Indian Antics VII

Hello again, all the way from Malkangiri. With my time here in Malkangiri quickly drawing to a close I've been keeping busy with medical and other related work, so I'm sorry this email is a few days late. Today we'll see a bit more of the village life and people - though what we get a glimpse of today will not be its most attractive aspects. We'll also meet some new patients, as well as catch up with some of our old friends and see how they're doing. Thank you again for your support and prayers, I appreciate them greatly.

Recent News
Early morning in Malkangiri. Now that the chanting has stopped from the temple next door I can hear the birds outside and the noises of those going to work in the early dawn light. I've seen quite a few sunrises this week, as the sun rises later and later. The three days of rain we had at the start of last week is unheard of around this area. But it had a beautiful cleansing effect, washing the dusty dirt from leaves, houses as well as the horizon. This means sunrises are all the more beautiful with less of a brown haze on the horizon. The heat has returned to the day now, and the dust is also returning. And though it is as much a part of India has anything, it's one part I won’t especially miss.

In the drizzly morning rain last Tuesday, the weekly market was late to open. I wondered how the villagers coped in the monsoon season, with roads washed out and travel into Malkangiri very difficult. The slow trickle of people to the market also affected the clinic pace, and we saw very few patients until the afternoon. However it did end up to be quite a busy day and I didn't leave until almost 7pm. The patients presented with things such as malaria, eye disorders (which will probably never be corrected), lung and urinary tract infections, infertility and a particularly nasty leg ulcer. We also saw a 30yo woman who was brought in an auto-rickshaw with dizziness and fainting as well as vague pain. We were able to keep her under observation for most of the afternoon before sending her off much improved. Padma also returned for a check up. She was looking very good, her oedema had completely disappeared and she was now a quite attractive girl. Though her heart and liver were still massive it was very pleasing to see her progress and we shared her joy in seeing her be able to return to a relatively normal life.

Clinic Activity
On Wednesday we spent most of the day at the clinic again. One of the patients, a 40yo lady called Aruthy, would become very familiar to us over the next week. Presenting with profuse bleeding, she was an extremely animated and intense lady. Her husband meanwhile, was obviously content just to follow and consent to her every whim. Lying in the shade of the half-built hospital through the afternoon, we had given her medicines and were letting her rest. Going to check on her I found her yelling, "I'm dying, I'm dying" and throwing her sari off. She settled down with some Paracetamol and was sent home later in the evening. Over the next week she recovered, but turned up again yesterday, passionately describing some other ailment she's suffering from now. There are so many of these characters, and half the fun (and pain) of doctoring, is getting to know them. Other patients that day included Mongali, a woman with a urinary tract infection on top of malaria, and Reneke who had a ruptured ear drum.

Thursday morning was an early 6:30am start off to Kalimela. We stopped briefly on the way at an aquaduct that our driver, Sapan, had helped construct years earlier. Here we also saw huge sheaths of ‘jude’ drying. These sheaths of straw-like sticks will become hollow as they dry and serve as roofing material, lasting up to ten years. Unfortunately the fluids that drain from the also destroy the water of the rivers nearby. At the Kalimela clinic we were kept very busy. I remember one boy in particular who had an enormously enlarged spleen taking up the whole of the left side of his abdomen. Along with other medication, Dr Iris gave him a plant they call 'boj ora', or land-gooseberry. Though it's not a gooseberry at all, the small berries bear some resemblance. It is used crushed into a paste and eaten raw - very bitter. It is very good for liver function as well as for the spleen, and Dr Iris uses it quite regularly. We finished at 8pm and started the long drive back to Malkangiri in the dark.

Clinic is Quiet
On Friday we saw only a few patients. One of these was Omar, a 24yo man with a nasty wound on the back of his leg. It had started as an ulcer and he had put some sort of tribal remedy on it to help it 'ripen'. Unfortunately it had ripened a bit too much and burst open resulting in infection. As it was now it was a medium apple sized open wound about 1cm deep covered in pus and blood. Charlotte, the NZ medical student, loves pus and took joy in anaesthetising and cleaning out the wound. After dressing it, it was quite respectable and should heal up nicely. We have seen many infections such as these, which people leave far to long, risking systemic infection. Fortunately most have recovered quite quickly. It was also nice to see a healthy lady come for a check-up in her first pregnancy. Care for pregnant women and their newborns leaves much to be desired here so I was very happy to see her taking the initiative for the good of her baby.

In the quiet of the afternoon I wandered out the back of the clinic and looked across the golden fields toward the distant mountains. As a sat, I heard a chanting moving down the road from the town centre. There is no temples that close to here so I paid close attention. Soon I saw a group of young men walking along the road carrying a body. I soon realised that it was a corpse and this was a funeral procession out of town to the crematorium. The crematorium is a small brick structure, a do-it-yourself sort of place. It seemed very strange that a funeral here was so loud and so public, very different to closed casket, quiet western funerals. It certainly made the death seem very real though, even to unrelated observers.

