Indian Summer:

August 10, 2009

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It was some time after midnight and the washing machine in the guest house had drained all over the floor again. I took the sopping clothes out and arranged them on the clothes lines dangling from the ceiling of the balcony. A few feet across from the house people still milled about the new apartment building under construction. Most were laborers and through the scaffolding and iron grates I could see work was still progressing on the second floor. The first floor, where workers and their families slept during the evenings, was quiet now until the eruption of movement that followed sunrise. The children can characteristically be seen playing amongst the timber scaffolding in the early morning as men and women prepared for their daily labor. The guest house is now much quieter. My roommates have returned to Cornell and the two girls from MIT are now gone as well. On the 11th there will only be two of the original eight still staying in Chennai, and that will soon come to a close as well. I woke up on Saturday to the familiar sounds of construction. Metal struck against metal, and a drilling noise, which had been my alarm clock more times than I can remember, carried across the apartment. My clothes were mostly dry now thanks to the searing temperature. I carried two arm loads of back to my room and left the crumpled mess on the bed for me to iron later.

A quick good morning to the two girls remaining in the house, and then I was on my way to the hospital again. Hema was at work entering some survey information, and Mr. James was characteristically working in the lab using a makeshift inoculating loop to streak a sample onto an agar plate. He showed me some slides of the coccidia he had identified which showed clearly under the bright field scope, and then we briefly discussed the laboratory findings so far. As was anticipated a large proportion of people tested positive for cryptosporidium (which can remain viable even in chlorinated water systems which are available in much of Chennai). The five students I had hired to assist in the study rushed through the halls of the laboratory section wearing a light blue half laboratory coat to distinguish them over their tan and brown school uniform. It was wonderful to see everything coming together. My feeling now is that everything will go well with the project in my absence. Despite difficulties in initiating the work, and a few setbacks during the first dozen or so patients, things are running as they should be. I stayed for several hours working with Hema on the Access database to ensure that this part of the project will not go awry. A quick goodbye to the director and I was on my way out into the afternoon sun. I stepped out of the hospital and walked along the paved path toward Tondiarpet High road. The crows were typically voluminous today, shaping twigs in their mouth and fighting over the remains of a large rodent along the edge of the walkway. Two house sparrows broke the monotonous sight of the crows, but quickly flew to a nearby building. I gave a pitiful bird call which did nothing except make a nearby crow cock its head towards me and then go about its business. The walk to the rickshaw stand was fairly short and I think the drivers recognized me. Maybe I had paid one of them too much at some point because they kept asking for unreasonable rates. I walked to the street and after a minute found someone to take me back to TTK road. This trip had become so familiar for me; the fresh sights that I once found intriguing had lost some of their color. When I got back to my street I walked a short way to a Xerox shop. Not wanting to make the same mistake as last time, where the guy double charged me due to a ‘miscommunication’ over two-sided printing, I inquired about the price first and in detail. The old man at the counter started telling me rates for 5 or 10 copies, and I interrupted ‘with what about 6000 pages?’ He quickly mentally calculated some rates and recorded them on a scrap piece of paper on the table. His manner and looks reminded me of my grandfather whose long, thin, spectacled face was prominent in my childhood. An agreement was reached fairly quickly, and I had gotten the best rate yet of a little less than .50 rupees per page (less than a cent). After this small bit of business was concluded I walked the few kilometers to Inseoul and sat down for a final meal there. Everything was amazing as usual, and the ttukbaegi bulgogi came piping hot in the dol sot. As I mixed the stew with my rice and kimchi I glanced up the Korean News Network program about budget travel in Asia. Several locations were mentioned from Indonesia, Malaysia, Thailand, and Vietnam. All of these spots sounded like excellent destinations and made me lament that my own travels, although not exactly on the strictest budget, were concluding.

As 7:00 PM came around I was getting ready to settle in for a quiet Saturday evening when I received a call from Neil. He was catching as bus to Pondicherry for a ‘full moon party’ that evening. I didn’t know what a full moon party was, and without asking agreed to tag along. Little did I know that nothing from this trip was planned. Neil and Surya met me in an autorickshaw several minutes after calling, and we asked the driver to drop us off at the bus stop of Pondicherry. On the weekends Pondicherry, the former capital of French India located along the shore near East Coast Road, is a popular destination with locals as well as tourists. However, this weekend was especially so due to a festival whose name eludes me, but there were countless depictions of Lakshmi, Shiva, Ganesh and other gods and goddesses in twenty foot high string light displays along the roads. Every bus was packed and the bus stop required several rounds of police vehicles to squish everyone back into an area that didn’t interrupt traffic. After getting frustrated that there wasn’t any space on the busses we began to entertain other options. An empty truck heading in our direction was flagged down and we hitched a ride. Surya was chattering with the driver about taking us to Pondicherry, and we slowly moved down the road south of the city. A 15-minute ride resulted in us moving only about 10 kilometers and now we were simply further away from our bus stop. Our brief foray into hitchhiking hadn’t gone according to plan, but as we were walking back toward the bus stop a number 803 to Pondicherry showed up. It was going fairly slow so we ran alongside and hopped on. Neil and Surya hopped in the front and I jumped into the back. I had to avoid stepping on a woman and falling out of the bus, and I am happy to say that I accomplished both. The bus had no room to move and people were hanging off the side and in the doorway. I squeezed my way into the aisle, and rested as best I could against a pole (and sadly probably a seated person as well). Neil and I exchanged some words across the bus about what to do next and decided to take this to Mahabalipuram, the halfway point between Chennai and Pondicherry. Ninety minutes later we pull to a stop 5 kilometers outside of Mahabalipuram. The driver was taking a 30-minute rest and the passengers of the bus vacated to stretch, have a cigarette, or use the restroom in the nearby foliage. Not wanting to wait to get to the city we begin our vain attempt to stop somebody to give us a ride. This wasn’t working, but a group auto spotted us along that dark road, illuminated only by the faint incandescence of the bus’s indoor lighting. The group auto already had about seven people, two flanking the driver, three in seats, two on the floor, but we managed to squeeze three more people in and plodded toward the city listening to Hindi music on a surprisingly good sound system.

In Mahabalipuram we decided to get dinner. There, sea food is a must and we stopped by Moonraker’s which is known to have some of the best in town. The three of us took a sea on the second floor in the open air room, and the air was heavy with the smell of fish and spices. Everything on the menu sounded great, but I had to go with the shark steak (I have no idea about what type of shark it was, and I’m pretty sure eating top predators like this is a great way to enjoy the industrial pollutants of water systems due to bioaccumulation). I got the steak masala style and had Surya explain to them that I wanted it as spicy as they could make it. Finally a restaurant complied and I had heaps of chili powder which gave the fish some kick. The three of us needed to meet some friends in Pondicherry quickly so we determined calling in a taxi from Fasttrack was the best course of action. Although taxis charge you an arm and a leg they are a pretty useful way to get around if you need it. Neil and I split a Kingfisher as we waited for the car, and I tried some of Surya’s calamari that she couldn’t finish. Ten minutes later our driver is downstairs and we departed from the restaurant thoroughly satisfied.

The cab ride went by very quickly and we had soon traveled the remaining 100km to our destination. We met up with Surya’s friends, members of a rock band in Chennai, who had just played in a calm, dimly lit outdoor café a kilometer from the beach. This café was closing down so the ten of us piled into two cars and Neil and I got to share the backseat with a bass. A pulsar motorcycle guided us the convoluted path to the place where the party was supposed to take place. The winding road was full of speed bumps that the Chennaikar driver seemed not to see or was enjoyed tormenting us with. Each one seemed to propel us further in the air and the bass would come banging down on my legs. A 20 minute drive out of the way landed us at the place. We were greeted by crowds of people being denied admission, and we shortly joined them. Our friends on the cycle managed to get inside, and after waiting around (and helping push some people’s cars that had gotten stuck in the sandy parking lot free) managed to arrange for our entrance as well. I tucked the paper bracelet given as a sign of admission into my shirt pocket. The place wasn’t what I had pictured at all. I’d envisioned a small get together by the rocky shore, but after following a lighted pathway past the hotel I could make out a stage with several DJs and multiple projection screens and lighting systems illuminating an impromptu dance floor on the sand.

