Medical Elective Report: Roshni Mansfield and Rebecca Haggie

Roshni Mansfield and Rebecca Haggie Elective in India funded in part by Selwyn College Medical Elective Fund (Roshni and Bex hit Injaaa 2013 – blog) 1st September Quick blog o’clock!!

Roshni and Becky say goodbye to Heathrow and prepare to say Namaste to Delhi.

After a night of ‘sleep’ In second class Humph Roll on top quality films and scrumptious flight food.

4th September Note to self: never order croissants outside France.

Today was wonderfully varied! My uncle met us in the morning and took us to see the tomb of Khan-i-khana, a very famous Indian composer in the 16th and 17th centuries. This was a peaceful place, quite the opposite of where we went next.

We clambered out of air-conditioned comfort into a dusty haze of colour and noise.

Goats roamed amongst the sweet lime carts, and babies perched on the bony hips of desperate mothers looked on at us with large, blank, black eyes. A maze of alleys lined by stalls selling paper plates of pink flowers and bright shawls led us to a shoefree area teeming with people paying their respects to the great Sufi composers and poets, Nizammudin and Khuzro. Women weren’t allowed in the shrines themselves, which was saddening and irritating.

After three courses of colonial foods such as mulligatawny soup, we left my uncle and visited the Red fort. Beautiful place! Go there if you can! Becky began to play photo wars with locals…

We had our first ride on a cycle rickshaw. Skinny man dragging two fat western girls around congested streets in Old Delhi. Needless to say, we gave him a tip. Jami Masjid Mosque was closing for evening prayers as we reached it. Maybe we’ll visit it properly on the way back from the mountains.

We have arrived!!

The bulk of the journey from Heathrow to our hotel in Delhi was as smooth as the sweet lassi (sugary yoghurt drink) that we drank with dinner. Just one slight halfsecond of terror when we thought the driver of our rattling black and yellow cab was kidnapping us…turns out he was simply avoiding traffic and trying to get us to the hotel faster! Possibly too anxious?

We appear to be staying in the culture hub of Delhi, as our hotel is situated amongst institutions like Alliance Française Delhi and a Science Centre. Even our hotel holds conferences and exhibitions, so before we submitted to the exhaustion induced by 3 hours of neck-cramping economy class sleep we took a look at the current exhibition on innovative Dutch architecture. My favourite was the display about Heineken`s plan to manufacture cuboidal beer bottles ideal for reuse as bricks!

After a nap and a quick lunch introducing Becky to local food, we ventured into Delhi proper. We walked for a short while to get our bearings before getting into a rickshaw to see some of the famous sights. Our driver, Rakesh, turned out to be a gem! We saw India gate which commemorates soldiers who died in WW1, the Third Afghan War and the 1971 India-Pakistan war. It was sobering news that we could not enter the near area due to police barricades. The recent attacks in Delhi are ever-present.

We saw the grand president’s palace from afar and then Rakesh took us on a personal tour of the Birla Temple. As a Hindu himself, he knew many interesting tales about the Gods and Goddesses we saw statues of.

We then got taken to an indoor fabric bazaar. They went crazy when they saw us coming. Very shortly we were forcibly sat down with 4 Indian helper boys holding up various wall hangings. They gradually pulled out bigger and bigger beautiful Kashmir fabrics, our eyes growing and growing with glee until the price was revealed when the nice rich western girls disappointed the equally nice not so rich Indian boys. A smaller purchase ensued and we escaped reasonably content despite the trauma of the Indian sales technique being expertly inflicted upon us. First time for signing away thousands of smackers…We’re rich!! Or were…

Figure 1 - India Gate

Now its day 2 and we have set ourselves a pretty impressive challenge of seeing literally every tourist site in Delhi‌

6th September Time zone change seemed to affect us last night with extraordinary energy between 12.30 and 1.30 making our planned early start much more of a challenge. Eventually we managed to make it to Lodi Gardens which we had been staying next to all this time. A true paradise of parrots, temples and water features. We saw a grass cutter man crouched on the lawn with nothing more than a scythe! That must be a long job.

This garden is at the heart of the area heavily populated by the privileged and it was evident that the rich Indian young folk hang out here, jogging track and trim trail and all. It contains picturesque tombs of the Lodi dynasty rulers.

Back to kahn market after this to pick up food for the journey (embarrassingly western including a baguette from a French boulangerie which also sold macaroons) and a quick rickshaw back to the hotel to check out.

The afternoon was pressured by the 5:30 deadline for the bus to Manali. We took a cab for the afternoon and went to Qtub Minar south of Delhi’s centre. This is a world heritage site and is spectacular! We had our packed lunch of Indian delicacies from the hotel and after being banished then asked back we ended up being offered the guards office to eat out of the sun. I have no idea what earned us such privilege especially given we paid barely anything to enter after some clever claiming of Indian heritage by Roshni. The half Indian paid half the foreign price! I kept out the way at this point with the enormous camera and other ‘I am a tourist’ items…

The site had an enormous pole which was more amazing than the pole you’re probably imagining. It was engraved and beautiful! You could see the layers where it had been added to- had a brilliantly touristy time taking silly photos, and turning down amorous young Indian boys requests for snaps together… hard life being this western! A very hot afternoon.

