women - should have that clinical skill nailed, anyway.

This is all contributing to my general opinion that actually, given the resources they have to work with and the problems they're up against, healthcare is probably better here than in the UK. On which depressing-or-happy note (depending on how you look at it), I'm off to pack for the beach and look up the Tamil for "lobster thermidor for me, please".

Gora Gone Wild, Redemption Through Bakeries, and Postcolonial Dining.

5th November
Pondi has just about redeemed itself. While calling it "Gallic" is still a stretch - the people are friendly, for one - it's not the gora-gone-wild hellhole it seemed last night as we exhaustedly passed a succession of street corners with whey-faced dreadlocked gap-year students vomiting excitably into gutters or dour sanctimonious hippies tutting at them. Pondicherry still has a hippie-'n'-hooligan air to it, but the streets are paved in stone, have pavements and gutters, some of the buildings are attractive, and there's a promenade alongside the Bay of Bengal which looks like you could swim in it.

Saturday started well; for all my you-can't-polish-a-turd- by-giving-it-marble-floors griping yesterday the hotel had outstanding showers, prompting Ben to comment that it had "almost made the entire utterly miserable experience worthwhile". This upset the girls enormously, as their room's shower didn't work - but as I'd gone and got us all pains-au-chocolat and pastries for breakfast by the time I relayed news of Ben's insensitivity to them, he only suffered a glancing blow to the head with a bottle of water for it.

From there we wandered through town to the Dumas Guest House where we'd initially tried to stay at the previous night, and checked in to a homely sort of appartment with two bedrooms, two bathrooms, a living room and a balcony. By the time we'd sorted that out it was near enough to noon that we felt we could start on lunch. This was when Pondi really started looking up - we had salads, and shrimp soup, and Ben's bleu steak in blue cheese sauce, and prawns in garlic and parsley, and lemon tart, bitter hot chocolate, and above all proper tea. After a fortnight of curry, it was basically food porn, and we went there again for lunch today (Sunday) and added more steaks, coq au vin, and perfect chocolate mousse to the list. Rough Guide to India (mine, on loan from my sister Susie) 1, Lonely Planet Guide to South India (Ben's) 0.

After the three or so hours we spent lunching, we ambled through town looking at the sea, buildings, things in shops (where Toyin comfortably took the "Shopper of the Day" award by buying as much as the rest of us put together), and then began to think about where to have dinner. Midway through our meander, my seafood-related reverie was interrupted by someone dropping an armful of tupperware down some stairs. I was about to suggest to the others that we let Toyin add some tupperware to her list of purchases when a carefully bedraggled-looking guy in his early 20s who asked if I wanted to buy one of his bongo drums.
"Thanks, but I don't want one," I replied, silently cursing the lost tupperware-buying opportunity.
"For you, special price." His response had a reassuring feel to it; I'd forgotten what it was like to be worked over by someone trying to sell tat to tourists. For all Vellore's flaws, being off the tourist trail has its advantages.
"I'm sure your prices are excellent, but I still don't want one."
"Come on, they're very good! As a present for someone."
"I don't want one." He was beginning to sound really whiny at this point.
"I'll do swap."
"No, really - I don't-"
"Ok, ok - I'll swap it for your watch."
"No - you won't." Mercifully he gave up at this point; I'd been expecting his next offer to involve swapping it for my passport, wallet, or perhaps one of my kidneys. Curiously, he and his ilk left the (numerous) Indian tourists entirely alone, evidently relying on the gora-gone-wild and hippie clientele.

After everyone but Ben had had the obligatory ayurvedic massage - which prompted Toyin to comment that "I've always known that I would know true love when I found it, and I'm sure Lina's the girl for me", Lina being her masseuse - we resorted to type by going for dinner. The evening's meal was billed by Ben's Lonely Planet as the best place to eat in Pondi, and somehow we'd managed to work up an appetite again by the time we arrived. The rooftop terrace was a bit of a let-down as places featuring green-painted bamboo and no views can be, but we had high hopes for the food - two types of salad, bouillabaisse, seafood gumbo, silver pomfret, sear, crab, and beef lasagne. Actually, this is only partly true - my hopes for the crab were deflated when they said they couldn't serve it in the shell (implied: because it comes from a tin), and they were dashed entirely when, seized by a desire fora post-colonial eating experience, I eschewed "baked" and "garlic" in favour of that well-known Indian staple, masala crab. The instant regret I felt after placing the order was alleviated somewhat by my seafood gumbo being very good while the salads were unremarkable and the bouillabaisse gloopy and full of gelatin - but after the crab the others have begun changing their order if I ask for the same thing: it was the worst of a bad set of mains. The pomfret was roasted to within an inch of the life of a fish twice its size, the lasagne had gristly bits in, and the sear was bland. All this culinary disappointment was accompanied by the most expensive bottle of Indian wine on the men (an insane ten pounds) which tasted like benelin and was barely drinkable when chilled almost to freezing point, and crowned by three puddings (Charlotte sensibly having abandoned hope after her pomfret) which tasted like they'd been freshly bought at Costcutter. Rough Guide to India 1, Lonely Planet Guide to South India -4. Not a success, in short, but we bought a few beers on the way home and sat up drinking in the appartment and setting the world to rights.

Sunday involved a fantastic breakfast (fresh fruit, toast, eggs, bacon, tea and coffee) and a lunch I've already praised, a trip to the botanical gardens where we entertained a dozen or so local kids by letting them take pictures of one another with our cameras (and unlike our bongo-selling friends, they didn't ask for a thing and were just a joy), and then a five-hour bus journey back to Vellore. This was actually preferable to the taxi ride as the buses have wheels like tractors and so can take the potholes and speed humps at speed without sending you too far into the air, and it's an eight of the price. On the trip we saw our first Indian elephant being ridden through Villampuram, and I had a long and endlessly entertaining discussion with Shankar, the Tamil man sat next to me. We started out with the usual where-are-you-from chat (he lives in Pondi but works in Vellore during the week making shoes for export), and then paused while he read Indian Marie Claire, which Fenulla and Sarah (two of the Aussie girls) had given to Toyin and Charlotte. He seemed particularly appalled by the article on transsexuals here, but gave it back without comment; from here, however, the conversation got markedly stranger.
Shankar: "People are healthier in England than here, no? Why do you think this is?"
Me: "Well, we spend more on healthcare, people are better fed and educated, and-"
Shankar: "No - it is because of the roofs! We get healthy by absorbing cosmic rays, and how do we do that?"
Me: [thinking correctly that there is no way I would be able to guess] "Er..."
Shankar: [triumphantly, making an arch with his hands] "The roofs are sloping in England! This means you absorb more cosmic rays."
He also enlightened me about babies being heavier when they were asleep ("I will give you an example. Take a baby who weighs ten kay-gees. Then when it is asleep, perhaps it will weigh twelve kay-gees."), summarised several ghastly management books with titles like "The ten types of person in business" and "How to create an ideas-culture", and explained how breathing through your right nostril slowly will cure headaches. There were some sane elements to the conversation, however, and not only was he thoroughly charming, but he also arranged for the bus to drop us just by Ananda Bhavan where we're staying and not 20 minutes' rickshaw ride away in town - so if, as he said while we were getting off the bus, that we would see one another in heaven, at least I know I'll be entertained. Odd thing for a hindu to say, come to think of it.