After walking a few more minutes down to the beach (I’m sure the hotel’s property was very beautiful, but I couldn’t make much out aside from the sporadic bungalows with their paper lanterns and a pool with a silent fountain) I took off my sandals and enjoyed the feel of the coarse sand under my feet. The group settled into a place near the stage and bought some food and drinks from the event staff nearby. We spent several hours lying on sand and taking in the electronic music exploding from the speakers. Hours passed quickly while the clouds overhead alternated between obscuring and revealing the brilliant stars and moon. Our friend Sidarth took the stage some time in the middle of the act and his Karnatak style vocals seemed to enliven the crowd. Despite not understanding the meaning of the verses, his guitar accompaniment and the rhythm of the music were a pleasure to listen to. Before the final act a juggle off took place between a man dressed in all black leather who had been tending bar and a paunchy fellow in a white collar shirt and khaki pants. It seemed fairly clear the man in black would be the favored and his large beard added an element of danger to the juggling of flaming bottles. A few bobbles by the man in the white shirt sealed the deal and the crowd cheered the leather-man. This will be a battle sure to go into his bar tending résumé. With the final act of pyrotechnics done eight of us made our way back to our shoes careful to avoid the thorns, which nature has seen fit to shape into perfect caltrops, which littered the beach. The night was nearing its completion and Neil and I had to find a room somewhere in the city. We elected to stay at the same place as our friends in the band which had very reasonable rates, and in any case we were too tired to conduct a more thorough search.

Neil and I started a late morning after our friends had begun the trip home to Chennai. The mid-morning sun baked us as we tried to find a nice place to get some food. In the morning the black rocky shore boarding the Bay of Bengal were stunning, and the waves fiercely pounded into them with a constant rhythm. Signs pointing the direction to the tsunami relief zones were a sobering reality to the dangers of living near such a body of water. Over 30,000 people were displaced from homes toward the end of 2004 here, and the signs of this damage can still be seen in some areas along the shore. We found a restaurant off the coastline to enjoy a nice brunch in and I had a good bit of leafy salad which I had been craving. At some point during our long brunch a mime ventured to our table probably because we had been clapping to the two-person band playing covers of western songs (the largely French clientele were unwilling to clap perhaps because it would disturb the air of ennui). He pantomimed karate chopping me and shooting me which was really not that impressive. After all, I had become a master of pantomime in my time in Chennai; such is the necessity of a traveler whose vocabulary borders on thirty words of Tamil, on the best of days, in a region that is fiercely loyal to its language (the Tamil language comes from Dravidian roots unlike Sanskrit which is the linguistic heritage of most, perhaps all, of the Northern native languages spoken in India’s various states). Stomachs full the two of us ventured off into Pondicherry proper. The old stop portion of the city is very striking and distinct from the rest. Much of colonial French architecture has been preserved, along with the grid system that made the city easy to get around in, and was a beautiful backdrop to the sun and surf. Neil went to look for motorcycles for us to rent, the streets here are amazingly calm and there is even a no honking ordinance in many parts of the old town which is sadly not followed, and I shopped around for a place to free myself from the hair that had been imprisoning my face since my electric razor broke. I stopped a saloon which can give you a straight razor shave after Neil talked up the serve you get (face massage, etc…). Apparently I chose the wrong place because I only got a mist of the water bottle before the razor came out. The feeling of blade on scalp is very familiar to me, but not in someone else’s hands. I spend most of the experience staring at the proprietor’s bulging, hairy belly as he quickly scraped away all of my hair. He did a decent enough job except for cutting me above the larynx.

Feeling very refreshed I took a seat on the uncommonly clean streets of Pondicherry and waited for Neil to get back. A few minute’s later the news was broken that all the bikes were rented, and with that our plans for visiting Auroville, described to me as a hippie commune started in the late 1960s 20km or so north of the city, faded away. We instead elected to go grab a Kingfisher somewhere, and settled on a place called Seagull after not finding the café we had been to the night before. The second floor featured open seating right of off the shore toward the edge of the city and near the port area. As we approached our table I noticed a guy wearing an Indiana University T-shirt, and we struck up a conversation. Surprisingly he worked in the same office as us back in Chennai and we invited him to our larger table to spend some time chatting. We talked of old spots back in Bloomington and our mutual fondness for Upland Brewery’s inferno burgers, but the conversation turned back to work and we discussed informatics topics at some length. The sun began to set and a light turned on near the dilapidated promontory which cast a rippled reflection on the tranquil waves below. We began to make plans for our return trip. Happy to have another companion for the ride home we asked if he would like to share a cab back to Chennai. He declined, but we offered to take him to the bus stop he was heading to. After getting in the cab and discussing a bit with the driver he found that it would be difficult to catch a bus back at this hour. Instead he accompanied us to Auroville along winding streets in the waning light. A short drive later we arrived at our destination, Paradise, a famous pizza place in the area which cooks everything in a large clay, wood-fired oven. The food was amazing, not just because of the quality of the pizza but thanks to the hot sauce available on the table in ample portions. Stuffed once again we made our way along the three hour ride along East Coast road passing countless string light images of deities and fireworks bursting in the road and offering a pall of smoke over the dimly lit roads. The windows of the small Tata four door let in the perfect night air, and the road quickly put the lot of us to sleep. I awoke an hour and a half later as we were passing over a long bridge over water whose striped black and white guard rails passed by hypnotically at 90km an hour. I smiled knowing I’d gotten to the chance to visit another part of Tamil Nadu, and spent the last hour of the ride reflecting on my experiences as my fellow passengers slept.

I still can’t believe that the trip has come to a close. The months I’ve spent here have seemed to slip away, and I am reluctant to leave this place. When I return to Chennai again the faces will be different, but I imagine the city will be much the same. ICTPH is a nascent organization and will experience a lot of transition as it grows. My friends, Soumik, Arjit, and Ravi will all be leaving in the near future, they have been the organization’s vice-presidents for each of three verticals here, along with the countless interns and a few full time employees. I’ll be curious to see who fills those positions as I was impressed with their knowledge in each of their respective fields. Mr. James will be retiring in the near future after working for the Communicable Diseases Hospital for over 33 years. He told me a few days ago that it has always been his dream to conduct a large multi-species study which brought a heart-felt smile to my face knowing his dedication to this hospital over the years. I am exceptionally humbled by the care he has taken in nurturing my study, and it wouldn’t have been possible without his guidance. I will tell him this much and more tomorrow on my last day at the hospital. What have I taken away from this experience? When I first agreed to this project I had understood that Dr. Dworkin would accompany me to Chennai during the first weeks to help set things in motion. I couldn’t imagine the trip if that had happened. By coming here alone, in a place where, by my best guess, %70+ of the people don’t speak English I was forced to confront many challenging situations, and grow from their lessons. The personal experiences, a small part of which I have tried to share with you as faithfully as possible, are the richest souvenir I could take from Chennai. Developing a personal responsibility for movement of the project and establishing connections with new colleagues, many of whom had precious little contact with UIC outside of a single conference or a few e-mails, has been my greatest challenge and pleasure. And yet, what have I really accomplished? I’ve counted a few organisms and asked people questions about their health and behaviors. Those men, women and children in the cholera wards with their gaunt faces and glassy eyes will still be silently lying there. Simply observing things has been, in some sense, unsatisfying. What would things have been like for Dr. Hershow or Dworkin (or any other clinically trained individual) who can bring their training to assist with individual health outcomes? Still, if I wish to make any contribution to the residents of Chennai or Mofusil, the real work will begin now. Cleaning the data, working patiently with SAS and ARCGIS, composing a paper, and sharing the fruits of these experiences with anyone who wants to listen will be encompass a portion of my time for the next several months. The outcomes of these efforts will shape the face of things to come for me both academically and personally. In the end, what can I help to build here in this place? Perhaps it could be anything.

