At Journey's End

We have now finished the NUR 480 experience!!!!!! Our next stop is Goa, but that's just to unwind. Since it has nothing to do with nursing in India I won't be blogging anymore after this..but I'll probably still be facebooking ;0)

Once we got back to CHAI we gave a presentation to some of the CHAI people about our overall experience. This trip on the whole, was quite good but I would be lying if I said I loved every minute of every day. I'm used to the comforts of home so this was a major major major step out of my comfort circle. I remember when I moved TO and I thought that was such a big change...but everyone there spoke English; communication mix ups were few and far between; people shared same general idea about what is considered appropriate and what isn't; there were very few times I felt completely mentally exhausted by the end of the day; and, for the most part, I always had at least general understanding and good idea of what was going around me.

India, has been basically the opposite, I felt confused pretty much all the time, the language barriers could become so frustrating, and by the end of the day, it was quite usual for me to have a headache because of the non-stop mental processing I was doing in a effort to try to understand my surroundings. The bugs and the reptiles drove me mad and freaked me out...(I don't think I've screamed out of terror as frequently as I have since being here). But it was more than that...it was emotionally exhuasting, especially at the care and support center in Warangal, where people would die on a regular basis (though not as frequently as a few months ago, according to the director), and you couldn't help but worry and wonder about what would happen to the kids when they got older, or get that sick feeling in your stomach when you thought about the centers' future and the day when the director of the center would no longer be able to run it. But it isn't a hopeless situation. The work at CHAI and the partner organizations, the effort, the commitment, and the dedication, by the NP's, the nurse supervisors, the coordinators, the directors, the programming, the planning, all of it...its inspiring and it's having a significant effect...it's working. The exposure to grassroots work has been eye-opening to say the least and I think A LOT of organizations working in developing countries could learn A LOT from work that has been done in Andhra Pradesh.

I know being here will influence my nursing practice, though I'm not entirely sure how. As for working in Global Health in the future...perhaps...I'm glad that now I at have some sort idea of what it means to work in such a complex and difficult field.

These past two months have been very very challenging and despite the number of times I whined and complained about wanting to go back home, I'm still glad I came. I hope you enjoyed reading my blog, I enjoyed writing it (it was therapeutic in a way). It's been an experience and I wouldn't have changed a thing :)

Tips and Tricks for Future NUR480 Students

So this section is dedicated to the future nursing 480 students who may be travelling to India, although I think a bit of it could probably be applied to anyone going to India in general. Keep in mind this is advice based on the experience of a person who stayed basically in the south, during the monsoon season (even though it didn't rain that match). Take what you want from these notes, remember it's just a guideline...

Be VERY VERY VERY VERY VERY CLEAR ABOUT ANY FOOD ALLERGIES YOU MAY HAVE...ESPECIALLY TO NUTS AND EGGS. They cook quite a bit with these two ingrediants, so make sure people know if these will make you ill. And be sure the person you are telling understands English.

Things to bring: Mosquitoe repellant is a must, although some repellants end up attracting flies while repelling the mosquitoes. Mostquitoe nets are kind of useless, not once did I have a place to hang mine at any of the villages we stayed at. Bring flashlight, camera and lots of batteries, a really big memory chip for the camera, USB key, mp3 player to listen to music (its good for those times when you're waiting around for hours on end, but it does have the potential to take away from the Indian experience), also bring a few books to read to help pass the time, and bring your own journal to record your experiences. Bring granola bars (a box of 40-80 should suffice) and 2-3 pairs of scrubs is a good idea, they're versatile and dry quickly.

You MUST MUST MUST bring with you toilet paper, kleenex (and keep the kleenex on your person b/c non of the public washrooms have toilet paper) disinfecting hand wipes and hand sanitizer, and a money belt. Bring nail clippers and a small swiss army knife.