This week I'm doing community health for three days, and then we're skipping school to go to the beach and eat more seafood before flying home on Sunday. I also apologise to those of you who've wanted to hear about the head-waggle; I'm hoping to persuade my fellow students to be filmed illustrating it for educational purposes, in which case it will have to wait until I'm back and am able to add photos to the blog. Bye for now.

Grim Portents, Bespoke Suits, and Night Drives.

4th November
We've come on holiday by mistake. With one exception, friday has been a disaster. It started innocuously enough for CMC with the removal of a huge abdominal mass from the elderly woman who'd presented with it. The initial incision exposed part of this thing, but wasn't big enough to get it out, so Dr. Peedicayil extended it almost to her ribcage; the lump was about the size of a basketball. However, the longer cut let him get hands under it, and heave it free, whereupon it burst spectacularly, spilling five or six litres of yellowish fluid all over the surgeons, the floor, the patient, and a poor student nurse who'd been made to scrub in for her first ever surgery and looked like she was going to pass out as she was showered in ichor. Even after the thing had burst the remnants of the ovary it had grown from were the size of eight or so stacked dinner plates.

This was the first of two omens, the second being the colossal thunderstorm which broke shortly thereafter, and soaked us all on the way to lunch - which would be the last meal we'd have for a while. Around 3pm, after we'd seen a nun have a hysterectomy for her endometrial cancer (which is very common in nuns, in case any of you were considering donning the habit), Ben and I headed to the tailor's for the second stage of our suit fitting. I've neglected to mention this before, but we realised early on that having clothes tailored here is pretty reasonable, so we'd both been and ordered suits fitted. This turned out to be what I understand to be a fully-bespoke service (although I'm sure my lawyer acquaintances will correct me if I'm labouring under a misapprehension here), involving a measurements and specifications session at which we rapidly devolved all decision-making to Charlotte, and then a second fitting with the suits at the not-quite-made stage. This followed the same lines as the first, with Ben and I meekly obeying orders and the tailor rapidly skipping directly to asking Charlotte what adjustments we needed. This was the exception to the disasters of the day.

Our final CMC appointment of the week was back at the university campus for a meeting with the vice-principal, Anand Zachariah, and the other elective students. Spectacular though his name is, I was disappointed not to meet the principal, Molly (not a woman) Jacobs. However, the meeting reinforced my impression of the general loveliness of the doctors at CMC, and their desire to make everyone's time here as enjoyable and beneficial as possible - it was a full-on "what could we do better?" conversation, and the tea and samosas also helped.

Then it all started to go wrong. Knowing the meeting would finish after five, we'd booked a car to drive us the 3-4 hours to Pondicherry that night, meaning (worst case) we'd get in at half nine and have plenty of time to check in somewhere, and begin the weekend's eating, and would then have a full day there on saturday.

It didn't show up.

After waiting half an hour or so in the monsoon rain, we took a rickshaw back to the chemist where we'd booked it (there was a sign outside saying "tourist cars", in our defence) to shout at the man behind the counter. He seemed rather baffled by Ben's open hostility, but did eventually call the driver who he quite clearly hadn't bothered to organise in advance or tell to meet us where we'd agreed despite our deposit. Toyin's ruthless negotiation got us a bit off the fare - but we still left more than an hour and a half late.

You'd think the worst of this would be a late arrival in Pondi - but you'd only be half-right. First there was the drive itself to contend with, the first unsettling part of which was the lack of seatbelts in the car. Second was discovering that the driving on Big Roads in India is very similar to the driving on Little Roads - but when you're in a car doing 60kph and are up against lorries, the stakes are higher than when you're in a rickshaw doing 20kph against other rickshaws. It was also pitch black, and Samson our driver tends to drive in the middle of the road until he sees something heading for us, whereupon a game of chicken ensues to see who ends up swerving into the potholes at the side of the road. The game is made all the more exciting by the cunning use of headlights (it being pitch dark by now) - some oncoming drivers just leave them permanently on full beam, which makes it impossible for either driver to see the road while they pass one another, but the clever ones dip their lights at the normal distance, then flick them back to full beam at the last minute, completely dazzling you. Passing another vehicle in either direction, or sitting behind one, is done to a score of horn usage, with painted signs on the back of lorries inviting this, often just below "DANGER - HIGHLY INFLAMMABLE", or advice on what to do if you get the toxic material inside on your skin ("wash in warm water", it appears). Many conversations were interrupted by a sharp intake of breath, by hitting a pothole or one of the vertical speed bumps at pace. Particularly brutal are the triple humps, which - especially sans seatbelt - are close to chiropracty. Even when you fall asleep, as I did briefly, the victorious blare of a horn would make my eyes start open just as the juggernaut bearing down on us flicked its light back to full beam. This went on for four hours, and about three hours in three bad things happened:
(1) We realised the fuel gauge was just above empty (it later turned out it was just broken)
(2) Samson's headlights failed for a couple of minutes, so we were driving blind
(3) Our ETA slipped past 11pm, when everything would be shut.

When we did eventually make it, the place we wanted to stay in was shut, so we got Samson to tour Pondicherry until we found somewhere to stay. In the process he tore up the bottom of his car on a particularly ropey section of road, and we finally reached a place called Soorya International, whose marble exterior started incongruously enough from a debris-filled drainage ditch, and sat opposite a sign saying "Don't urinate here". The marble floors throughout, including in the rooms, belied the shifty, rude receptionist, and the pack of lies they fed us about restaurants which were open until midnight and when we began to check in but had mysteriously shut when we came back to order food, and about 24-hour bakeries. So I tramped up to my room, where the A/C didn't work, the windows didn't close, and my pillow appeared to have been run over by one of the lorries we'd passed on the way here, tired and hungry.