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Errata:

August 2, 2009

I was checking my e-mail the other evening and found a message from the UIC School of Public Health online news which posted about several students writing from abroad this summer: http://www.uic.edu/sph/news/news_237.html.   I wanted to issue a few corrections in the instance that someone familiar with India sees the posting.  The photo used in the article is from Chamundeswari temple not Mamallapuram and is a classic example of South Indian Hindu temple architecture rather than having Buddhist influence.  The caption they used would have been suitable for “the five rathas” in Mamallapuram (this is the UNESCO site).   I was also described as “fighting bureaucracy”  which I think is a more dramatic way of saying “rolling with the punches.”  Sadly, the only quote used from my blog was about me eating Korean food. I suppose I haven’t focused the writing here on my work, but I set out to provide family and friends a small window into my summer experiences which I feel I’ve accomplished.

This weekend has been very enjoyable but tiring.  A good deal of my time has been spent with several of the friends I’ve made here enjoying Chennai’s night life.  I’m hoping that next weekend I will have a chance to visit Pondicherry as a final trip, and also spend an evening at the beach about 15 or 20 kilometers from the guest house.

Rains:

July 31, 2009

Kerala
July is coming to an end and with its conclusion the hottest days of summer seem to have passed Chennai. During the week the rains have picked up.  Although, these are a far cry from the full effect of the monsoon season. August is known for light rain here, but it is still enough to make travel in autorickshaws uncomfortable. The three-wheeled vehicles feature a canopied cab with open sides, but some have foldable coverings which can stop some of the rain and runoff from ending up in the back seat. I was surprised when the first of the truly heavy downpours came. It had rained perhaps twice before the start of this week, and none have had the intensity of the recent showers. I’d imagined that traffic and things would come to a crawl or stop during this weather, but to my surprise men and women scooted around on their bikes and the autos were just as plentiful. People seem to be going a bit slower, not least of all because the poor drainage in the city necessitates that people who walk on the road encroach further into the roadway to avoid the accumulations of water near the curb, but otherwise it’s business as usual. I’d like to see the city during the heaviest of the rains, but sadly I will be gone by then. These rains also have the effect of bringing effluent waste into contact with many of the people who live in makeshift homes or on the streets. This means that the number of cases is picking up at the Communicable Diseases Hospital which makes me grateful that everything has been set in place for the project now. We have done a week worth of screening now and have amassed over 40 patient interviews with laboratory testing forthcoming for the many organisms of interest to the current study. If IRB approval comes I will be able to increase the sample size of the study to 500 patients which should provide a more fruitful statistical analysis.
Today I visited the hospital again to do some data entry and discuss some concerns with the multipurpose health workers who are assisting with survey administration, but Dr. Devi and Mr. James have gone to New Delhi to discuss funding for the hospital with the government and I was there alone. Nobody was able to assist me with Tamil translation to communicate with the workers, and all of the data locked away in Mr. James’s office. I decided to head back to the ICTPH offices on Anna Salai. I hadn’t been there for two weeks because the hospital has occupied my time, but I wanted to stop by as it was two of my friends’ final day at work. Fortunately for me the office was taken out to a lunch at a Keralan restaurant which was exceptionally good. I particularly liked the appam, a basin shaped rice-based bread, which had a somewhat sweet taste. It paired well with all of the curries, and the seafood, something Kerala is known for, was the best I’ve had so far in India (although, to be fair I haven’t eaten it at more than a few meals). When we returned back to the office a few presentations were given so that the interns could share their work with the staff before they departed. I managed to stay awake for most of it, and will have to give some exit speech myself later on next week.
It’s hard for me to believe that this trip is already coming to a close. Everything I set out to accomplish here has only begun to move over the last several weeks, and now I must trust the staff at the CD Hospital to oversee the completion of the work. That presents me with a certain degree of anxiety, but I think with Mr. James around everything will work out for the best. This weekend will bring the departure of one of my room mates with another two house guests leaving on Tuesday. It will be nice to have a little more space, I’ve felt as if I am on a reality TV show due to sharing relatively little space with eight other total strangers, but it will still be a bit sad to see them go. I have a few regrets about this trip. I didn’t get a chance to see Goa (although I had an offer from my cousin, the timings just didn’t work out), visit Kerala and take a trip down river on a thatched house boat, take in everything Varanasi has to offer, make a trek to a hill station at Ooty or Kodaikanal, learn more Tamil, and many others. However, I still feel that it has been a great trip, and hopefully I’ll be able to pack a few last minute adventures into the final two weekends.
Arjit said the other evening that it would take more than 100 years to see everything India has to offer, and I can completely agree. Part of me is already looking forward to when I can return here again, and I think I’ve found the perfect reason to do so. A friend I met at a party the other evening was telling me about an autorickshaw rally that takes place five times a year throughout different parts of India (one is starting in Chennai today). The basic idea is that a team of three rents an autorickshaw and putters across a 1000 or so kilometers of India in a race to the finish. Most events take roughly 10 days and the entire thing seems fairly well run (http://rickshawchallenge.com/). After being ferried around in the back an auto all summer, I’ve often wondered what it would be like to drive one (many times ‘race-like’ events have broken out between different drivers on the road with autos jockeying for position [on two rare occasions I’ve seen disputes where drivers have began hitting another autowalla {maybe because of some fare stealing or some such thing which tends to get them very vocal}], and, all kidding aside, I have seen spike-like axel extensions from he wheels of some autos which evoked images of the chariot race in ‘Ben Hur’). I have designs on getting my international driver’s license so I can qualify. Now all I have to do is find two other people… preferably one who speaks local languages and a crack mechanic.

King of Brunch

July 26, 2009

Not much to report this week.  Came down with another bug.  My stomach had a fairly intense pain Thursday through Saturday night, but after getting some rest and eating a piece of bread or so per day things got better.  I’m promised, once again, that everything will commence on Monday regarding my project, and despite past experiences I have a good feeling about this one.  Sunday morning I was very hungry from just getting over another stomach bug, and I went to the kitchen to make some eggs I had purchased the night before.  Upon opening my six pack carton I found that it had come with an insect companion. I was forced to track down the scuttling roach before examining my eggs;  roach droppings were scattered on top of them like pepper, and my brief morning exercise had made me decidedly less hungry.  I closed the carton and elected to make some cup-noodles (vegetable masala flavor) instead.

Shortly after boiling the water and moving my meal to the dining area the girls asked if I’d like to accompany them to brunch at the Raintree Hotel.  Dr. Dworkin had informed me about how nice this place was, but I hadn’t showered or gotten ready and the cup noodles was right in front of me.  After asking Nick if he was going to tag along I relented and we took an auto the short distance to the hotel.  To our dismay brunch began at 12:30 so the group decided to walk the short distance to the five-star Sheraton to see if they were serving brunch yet.  Sunday Jazz brunch hadn’t begun there yet (12:30 again), but they told us we could have complimentary tea while we waited in the lobby area.  I took this opportunity to approach the concierge as a guest and inquire if he knew where I could find the bhut jolokai pepper.  He didn’t know what I was talking about so I rattled off a bunch of its other names.  Still unfamiliar, he directed me to a nearby grocery store which was going to be closing in 12 minutes.  I rushed across the street and stalked the few aisles looking for something resembling the images I saw online.  Nothing did, but I picked up a few items anyway including a huge bag of red chili for only 20 rupees.  I’d been unsuccessful everywhere I’ve looked in India for this pepper, perhaps due to my inability to speak any regional languages or that it is grown far north in  Rajasthan, so I simply ordered 75 seeds online.  I’m hoping to grow the peppers in Chicago and sometime within the next year I’ll have my own pepper garden.