Also bring: an umbrella and a poncho, travel alarm clock (or just use the one on your cellphone). A water pump and water drops (Caitlin bought hers from MEC and so far they've proven pretty useful, the rest of us just bought bottleld water though. Buying water was not as much of a challenge as I expected too and FYI: a 1 liter bottle shouldn't be costing you more than 15 rupees). Don't forget to bring: your own travel cutlery, a bed sheet, pillow case, a small pillow (if you have space). Also brings lots of small "Canadian" gifts to give to the staff that you will be working with (boxes of maple candies is a must. Other things we brought were pens, notepads, small shampoo and lotion bottles for the nurses).

Bring topical analgesics, (such a Benadryl pen) so you can apply them to those oh-so-annoyingly itchy mosquitoe bites and be sure to keep it on your person at all times since you can itch anywhere you are. It is also very dusty in the rural areas so eye drops to keep your eyes moist may be helpful. Bring twist ties to tie the zippers on backpacks, bring ziplock bags, bring flip flops and decent runners, and a fly swatter.

When crossing the street, walk alongside the locals, b/c they know how to navigate their way through these insane roads without getting hit.

If you are going to buy a cellphone while you are here (which is a very wise investment as long as you don't get scammed) have with you: ~1500 rupees for the phone itself and ~1000 rupees for activation and buying minutes. Also have a passport sized photo of yourself, a letter from CHAI stating that the purpose and duration of your stay, and have it signed, and it should be on a CHAI letterhead.

When at CHAI or any of the other rural place you will be staying at, make sure to wash your own dishes after you've finished eating. Dress conservatively, long pants and t-shirts are generally acceptables, as well as pants 3/4 length or longer.

Expect things to go wrong on a fairly regular basis. Things here have a tendency to be 10 times more complicated and take 5 times longer then they ought to.

Take few pics of friends, family, and familiar things from home, that way you can look at them when you are feeling homesick.

They have tea time here twice a day, so get used to it...especially if u don't like tea. They don't really take no for an answer when it comes to continuously feeding you.

Try to avoid overly crowded places as these tend to be target areas for bomb blasts.

Expect to find the following in your room at one point in time (especially in the rural areas): geccos of all sizes, giant cockroaches, giant spiders, ants, really big ugly catipillar/worm things and toilets that don't work.

Give yourself a lot of extra time when travelling to a new place since nothing here has an address and therefore, can be difficult to find. BEFORE you get in the ricshaws, have the price of the ride negotiated with the driver, because if you use the meter, there is a pretty good chance they will take you around in circles so they can charge you more. Since addresses don't really exist here, you'll have to give the drivers landmarks close to places you want to go. For example, to get back to CHAI from Abids, we would tell the driver "Diamond Point Hotel" and he would drop us off there, and we would just walk to CHAI from there. To get to the mall, we would ask for Abids or GPO (General Post Office).

When you're in an area that sells stuff you need, buy it there. Don't wait until you go to the next village because the next place may not sell the thing you're looking for.

One interesting thing is that people here always seem to stop whatever they are doing, from giving presentations to giving you customer service at a store, to answer their cellphones...it's kind of funny, but has the potential to be annoying as hell when you just want buy a bottle of water or something.

Educate yourself ahead of time about HIV/AIDS, including its four stages, the CHAI organization and it's projects (their website is good place to start). Bring a drug book along to look up meds.

People will be very curious about you, so get used the blatant staring which occurs every time you are out in public. You will also likely be meeting a lot of people who are directly or indirectly involved with CHAI, so be prepared to explain who you are and your purpose in India very often.

Telugu is the local language in the rural areas we stayed at so here are some words that may be helpful (which I'm sure I spelled wrong):

meepeduenti - what is your name?
napedu - my name is...
manchidee - good
bowoonarda - how are you?
ownoo - yes
kadu/ledu - no
coonchin - small
aiepoientee - finished
nopeeunda - are you having pain?
tinadra - did u eat?

A couple good mottos to live by while in India:
1. I'll shower later
2. In the midst of all this craziness you have to be crazy yourself...

