With aching legs she sits and types

"Yoga, an ancient but perfect science, deals with the evolution of humanity. This evolution includes all aspects of one's being, from bodily health to self-realization. Yoga means union - the union of body with consciousness and consciousness with the soul. Yoga cultivates the ways of maintaining a balanced attitude in day-to-day life and endows skill in the performance of one's actions."

- B.K.S. Iyengar

We've been doing yoga classes at the nearby centre every morning at 6.30. This is going to sound like the biggest cliche, but it's the best way to begin the day that I know of. It's dark when we get there but as we start, the sun rises over the mountains and makes the sky go a delicious yellow. The light comes through the windows and lights us with a Vermeer-like glow. I'm feeling very healthy - although that could be the diet that's exclusively vegetarian with no desserts!

On an aside, I'm awfully glad to read about how Barack Obama is doing so well. I'm not a huge fan of anyone in American politics (sorry if that sounds too cynical!) but I think he's the best hope there! I read the funniest article in the Guardian today . http://www.guardian.co.uk/g2/story/0,,2249501,00.html It made me chuckle! But yes, I generally don't think much of many US administrations dating back a while. I'm reading "A Prayer for Owen Meany" at the moment - John Irving's best book, in my opinion - and it's amazing how if you substitute the word Vietnam for Iraq you would have a story that could be about now! But hey, here's hoping Obama gets in and does some of the great things he's promised.

Reinvention

I remember the rotation I did just before I came here. It was a horrendously busy A&E and I did actually quite enjoy the placement - I've always loved A&E for it's excitement and brutality! But there was this one night - about 3 in the morning. A boy - he didn't look 18 - came in with a gang of friends effing and blinding and saying he'd been stabbed. Of course he was seen that second by the most senior doctors there. It was found, though, that the "massive fucking machete!" had barely broken the skin on his thigh and he was not even bleeding any more. A good examination found nothing else of note all all and there was absolutely nothing else wrong with him. I was going to put a few stitches in - two at the most - when I saw a woman coming in by ambulance saying she couldn't breathe. Not just saying it - she looked it too. She was bought into "resus" - where all the monitoring and equipment is for sick patients. She was attached to a monitor and I saw ST elevation, (the tell tale signs of a heart attack), and she very quickly went into VF (for the non-medics - it means your heart is still moving and making electical activity but is not pumping blood. Basically it means you might be able to shock it back into rythym but if not you are dead). I was there as the bossman doc had asked me before to cannulate (put a drip in her arm for medications) so I saw them attaching the defib (the thing people use when they saw "clear!"). I saw them shock her and shock her. I saw the line on the monitor go flat. I felt her broken ribs crunch beneath my hands as I did CPR. After not all that long they stopped and went to speak to the family. I went out to stitch up a thigh (the job of talking to relatives in these circumstances alone is as yet awaiting me.) He yelled at me - "Why the fuck do they need so many doctors in there? Don't they know I've been stabbed! This is the worst hospital ever! I'm going to so complain about this shithole!" I apologised, and said I was really sorry to keep him waiting, and was really calm and nice to him, but he wasn't listening. He wasn't waiting more than 25 minutes.

The reason I have written about that incident was because it was an example of the kind of stuff that makes me think that teaching is a good career option. But the thing that maybe I like most about this trip is how it is reigniting some feeling of purpose and hope about medicine that I thought I had lost. The staff who work for the organisation here are so inspirational in how they are trying, and succeeding, to improve the health of a neglected and downtrodden, yet so fascinating and kind, people. I was becoming so cynical and downright depressed about medicine, what with horrid arrogant doctors, and an unbelievably frustrating health system, with patients that hated being in hospital (often understandably!) and who gave the staff nothing but abuse. Not to mention MMC / MTAS / UKFPO - whatever it is they are calling it these days - which has got the morale of doctors and medical students at an all time low. But here, I remember the 17 year old who went off smart and funeral-suited and trembling to her medical school interviews - a long time ago now - hoping beyond hope that the as yet unknown interviewers would see how much she wanted to be a part of medicine and how much she thought she would be able to do for people, and allow her to join their hallowed club. I haven't remembered her for a while - but now I'm thinking again how much I enjoy medicine. I hope to remember this to see me through finals - I think I'll need to to avoid going mad!

On weddings and random diseases

...or as I'm discovering, not so random. In one outpatient session, I saw leprosy and measles. It's the first time that I've seen either. The girl with measles caught my eye as soon as she came in. During my paediatrics placement, we were told, incessantly, that the most important thing that we should take from the rotation is being able to tell a sick child by simple observation. When I did my paediatrics, I don't really think I ever saw a very sick child in outpatients. Parents bring them in to A&E at such an early stage in England. But she caught my eye because she looked sick. There's no other way to describe it. Anyway, she was admitted and she's doing reasonably well.

And there was a lady with leprosy. Her hands were mutilated by this most strange of diseases - her fingers were shortened and bent, with the classic white patches as well. The fascinating illnesses I'm seeing here astound me - the diseases I read about dutifully for exams but never see are walking through the door and presenting themselves to me.

Lots of TB as well, but doing work in the city where my medical school is means that sadly even in England this is not anything new. TB, along with other emerging and re-emerging infections, is again rearing its head to remind us that we live in a pretty precarious balance with nature. I have a very good friend who lived in one of the most notorious areas of the city who got TB. He was trying to figure out where on earth he got it, but I told him that you don't always have to be anywhere exotic to catch TB now.