Special Days, the Four Gora of the Apocalypse, and Choosing the Right Bucket

2nd November
Today has been a special day for Dr. Peedicayil, who’s the doctor responsible for us during our time at CMC. Charlotte and I met him on the Bumper Admin Day, when he was both friendly and efficient, the four of us all saw him again the next day, and then Toyin and Ben spent part of the rest of the week with him doing gynaecology. It would have been all of the rest of the week, except that his immune system only resisted Toyin’s chest infection for about 48 hours, so that by Thursday he was off sick. Although Toyin claims it wasn’t her, both of their coughs sounded like a tractor being started in a vat of custard, so the rest of us are pretty convinced despite his chivalrous denials. Today, then, has been special because it’s the first day he’s managed to drag himself from his sickbed to come back to the hospital. It has therefore also been a special day for Charlotte and me as we’ve got to go on a ward round with him. In the UK, with honourable exceptions, ward rounds are housekeeping – are the drug charts up to date, does the house officer know the patient’s mother’s dog’s name, when can we send them home, have they died in the night, that sort of thing. Surgical ward rounds are particularly entertaining thanks to the intense focus in recent medical education on InterProfessional Education, which is a pompous way of saying “be nice to patients”. It’s generally taught self-importantly and badly by people who give the impression that they believe Being Nice can cure the common cold. Thus a surgical ward round often includes exchanges like:
Surgeon [pointing at patient’s heavily bandaged leg]: Good morning, Mrs. Jones. How’re you feeling today?
Mrs. Jones: Oooh, terrible, doctor. My arthritis is playing up something rotten, I’ve got a terrible headache, the tea tastes like dishwater, and the food gives me wind.
Surgeon: Good, good – let’s have a look at that wound, shall we? [tears off bandages and begins prodding]
Here, however, ward rounds are an all-singing, all-dancing affair which actually involve teaching. The round today ran from 9.30 till after 1pm, and featured three consultants, three registrars, and six or seven house officers of various grades, the two of us, and the irregular sputtering of Dr. Peedicayil’s gora-infected lungs. It was fantastic – we’d arrive at a patient, watch the house officers present them at absolutely lightning speed, and then get grilled by the consultants on the particular condition. There was no malice in it, either – no one got shouted at for not knowing things – they’d just move on to the next house officer until someone got it right. The whole thing had a very schoolmarmly feel, partly because Dr. Peedicayil is the only male consultant of the three, and partly because here consultants are addressed as “sir” and “ma’am”, even when they’re being talked about, as in: “So sir is still off sick? Perhaps he’ll be back tomorrow.”
In theatre, too, when many surgeons are so focused on what they’re doing that even the good teachers often just get on with what they love doing, the doctors here take time to point things out. I’ve seen a couple of hysterectomies this week for fibroids (painful, bleeding lumps in the womb) and endometrial cancer, and in every case the surgeon has either dissected the specimen up with us and shown us the extent of the tumour or the fibroids or had a house officer (the very entertaining Arpudh) do it for us. I know it sounds trite, but it’s amazing how having someone pointing to the thickness of the wall of the womb and highlighting the white, sloughy tumour will help you remember how endometrial cancer’s staged. The long and the short is that, perhaps because there are less students per consultant here and perhaps because of something about the place, the quality of teaching is just *better*.

Toyin's impressive infection of key members of the hospital staff has meant that we have assigned ourselves nicknames based on our gora status - Ben is tall gora, Charlotte is small gora, I am sleepy gora, and Toyin's lurgee gora, all for fairly obvious reasons (I am still prone to falling asleep in warm rooms when I am bored, as happened slightly embarrassingly with the only bad consultant we've run into who essentially totally ignored my presence in outpatients).

She has been the exception, however, and the afore-mentioned Arpudh is entertaining both because he's really easy-going but extraordinarily helpful, and because he told us the famous Seven Things about Vellore.
(1) It has a Fort with no King. (The fort in Vellore wasn't ruled by any one person)
(2) It has a Moat with no Water. (and its moat is normally dry)
(3) It has Mountains with no Trees. (the mountains are, as suggested, treeless)
(4) It has a Temple with no God. (the temple in the fort was originally dedicated to a now-forgotten god, although they've shipped in a bunch of Hindu statues now, along with several metal filing cabinets with what look like names and addresses painted on them)
(5) It has a River with no Water.
(6) It has Women with no Beauty.
(7) It has Men with no Brains.
I suspect that finding this funny is more likely if you've spent some time here, but hey.

I've also run into some of the other gora here - there are a heap of Australians over, presumably because India's not that far away. They're a really good bunch, although one (Jim) told an anecdote which worried me. Just after he'd arrived, he was getting to grips with the bucket showers, and thought he'd check he was going to use the correct bucket (there are normally three in a bathroom). So he called one of the hotel staff, who took one look at the bucket full of water and the dumb gora, looked utterly horrified, and whisked the bucket away. This suggests Jim was about to shower in the bucket used for washing the left hand after using the lavatory.

I have no idea which bucket I've been using to shower and indeed shave in at our hostel, and given that Jim's story came about ten days into my stay here, I don't plan to ask.

Rice dumplings, Words of Wisdom, Chay, and Advice to new mothers.