That's pretty much all I can think of so hopefully the tips and tricks (and the blog in general) has been helpful. Good luck!!!

Eluru Pics

On the train to Eluru
On the train to Eluru again

The place we stayed at in Eluru, nice on the outside, but way to many roaches and geccos inside...

Farzina with her tiffin and no shoes


Caitlin getting a blessing from an elephant we fed, on our way up to see temples


Enjoying the view on our way up to the temple


The front entrance of the temple :)

Temple views from on top of the hill


The lovely paddy fields


In the back of the ambulance we rode to do another hospital visit

To Eluru and Back

So it turns although internet was available, I just wasn't in a blogging mood most of the time and when I was there were always a bunch of men standing around my computer reading what I was writing (rolling my eyes).....but no harm done b/c I know you're still reading this Chika :)

Getting to Eluru turned out be an adventure in itself. It was pouring rain outside the night we left CHAI and we had to take ricshaws (luggage and all) to the train the station. Obviously the four of us and one of the sisters couldn't fit in one ricshaw with all our stuff so Farzina and I took one Kim, Caitlin, and of the sisters took another. Mine and Farzina's driver arrived at the station first, dropped us off and unloaded our bags. Little did we know, he dropped us off at the back while Caitlin, Kim and the sister were dropped off at the front, waiting for us inside. Our train was to leave at 9:15pm and by 9:05 me and Farzina were still waiting for Caitlin and Kim on the wrong side. To make matters worse, the place was filled with A LOT of men, many of which were eyeing our bags. By 9:10 we decided to walk around a bit (still at the back) to try the find the rest of our party. We found a couple of employees (I'm assuming that's what they were but I can't really be sure) in a booth and asked them how get to the trains. He pointed outside and said around. So we had to walk outside in the pouring rain to the other side to station. As soon as we got in (but not before we were totally soaked), we found the rest of our party and made a mad dash for the trains. We were on platform 1, got on the train, walked down the entire length of train car dragging our luggage and hitting passengers with it, only to find out by the ticket guy that we were on the wrong train and that our train was on platform 10. The ticket guy handed back our ticket, the sister handed it to me, and I put it in my bag (at least I thought I did). We ran like crazy people (with all our luggage I might add) up these never-ending stairs, across a bridge, to platform 10 and on to train which, by God's good grace, was running late and had not yet departed. However, when we got on the train and I went to take out the ticket I couldn't find it!!! It turns out I had dropped the ticket when I was putting a way, and by sheer blessing, some random guy had picked it up, followed us to platform 10 and gave us the ticket that we needed to be on the train. As we sat the down, the train started to move and we were off to Eluru...

Eluru itself is decent enough, but I was eaten alive by mosquitoes by the end of it. The rooms we stayed in were okay, but there were some serious gecco and cockroach issues, and our bathroom was dingy and gross...at one point, we had toilet that just would not flush, we got to swtich rooms a little later on during our stay. Things were less gross once we were in the new room and all-in-all I think we managed okay. Our time in Eluru consisted of making visits to various Integrated Counselling and Testing Centers (ICTC) across the district with two nurse supervisors. The ICTC centers provide HIV testing and counselling services as well as prevention of mother-to-child transmission counselling. The ICTCs are found in the primary health centers (PHC) which are health facilities meant to serve rural populations.

We met with the district medical health officer of HIV/AIDS and Leprosy as well as different hospital administrators at the numerous health centers we visited. I guess the biggest highlights of this sixteen day experience were going to the inauguration ceremony of the government hospital getting a CD4 machine. It was attended by this mayor-like figure head of Eluru. Up until then, blood samples were being sent all the way to Pune for testing, so with the CD4 machine now in the hospital, turnover time for test results will significantly improve, which means less waiting time for confirmation to start positive people on treatment regimens. The other big highlight was the presentation we gave to probably about 250 junior college students about HIV. We gave them the Canadian perspective, compared it to India, and even got some participation out of the students. It was difficult though b/c although they understood English, the language barrier was definitely present. Thankfully, there were people to translate :) We also visited another leprosy center, this was quite extensive and had more patients than the one in Warangal.