Tula's Village
On Saturday we had another early start, setting off towards Tula’s village at 6:30am. The walk into the village was peaceful and quiet under a cloudless, sunny blue sky. But the news we received when we arrived quickly made the sunny sky turn grey. About two months ago a disari (medicine man/witch doctor) told Tula’s family that their house and land had evil spirits and Tula was sick because of a curse. They then packed up and moved into a tiny hut beside Tula's uncle's house. Their land, its produce and their house were sold off cheaply, some going to the disari himself. Most disaris take some produce, some money and lots of liquor for their services. And they are often influenced by others to put curses on people or land (as was probably the case with Tula’s family). Some of these disaris are just fakes, but many do have powers, doing such things as keeping chickens alive even as their organs are spilled out. Dr Iris herself has felt the curse placed upon herself, and tells of waking one night completely paralysed and being choked by some sort of black figure. After being released she woke her husband a found their mosquito net had been thrown back and the bolted door now wide open.

For Tula's family, the issue seemed over, that was until last Monday. A man called Gurutuba, from a nearby rival village, came to see Tula's father. An old belief among the tribals is that if a person gets sick under a curse but doesn't die, they must have a stronger magical power within them. This is seen as a threat to rival tribes. So Gurutuba came to take the magic away (i.e. destroy Tula and her family). Once this sort of animosity begins, it starts of small but quickly grows until a murder takes place. In this case, Gurutuba tried laying claim to a small fishpond belonging to Tula's family. Tula was alone at the time and tried to prevent him taking the fish. After a tug of war, Tula was thrown to the ground landing hard on her swollen belly. Meanwhile her father had returned and proceeded to have a verbal fight (very rarely are fights physical). As Gurutuba turned to leave, Tula's father threw a rock toward him, Gurutuba responded in the same way, his rock landing square on Tula's father's back.

Tula's father went to the police and laid charges paying 1000 rupees (all the money from his house, crops and land) then proceeded to the local hospital, where once of the RHS missionaries met him. Gurutuba likewise went to the police and paid 2000 rupees. When the RHS missionary went to police station it was obvious what was going to happen. The lawyers and police would continue taking money and making promises to both sides before finally leaving both families destitute.

This was the story up to date when we had arrived. As the conversation continued it became clear that Tula's family (particularly her mother) held Tula responsible. If Tula hadn't got better, Gurutuba or the disari would not have challenged them. At one stage Tula's mother told us that she wished Tula would die, because then Gurutuba would be blamed and locked away. (The truth is, he'd just pay a bit more and get away with it) I watched Tula as her mother said this in front of us all; she looked away, seemingly on the brink of tears. But it was not the first time she'd heard this, and probably not the last. Healthwise, Tula did worsen after she'd be pushed over. But now she seemed very stable and returning to health. As we left, Dr Iris, who's had her fair share of courtroom appearances, promised that they would try to sort something out. According to her the only resolution will be to face the police and pay to drop all the charges, thus avoiding more pain and ultimate destruction of the tribal families.
This sort of thing happens weekly, tribal families being raped by the very authorities there to protect them, simply because in their ignorance they are so very vulnerable. Many of the jail inmates have similar stories involving disaris, rival neighbours and corrupt officials, all leading to the destruction of the very families they were seeking to protect.

Red Nailpolish
Sunday was a relaxing day without any work, so in the afternoon I painted the fingernails on my left hand red as I’d seen many Indian men do. Showing it to Dr Iris I asked the meaning. She recoiled and burst out laughing. Apparently it is a sign of homosexuality (or rather, seeking male sex). Many married men with children get their sexual satisfaction with other guys, so that is why I’d seen it quite a lot. Needless to say, I didn’t wear it out in public.

Clinic Limitations
Monday was another clinic day. Kutlamuji, a 25yo man, was brought to the clinic in the afternoon with dizziness and fainting. When I examined him he was barely responsive and couldn’t even sit up by himself. He’s been staying at the hospital since then, slowly improving. It has now been decided to send him to Vizakapatnam to see an ear specialist, since it appears to be originating there. It is often frustrating not having the normal tests and specialist opinions close at hand here, but we do well with what we have. We also saw Sharada, a woman with a large open wound on her foot and ankle. Wounds like this are all too common here, simply because of bad hygiene and lack of knowledge about infection.
On Tuesday we had a busy market day clinic. A young child presented with malaria in the morning. Many children are very frightened of medical people due to their experiences with disaris. In this case, he was quite happy for me to examine him in my arms, but there was no way I could examine him lying on the table.

Markets and Saris
In the afternoon I walked up to the market as it was closing and wandered around, savouring the colours and smells which are so uniquely Indian, particularly tribal Indian. I looked and the fluorescent yellow and orange patterned saris so popular in villages hanging beside rows upon rows of sparkly bangles. Then I compared it to the simple blue checked lungis that the men wear - pretty boring in comparison. Later that evening I did learn to put on a sari, and after a few practises could even get the pleats looking half decent. Can’t let the girls have all the fun!

The differences here are impossible to articulate. Even after seeing it for myself, it will still be sinking in after I return. I must head off now. It’ll probably be a pretty relaxed day today, so maybe I’ll have time to catch up on my journal (entries are getting further and further apart). Some of the other volunteers leave tomorrow, so we’ll probably have a bit of a farewell for them too. Thanks once again for your letters and prayers. I hope your New Year’s resolutions haven’t fallen apart yet.