Tuesday 31st October
I’m afraid that Hallowe’en isn’t celebrated here, and as gynaecology is less easy to write delicately about than obstetrics, instead I’m going to tell you all about the food. As most of you know, India’s reputation is both very good – chicken tikka masala is Britain’s favourite food - and very bad – everyone who comes here gets the shits. Although Tamil Nadu, where Vellore is, has slightly different food to what the British palette is used to – which is more Northern / Bengali cuisine – it’s been much more good than bad. I must at this point congratulate Padman, who’s also on the graduate medical course with me, for being the only one of us to get the runs. His family are from Jaffna in Northern Sri Lanka and so he’s Tamil and basically a native, so he must have thought he’d be pretty safe, particularly when he was coming here with Tom Pollak, who’s not only pale-skinned, but also managed to get typhoid while in India over the summer. Alas not – Pad had the runs for the whole of his first week. As he himself put it: bit embarrassing when the gora’s absolutely fine. Given that he also arranged for the two to go to Mangalore when they wanted to go to Bangalore, a mere eight hours away by train, it’s also possible Padman is lying about his heritage.
However, tempting fate, the four of us in Vellore have been fine. Breakfast has been the biggest culture shock, perhaps because you’re that little bit more vulnerable at that time of day. For most of the first week we tackled either idly or poori masala. Idly are steamed rice dumplings served with a little pot of very liquid vegetable curry which we’ve affectionately dubbed ‘pond water’ because of the close resemblance of the two. Happily it tastes fine, although picking up rice dumplings at 7am with your fingers, dipping them in curry, and then getting them to your mouth without dripping pond water down your shirt takes some getting used to. Poori masala is a thicker vegetable curry with some quite oily, thin, savoury wholemeal pancakes. That these two dishes feature on the breakfast menu tells you several important things about Tamil food:
(1) It’s vegetarian.
(2) Its major components are fat and starch in various forms and invariably fried.
(3) Cutlery is not routine (as toilet paper isn’t either, it’s important not to use your left hand to eat with).
(4) Every meal, from breakfast on, is curry.
We eat breakfast without exception in the YWCA canteen at the hospital. For those of you who’re confused by this, I should explain that CMC, standing as it does for Christian Medical College, is quite a religious place, although only occasionally overtly so. Although there are morning prayers on the days there are ward rounds, no one has yet sat us down for Earnest Conversations, nor asked if we Believe or are Going To Hell. On the upside, the college is studded with plaques bearing bible quotations, and many are also written on the top of ward whiteboards; although “If God is with us, who can be against us?” may not be to everyone’s tastes (and as Ben pointed out, the obvious answer is “Satan”), it’s a lot better than “You don’t have to be crazy to work here, but it helps!!!”. Some are a little bizarre – the bins have the biblical-sounding “wealth through waste” and “health is wealth”, which leads to the baffling conclusion that waste is health – one for those who believe in the constitutional power of a glass of urine, perhaps. Best of all is the incinerator tower, which bears the legend “God’s presence will go with you in spirit”. There are also lots of great pictures of the missionary doctors who set the place up, chief amongst whom is Ida S Scudder. Her family have, as one plaque not unreasonably trumpets, dedicated 1,047 years of life to CMC Vellore. The library in which I’m typing is named for Gertrude Dodd, a plumpish lady whose photo, which hangs over the door, makes her look sallow and sunken-eyed but somehow also matronly, sort of like a vegan zombie. While praying over the incision you’ve just closed, as a lovely doctor from the Labour Room does, is perhaps taking things too far, it’s actually a very tolerant and cohesive place. Granted, I was unsure what to make of one nurse with a <bindi being called Sister Sebastian Ignatius, but even if she isn’t Hindu, a lot of the patients are that or Muslim and get treated identically to the Christian ones. The main advantage of the place’s religious leanings, however, is unquestionably the canteen, which while serves excellent food cheaply – and of course, being a good Christian establishment, beef biriyani makes the menu most days.
Breakfast, however, was a battle at first, particularly for Charlotte, who reached curry saturation point earlier than the rest of us, and Toyin, who had to battle with the coffee not giving her the necessary fix because of its contamination. All of us have had problems on this front due to the unusual nature of tea and coffee in Southern India. Tea is not Darjeeling, nor Assam, nor Ceylon – instead it’s some unidentifiable black stuff boiled in what looks like a metal sock and immersed in hot milk. To this mix is added (unpredictably) cardamom and (predictably) about an equal weight of sugar. Despite the skin which invariably forms on it as it cools, it’s fine – but I was hoping for real tea, and instead I’m getting something closer to a boiled cardamom milkshake. Toyin and Charlotte have now persuaded the canteen, which is a small-scale model in production-line efficiency, to make them black coffee specially in the mornings, and our favourite chef indulges the gora by bringing it over. We’ve also regressed from idly and poori masala to “egg fry” and toast, although Ben and I occasionally brave the porridge (equal parts hot milk and sugar, with either semolina- or spaghetti-like stuff in) or the pongal (like kedgeree without the fish and with the curry).
After that, though, there’s pretty much nothing but curry, with the main difference between lunch and dinner the availability of biriyani at lunch. This is a healthy portion of spiced rice with bits of meat in (chicken as well as beef, and allegedly mutton, although they never have it when I order it despite there being plenty of goats around), and a yoghurt-and-chopped-onion raitha. In addition, lunch offers the mysterious “chicken cass roll” – see if you can guess what that is before I tell you. The other options with rice are a “veg meal”, which is four or five little pots of pond water, rice, and a poppadum, or something western-sounding on rotation (“lemon chicken rice” one day, “tomato chicken rice” the next) which is curry variant. All the little pots, including the “chicken fry” and “beef fry” which are delicious, focus on the fried fat part of the diet – they are swimming in oil. When starch isn’t supplied by rice, it comes as some sort of bread – not naan, but rather chapathi (doughy fried flatbread), parotta (moister, thicker dough in spirals), or uthappam (thick dough often with red onions or something fried into it). These all come with a pot of vegetarian fat of some description.
This leads neatly on to pudding, which covers the other staple of the Tamil Nadu diet – sugar. Their attitude to pudding is, to quote Ben, “pretty much spot on. If you’re gonna have pudding, make it very sweet and have a little bit of it, d’you know what I mean?” Some of them are similar to the porridge only with nuts in, some (gobi) are a dough ball in a little pot of syrup, some (“pine apple cream”) are basically milk, sugar, and fruit juice, some (“pineapple upside down”, “caramel custard”) are english puddings. I love them, particularly as they make the tea taste less sweet.
That leaves only snacks, which you can perhaps guess about: samosas (vegetable or chicken wrapped in butter, albeit in the form of filo pastry), egg puffs (eggs and filo pastry), strange things which can all too easily be bought as doughnuts but which are actually tasteless deep-fried suet with bits of spice in and are the only bad thing I’ve eaten so far. Sweet snacks are cakes (sponge with sugar icing), genuine doughnuts, biscuits (quite like shortbread), or a sort of fudge made from ghee (clarified butter), sugar, and occasionally nuts and topped with more sugar. You can also get fruit, thank god – but a pineapple costs 35 rupees (~40p) where ghee fudge costs 5 rupees (~12p), so small wonder everyone here’s diabetic. I’d give myself at least another couple of months.
As Ben discovered recently, however, you can get gora food in the canteen. He had noticed the excitement of the chefs as they served his chicken cass roll up – half a roast chicken, and some cold potato and carrot slop. It took Toyin to point out as he and I wondered where the roll was that it was chicken casserole. I’ll leave you with a final example of how deep the differences run. All over the world, you try to persuade new mothers to breastfeed, as it’s better for the baby every which way. This runs into problems in the developed world, where mothers may be on medication which makes it unsafe, or just feel they’ve better things to do with their time, or they may not produce enough milk. In the developing world, corporations like Nestlé prey on very high infant mortality rates by aggressively and utterly dishonestly marketing bottle formula as “safer”. This means not only that the baby’s immune system does not get the benefit of breast milk, but that formula is often made with contaminated water; this directly causes about 1.5 million infant deaths per year according to UNICEF figures. If you can do without that kitkat… In India, the problem is rather different – the mother-in-law often believes baby will be stronger if they’re fed on diluted cow’s milk (the same problem exists in the UK where mothers who don’t know better or who struggle to breastfeed dilute milk in the same way). One way of addressing this is by dazzling mum with science – so there are charts back home showing the main components of breast milk versus cow’s milk, and so illustrating the “Breast is Best” message. One of these was in the neonatal ward (sweetly called “Nursery” here), and alongside “Human” and “Cow” was “Buffalo”.
It is less good than cow, in case you were considering it. Bye for now.

Bollywood, obstetric surgery, and swimming in the rain.