Figure 2 - buzzing route to tomb

Figure 3 - Roshni

We then took a quick 2 rupee visit to the national museum (thank you Cambridge card!) where we saw some incredible ivory carvings and got reported by security for walking round and round a carved ivory tusk depicting the story of the life of Buddha.

Woops. We then undertook our second onslaught at a fabric bazaar feeling much more wise but still overwhelmed by such insistence.

So now we are on the luxury bus.

If this is published we will have survived despite no toilet, the almost certainty that someone will vomit, the crack in the windscreen that just appeared due to an enthusiastic attack of a bump and my lack of seat belt… Budget.

13th September Surgery Camp Just returned to Manali after the most incredible week! Posh and Bex did surgery!!

Ok, slight exaggeration – we sutured up open wounds, but it was so exciting. Feeling like actual doctors.

The 6 hour drive to Anni went really quickly. Stunning scenery and great Indian beatz blasting from the radio. Anni is a small town of puddles and poop named after a daughter of a British official who died as a baby. We stayed in Prince Guest House.

The name belied the quality. Our delightful room was damp, dingy and dusty, with a hole in the roof where a fan had once been, no toilet paper, and buckets branded with ‘Quality Grease’ for us to wash with. However, we are made of tuff stuff, and Becky’s impressive bug-battling skills were put to good use.

On the first afternoon there, we did a pre-op clinic. We mainly watched as Dr Laji (our friend and host from Manali) made speedy diagnoses of the dozens of complaints he was presented with, using nothing but an ultrasound machine and a battery of jokes. We saw everything from epigastric hernias to echinococcus granulosa infection. The latter is a parasitic dog tapeworm which normally infects dogs from sheep, but in humans it causes a massively swollen belly, like a lumpy pregnancy.

Figure 4 - cows outside hospital

People seemed to leak through cracks in the doorway from the throng of excited and anxious locals outside. The mood lay somewhere between a festival and a natural disaster. A couple of people had travelled all the way from Manali for this free surgery camp because they couldn’t afford to pay for the basic surgery they required.

One little old lady came in, lay down and exposed her stomach as instructed. There was a small plaster over her belly button. Her equally little old husband earnestly explained that it was a treatment for travel sickness! My favourite patient was a cheeky, sneaky granny who managed to wriggle into the consultation room 3 times within an hour ‘just to feel your touch, Doctor’.

My little Hindi that I acquired just before the trip proved useful – I was able to understand that Dr Laji was telling most of the older ladies to lose weight…’moti, moti’ he’d say, slapping their jellied bellies. ‘Fat, fat!’.

Anyway, the actual surgery is the cool bit. The OT was a ‘white’ room lined on most sides with small tables covered in bottles and boxes and packets of things. Two operation beds lay side-by-side, and often over the next few days, we witnessed Dr Laji hop between patients to help out the less-experienced surgeon who had come

from Delhi, and who could only do gynaecological operations. Laji is a unique surgeon as far as we are aware because he is incredibly skilled in all surgeries, from cataract removals to cholecystectomies. He explained several innovative techniques that he has developed over the years. Dozens of cholecystectomies, hysterectomies and even some nephrectomies. We had ample chance to test our anatomy and applied anatomy, and also to get our (thankfully) gloved hands bloody. We held open incisions using levers and clamps, sucked up blood using a glorified hoover, and most importantly did our first suturing. We have both definitely got the surgery bug We were gladly unfazed by the operations and the sometimes copious amounts of blood, simply because it is so fascinating. The first one, a vaginal hysterectomy (sorry to those more delicate readers) was a bit of a shocker after an early morning and a spice containing Indian breakfast (this is Becky now, Rosh has gone for a bucket bath) And we even felt like we understood the essentials what was going onthe inguinal canal difficult? phfah piece of cake (you’re the best bob!).

Figure 5 - team hard at work

The patients were all so grateful; it was so nice to see. Following Laji round the hospital in our blue hospital robes we felt like celebrities, by association of course.

People would come up to the surgeon and hold their hands together. All in awe and gratitude.

The system in the hospital is, however, crazy. All the patients carry their own records on crumpled up pieces of white paper. Notes scribbled on it from nurses doctors and the subsequent prescriptions. All in half accurate English so goodness knows how these village people know what to do next. An incredible organisation though. The dusty hospital becomes such a buzzing hub of people, and animals, dogs sat outside the operating theatre, and cows in the night… evident from the presents they kindly leave. Truly sanitary. And the mobile camp will move on Saturday to the next village along, taking with it the stacks needles iv bags, scrubs, gloves, scalpels to give the service so sorely needed in another intensive bout of 12 hour days. And they say hospital medicine at home is hard.