It wasn’t 12:30 so I sat down on an armchair, and had a glass or two of chai.  Observing the elegance of this place made me wonder how much I’d be paying, but I couldn’t imagine it would cost more than 600 rupees or so (about 12 bucks).  A few minutes later our group of six was taken to our table and the gluttony commenced.  I haven’t seen a spread like this anywhere.  Grilled lobster, prawns, every type of meat (except beef) that you could imagine, dessert platters that boggled the mind, breads, cheeses, sushi, fruit cut to look like tiny sculpture, and basically anything else you could want surrounded you upon entering.  It was pretty clear that my budget for brunch was going to be exceeded, and that this was going to be a far cry from the toast, sunny side up egg and pancakes that I envisioned when I went on this trip.  After settling in for the second course one of my friends posed the question, ‘Do you want to know the price now or after the meal?’   The table reluctantly agreed to knowing now, and we were astonished to find out that it would be a little over $30 dollars a person.  I haven’t paid anywhere near this much the at one time since I’ve been here for anything, my entire stay in Hyderabad or Mysore were close to this amount, and as the shock washed over everyone we committed to stay for the duration of brunch and get our money’s worth.

One of the reasons for this price was probably that the service included all the champagne, mamosa, or other type of alcohol, as well as the accompaniment of a nice two-person Sikh jazz band (alto saxophone and keyboardist) who took any requests from the audience.  The food was absolutely amazing, and the group gorged themselves far more than we should have.  The establishment even had an eating competition for a ‘fabulous prize.’  Enticed by the fabulous prize, and a rapacious appetite brought on by days of not eating, I entered. This type of feasting is probably the worst thing to do after a bout of gastroenteritis, but I had already locked myself in for the ride so… I demolished the opponents with only Nick close behind me.  I won a free massage at the hotel’s spa and the congratulations of all the staff.  This is the most dubious honor I’ve had in quite some time (winning an eating contest in a region with so much nutrition deficiency seemed wrong [I recall talking to a physician here about demography where he told me that he didn’t think of people along the lines of how many rupees they made but rather if they were able to eat at least 1800 calories per day or not]).  Voucher in my pocket I waddled back to my seat.  Thankfully we stayed because I wasn’t ready for what happened next.

The musicians took a brief break and several Michael Jackson songs were played in succession.  Perhaps in a bottomless mamosa induced burst of energy or some grief ridden tribute a nicely dressed man began dancing between tables and buffet tins to “Black or White.” He had some pretty smooth moves which Amudah faithfully captured on her camera.  For once I didn’t bring mine with me or you, dear readers, could experience this in HD quality.

After a surreal brunch our corpulent corps did some shopping at a few nearby stores.  I picked up several small gifts, and then promptly slipped into a food coma when I got back home.

Hyderabad Day 2 or Empathy:

July 22, 2009

After returning home late in the evening after viewing an Imax show at Prasand’s (according to an outdated guide, the largest Imax in the world which is almost certainly no longer true) we puttered off on an auto for hotel Rajmata.  The accommodations were slightly bad, but because we weren’t planning on spending too much time in the room over the weekend it wasn’t such a big deal.  The fresh towels we had heard so much about were rather natty, and the pillow and blanket both had a subtle foul odor.  Despite these things we were quickly asleep, and the following morning we set off for Golconda fort (the capital of the region between the 14th and 16th centuries.)

The auto ride to the fort was delayed for the Bonalu (meaning feast) festival, a dedication to Kali, which began in Golconda and continues through the old city.  After skirting around the Hindu parade and taking some side streets the driver was met with another part of the procession.  After  several additional attempts the driver succeeded and we were quickly approaching the massive outer fortifications of Golconda.  Within these out walls lies a small city full of shops catering to the number of tourists and pilgrims who visit the ruined fortifications.  Because today was a festival holiday admission fees were waived (even for foreigners, and we were also not required to pay the camera fee) and we began the climb through the expansive 7 km fort complex.  After dodging many guides we entered through another wall of fortifications and into the clapping pavilion.  This area was said to be used as a warning to the Shahs at the top of the hill, and a clap within this domed area reverberates the 1 to 2 km to the highest point of the hill.  Because we didn’t have a guide Nick and I traipsed around the hill without following the prescribed paths (which sometimes brought the attention of the numerous police scattered through the fort perhaps to provide additional security to the large number of attendees due to the bonalu festival.)  Ascending the hill I was impressed that the Mughal army could conquer such a massive and easily defensible fortification.  As we climbed higher the views of the surrounding city were exceptionally beautiful, and the worthless pictures I captured can’t do justice to the panorama experienced actually being there.  Much time was spent hiking around the granite pathways and off-limits dirt footpaths. I was somewhat disappointed that I had left my bottle of water in the auto which took us here, but I knew that after finishing at the fort the two of us would head to Restaurant Bahar known for having the best Biryani in the city.  On the way to the peak there were several other spots such as Ramdas’s prison and two mosques.  While walking along a crumbling granite wall to get a nice photo of the surrounding landscape, I heard a sound which, to me, seemed like a child unhappy to be at the fort.  I leveled the camera to where the noise was coming from to find that it was the braying of a goat who, under the base of a tree and near a mound of turmeric and vermillion, was deftly having its head severed as an offering to Kali. Its blood mixed with the dirt and spices under the foliage and provided a fitting meal for the blood goddess.   This is the first of many sacrifices I would witness as we ascended the steps of temple located near the top.  At this temple there were the signs that we had missed a large festival from the previous evening with many paper mache and wood constructs (Thottela) filling the grounds near the shrine.  Opposite a large image of Kali painted vibrantly onto a granite stone a beheaded rooster thrashed about while his cousin was made ready for the chopping block.  There were many pilgrims climbing the stairs to the shrine at the base of a phallic-looking granite sculpture, and among these Hindus offering puja a dark-skinned, elderly woman had entered a trance and twisted her body in the midst of many unsurprised onlookers.  A short way away from the shrine was the king’s court on top of the hill which offered tremendous views of the surrounding landscape.  The structure’s beauty had been weathered away as with much of the other ruins, and graffiti in the form of names crudely etched or painted on the stone was rampant. This and the extensive litter marred the natural beauty of the site, but not so much so that the stunning vistas from the summit were diminished.

Instead of going right to the Hyderabadi biryani place we decided to goto the nearby Qutb Shah Tombs.  Unlike the beautiful ruins of Golconda I didn’t care for this place.  It seemed to have been left to molder and despite the seven large once-beautiful domed buildings not much remained to be seen.  These spots were husks of their former beauty with the occasional vibrant floral patterning not being entirely weathered from one small portion of an arch.  Like Golconda, everywhere that hadn’t been taken by an earlier party had been scrawled on by earlier sightseers.  The most charming thing about this place was that many games of cricket were being played amongst the tombs anywhere that space allowed.  Granite stones from the tombs had been moved to be used as wickets and everyone from kids to adults seemed to be enjoying the games much more than the only two tourists in the site.

After a brief stay at the Qutb Tombs we headed to the Bahar.  I was feeling pretty bad by now, but I counted it as just being a bit dehydrated or simply being in the heat too much.  When we arrived at the place we sat down to the only available table in the restaurant and placed orders for mutton and chicken biryani.  I asked for a bottle of water as well which didn’t come any time soon to my dismay and I sat in the warm air feeling increasingly uncomfortable.  I could only take a few bites of the food and told Nick that I had to go.  The auto bumpily carried the two of us back to Hotel Rajmata where I plopped down face first on the bed not feeling well at all.  I told Nick that in a little while after I felt better we could visit the Mecca Masjid and the Charminar.  A few moments later I found myself on the toilet regretting eating or drinking anything for the past several days.  Within a few moments a thought came into my mind that I might vomit, but before it could be processed into action an upwelling of bile and biryani frothed onto the soiled floor bringing with it the characteristic aroma of each.    After tip-toeing around this mess I made my way to the front desk to purchase a bottle of water and ask for housekeeping to come take care of the bathroom because I had gotten sick.  The fellow at the desk didn’t understand my request aside from the housekeeping portion, and young man came up to the room asking what need to be cleaned.  I told him I’d been ill in the bathroom and after entering he said something which I like to think was ‘my god’ in Telugu.