Working saturdays is not so bad - I completed the set of deliveries by seeing a breech birth (legs first, uncomfortable), two emergency caesarean sections (which Charlotte had been hoping to see) and an ectopic thrown in for good measure. There are four reasons I like obstetric surgery - first, the patients generally aren't too decrepit and so tend to do better afterwards. Second, caesareans (which make up a sizeable chunk of the caseload) are quite like opening a matryoshka - you keep opening successive layers (admittedly of flesh rather than painted wooden doll) until the final layer reveals a baby (I should warn you all, though, that it initially looks a lot worse than the final doll in a matryoshka, and is much harder to put back). Third, it's all quite necessary - the things that get taken out or sewn back up really need to come out or get repaired. Finally, it's very quick - I've seen an emergency caesarean at St. Thomas' done in a little over a minute from opening the skin to production of baby, and as somone prone to falling asleep during particularly interminable vascular surgery (even though the consultant was a bit of a hero and a keen teacher), this is good.

The only slight downside of saturday was that things went crazy around lunchtime and stayed that way for several hours. When that happens you have two choices - decide now would be an excellent time to sneak away for lunch while everyone's too busy to notice, or go hungry and eat when things are quiet again. Partly because Charlotte and I are so wonderfully conscientious, and partly because the four of us are planning to skive the thursday and friday (and arguably saturday) of the last week to go and sit on the beach and eat seafood, we stuck it out. Charlotte and I had different outcomes from this. She was given the chance to scrub in (get gloved & gowned and in this case help deliver a baby) first by Rohit, a tall, skinny junior doctor who spends the minutes between finishing one thing and being told to go and do something else in the incubator room playing with the babies. He has an almost supernatural way of quietening down the bawlers. Anyway, the woman he and Charlotte scrubbed in for promptly stopped moca-ing, and shortly before she was abandoned by the medical staff to a few more hours of "Amaaa! Amaaaargh!" one of the consultants appeared and ticked Rohit off for allowing these incompetent gora to scrub in. Happily this didn't stop the other junior doctor, Debánjali, from getting me scrubbed in on the next woman who looked on the verge of giving birth, and she duly did - so as well as a tick in the "assisted with a delivery" box, I did a bit of suturing afterwards.

There were two bad things about the busy spell at lunch, though – I’m not sure if it’s now 26 or 27 deliveries, and we didn’t leave until past 4pm, which was a bit rough for a Saturday. We then went to get presents for Rohit and Debánjali, which involved visiting the Street of Low-Rent Beggars. These are perfectly normal people going about their business until they spot a gora, whereupon they stick out a hand and do their best to look hungry. It is fairly easy to distinguish them from actual beggars, however, as they are invariably quite fat. The more wily example is the boy who has now approached me twice to ask if I can help him with his hobby – collecting foreign banknotes.

By the time all this was out the way, it was half five or so, and we decided to take in a bit of culture. Toyin had wanted all week to go and see Don, a Bollywood film featuring Shahrukh Khan, whose face adorns the bag she keeps her underwear in (as Charlotte somewhat indiscreetly revealed). So we bounced our way in an autorickshaw to part of Vellore which was particularly slummy even for a place composed largely of compacted excrement, open sewers, and an improbably good hospital. The equivalent of 30p got you access to a huge screen with a concrete roof, rows of benches, and twin cesspools each side which you had to cross on sandbag stepping stones to get to the urinals or the popcorn vendors. The audience was 95% male, with the exceptions including two burqa-ed up girls in the row in front who progressively removed articles of clothing through the film until they were completely normally dressed. The film itself was extraordinary – a deeply silly plot (which used roughly the same trick twice to bring two different characters back from apparently fiery/sticky ends, in one case quite blatantly to set up Don II, and awkwardly shoehorned an entirely superfluous character into the plot so they could get another star on screen), some hugely enjoyable song-and-dance set pieces, a leading man (Khan) who has done alright for a short bloke with a nose it wouldn’t be uncharitable to call bulbous, and proper whooping and cheering from the audience when the actors broke into song and/or when a new star hit the big screen. I should have mentioned that the film was entirely in Hindi, but we followed the plot fairly well for three reasons. First, Toyin got chatting to the person next to her and had him explain the bits we hadn’t understood. Second, there were regular injections of amusingly-pronounced English in the script:

“Gentlemen, I’ll get straight to the point.”
“Do you think I’m some kind of fool?!”
“Don’t worry, I’ll handle it.”

Third, whenever we should have realised someone had been revealed as a baddie (as happened roughly every 20 minutes through the film), they abruptly became much better-dressed, with the police chief going from grey nylon suits to ray-bans and leather jacket and Don favouring open-necked patterned shirts with ties of identical material.

The first dance scene was particularly special, as it involved lots of frantic and inelegant jiggling, coupled with the repeated assumption of overtly sexual positions for a couple of seconds, whereupon the dancers would separate and indulge in some chaste not-quite-kissing. The overall effect was a little like watching Beyoncé have an epileptic fit. My favourite scene, though, was right at the outset at the first (roof-raising) appearance of the villain (Don/Khan was definitely a baddie from the outset) when he’s practising his golf driving on the beach as a group of henchmen arrive.

Don: hurba-hurba-hurba-hurba-hurba. [whacks golf ball straight into the middle of one of the lackey’s foreheads, killing them stone dead] Now that’s what I call a good shot!
Main henchmen, resplendent in bushy moustache: hurba-hurba-hurba?
Don: -hurba-hurba-hurba-hurba police informer!

All in all, though, it was actually fantastic, particularly because the cinema was packed with people really getting into the film, and we plan to go again.

Today (Sunday) involved sleeping till close to noon, and then heading over the road to the pool which our landlady owns. It is an absolute oasis – impeccable lawns, hedged paths paved in stone rather than the Vellore default, a gym which we all studiously ignored, billiards, table-tennis, and a pool which must be 30m x 10m and is crystal clear. The snag was that it’s also a favoured spot for the local mozzies, who having only bitten me twice in the first six days trebled their record this afternoon. After that we had dinner in the canteen, where we are constantly finding new ways of convincing the woman behind the counter that gora (NB: Ron – I mean ‘white person’ here, not ‘little horse’) are imbeciles. Tonight I tried to order pongal after Ashok (a guy we met at the pool) had said it was his favourite food; she smiled pityingly, shook her head, and said very slowly: “No – it’s only for breakfast.”

Just before bed we plotted to escape Vellore next weekend for Pondicherry, a former French colony on the coast which oddly only became part of India in the 1950s. Ben’s guidebook says it “manages to retain a mildly Gallic air superimposed on a typical Indian background”; I’m curious to find out if this means they dust the turds with icing sugar. Despite today being relatively idyllic, I think we’re all keen to spend some time away from Vellore – when I asked Debánjali where to go here she shrugged and said: “There’s nothing to do here. I’m from the North so I don’t even like the food – so you work, go home, sleep, and come to work again.” For the junior doctors here that means 12-hour shifts seven days a week, too.

