The Top Ten Foods of Saragur

To change things up, I've decided to make a top ten list (for the buzzfeed-inclined). It started as a top ten list for foods served at the canteen, until I couldn't think of ten different foods (variety is lacking). Luckily, I've found some other eating options around town.

10. Dosa: A breakfast food made from some sort of fermented flour served with a savory tomato sauce and chutney. Something about tomato sauce for breakfast just isn't right.

9. Chapati with Sagu: A thin, almost tortilla-like bread used to pick up bits of sagu, a thick, chunky, vegetable sauce and paela, a mixture of chopped vegetables and sometimes lentils. I think I overdid it on the chapati when I arrived since it is served for lunch and dinner daily (either the one-chapati meal or two-chapati meal; I think McDonalds should invest in developing it).

8. Gobi: The first street food I tried, made from breaded and fried cauliflower, that is further fried with a spicy red sauce that almost has a barbeque flavor, and definitely has a spicy kick.

My favorite gobi guy.

7. Breakfast Rice (for lack of a better name): The rice served at breakfast is always seasoned with something, but it rotates on a daily basis. Some are spicy, others have a definite tomato flavor, one is made with a lot of cardamom, and my favorite has peanuts in it. It's usually pretty good (once again, getting over the fact that it is savory, spicy food for breakfast).

6. Roti: Another thin tortilla-like food, but made from smashed rice and seasoned with onions and chilies- much more flavorful than chapati. My friend in Saragur, Priya, made it for me in her home.

Amy, the other med student who was here when I arrived, enjoying roti while teaching english.

5. Rice and Sambar: The staple of my diet for the past week has been "half rice" (indicating that I don't need the gigantic portion that they typically serve). At lunch and dinner, there is always plain white rice with a side sambar, a thinner sauce related to sagu, but with fewer chunks. It is also customary to eat curd (yogurt) with rice, but I usually get it on the side and drink it plain.

4. Pani Puri: My favorite street food, small hollow puff pastries filled with chickpeas, a salad of chopped carrots and onions and crunchy bits, and a sauce to drizzle over the top. The only problem is that they are meant to be eaten in one bite, which I definitely cannot do.

3. Masala Dosa: A breakfast food that almost reminds me of home. It's made with the same fermented flour as the dosa listed above, but is fried, more like a pancake, and filled with a mixture of potatoes and caramelized onions.

2. Ice cream: I love ice cream, no matter where I am. Earlier this week, the canteen got a shipment of ice cream, so I've been enjoying it daily, but the best I've had is this falooda, a sundae concoction including vanilla and mango ice cream, jello chunks, bits of fresh and dried fruits, and little noodles.

Technically, this was at a fancy place in Mysore.

1. Jamoon with tea or coffee: A jamoon is like a little doughnut hole served swimming in syrup. It's best with one of the tiny, sweet, milky cups of coffee or tea that I have daily. Tea break is alive and well.

Honorable Mention: Domino's in Mysore for their "Cloud 9" Pizza, complete with baby corn and paneer. The crust was remarkably similar to the US, though.

(i apologize for spelling errors- I've never seen most of these names written).

Mobile Clinics

Hello!

I'm blaming my week+ absence of posts on my GI tract... you don't want to know the details...

Anyways, I still managed to have a very busy second week at the hospital, including going on two more Mobile Clinics into the forest area.  As you may know, I spend a lot of time back at school coordinating the UI Mobile Clinic, so it's been interesting to see the similarities and differences between these two clinics with the same mission half a world apart.

All of the Mobile Clinics here have a similar structure, but each day of the week they cover a different set of villages. We travel in a large ambulance van with a well-stocked pharmacy in the back, which also serves as the exam room.

The van stuck in the mud. Took half an hour and 10 men to get it unstuck.

Kabini Dam + cow

On all three of my excursions, we've left the hospital in Sargur around 9 am, then driven to Kenchanahalli, the smaller (original) SVYM hospital to pick up an ayurvedic doctor. Kenchanahalli is quite a beautiful spot, tucked away on the east side of the Kabini reservoir, but the villages I've been to have all been on the west side of the reservoir, which means a long drive around the lake. It's quite the scenic trip so I enjoyed the long hours in the bumpy van. Along the way we also picked up another community health worker to complete the team. This map shows the general area that I've been through- from Sargur to Bavali.