I'm pretty sure I'm forgetting details here and there, but that was, essentially our Eluru experience. We leave to go back to CHAI tonight....another night train...so hopefully this train ride experience will be a lot less stressful than the last one. I'll post pics once we're back at CHAI. Bye for now :)

Warangal Pics (again...in no particular order...)

Warangal Fort...the intricate stone work....

Caitlin walking by some pillars

Me beside a beautiful stone carving...the pic really doesn't do it justice

Examining the amazing work...I still can't believe things like this could be created with minimal technology

On top to the stone elephaht...getting on that thing was A LOT harder than it looks....

Caitlin and Farzina showing off their saree material after an evening of shopping :)

First of all the hill is enitrely stone and at the top is the temple thing....if u get closer you can see a wall spiraling up and around the hill to the top of the temple (kind of reminded me of the one in China)

Kim on the top part of the place we resided in Warangal :)

Farzina and Caitlin working away...trying to put the research on paper....

Down the road on the right hand side was the care and support center where we spent our days working with the nurses...

More pics to come in a couple of weeks....

The Life and Times in Warangal (Including Attack of the Gecco!!)

So we finally have access to the internet at last!!! I'm not sure anyone is reading this anymore but I'll update it anyways to remind myself....We spent 12 days in Warangal, which a small city about a 2.5hour drive from CHAI. The ride there was decent enough. On the way there we saw this massive rock hill which actually turned out to be a sort of fort. As we got closer we could see this stone wall built all the way up and around it and at the very top of the of the was a temple. It was quite impressive, unfortunately I wasn't able to get a decent enough picture so you'll have to use your imagination. We arrived at the Care and Support Center (CSC), which is outside of the main city of Warangal. My first impressions of place...rural, rural, rural!!! Being more of a city a girl, this was quite the adjustment for me....The actual building we stayed in about a 30 second walk from the CSC. One thing that took ALL of my enegry getting used to (and I never fully did) was all the flies. It felt like there were hundreds of them all the time!!! Anyways, getting back to the CSC, it is for HIV positive pts providing inpatient services for those whose health status has deteriorated because of the disease. There are also 60 orphans at the center, all of which are HIV positive. The kids have their education, food, recreation, etc. provided for them by the center, but it's definitely a struggle because the funding for the kids is so little. There are 9 nurses that work at the center as well as a counsellor, and the director. The people at the center and in the village in general were all so friendly. But we got a lot of stares everywhere we went b/c I guess they don't get to many foriegners in that area. Everyone was so curious about who we were and where we were from and my goodness were the girls ever interested my braids!!!

We spent most of our time at the center in the mornings helping the nurses give meds, taking blood pressures(manually I might add!!!), checking weights, and in the afternoons doing rounds with the doctor who would come in to see the patients. I think my favorite thing was spending time with the kids though. They were so full of energy and brought the whole place to life. Unfortunately, b/c of confidentiality rules, I can't post pics of the patients or kids :( which is a shame b/c they're amazing pics...

After a couple of days into our stay at the CSC we got to go into the city and go to this place called Warangal Fort. The fort was amazing, the architecture was so intricate and the size of the fort was huge!! It's hard to believe such work could be created without the use of the technologies we have today. Across from the fort was a rather large park, and if you climbed up this hill you could get beautiful views of the district. One thing I thought was funny was, once again, all the attention we got. So many people wanted to take their photos with us!!! Like I said before, they don't get many foriegners there so I guess it was kind of a big deal. People would even just snap our photos when they thought we were not looking!!!

Back at the center, the kids and the patients were getting used to us. The kids were even calling us "sister" which is what they call the nurses. One thing I have to mention here is about the nurses is how phenomenol they are at start IVs. For all fellow nurses out there, you can appreciate why I would mention this. Some of the pts have such tiny viens, or they're so difficult to find, but the nurses can still start their IV with no problem...we never attempted to do that, I should also add, but it was always so amazing to watch.