I scooted a wastebasket near the toilet which would become my perch for the remainder of the night.  My insides danced and my face contorted into what I imagine was a gruesome visage as dry heaves or otherwise sculpted me into a gargoyle.  By the time I could actually keep down some of the water I’d mixed with an electrolyte packet it was well past two in the morning and my back and stomach muscles ached tremendously.  I can’t remember a time when I had been so violently sick from a GI bug.    I was scheduled to visit a rural field site at eight the next morning and I woke up at six forty-five feeling sapped of all energy.  My walk up and down the stairs to get another bottle of water made my legs feel as if I had just freshly exercised, and I buried my head in the  hotel’s smelly blanket to hide my exceptionally photosensitive eyes from the light bending through the window.  Despite this I was determined to make my meetings for the day and I called Revina from the SHARE agency and told her that I wasn’t feeling too well but that I would still like to attend.  She mentioned that there were no bathrooms at the rural field site and that this would probably be a very bad idea, and I reluctantly agreed but stated that I was sorry for causing this scheduling disturbance. Twelve hours until my train leaves.  Fourteen hours until my train gets to Chennai.  This was indeed becoming a long trip.  I felt so out of it that I didn’t even want to listen to music I just sat with my eyes closed avoiding any light as best I could counting down the time until I could be back to Chennai.  Fourteen hours in sleeper class, a complete misnomer for me, was going to be quite an ordeal.  I spent the day eavesdropping on the television shows watched by Nick with my face buried and taking sips of a foul salty, sweet electrolyte mix approved by the WHO.  By the time we left for the train we only had a few minutes to spare so we rushed across garden street to the station and back onto sleeper class. I asked a gentleman to swap for a top bunk, and within an hour I was lying down as the incandescent lights on the roof of the car acted like a gimlet drilling into my head.  Even after the passengers had began to turn the lights off (somewhere around 11 o’clock) the emergency lights, dampened by a blue plastic shell, were still tormenting me.   I slept for a total of maybe one hour on the trip, and most of my time was spent draining the battery of my music player listening to audiobooks whose words swam above my head but did not enter it.  All in all, this was a wonderful experience which helped me to understand the discomfort of patients with severe diarrheal diseases that I’m studying at the hospital.

Hyderabad Part 1:

July 21, 2009

Near three P.M. Friday afternoon I found myself in the office of Theodore James, the laboratory technician at the Communicable Diseases Hospital, pleading with him to share some information I needed to make changes to grant documents and other forms.  In typical fashion I was told that I would get the information the next day, my entire purpose for arriving at the hospital early that morning was to attend a meeting that never happened, so I was a bit frustrated.  But within an hour and a half I’d be meeting up with Nick to go on our weekend trip to Hyderabad.  Mr. James had visited there a short while ago and the conversation drifted from work to travel as we discussed where to pick up the best Hyderabadi Biryani, a mix of basmati rice and spices often served with some type of meat, a famous dish in the city.  With the name of his recommendation tucked away I said goodbye, and heaved my bulging backpack, stuffed with everything I’d need for the weekend, over my shoulder and began the walk off the hospital grounds to a good place to catch an auto.  A short while later I had arrived at the station a good thirty minutes ahead of time.  Because of the early meeting I hadn’t taken the time to eat breakfast and decided to poke around Chennai Central for some things to eat.  Seating was hard to come by as waves of people moved throughout the station and I decided to get something that wouldn’t take much time to eat (Chennai Central station has an enormous amount of selection to choose from and I was told by Mr. James it would be better to eat here and perhaps pack something with me than to eat the food sold on the train itself [which seems to be sold by people hopping on and off at each station and not operated by the railways itself, at least in the lowest class seating which I would be utilizing]).  A nearby vendor was offering samosa which I hadn’t eaten since my guest house was relocated.   I waded through the people toward the counter and placed an order for two samosa and a chai.  I handed the owner a ripped hundred rupee bill to which he responded ‘what is this’ in an annoyed tone (I had quite a bit of fun trying to pass off this bill over the weekend, each attempt unsuccessful and causing some outburst from the recipient).   The only other bill I had was  a 500 rupee note and the owner laughed at me when I tried to cash it for an eight rupee purchase (it can sometimes be hard to get  change and all the small bills I have go to autorickshaw drivers).  I instead shifted about the station looking for something else to eat where my 500 rupees could be of use.  I found a restaurant stall called Hot Breads, a chain store in India serving pastries and sandwiches, and purchased two chicken rolls and a bottle of water as a meal for the train.  Some of the change from this purchase went toward buying the treat I craved earlier and I passed the twenty minutes waiting for Nick by sipping on my scalding chai and eating simple, unhealthy, golden fried samosa.  The heat of the waiting area in the station was starting to get to me and once the train arrived I made my way there without Nick.  I found the sleeper class cabin (sleeper class is the lowest class cabin, aside from sitting room only, and features 3-tiered beds, a fan, and nothing else at all [even the curtain and tiny pillow, which I foolishly didn’t consider a luxury from the AC class three, were absent]).  This had the makings of a long trip, but Nick arrived quickly and we made some small talk as the train prepared to depart.

We set off from the station a few minutes behind schedule, and it seemed that the entire train was full.  Nick and I were seated on the side compartment and took advantage of the window despite the grime covering the sill.  Neither of us had invested much time in planning activities for the weekend, with the exception of several meetings on Monday, and our thoughts shifted from the scenery to our accompanying travel guide.  The guide suggested that it was best to book ahead because rooms fill up fast in Hyderabad over the weekend, and I looked through the bargain hotels listed in the guide.  ‘Hey, this one says it has clean towels,’ I remarked to Nick and a short phone conversation later we had a reservation for 700 rupees a night (although the gentleman never took any information, perhaps belying the guidebook’s statement of booking ahead.)  The train ride began very peacefully.  Some time was spent snapping some photos as best we could through the windows of our car.  Intermittent showers cooled the dawn’s temperature and the sun quickly set behind villages, fields, and forest between stations.  As the dim of evening made taking any more photos impossible I decided to unpack my dinner and start to settle in.  Sleeper class is remarkably different from the other tiers I have traveled in not only due to the absence of any sort of superfluous luxury but also because the cabins are constantly frequented by sellers.  Each would announce themselves as they entered the car, often in hoarse tones that revealed they had been at this too long.  They stated what they were selling ranging from tea, varied food, cold drinks, DVDs or beggars singing a doleful melody or otherwise declaring themselves.  This wasn’t such a bad thing while not attempting to rest, but when you are woken up at 4:30 A.M. because someone wants to sell cigarettes it is easy to be unhappy with the circumstances.  That night I had a poor rest.  Each time I managed to fall asleep some noise or odd person sitting on my bed would rattle me to alertness and when we arrived in Hyderabad early in the morning both Nick and I were quite groggy.

Nick and I woke up to crowds of people exiting the train, and I asked a fellow leaving the car if this was Hyderabad.  He affirmed this and we quickly gathered our things and headed to the station entrance.  After trying to get a fare from the hordes of rickshaw drivers at the station and getting only outrageous fares one of them told us that it was a very far distance to our location.  Incredulous, I showed the driver our map and said it was less than a kilometer to Garden St.  The driver informed us we were in Secunderabad, a nearby station named after Hyderabad’s twin city (now for the most part the two are referred to as a single entity.)  The two of us raced back to the train hoping that we hadn’t missed it.  We arrived barely on time, and moments later the train was moving again to the correct station.  After departing the train we had to contend with a gauntlet of autorickshaws and beggars flanking all exits to the station.  After declining a ride for nearly the fiftieth time we took out our guide book to get directions for the walk to our hotel.  To our surprise it was right across the street, and it was amazing that we missed the yellow and black sign nearly perfectly opposite the station’s exit.  A surprise phone call from one of my contacts with SHARE, a non-profit organization focusing on international collaboration, improving affordability, quality of care, and competency for healthcare professionals in India, alerted me to a meeting at 10:30 in the morning, and despite being very groggy I arrived to meet with Dr. Ganesh.  Dr. Ganesh runs a organization spearheading many HIV/AIDS interventions in Andra Pradesh as well as operating an advanced reference lab servicing several nearby hospitals.  I briefly introduced myself and the project which he was already familiar with thanks to Dr. Dworkin’s contact.  Hopefully a future extension of this study will be possible in Hyderabad, but for now I have to focus on actually getting the first step done.

