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.
Monday, October 30, 2006
Thursday, October 26, 2006
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.
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.
Wednesday, October 25, 2006
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...
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...
Tuesday, October 24, 2006
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.
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.
Sunday, October 22, 2006
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...
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...
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