On one of the afternoon, when Caitlin and I returned to our room, we saw this tiny little lizard gecco thing (I'm pretty sure I spelled that wrong) on the wall. I, of course, was disgusted. Caitlin tried to scare it off, but it ended up falling into the garbage can. When she went to move the can the thing jumped out onto her hand and she flung it off. This would have been okay, except the creature went flying off her hand and into me.... landing right on my chest!!! I, naturally, screamed and flailed around and flung it off of me. Then we couldn't find it for a couple of seconds and we were worried it might have crawled into to Caitlins open bag. But it turned out it had found it's way back onto the wall (by this time I was standing on my bed completely flipping out...). Caitlin actually managed to scare it off and it scurried it's way outside our room. I was so paranoid and jumpy for the rest of the week. Every time I saw something move out of the corner of my mind, I would freak out!! The next morning, I woke up to the sight of yet another gecco thing on my wall. However, this one was high up by the window, not really close to Caitlin or myself and so, in an effort not to have nervous breakdown, I decided to name the thing George. As crazy as it sounds, that actually helped to take the edge off!!!

The next night, it was the birthday of one of the nurses. We had delicious food and cake. The kids all got a piece of cake to and I have to say, they were extremely well behaved during this process. They all patiently and quietly waited their turn to get thier piece...very well disciplined that bunch!!

The remaining days we spent in Warangal we got take tours of other community services. The places we visited were all about 5-10 minutes walking distance from each other. One place we visited was a center that cares specifically for leprosy patients. That was really interesting, and we got to briefly meet some of the patients as well, but they didn't speak much english. On the walk there, we saw bunch of monkeys and I stopped to take a picture...but I have to say, I think I had paused any longer I would have been attacked...I got the sense they felt threatened rather than amused by my camera. But luckily no harm came of it.

We also got to visit another nearby village and got a tour of some of the services they provided for that village and surrounding area. I should mention, all the services provided for the people, that we saw, were provided by sisters and priests. Basically they were faith-based organizations and the work they do is very impressive. It ranges from schooling for children that would otherwise be able to afford an education to health care for the sick and a lot work around education and reducing stigma regarding HIV/AIDS.

We went to another orphanage about 30 minute drive from the center. It was specifically for girls. It was funny b/c as the jeep pulled up to the orphange, when the kids saw us in the car they all started screaming!!! I guess they were pretty excited to see foriegners!!
Of all the visits we had, my favorite, by far, was at the school for the deaf. The school, was about a 5 minute walk for the center and is for children from probably about kindergarden age to teens all of who are deaf. As soon as we walked into the area all of these kids came pouring out of the building and were so excited to see new faces!! There was no sound but you could feel the energy and excitement. There really are no words to describe it. They just surrounded the four us and had pads of paper and wrote questions, to which we wrote replies. They did these high five things with us, and they wanted to show us dances, they wanted us to dance, they were just so interested and so excited...it was truly truly truly amazing :)

On our last evening at the center, the director took us into to town so we could buy sari materials. It was pretty sweet b/c he knew the owner of the store so we got everything half off. The car ride back was okay....except when Farzina threw up...poor thing...
We finally headed back to the CHAI on Wednesday. We head out for Eluru on Sunday evening...taking the train (should be interesting). The good thing is, unlike Warangal, we should have internet access at the Primary Health Centers so hopefully I'll be able to update this a little more frequently :)

Farzina and the Cockroach, Hospital Visits, and some Local "Celebrities"

So it looks like I have little bit of time before we leave for Warangal so I'll take the opportunity to give an update. So on Tuesday night Farzina was outside her room on the phone but had left her door open. She saw something scurry across the floor in the hall into her's and Caitlins room. Unsure of what she saw, she and Kim searched through the room using Kim's flashlight but couldn't find anything, so everybody just went to bed. The next morning as Farzina and Caitlin were chatting, Farzina was going through her bag when this huge cockroach scurried up her arm (which apprantly felt very fuzzy). That's when I heard her scream from mine and Kim's room and she ran outside. When I took a peek in her room I saw this thing which was, without a doubt, the largest insect I have ever seen in my life!!!! It was so disgusting!!!!! Caitlin was finally able to trap and throw it outside and that was how our Wednesday started.