After struggling to get someone to take me back to the station, Nick and I were off to our first two stops Charminar and the Mecca Masjid, two important Islamic landmarks in the city, erected by the ruling Shahs after relocating to what is now Hyderabad from Golconda due to water shortages.  Both buildings are large granite structures the first of which was built shortly after relocation and the second 20 some odd years later.  That’s all I really have to say about either of these sites because I wasn’t allowed inside due to wearing shorts (also I had a backpack which isn’t allowed for terrorism concerns.)   However, Nick and I agreed to come back the following day, and we shuffled through the pages of our guide to decide on a new site to visit.  The Chowmahalla Palace was close by so it seemed like a good enough choice. Chowmahalla means ‘Four Palaces’ and it was the seat of the Nizam (rulers of Hyderabad from 1719 until forced into joining the Indian Union).  The palace was completed near 1880 and the grounds are still splendid despite being constructed roughly 130 years ago.  However, many of the smaller rooms not on tour seem to have been left in disrepair.  When we first entered the complex Nick and I thought it would be a quick walk through, but the palace covered an enormous distance.  We visited display after display varying from rooms dedicated to displaying armaments to the Nizam’s car collection.

Our next stop would be Hussain Nagar Lake.  The lake is man made and was designed to meet the drinking and sanitation needs of the population after relocation from Golconda.  However, we were there to see a 19m Buddha statue situated on a small island in the middle of the lake.  After eating at a spot recommended to us by another student we set off on a small boat for the statue.  Around the base of the statue were reliefs in the granite depicting the four stages of Siddhartha’s life, and ringing the base in the shape of a lotus leaf is a shallow pond.  After taking a few photos our group was hurried off the island so that other tourists could feel closer to enlightenment (the statue was consecrated by the Dalai Lama in 2006 making it official and not just another 19 meter monolith.)  The weather near the lake was beautiful, and after spending the day making the rounds at various landmarks Nick and I spent the remainder of the evening enjoying some of the less famous spots ringing Hussain Nagar.

Extended Stay:

July 15, 2009

The Ripon Building, where anything can happen

The Ripon Building, where anything can happen

The past two days have been very strange concerning my project. The status of the enteric diseases study was in limbo as of last week, with me still awaiting approval from the IRB, and not knowing what type of support I would receive from the CD Hospital. Now, shortly after receiving approval from the Office for the Protection of Human Subjects in Chicago, another visit to the Ripon buildings to meet with the Chief Health Officer has changed everything. Firstly, the Dr. Kuganatham wanted me to remove patient incentives as a part of the study. Oftentimes some type of financial reward is given to participants to increase enrollment and under the time constraints of our project it was assumed that this would be a necessary requirement. However, because we are working through a government hospital it was thought that this could open a ‘Pandora’s box’ wherein patients could expect a financial reward for future studies or draw the suspicions of politicians who could question why we needed to give these parties money (were they incurring some risk to physical harm to warrant this money, why only 200 rupees, etc…). This concern makes complete sense, but it is another bureaucratic hurdle to overcome, necessitating a further human subjects review, to begin actually screening patients. Next, a state epidemiologist from Tamil Nadu suggested that with only 100 patients we would have a somewhat weak power to detect statistically significant associations I agreed with him but explained that this was a pilot project intended to inform future studies in the region. This, coupled with a comment I’d made that there hadn’t been a multi-species study of acute diarrheal disease causing organisms in Chennai since 1992 (the O139 V. cholera outbreak I mentioned several posts ago), prompted the Health Officer to decide that this type of study needed to be undertaken. He recommended that we increase our sample size to 500 persons (another IRB review) and that the Corporation of Chennai would undertake the extended screening for a diverse scope of pathogenic organisms including but not limited to Shigella, V. haemolyticus, Salmonella, Enteropathogenic E. coli, enterohemorrhagic E. coli, Giardia, many helminths and amoebas, and of course our original organisms of interest the coccidian parasites. Needless to say I was terribly excited by this comprehensive study (especially after being nervous about if anything would get done with this project), but that enthusiasm was tempered by the knowledge that this study would require a great deal of paperwork to be completed in very short order (it isn’t some much completing the items but rather hearing back from the reviewers.) This type of comprehensive study was what I envisioned the next stage of my project to be and I hadn’t seen anything similar to it(at least any publicly available data) from journals concerning southern India’sprevalence of enteric pathogens during my literature review.

There is another potential downside/opportunity to this. It could likely necessitate me being on site for the project until mid-September. This is problematic for several reasons: Classes begin on the 24th of August (I would be missing at least 18 days of class), I have told my employers in Chicago that I’d be back in the middle of August (would I even be eligible for assistantship?), I’d be missing an important non-UIC exam date, will reallocation of funding in the grant lead to me not being reimbursed (-$1000 dollars could hurt), and I’m impatient to see family and friends once I get back. To top it off, I don’t even have internet access at home (I haven’t for over three weeks now), so I can’t communicate any of these concerns with anyone over Skype. All in all I have some important decisions to make in the next couple of days. The concern about classes doesn’t bother me too much. I feel that experiences within your field trump text books any day (why have I been in school so long then?), but the concerns about employment raise some issues because aside from my plane fare I have been paying for things on this trip out of pocket which will become more troublesome as I stay longer (plus I think there is a $200 dollar charge for changing my flight). I still can’t believe how the entire outlook of my trip could change over a several hour meeting, but Mr. James, the chief lab technician at the Communicable Diseases Hospital, tells me that these grand reimaginings of public health projects are characteristic of Dr. Kuganatham.

Outside of work I have been going to several nice restaurants since my bout of food sickness last week. Some of the most memorable places include Inseoul my new favorite Korean restaurant and Amethyst a multi-cuisine restaurant (multi-cuisine typically means that they have Indian and Chinese dishes and occasionally continental cuisine). I’ve gone to Inseoul several times now and it never ceases to impress me. I’ve probably tried nearly every Korean restaurant in Chicago and none of them really compare to the food here. For 300 rupees (~$6) you get an outstanding assortment of (unlimited) side dishes and the entrees are typically big enough for two people to share. On top of this, I didn’t think I would be eating bulgogi at any time during my stay in India, but this place’s beats out any that I’ve had before. The restaurant is run by a Korean family and is constantly packed with Koreans and the occasional Caucasian business group enjoying the traditional Korean style seating. Amethyst is located a bit farther from the guest house in Alwarpet but it has amazing outside seating. The garden seating twists restaurant goers into secluded areas and the dense trees and plants occlude sounds from the noisy streets nearby. They also have remarkable food and I had some type of whitefish fillet with chili, lemon and some other spices thrown in which definitely made me want to go back. Lastly, I read an article about an Indian chili the bhut jolokai (King Cobra Pepper, Ghost Pepper, Ghost Chili, Naga Chili) which is said to be the spiciest in the world. It is currently being weaponized by the Indian army to control rioters. Since I read about it I’ve been trying to find some in Chennai (it isn’t native to the south but rather northeast India) but have been unsuccessful. Hopefully with some luck I’ll be able to try it before I leave. Friday of this week I am leaving Chennai for Hyderabad on another overnight train. The distance is about 700km north west of Chennai and it should make for some great sight seeing as well as work-related travel. I will be back in Chennai Tuesday morning when I can hopefully share some photos of the trip. I hope everyone back home is doing well and that with some luck, if I’m ever able to get the Airtel people to fix the internet, that I’ll be able to talk with you.