However, if I’m tiring slightly of the sight (there is a fort here), sounds (see Monopoly money, traffic horns, and go-karting), and smells of Vellore, I’m switching to gynaecology this week, so Ed Genochio, who commented that he had “never read a blog about gynaecology in india before, but perhaps it is time”, will be pleased. Given that no one had ever read a blog about a solo winter crossing of the Tibetan plateau on a bicycle as part of a journey from Shanghai to London before Ed wrote his, I thought this was rather generous of him. So I will keep you posted on how the gynaecology goes, will continue to spare you the photos as the computers here won’t upload them from my camera, and will tell you about the food at some point. Bye for now.

Sleep disturbance, 19th century Irish psychiatric nurses, and upsides and downsides

Friday 27th October
Police station visits: 5
Different police stations visited: 2
Births seen: 20

Wednesday morning started bright and early (6:30) with a shower (always cold, but they are at least proper showers rather than fill-the-bucket type affairs, and the new hostel has bathrooms which are spotlessly clean unlike the hellhole from monday night) and a trip back to the police station to re-register. When we arrived, the large group of men in brown uniforms took themselves and their big, curly moustaches inside where they proceeded to stand in formation and talk at one another very formally; we decided this was some sort of spectacle for our benefit. Eventually, our policeman showed up in chinos and a very fetching salmon pink polo shirt, and when he found out where we were now staying, told us to go to the police station over the road "later on, or tomorrow". Third police station visit down, we set off for breakfast wishing a fiery doom would befall the people at VDM lodge.

We attempted to go to the local police station in Bagalayam on thursday morning...but the paper-shuffler we needed wasn't available, so we were told to come back at five. Fourth visit down. We came back at five and handed over passports and photocopies of them and of our visas. The public face of law and order in Bagalayam half-heartedly shuffled our photocopies and suggested:
Policeman: "Aren't there four of you?"
Charlotte: "Yes - there are four copies..."
She then proceeded to lean over him and flick through the pages for him, pointing out each of us in turn. Although none of us cracked, there was a collective disappointment that he couldn't even be bothered to shuffle the paper adequately.
Policeman: "I need two copies of these."
Charlotte: "Er, why is that? The policeman at Vellore North only wanted one...
Policeman: "One for here, and one for the police station at Sringipat."

We glanced at one another, and wordlessly agreed to get the hell out of there as soon as possible. After thanking him kindly for his time, and carefully writing down the name of the next police station in the neverending chain those bastards at VDM lodge got us into, we left the building and, as one, turned to each other and confirmed that there was no way on god's good earth we were going to another police station.

On a happier note, I've now seen more babies being born in two-and-a-half days (we skived off thursday afternoon to go shopping) than in three weeks back in the UK, and - unlike there - I haven't even had to stay all night at St. Thomas' to do it. They run at around 8,000 deliveries a year, or about 22 every day, and they're very good at what they do despite lacking certain refinements we have in the UK. For instance, back home if you give a woman oxytocin to encourage contractions, you automatically give her an epidural as it's otherwise 'too painful'. Not in India, where I have yet to see anything other than pethidine (an opiate) and local anaesthetic given during the birth process. Despite this, individually the women tend to be much quieter than in England - some are incredibly stoic - and the noisy ones get told in no uncertain terms to shut up by the medical staff, with (literal) slaps on the wrist if they wail too much. When the wailing does get going, though, it's very melodramatic-and-prolonged-B-horror-movie-death-scene, particularly with the amount of blood flying around. So although the mums here are overwhelmingly quieter on average than back home, here they're stacked next to one another on the ward in beds separated by curtains which don't close all the way round the beds, where in the UK all the mothers have their special birth rooms +/- water birthing equipment, etc. This makes walking onto the labour ward in the morning quite a bracing experience (more so even than cold showers), as there's quite a lot of yelling of "Moca-moca-moca-moca" (which I deduced pretty quickly is Tamil for "PUSH!") from the hospital staff, coupled with "Amaaaaaa! Amaaaaa!" from the labouring mothers-to-be. That actually means "Mother!". In addition, there's a lot of gore (possibly related to the overwhelming bluntness of the episiotomy scissors), and I find it exceptionally difficult to reconcile someone who's just given birth (and whose baby is elsewhere, of which more in a moment) lying in a pool of their own blood with the popular view of childbirth as a wonderful experience. Once mum's been patched up, baby's been cleaned up, and both have stopped yelling, I can get the whole amazing-spiritual-experience bit - but before that it strikes me as a whole lot more brutal than beautiful. That said, you do get a sense of achievement from it, entire families want to shake your hand simply for fetching gauze and vials of drugs, and the end just about justifies the means. I suppose.

Another difference here is in the number of extremely rare things you see - some of you will have heard of pre-eclampsia back home, which is regularly screened for during pregnancy and treated aggressively when it shows up. The eventual end point is 'eclampsia', or seizures due to the high blood pressure that comes with it - but it's exceptionally rare because the condition is so well picked up. We had a patient with full-blown eclampsia on the second morning here, and during her delivery, because she kept thrashing around and getting her hands into sterile fields, they ended up basically manacling her hands to the bed up by her head - which was almost certainly necessary but a little discomfiting all the same. I've also seen pretty much every different type of delivery - normal, with episiotomies, forceps, twins - you name it. The exposure you have to clinical situations here is just great, and everyone is incredibly willing to teach. This may be because the only local medical students on labour ward are two in the "B stream", which means they've failed a year and are resitting it. This means that all the consultants are deeply suspicious of them (Ben, in clinic on day 2, told how the doctor he was with gave the pair of them a proper "I'm watching you, sonny Jim - get out there and see some patients!" talk) - and with good reason. They are currently assigned to labour ward full time, and over the past three days I have seen one of them there on two separate occasions for a total of about five minutes. The first time Somarjit was greeted by a weary "Are you going to stay and do anything?", which provoked a non-committal head-waggle and a prompt sodding off two minutes later. Today, he showed up again during the delivery of twins, and responded to a surly "where's your other one?" from the doctor handling the delivery by lasting all of three minutes. This helps reassure me I'm not stealing teaching time from the local students, or at least not from those who want it.

The two downsides of being on the labour ward are the babies who come out and aren't quite right - miserable for all concerned, really - and the scrubs you have to wear, which make you look like a 19th century psychiatric nurse. The Irish part comes from a discussion Ben and I had about it in which we both involuntarily assumed Irish accents to reinforce the point. The slightly alarming turn that conversation took may have contributed to the continued disturbance of my sleep, on this occasion by Ben first pulling down his mosquito net (and thus mine also) in the middle of tuesday night, and then waking up with a shriek on wednesday, busting out from under his net, and scrabbling around at the door like a medium-sized animal (Ben, reading over my shoulder, objected to "little"). Happily, although I was worried he was going to bite me when I reached over his shoulder for the light switch, he slept through the night on thursday.

