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!

Week One

I absolutely cannot believe that I've been in India for over a week already! Time has flown by, but when i reflect on it, I have packed a lot into these past seven days. I arrived at the airport early Thursday morning, one week ago, and spent the first day being oriented to SVYM, shopping in Mysore, and recuperating from massive jet lag (10.5 hours different takes a lot of adjusting). The following morning, I was driven to Saragur, home of the Vivekananda Memorial Hospital, where I have been living and working ever since.

In my first week at the hospital, I have participated in general ward rounds, outpatient medicine and pediatric clinics, casting in the orthopedics dept, and a Mobile Clinic to tribal areas adjacent to Nagarhole National Park. In addition, I presented at Grand Rounds, observed a special clinic camp where outside specialists came and made referrals, and most importantly, have gotten to know many of the doctors, fellows, and students who work at the hospital. There have been a lot of practical lessons as well, like learning the names of different types of food so I can order at the hospital canteen, learning how to eat properly, figuring out how to get hot water for a shower, and knowing how many rupees various things should cost. Amy Foster, a fifth year English medical student also on the medical elective, was integral to my learning but since she finished up today, I'm now on my own!

Out on a Mobile Clinic. The driver blasts the siren near a village and then we'd wait for patients to come to the van. We went to 9 villages and saw 37 patients last Saturday.

 

Front of the hospital on the special clinic camp day. Apparently over 400 patients were seen and about 50 were referred to specialty centers.

Swami Vivekananda Youth Movement

Hello everyone! I've made it to the hospital where I'm working and have settled in over the past few days, so I figured it was about time that I told you a bit about what I'm doing.

Swami Vivekananda Youth Movement is the organization that runs the hospital at which I am working. It was founded in the 1980's by a few medical students from Mysore (a nearby city) who wanted to provide healthcare and improve the lives of the poor and marginalized. Initially they provided affordable, basic healthcare to tribal villages in southern Karnataka. These people had been forced away from their homes for the building of a dam and national park. As the doctors learned more about the plight of the tribal villagers, they expanded their services to include education, water quality projects, community development initiatives, and youth empowerment programs. The hospital that I am now in was built over 10 years ago to support the growing needs of the community. There are still daily mobile clinics going out to some of the more remote villages to take away the challenges of traveling to the hospital and meet these communities where it is most convenient for the people working there. They also have public health outreach programs, palliative care services, and a special focus on HIV management.

The umbrella organization of SVYM also oversees education of the tribal children, leadership training for work in the development sector, and courses in Indian culture for study abroad programs to take part in. Throughout all of these activities, SVYM strives to partner with the communities, rather than imposing projects, and maintains good relationships with the local government and other similar institutions. From the first time I heard about SVYM, I was impressed by its organizational structure, involvement in areas beyond just healthcare, and its community driven projects, and now that I am here, I continue to be impressed.

I hope that gives you more of an idea of why I'm here- I'll discuss the medical aspects of the trip and my daily life in greater detail in another post (or many- with pictures!).

-Courtney

By the way, this is Swami Vivekananda, whose picture appears in nearly every room in the hospital. He was a Hindu monk credited with bringing Hinduism back into greater prominence within India, and sharing Indian philosophies with the world in the late nineteenth century, making Hinduism one of the major world religions. His teachings focused on human development and nationalism and are embraced in the vision and mission of SVYM, striving:
"To facilitate and develop processes that improve the quality of life of people... [for] A caring and equitable society, free of deprivation and strife"

India!

I've gotten the wanderlust again so I've revived this blog to share my travels to India. I'll primarily be in Saragur, India working at the Swami Vivekananda Youth Movement Hospital. This will be rural, low-resource medicine- a great opportunity for learning. You can find out more about this excellent organization at svym.org.

Once I'm in India, I should have a better idea of what I'll be doing on a day to day basis and what my living situation is like. But now, I have to finish some packing and get to bed so I'm ready to take off tomorrow!

Courtney

the Grand Excursion

I have been very negligent, due to being away from Bamako for ten days, followed by diving headfirst into research. But now, I hope to catch you up on my travels.

My travels followed the Niger River through the safe parts of Mali, so Timbuktu was excluded. Nevertheless, I was able to see a whole different side of the country and many historically important sites. Our normal travel pattern was a day of driving and a little sightseeing, followed by a day just in one location, and our mode of transportation was two large vans. We started by going to Ségou, where we had an excellent hotel (that would be nice by US standards- I had my first shower with hot water in Mali!) and the opportunity to wander along the river through the old city, which was heavily influenced by french colonisation. The highlight of Ségou was having random conversations with the people we met along the river, even if they ended with getting proposed to or getting told to buy something. The market in Ségou was a lot less intimidating than in Bamako, so I could really work on my bartering skills (which are surprisingly good).While in Ségou, we also visited a few women's coops and the ancient village where the founder of Ségou was buried. In Markala, not far from Ségou, we walked across a huge bridge and dam that was built by the french and created an irrigation system for l'Office du Niger, now one of the most profitable farming areas.