Insanity Pepper

Insanity Pepper

Mamallapuram

July 13, 2009

Last week passed by quickly as I scrambled to get various documents ready for the Office for the Protection of Human Subjects to examine.  Unfortunately, there were still items that necessitated future review, and my project is still not able to proceed.  However, I’ve heard some good news that I will likely be able to begin English language interviews tomorrow (I’m not sure how many of the patients at the government hospital would prefer to take an English language survey instead of Tamil, but the Tamil approval should also be forthcoming soon.)   I’m still anxious that I won’t be able to collect the population sample that I specified in my proposal, but there isn’t much I can do aside from get everything in place for the eventual approval.  This upcoming Friday I am leaving for Hyderabad to meet with several physicians to discuss the possibility of extending the project by including Hyderabad as a performance site there.  This will likely require an additional translation of the survey into Telugu or Urdu, the most commonly spoken languages in Andhra Pradesh, but it will definitely be worth it to allow for some comparison between Chennai’s metro and rural areas to the population seen in Andhra (this is especially true now that we have been restricted from collecting retrospective case counts from the Communicable Diseases Hospital.)

Over the weekend I was planning on visiting two different cities, Pondicherry and Mamallapuram, with Nick and John.  However, I got quite sick Thursday evening and despite packing my things and getting ready to set out Saturday morning I decided it would be better to forgo the trip given my nausea.  This was the second time I had missed the opportunity to visit Pondicherry, a former French colony whose influence is still present in the architecture and culture of the city, but I’m still hoping that I get to make a day trip there at some point.  I spent the day alternating between being remorseful about not going and thankful for staying at the guest house as my stomach dictated.  Thankfully, Amudha, an ICTPH intern from MIT, was planning to meet two other MIT students on Sunday morning to visit Mamallapuram, and I was determined to tag along.  Sunday morning came and I was feeling much better after resting and taking several days of Cipro.  Amudha, Gabrielle, and I walked the short distance to where we were scheduled to meet the driver (this was a luxury that all of the interns here were unaccustomed to, we typically cram as many as possible into autorickshaws and haggle over every rupee, but the two MIT interns we met were working for Ingersoll Rand, a multi-billion dollar heating and cooling company, so we had an A/C car and driver for the entirety of the trip.)  I felt somewhat bad because my presence inflated the group to five students and one driver, requiring the four girls to squeeze into the back of the sedan, but I was too desperate to get out of the apartment to decline the invitation.  Our driver made his way through Chennai and onto the East Coast Toll Road.  The ECR was comparatively lightly trafficked and made for a relaxing hour-long trip south to Mamallapuram.  Along the way we passed many people seeking shade under the stands of palm trees which rose from the otherwise arid landscape and fisherman’s hamlets with fleets of beached boats off the Bay of Bengal.  Also dotting the road were artificially verdant resorts and tourist locations (such as dolphin world, whose dolphins are all long dead and now boasts sea lion shows instead.)   Shortly after our arrival we decided to call a tour guide who came highly recommended by one of our friends.  After winding through several narrow roads, heavily trafficked with tourists and street vendors, we arrived at the parking lot to meet our guide Mr. Stalin, a Mamallapuram native who gives tours and also works as a stone carver.

Mamallapuram is now designated a UNESCO world heritage site for its amazing stone carvings often sculptured from single enormous granite stones. Unfortunately, this also means that to visit these sites foreigners have to pay 250 rupees (compared to 10 rupees for Indian citizens), and I wasn’t feeling confident enough this time to try to get the Indian rate.  Our first stop a short walk away was the five rathas.  The five rathas represent pyramidal chariots in various styles of architecture, and each shrine is dedicated to one of the five brothers from the epic Hindu poem Mahabharata.  All of the five shrines were carved from a single monolithic piece of granite in roughly the 7th century AD and must have required the work of hundreds of artisans from the reigning Pallava dynasty.  However, the works are unfinished due to a change in the ruling dynasty.  Despite this, the temples are amazing and feature intricate stone bas-reliefs which in the face of centuries of weathering still are recognizable.  Many of the monuments are located nearby one another and they formed a kind of granite playground where numerous Indian and non-native tourists were happily climbing on the massive sculptures and twisting through the cave temples.  After taking countless pictures of the rathas we walked to a nearby temple dedicated to Lord Vishnu.  The temple was originally a bas-relief depicting a scene of Vishnu saving a village from an angry god flooding the region with rain by lifting a mountain.  Since the time of its creation there has been a columned structure erected to preserve the sculpture with elaborate carvings of animals adorning the bases of each column.  My favorite site from the trip was an immense relief carved into the side of a massive stone near this scene of Vishnu.  There are 134 figures carved into a scene called Arjuna’s penance wherein each figure poses in a meditative position and is  depicted with an empty stomach (with the exception of a cat toward the bottom of the relief surrounded by rats).  The detail and scale of this piece were truly incredible, and it was hard to get a good shot as masses of people were cramming near the guardrail to get a photo or a better look.  Following this site we visited several cave temples and climbed around paths carved in the granite.  Another interesting site was called ‘Krinsha’s Butter Ball’ according to our tour guide.  It was a massive stone boulder which has been in place on an inclined slope for over 1400 years.  To me, it looked like a gigantic toe of an unfinished, overly ambitious sculpture, but the tour guide didn’t confirm this observation.  After walking through the carefully kept sculpture grounds we were taken to the shop where Mr. Stalin and his master work to carve stone sculptures.  Like I said in my post from Mysore many of these items can be found at tourist sites all over India and I question if there isn’t some mechanized way of producing these pieces.  I was assured that each was hand carved and picked up a few things as souvenirs for people back home.  Humorously, I remembered a complexly carved stone elephant on display in my family’s home which I always assumed must be unique.   Little did I know that there would be thousands upon thousands of analogs to this sculpture at any tourist spot in India.

Our last stop was the Sea Shore Temple, another ancient shrine which has been partially weathered away by salt water from the Bay of Bengal.  The temple has three shrines, two to Shiva and one to Vishnu, with smaller sculptures of Lions, Nandi (Shiva’s bull mount), and other deities forming an outer wall.  The Shore Temple was especially busy as we seemed to have come during a field trip and a 100 some children walked single file through the structure (this obedience was maintained by a heavyset woman in a sari holding a ruler.)

After visiting the sea shore temple we looked for a good place to eat.  My attempt to get people to go to Moonraker’s, which was touted by the Lonely Planet guide as having great seafood, was trumped by a member of the group’s insistence that the restaurant be vegetarian only.  We stopped by a place called A2B restaurant which will be memorable to me for its exceptionally loud manager.  I ordered some nann and alu gobi masala which I picked at for fear that my upset stomach would return.  As we made our way back to the car I was exceptionally grateful for the air conditioning which eased my sun-addled, bald head.  Sapped of energy from the heat of the morning and afternoon I fell asleep for the majority of the trip aside from those moments where a road block or speed bump interrupted the smooth rhythm of the East Coast Road.

Chennai, Mamallapuram, and Pondicherry:

July 8, 2009

Trip2

Fourth of July weekend came and went uneventfully; the attempt to attend the function at the consulate required an RSVP far in advance so that option was off the table.  There were only two other guys staying at the house that weekend, and, because there had been uncharacteristic downpours throughout the day, the few people we invited over were reluctant to venture out.  However, we still decided to try to celebrate by concocting the most typical 4th of July meal we could fathom of Hamburgers and Hotdogs.  Pork and Beef are not easily procured in common groceries here so we had to settle on mutton dogs and chicken burgers.  However, we did manage to find some Heinz ketchup which was a departure from the typical Maggi tomato condiment used most frequently in India.  Finding the hotdog and hamburger buns wasn’t an easy task, but we found a bakery called The French Loaf on TTK road which had what we were looking for.  John and I left the groceries with Nick and we headed off to Pondy Bazaar.  There are several large silk and cloth stores there, and, because I had wanted to get some shirts tailored while I was here, I figured this lazy weekend would be a good time to check out the cloth shops.