Kabini reservoir on a rare partly sunny day

After assembling the full team, the van leaves the well-traveled roads and heads deep into the countryside. My very first clinic experience was confusing, to say the least. The van drove down a gravel path 1 km, turned around, stopped, and started the siren. Everyone started watching a cluster of houses about half a km away, until people started trickling down the path towards the van. Apparently this is a universal clinic sign:) At most stops, only a few people would come to the van with concerns, but at some villages, we had over 20 patients. The patients crowd around the back of the van, and one by one come in to speak with the doctor while everyone else (including some curious children) watch. The most common complaints are fevers, coughs, and colds, since it is monsoon season- the coldest part of the year (I'm not complaining), but I've also seen wound infections, scabies, hypertension, diabetes, heart murmurs, anemia, dizziness (which they call 'giddiness'), and prenatal visits not infrequently. My role was taking blood pressures and auscultating. Every patient gets a prescription for something- often just PCT (paracetamol aka acetaminophen aka Tylenol) or an Ayurvedic cough syrup. They also give out a lot of vitamin supplements and are fairly overgenerous with their use of antibiotics. The cost of the visit is always 2 rupees ($0.03), no matter what is given. Occasionally, patients were referred to the hospital, where they also get subsidized care if they are tribals.

You never know who'll be coming by for a clinic.

Not everyone comes crowding up to the van, however. Sometimes the community health worker would have to go and talk to people, asking if anyone in their family was sick, and other times, they seemed to know about certain patients who should be coming for chronic disease follow up. At a Grand Rounds case presentation last week, an intern presented on a baby with meningitis, but the discussion took a turn as a few of the doctors shared their experiences of getting to know the child's mother, who used to run and hide or climb a tree when the mobile clinic came to her village. A few of these doctors slowly built her trust by talking to her week after week, and eventually coaxed her into coming into the van and getting her blood pressure checked. Then, there was another long struggle of trying to get her to accept anti-tubercular treatment for her TB, and eventually enough trust was built that she took her meds and would come to the hospital for all of her prenatal visits before delivering this child. The doctors emphasized the extra effort it took, and the delicate nature of such a relationship, but throughout the entire discussion, I was thinking about how extremely worth it that effort was. If she had continued to distrust healthcare, she personally would most likely still have active TB, she probably wouldn't have come to the hospital for her delivery, and her baby would not have gotten the care it needed when he developed meningitis. In going the extra mile for one patient, the doctors also helped her family in the long run, and as this one woman tells her community about how the hospital saved her baby (as she sees it), she will plant the seeds of trust in many more people. This point is important in a place like Saragur, where resources are limited and patients have very low health literacy, but can carry through to practicing in the US, where it is important to remember that every patient is worth the extra effort, every time.

Cricket by an old cement factory with the Kabini river in the background.

Back to the clinics- each day, the van stops at 9 or so villages, and sees around 40-50 patients, in my experience (although I've heard about days with close to 100 patients). We stopped for lunch alongside the southern Kabini river, near Bavali, which marks the border of Karnataka with Kerala, and had an impromptu game of cricket with some boys...by we, I mean the others played and I watched. I have yet to learn any of the rules. Stopping for tea is another important part of the late afternoons that I enjoy. They take their tea in small metal cups, heavy on the milk and sugar, light on the tea. The same goes for coffee, so I may have trouble adjusting back to my large mug of black coffee every morning when I return home.

In addition to being interested in seeing patients and promoting health at the most basic level during these clinics, I can't help but enjoy the beautiful scenery. On Fridays, the clinics are all within Nagarhole National Park, where I've seen a variety of wild deer, elephants, and monkeys. Even outside the park, the rice paddies are bright green, cotton fields are covered in white flowers, and there are fields of bright orange marigolds that glow even in the rain. I wouldn't mind having a commute like this everyday, notwithstanding the bumpy, muddy roads.

I have at least three more blog posts in my head, as well as a somewhat important personal statement to write for residency applications, so I'll most likely post again soon (and procrastinate on the personal statement). Let me know if there is anything in particular you'd like to read about!