Our next stop was Djenné, home of the world's largest mud-brick building, the Grande Mosquée. We couldn't actually go in, as non-Muslims, but we saw the very impressive exterior. We also walked around the city as a group and took a pirogue (large canoe shaped boat) ride to an ancient archeological site, which unfortunately is not worth much, since the remains mostly consist of small pottery shards, which littered the ground and only a couple of foundations are intact. It rained most of the time in Djenné so i saw more of my hut than the city (that is, i saw my hut until the electricity stopped working for my last 16 hours there).

I left Djenné in the rain and bought some souvenirs for a "good price" that was actually good for once. We were stalked by vendors walking around with their wares the entire trip, since a large group of white tourists like us is a giant dollar sign to them. Usually they were annoying, but sometimes they were cute. For example, that day, when the bus stopped, vendors mobbed the bus and started dangling things through the window like normal. One boy in particular caught my attention. "This one is box. This one is orange. This one is marron." But when i showed no interest in the box, he brought out carved wooden animal key chains. "This one is popotam. This one is noceraus. This one is leon. This one is femme (woman). This one is homme (man). This one is en train de dormir dans l'eau (in the middle of sleeping in the water)," and he set it down on the windowsill. At this point, we could not contain ourselves since this was all said very seriously and we all burst out laughing. He stared at us for a moment, then let out an indescribable laugh, even though he obviously had no clue what was so funny. I ended up buying a popotam, more for the entertainment than for its value...can you guess what it actually is?

Eventually we made it to our next destination: Sangha, in the Dogon country. Getting there required two hours of driving on really rough one lane roads- luckily I don't get too carsick so I could enjoy the beautiful country we passed through, scattered with low stone walls, goats, and patches of onions. The Dogon country is seriously a country of its own, with much less western influence. It is famous for villages built into the cliffs centuries ago, that seem impossible to access, but were built without modern technology. We took a five hour hike from our village to the edge of the cliffs, hiked down and across the plains of millet fields, then climbed back up at a different point...I took way too many pictures there, if you'd like a play by play. As if that day couldn't get any better, we had an excellent lunch at the hotel, then saw a traditional dogon mask dance, shopped for the local indigo fabric, and slept on the roof of the hotel, under the stars. I actually got cold that night (a very rare occurrence), then woke up before dawn and walked back to the edge of the cliffs to see the sunrise. amazing.

The final big destination was Mopti, another town on the Niger that uses the river heavily for fishing and shipping to Timbuktu. We took a luxurious pirogue ride and also had a tour of the city, like usual. Watching pirogues being made was interesting- the men were hand making nails in front of us, just using a little charcoal marmite to get the metal red hot and hammering them into shape. The tour ended in a tourist trap of a market, but i bartered things down to less than half of the original price, so I didn't feel too bad. My friend and I took advantage of the free time by just walking down to the river and finding a quiet shady spot away from pesky salespeople and closer to normal Malian life. After Mopti, the trip ended all too soon, with just one more night in Ségou.

My return to Bamako was less than peaceful. I was happy to see my family, but very stressed out since my research topic was up in the air for the first few days. Now I am completely in research mode and my final topic is meningitis, and the possibility of its eradication in Mali. My research has led me to the different levels of health care in Mali, as well as research centers and the government, so I am in my element (except for the fact that most doctors don't speak English). Mali is excellent, in the vast networking of people, that makes networking in the US look like nothing, and the open nature of most people. The easiness of bypassing bureaucracy and the lack of complete confidentiality in the medical world also makes my life quite a bit easier.

This might be one of my last posts...my time here is running out, and I really should start devoting my computer time to writing my ISP, since it will be lengthy and I don't want to procrastinate (though blog writing is the perfect excuse). I would like to share some of what I've found out about the medical system, as well as talk about the second biggest fête of the year, Tabaski, that is coming up on Saturday. I'm quite lucky to be here for the two biggest holidays of the year!

sorry

I'm sorry I haven't posted in awhile. I got back from a ten day trip around Mali on Friday, and since then have been planning my independent study project that I'll be working on for the next month. Things should settle down in the next few days so I can actually write a novel of a post about what I've been up to.

P.S. If you happen to have any information on yellow fever, measles, meningitis, or cholera, let me know, since they are the focus of my research.