The main upside of Labour Ward, though, is not the birth per se, but rather the Presentation. Another difference between the UK and Indian practice is that men are very much not allowed on the ward - normally mum is accompanied by an elderly lady who is probably her mother-in-law, and this is only up until labour starts, when they are dispatched to the Presentation Room to join the rest of the family. Once the baby is born, it gets whisked off to get checked out by the neonatologists, wrapped in swaddling clothes, and taken by one of the nurses to be Presented. This involves going up to a counter, much like those in a post office, and hollering a name through the glass. A gaggle of family members then rush up and stand looking nervously at baby until it is unwrapped for their inspection. A girl tends to get a slight frown from the mother-in-law, implying that her daughter-in-law needs to take a leaf out of *her* book, and an equivocal "well-she's-alive-and-healthy-at-least" head waggle from everyone else. Boys cause the mother-in-law to break into a smile, and everyone else to go into paroxysms of joy. The best thing about this is that if you go through with the baby and the sister when this happens, everyone wants to thank you for the new arrival, even though your actual role in the delivery was restricted to badly-pronounced "Moca-moca-moca" at key moments.

Anyway, we only finished recently today having been in since eight and - just to thank those of you at work for reading - saturday is a working day in India, so we're back in at eight again tomorrow. So I will have to cover the food and what exactly the Head Waggle is in the next installment. Bye for now.

Monopoly money, traffic horns, and go-karting

Tuesday October 24th
Police station visits: 2

After writing last night the four of us took a tuk-tuk back to where we're now staying, and on getting out it became apparent I was still tired when I attempted to give him 10x the actual fare. Luckily I realised my mistake; unluckily this was shortly after Ben, Charlotte and Toyin did and asked what the hell was wrong with me. I blame fatigue, and the fact that it's so hard to believe how little things cost here. The ride back takes about 20 minutes and costs about 40p, for instance, a cup of tea is about 3.5p. Happily I got to bed pretty early, so these should continue to be the prices I actually pay for things.

Given that today, much like yesterday, was largely speeding Toyin and Ben through the hospital admin process, and given that said process seems only marginally more entertaining today than it did yesterday, I'll try to give you some idea of my general impression of Vellore so far. The first things you notice are, probably in order, the bustle the place has, how friendly everyone is, and the smell. I'll deal with the negatives first: to quote Toyin, "this place smells like butt". Perhaps it's the cows impudently wandering the streets, rooting through garbage, ambling out into lines of traffic, and crapping everywhere; perhaps it's the weather; perhaps it's the piles of rubbish everywhere; perhaps it's the fact that sewers seem to run under the pavements and are often open to the air - but the place smells bad. There are exceptions - the Christian Medical College (CMC) campus (where the lectures etc. are held, as distinct from the hospital) is beautiful, impeccably kept, green, and smells of whatever tree is nearest at a given time. Charlotte got inordinately excited when she realised all the trees on campus had little signs on with their (Latin) names. It was largely as a result of this that we've moved hostels - our new place is right next door.

How friendly people are - and they have been, without exception, charming - is a little surprising in the context of a place which seems very commercial. I can't talk about India as a whole, but Vellore is essentially a backwater town plucked from obscurity by the advent of the CMC and selected purely because it was midway between two urban centres and cheaper to buy real estate. Despite this, people are always interested in selling things and there's a real competitive edge to it in the sense that they really seem to want to work and to enjoy doing whatever it is they do. Given that's the case, it can be surprising they're so friendly - if you decide not to take a tuk-tuk somewhere because he's overcharging, he'll just head off with a head-wobble and a smile. It's perhaps also that there's very little of the crass attempts to overcharge the gora (Hindi for "white person") by a factor of ten that you see elsewhere (and this is not merely because some try to overpay by that amount anyway). This ties in to the bustle the place has - part of that is the sense you get that everyone wants to work and takes a certain amount of pride in what they do, whatever that may be. Calling it a stark contrast to back home is probably overstating the case, but it's unusual. Bustle takes many other forms - the noise here is incredible. The main component is traffic noise, and that's largely horns. I can only assume that part of the Indian driving test (there is an assumption in here somewhere) involves knowing that your vehicle will stop working if you go longer than a minute without sounding the horn. This is made all the better by the sheer variety of horns on offer - the buses have big, blasting, foghorns, the cars have more reserved brassy toots, and the tuk-tuks - who make up the majority of the traffic - have everything from quiz-show buzzer sounds through pig, sheep, and geese noises to ear-splitting shrills. It's a bit like a constant carnival, and I'm as glad to experience it during the day as I am to get the hell out to the quieter areas at night.

The traffic is the best and worst I've ever been in. It's a little like a go-kart track with lots of crossings, traffic coming at you as well as from behind you, and instead of piles of tyres you have crowds of people forming the crash barriers at the sides of the road. It's part exhilarating and part terrifying; happily I'm tall enough that I normally can't see how close the bus-juggernaut behind us is (although I can certainly hear the horn).

At some point, incidentally, I will probably tell you about the medical side of things - I did meet some of the doctors who'll be looking after us today, and the consultant who has to sign our books seemed busy, extremely willing to teach us, and more than a little surprised we were there at all - he assigned two of us to the Labour Ward for the first week, adding "There are supposed to be two of my (CMC) students there, Franklin and Sumarjit, but I don't know" with a faintly disgusted shrug. I can reassure those of you who were worried, however (particularly James Foster) that if there are photos I won't send them to anyone's work address...

Sleep deprivation and problems with the law

The start of the trip has basically been a sort of giant endurance event whereby circumstances contrive to deny me of any sleep at all for as long as possible to see what happens. The flight involved my being disturbed at least every 30 minutes and whenever I tried to get some sleep by someone behind me who appeared from the constant wriggling and prodding in my back to have either a half dozen restless children or a large and amorous octopus who'd taken a liking to her tray table on her lap. It turned out that in fact there were only two children, but whenever the one went off to sleep she would carry it forward to a cot from where she'd collect the other squalling brat to come and resume the assault on my back. Happily, Charlotte was kept awake throughout because the women in the window seat across from her went to the loo every half-hour, which allowed us to get our minds into diagnostic mode by unkindly wondering if she had some sort of bladder infection. In fact it was probably that she drank about twenty cups of water through the flight; every time the stewardess came past with a tray she would take two and I would glance across the aisle and smirk at Charlotte, whereupon the baby behind me would boot me in the kidney. Aside from that the flight included the last salad I can safely eat for three weeks (thanks to all those of you who offered this in lieu of e.g. places to visit when asked for advice about visiting India), and has made me decide to tell the mother of each little bundle of joy we bring into the world over the next few weeks the importance of controlling junior on aeroplanes, particularly the 0400 from Chennai on the 12th November. It gives me a warm glow of satisfaction to know that the provision of such invaluable aeroplane etiquette means I am educating people here, rather than merely having them educate me.