I spent Thursday night staying in one of the tribal villages staying with the local people. It took almost an hour to walk to, through acres and acres of tea plantations and palm trees. The hospitality was astonishing. They piled heaps and heaps of rice and daal and all sorts on my plate, and despite my pleas didn't touch any food themselves until they were sure I had been well and truly stuffed. And they gave me and the other student a room to ourselves when they really didn't have the room for it. I did my best to tell them that I didn't need so much room but they wouldn't hear of it. They made us chai after chai, and lit a fire so we weren't cold. The next morning they boiled water before we even woke up so we had warm water to wash our faces. I was humbled! And the kids! they followed us round in their bare feet (sometimes more was bare!) and smiled and laughed and delighted in my obviously hilarious attempts at Tamil and my camera and my watch. It was lovely to see their energy and enthusiasm that I don't think I ever had as a kid!

And on Sunday we were invited to the wedding of one of the nurses that works in the hospital. We all dressed in saris and again felt so welcome! It was a traditional tribal ceremony with the very very old dancing and music - the drums and pipes they were playing were so rythmic and hypnotic and everyone was dancing. And the scenery just couldn't be bettered - in their house surrounded by tea plantations looking out over the valleys of forests. It was stunning.

Tribes

"He who has health has hope, and he who has hope has everything."

- Arabic proverb

The hospital that I'm working in was set up primarily to provide access to healthcare for a previously rather neglected area of rural South India. One of the things that attracted me to this place was that it would be an opportunity to see and really get to know people in the tribe and see how they live. It's been absolutely fascinating. The people lived in quite a lot of isolation in this mountainous area and I have never seen a way of life that's had so little influence by "Western" culture. They live in the most splendid surroundings - covered in palm trees, endless tea plantations, eucalyptus trees grow so tall on the hilsides. Dark mountains frame the whole area.

So one of the things the hospital has organised are people, trained from the tribes themselves, to become health workers. It's not really a formal qualification or anything, but they go around the villages, weighing children to make sure they are not malnourished, taking blood pressures, testing for diabetes, following up on illnesses like TB, and one of the most important parts of their jobs - health education. Concentrating on areas that cause a lot of the health problems; for example, they might educate people about child nutrition (as many of the children here, for many reasons, are very underweight) , anenatal care and childbirth (as death in childbirth - of mother and baby - used to be a lot more common than it is now!), recognising the signs of an ill child (to make sure they get early treatment) and generally trying to help people understand the hospital and what happens there. So I have been out with them three times, "into the field" as we call it, with the health workers. It involves miles of walking in the sun, between all the villages. Last Wednesday we covered about 8 or 9 miles, seeing the most remote villages, many times that don't even have roads. I feel so lucky to be able to have seen these places - I get the impression that life hasn't changed much for thousands of years. Living off the stunning land, in the mountains that their family has lived on for countless generations.

The people organising the hospital have gone to great lengths to make it approachable - like almost all the staff there are people from the tribes. And they don't rely on written material for anything as most of the tribal people can't read at all. The health education is mostly word of mouth, and pictures. This is what I like most about this project - it's not just people from outside, say a Western country, that come in and put programs in place that just aren't understood or trusted by the local population. It has a real grassroots feel - like it's owned by the community. I really feel that the community trusts what goes on at the hospital and aren't scared of it any more.

I think I can tell this from how people treat me. They smile and are so happy when they learn I am staying there. (Sometimes they even know without me telling them, there aren't many white people around here for any other reason!) They tell me stories about how they were helped there. It makes me hapy to be part of something so special.

Oh and we rode an elephant yesterday at one of the nearby wildlife sanctuaries. Pretty awesome!

Incredible India

"In India, I found a race of mortals living upon the Earth, but not adhering to it, inhabiting cities, but not being fixed to them, possessing everything, but possessed by nothing"

- Appolonius Tyranaeus

OK, so this is the first time I've been in India. It's fascinating. The whole place is teeming with life - all sides of life. I think in all the places I've been this is the one where I have seen bare humanity in all its brutal horror and in all its shining glory. A land of contradictions like nowhere else I have seen - ornate, bristling wealth alongside some of the most desperate poverty I have seen outside Africa. And so head-fuck random - on the bumshaking 8-hour drive from Cochin (a fairly big town in the laid-back southern state of Kerala) to the hospital where I'm on elective, I saw temples sixty foot high, children playing cricket in the road, padi fields with the light on the water making it shine like it was made of light, banana trees, lakes and rivers, big dusty towns, and once, opening my eyes to see an elephant walking alongside the car so close I could have reached out and touched it. I gasped in genuine delight and the driver rolled his eyes with a little smile on his face, like London taxi drivers do when tourists stop and take pictures of themselves next to red English postboxes.

In the beginning was the word ...

Well hello and greetings! Decided to join the information autobahn and start posting my random musings for all and sundry to see.

I guess what made me want to start writing is that at the moment I'm on elective. (For those unfamiliar with the ins and outs of medical education, it's the time that medical students get off, usually near the end of the course, from teaching and are able to choose where to go for 2 or 3 months - as long as it's vaguely medical). I'm in very rural South India at the mo, in the only internet cafe for many miles, and I feel like I want to get some of the experiences down somewhere - it's so intense and wonderful and so many things that I hoped to be able to share some of that. Who knows, I may forever be condemned to Google obscurity.

Anyway, hey to you all, dear reader, if you are there. Enjoy.