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.