I therefore didn't sleep between 0830 and 2300 London time (0330 India time) at all. Before I go into all the other ways I was prevented from sleeping, I should say a little about what I'm doing here. As part of the medical course at Guy's King's and St. Thomas', you're able to spend three weeks of the Obstetrics (pregnancy & childbirth) and Gynaecology (women's problems) rotation and of the Paediatrics (children) rotation abroad, and four of us from the grad course have arranged to come to Vellore to do this. Apart from me, there's Toyin, who some of you may know and some may remember from my Ethiopia missives. Toyin is my clinical partner on the course, did extremely well on her USMLEs (American medical exams) over the summer except in that she therefore didn't have a summer holiday, is profoundly disillusioned with the quality of the GKT teaching as a result of her revision, and has an extremely curious accent. Then there is Charlotte, who was on the flight with me. Her last trip abroad was her honeymoon in September, and she used to be at Goldman Sachs and so was fond of saying at the end of lectures in our first year, "If we'd seen a presentation like that at Goldman, someone would have been fired by now." Finally there's Ben, who's a tall, very pale Lahndahner who constantly amazes us by having or having had most of the illnesses we study (gynaecology being the exception thus far, although we all have high hopes for him). We're all here because we preferred India to the delights of the places GKT send you, which tend to be either inbred Kentish hellholes ( e.g. Gillingham) or seaside resort towns-cum-retirement homes (e.g. Worthing).

Charlotte and I passed the remainder of the flight watching some quite bad and some quite good films (the Devil Wears Prada was good, X-Men III plotless, and that one with Jennifer Aniston and Vince Vaughn dreadful), and in Charlotte's case by displaying her diplomat's-wife skills by getting a business card from the gentlemen between her and the woman with cystitis. We got in to Chennai (aka Madras) at 3.30am, and having spent an hour or so collecting bags and changing money, headed out to decide how to get to Vellore. We eventually settled on the bus, and one of the two men who'd been following us around trying to get us to pay thousands of rupees to take us places agreed to take us to the bus stop for 200. For this, he said, he would "catch the bus for us!". As the prepaid taxi firm had quoted 260 for the same trip, this seemed entirely reasonable. It was only as he headed off into the night to get his "vehicle" that Charlotte commented, "Oh god - I hope it's not a tuk-tuk." Sure enough, our man chugged up in his auto-rickshaw, and we set off into the night like a large yellow lawnmower with extra seats, Charlotte clutching the field dressings which she had promised her husband Arthur she would have to hand in the event of using a taxi in India. The journey wasn't too hair-raising, although the lack of any real traffic laws is interesting; the hair-raising part came at the end when the driver appeared to be turning into a lane of oncoming traffic and hollering at someone coming the other way. It turned out that he really did mean he was going to catch the bus for us, so we hopped on and set off for Vellore.

It was at this point that my second attempt at sleep was foiled. Buses in India have TV screens showing Bollywood films, and when these are played at ear-splitting volume throughout the three-hour trip, sleeping is a virtual impossibility for longer than the time between songs and/or fights. In Bollywood films, this is not very long.

By the time we finally arrived in Vellore and found the hotel Ben and Toyin had booked us into, we were both feeling well enough that we decided to get set up at the hospital before getting some sleep. Thanks to the love of paperwork here, this took bloody ages, but by about 4pm we had our ids promised to us in the morning, so we headed back to the hotel and precipitously collapsed into our respective beds.

At about half past five, someone hammered on the door. I didn't wake up, but eventually, when whoever it was began trying the handle, Charlotte opened it to find one of the hotel staff outside.

Him: "The manager needs to see you downstairs right away!"
Charlotte: "Um - why?"
Him: "The police are downstairs and say your visa is not complete."
Me: "Are the police downstairs now?"
Him: "Yes."

After brief discussion, we headed downstairs to find, to our total lack of surprise, that there were no police there. Instead there was a rather self-important looking man behind the desk who had evidently replaced the kindly elderly gentleman who'd been there when we arrived. He claimed that we had to go to the police station at 7pm to see the policeman, otherwise he'd get into terrible trouble. We eventually negotiated our way into going straight there (he claimed that we had to go at seven, we point-blank refused as we were so tired), and headed off to the police station with a guide from the hotel, Charlotte still in her pyjamas. At the police station, our helpful guide instructed us to sit down while he went to find out what was happening. He came back and told us to wait. After about five minutes of waiting, we had had enough and went into the office, where it emerged that:
(1) We needed to register with the local police station (this is not mentioned in any guidebooks)
(2) The policeman in question wasn't there, and no one else could deal with the trivial paperwork in his absence.
(3) This meant that our helpful guide had evidently intended us to wait around for an hour and a half until the policeman returned.
(4) This was not important at all, and we could come back the next day between 7 and 8am.

So we traipsed back to the hotel to talk to the man behind the desk again.
Him: "So - you found the man?"
Me: "No - he wasn't there, so we're going back tomorrow morning."
Him: "There will be no one there then. You go back at 7pm."
Me: "No - we're going to bed."
Him: "No no! You must go tonight, or I am accountable!"
Me: "We're going back tomorrow morning between 7 and 8. It can wait until then."
Him: "The policeman will not be there then!"
Me: "We have just been told that he will, so we will go then."

At this point we repaired to bed again, seething at the fact that these incompetent bastards had got so over-excited at having foreign guests they'd told the police we were here and then woken us up two hours before we could do anything about it. At around 7pm, someone banged on the door again, so I leapt up, unbolted it, and opened the door in utter rage. One of the lackeys from downstairs took one look, said "Ah - sorry..." and ran for the stairs. In the morning, when we finally went to the police station, we were seen immediately by a policeman who accepted copies of our passports, put some vital stamps on the photocopies and some other bits of paper, and told Toyin and Ben who had arrived the previous night and been turned away from our hotel, that they could come back in a day or two to register.

Happily, Charlotte and I had had a hotel recommended by one of the doctors, so the four of us immediately decamped there, leaving the worst hotel I have ever stayed in behind. So - should you ever find yourself in Vellore, don't stay in the VDM lodge. Not only are the staff largely imbeciles, it is right next to Vellore's largest nightclub, which meant I was effectively sharing a room with most of the dancefloor, and it is also home to several pigeons who attempted to break in through the window at around 4am.

So I'm quite tired. But the hospital looks great.

The weigh-in

I'm about to leave for the airport and, in a nod to Helen Fielding:
Weight at departure: 88kgs. Feel free to post your guesses as to my weight on return in the comments thing below; I'm afraid you'll have to arrange your own sweepstake...