We first stopped at a large silk store with two stories located on Anna Salai road.  Inside, tremendous quantities of silk were carefully folded and stored throughout recessed racks along the walls, and the dizzying array of colors made this assortment of fabric quite a sight.  The layout of the store reminded me of the interior decorating trick where mirrors are placed on one end of a room to give the appearance of the space seeming larger, but in this instance the identically shaped rooms were real and sprawled on with great numbers of men and women conducting business within.  Upstairs we found the cloth fabrics used for men’s suits and shirts, and after John examined some of the fabrics he said they weren’t of such a high quality (I couldn’t tell if he was BSing me or not, but I took his word for it as I didn’t know what a box pattern was) and we headed to another store.   The next store was possibly the most densely packed place I’d been in the city thus far.  It was eight floors of wall to wall fabrics with the center aisles containing shirts and dresses already crafted.  Walking through the place felt like cutting through a wall of people.  I managed to find three cloth patterns that I liked and asked for the amount it would take for a shirt of each (about 1.6m for short sleeve 1.8m for long sleeve, but I’ll see if this is an excess after I eventually get the items tailored).  After John and I exited the store it was pouring again so we found an auto willing to take us the short distance back to our guest house in Alwarpet.  That night we sautéed some onion and garlic while we made our chicken burgers and mutton dogs on the flat pan over our kitchen’s two gas burners.  With the feast on the table we plopped down in front of the living room’s TV to watch some bad movies on one of the few English stations that came through. The mutton dogs were pretty great, but the chicken burgers were of a slimy consistency which fell apart as we tried to cook them.  The end product tasted peculiarly more like a potato than chicken, but we finished the batch nonetheless.

This week has been spent anxiously preparing documents for the next, hopefully final, IRB review.  I had run the documents in Tamil by the Director of the Communicable Diseases Hospital once again to ask for corrections which she found a few.  Most glaringly the survey was asking a question regarding if the respondent’s work involved children but the Tamil version read more like do you work alongside child laborers (we then prompted them to say if they worked with child laborers under 2 years of age, 2-10, or 10-15) which would have collected less than reliable data.  The week has also been a bit frustrating.  I met with Medical Director on Monday to discuss collecting the cholera  and non-cholera diarrheal disease case counts for mofussil and metropolitan Chennai over the past several years, which we would use to establish seasonality trends and to understand if there is a greater risk amongst rural residents, but the director refused this request stating that it wasn’t part of our original agreement.  I was surprised, but didn’t protest this development.  I’m now resigned that I will not be able to collect this information which would have been among the most interesting data collected during this study.  I only hope that with the small sample that being collected that I’ll still be able to craft some academic paper or proposal for further research.  In any case, the project will be starting as soon as I get the go ahead from Chicago, and that is a great relief.  I’ve felt very idle waiting for these requests to be processed, and it will be quite nice to actually begin the laboratory testing and patient questionnaire this week.

For the upcoming weekend we are trying to schedule a trip to Pondicherry (Puducherry) and Mamallapuram (Mahabalipuram), two cities located nearby in south India situated near the coast.  If the trip works out I’ll be sure to take plenty of photos to share with everyone when I get back.

Pucca/Kutcha:

July 3, 2009

school bus

This week has been particularly busy.  I’ve spent quite a bit of my time working on making final revisions to the patient questionnaire and discussing other issues with physicians at the Communicable Diseases Hospital.  The other day I finally got a chance to talk with the medical director again.  Dr. Dworkin and I had been trying to get input on the questionnaire for quite some time over e-mail, but, as has been echoed by so many people here, things seldom get accomplished in India without face to face interaction.  As we reviewed the survey item by item my intentions for asking several questions were discussed.  One of the earliest items was asking participants about their religion followed by caste, a sensitive area but one that is present on nearly every Indian survey I’ve observed (including the National Family Health Survey, by far the largest undertaken in the country).  The director felt that this was a particularly insensitive question to ask this population (many of the patients of government hospitals utilize these services because private providers are prohibitively expensive), and despite my chiming that this could be a socioeconomic marker perhaps related to disease acquisition she was adamant the caste question be removed.  We delved further into the survey with several items prompting further review.  The question which made me feel the most ignorant concerned housing.  I hadn’t revised the answer choices since I had arrived in Chennai and they still listed the original options I’d concocted (or co-opted from another survey, I don’t remember) and included items that were wholly absent from the city (e.g. Mobile Home was laughably one of the choices).  The question was revised to describe dwellings as either Pucca, Kutcha, or outdoor/concrete dweller.  Pucca are ‘proper’ houses meaning that building materials such as concrete, brick, etc… have been used to construct the dwelling.  Kutcha on the other hand are the improvised homes which dot nearly all streets where space is available and are fashioned from any materials the occupants have been able to find (the last category is self explanatory).

The revision of this question dredged up from my memory a conversation I had early on with Dr. Kalita.  He had told me that India was a land of ‘chances not choices’ reflecting the unavoidable observation that many people, through chance alone, would be deprived of he necessary tools (education, health, adequate food, water and shelter) to struggle for their aspirations.  A very sobering reality, which was reflected with the stark dichotomy of the answer choices to that question.  When I walk through the city it can sometimes be tremendously depressing;  upon exiting from the magnificent hotels in T. Nagar you will see homeless men and women resting meters away on the sidewalk or seeking shelter beneath tattered tarpaulins for the evening.  The organic growth of India’s cities, and indeed the sheer number of people, means that cordoning off of well to do neighborhoods is improbable.  Instead the resplendent areas keep the kutcha at bay by sequestering tiny areas behind gates and walls.  The tremendous financial development in some sectors of India has yet to trickle down to the many, and the disparities are burnt into the eyes of anyone not yet inured (this isn’t intended to say that America is devoid of desperate living conditions in any way [Often I feel that the treatment of homelessness here is, in some ways, more human than in America.  For example, bans on outdoor sleeping force the destitute to seek shelter in unsafe areas, sleeping alone for fear that larger groups will be harried by police, or kept on their feet in a shambling, half-awake state to avoid fines.])  Addressing health issues can often seem intractable in the face of the enormous numbers of those wanting for basic necessities. However, realizing the fortune I’ve had in my life, that I could choose among myriad fields and settle on healthcare/public health as the area in which I wanted to serve, makes me staunchly want to do more for those whose circumstances necessitate a focus on immediate survival rather than development.  It is my sincere hope that this pilot project leads to some type of intervention in the future which could, in some small measure, improve the quality of life for some of the people in Tamil Nadu or elsewhere in southern India.  Ideally a high impact one intervention such as a sustainable water purification effort, there have been some rural health initiatives that have been able to provide 15 liters of clean water for as little as 2 rupees while maintaining the infrastructure necessary to provide the water, could greatly reduce the burden of many enteric pathogens.

On a personal note, we’ve had to relocate from our apartment in T. Nagar to an area nearby called Alwarpet.  The issues with Babu had escalated to the point where the housekeeper was instructed to remove all the dishes, etc… so that we couldn’t cook in the apartment as well as not providing any water (water is delivered daily from a treatment facility in large jugs carried a water lorry).  Because of this, some of the house mates had complained to the bosses of the NPO (without my knowledge) and we were to be rushed out of the apartment that day.  I was very surprised when I received a phone call from Nick that I had to return from the hospital so that I could pack my things immediately.  The housemates were all hurriedly packing up their belongings and I did the same. I tossed my clothes en mass into my large suitcase, and then dragged the hefty load down two flights of stairs.  The seven of us crammed into a van and made our way to the new guest house.  We were all joking about what the accommodations would be like, but after arriving we were quite shocked to see the nice apartment where we’d be staying in for the remainder of the trip (the downside is that we are no longer within walking distance of work and the gym to which five of us belonged).  Because I’d been staying in a cramped room with two other guys [we couldn’t even open our closet more than 45 degrees without hitting a bed], we were given the larger master bedroom which is by a considerable margin nicer than the two rooms the girls share (we also have the only western style toilet in the house, a definite plus for me).

I hope everyone back home is planning something fun for the Fourth of July weekend.  Here, we are planning on having people over to the new guest house, but many of the office members and house guests will be out of town for the weekend, so who knows if this will happen.  Maybe we will end up going to the Consulate which is supposedly having an event that evening?


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