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 :)