After breakfast the four use, accompanied by one of the CHAI workers, took a tour of the government hospital, which I talked about in my previous post. I'll add a little more here though. The place was quite huge. Unlike hospitals in Canada, this place had two separate buildings. One for inpatient services and one for outpatient (OP) services. Like I said before, we took tour of the OP building, talked to a couple of docs and counsellors. The only thing missing was that we never got a chance to talk with any of the nurses. But what we did learn about was quite informative. There seemed to be a lot of services in OP dedicated to HIV, STD prevention, treatment, and counselling as well as Prevention of Parent-to-child transmission programs and services which, I thought, was pretty great. One thing that was interesting to us was how some of those we talked to had the view that Western medicine relys predominantly on technology as opposed to clinical skills. I would argue, however, that while the technology has been a major asset in improving the care we give patients, as nurses, or doctors, or PT's, or OT's, etc. etc. skills are still used a great deal and play just as important a role, actually more-so, then the role of technology.



This morning, Thursday, we visted another hospital. This time it was faith based institution. The hospital is named St. Theresa Hospital, and it has connections with CHAI. They several other hospitals throughout India, as well as a hospital in Ghana. It was very interesting to compare this hospital to the government one. St. Theresa's was very impressive. Just the atmosphere alone was so warm and welcoming as opposed to the often cold sterile environment of many of our hospitals back home as well as the hospital from yesterday. I actually felt quite at home and and content to be there. Being faith based, St. Theresa's is Catholic hospital, offering the same services as any hospital in Calgary or Toronto, but one thing that makes this place quite special is that they have an orphanage. Children/babies would be left there because of whatever circumstances and they were taken in, raised and cared for, by the sisters. Up until a few years ago, these kids could also be apoted by families within India and abroad. However, this has been stopped temporarily but will hopefully continue in the future. While the kids are there, they go to school and are raised to just like any other child would be. We met the sister who takes care of them...she was such a sweet lady :) The hospital also has a nursing school attached to it. We met with some of the students which was pretty neat. Their system of teaching is intense, to say the least. The students even have a lab component which incorporates labs from micro and biochemistry. They also have their own SIM lab, which I think gets used pretty extensively. I was very very impressed with the school.


Us with the sister who takes care of the orphans :)




The nursing school

I also have to say, that I am quite impressed with the work of Catholic organizations in India. I know that there are other NGO's that do things that are just as great, but the ones we have seen have been Catholic and their work has been quite remarkable.

Outside the hospital with one of the sisters (in the orange), she is a teacher at the nursing school. The other sister (in the blue) is from CHAI.

On a less deep note, it would appear that the four of us have become local "celebrities"!! Our pictures showed up in two different newspapers today!! One of the pictures was of us standing along the bridge on Tank Bund road. We had been on our way back to CHAI from Lumbini park couple of days ago and I guess a photographer snapped our photo. Then we found out that at the government hospital we had visited on Wednesday our photos were also taken there. In that situation, an MP had come to the hospital that day for an inaugurational ceremony of the GI department getting an endoscope. The media was there and a photographer was snapping our photos which ended up in the newspaper!!. We were informed about this by one of the sisters at St. Theresa's Hospital today. LOL!!! We're not that special in Canada though!!
Page 5 of "The Hindu", a local newspaper. Believe it or not, that's Kim, Farzina, me and Caitlin standing on the right!!! -- Unfortunately we couldn't find the other newspaper that had published our picture at the government hospital :( But at least we got this one!!!