So now we are back in what feels like paradise Manali in the guest house of the Vargheses where upon arrival we consumed large quantities of wonderfully unsweetened tea from a Tetley’s box. I feel so clean and not damp- the glories of basic hygiene. Torrential rain storm on the way back was a little reminder of the monsoon season ending and made for dramatic scenes over the Jailori pass where we were in the clouds. (see photos which I hope will upload!)

2 days of rest and seeing Manali and potentially a honeyed delight at our favourite café as a treat… trekking perhaps and a must see temple before we head to the desert planes of Spiti with its lamas and Buddhists and shells up the mountain. So much to look forward to I just wish it wasn’t all passing so fast!

Now for a much needed sleep and lie in. Zonk !

15th September We’ve been sinfully comfortable for the last 3 days. That is, until the attack of the Prickled Spectacle and his Shiny Friend this evening. Pictures to follow. But I warn you, arachnophobes steer clear.

Brief blog just to let all our faithful bloggees know that we may not have access to WiFi for the next week-and-a-bit. But keep checking, just in case!

Don’t know why we’re still awake. We have to leave at 6am tomorrow for the mountainous desert-scape of Spiti. Hoping to see yaks and llamas and Buddhist monasteries and SNOW. We’ll be staying in accommodation attached to the clinic set up by Dr Laji and his wife several years ago. Besides seeing some local diseases etc, we’re going to give a talk about Hep B and the importance of the Government vaccination programme as Hep B is particularly common in Spiti valley. Jo, our new friend from New Zealand, will travel with us to work with a preschool attached to the clinic. If there’s time, we’ll help her teach the kids some basic English and some songs from home. Nursery take 2!

Today, we trekked and tree-whispered. Hair braids and hippie trousers were the words of the day. Peace, love and progression. And pizza for supper.

Figure 6 - Manali

24th September So much to tell! Going to have to blog like a dog to do it justice.

‘Be gentle on my curves` said the road signs as we approached the Rohtang Pass on our way out of Manali to Spiti. ‘Curves’ is a massive understatement. The views at the top made the vestibulocochlear discomfort completely worthwhile though! The great Himalayas with a fresh dusting of snow on the mountain tops… The journey got better and better, with a 4550 metre toilet stop and the best breakfast location ever. This risky ride can take anything from 8 hours to several days, and at one point we ended up tugging at boulders by the road to try and pass a broken down truck!

We arrived in Kaza (the biggest village in the Spiti valley) and then began one of the most incredible weeks of our lives so far.

Figure 7 - Rhotung pass - our van

Figure 8 - Rhotung pass

Figure 9 Rhotung pass- Roshni

The valley is like mars with red rocky mountains flanking it and a river braiding its way towards Tibet. Electricity is very temperamental, with the assumption being that there isn’t any… making for very cosy evenings with the other people staying at the clinic. Architects, preschool workers, nurses and friends of Dr laji stay at the clinic and all take it in turns to cook and help. The architects are from Oreville in the south of India which is a partly UN funded model city. Really interesting, you should look it up! Others seem to think it’s a bit like a cult though. Dolma is a wonderful lady and old friend of Laij’s who takes care of the clinic building full time. Her English is minimal but her smile is wonderful!

Figure 10- The road to Spiti

Figure 11- Kibber - highest inhabited place in India

We also met a lovely couple (Cara and Tom) who we spent our first morning doing some touristy things with. Ki Monastery sits on top of a village like a wonky top hat, and its views are incredible! Unfortunately for Bexta, its monks seem to be a rather short breed of people with exceptional night vision, and the lack of lighting led to a luminous bump on her head. We were given a hot, sweet concoction in a woodpanelled, candlelit room before trying out a prayer wheel. By the way, those ‘llamas’ we mentioned…. they turned out to be of the monk-y variety. Kibber was our next stop where we waited for an hour to get some momos (Tibetan dumpling thingies).

The village is pretty idyllic, though it left us wondering how the locals pass their time.

Hysterectomy in the afternoon. Becky in pointed, homemade surgery cap (unfortunately no picture) and Roshni scrubbed up and ready to go. Roshni began to wobble and collapsed into Becky’s ready arms. Romantic? Embarrassing. Beck then dived in, determined to show how it’s done…and took a tumble herself not 5 minutes later. At least we made the anxious patient chuckle mid-surgery. I feel I have to remind you of or heroic 50 surgeries in Anni last week to save face.

The clinics every morning for the next few days involved Dr Laji’s typical assortment of maladies. Old lady hit by a yak, girls crying about infertility, ovarian fibroids, and rectal cancer, to name a few. We did ultrasound on pregnant women to assess the progress of the baby and to help estimate the due date. Wriggling 16-week old babies in black and white can bring a tear to the eye. But they do look like aliens.

Figure 12 - Cute baby

We cooked pancakes for breakfast and pasta and ratatouille followed by apploffee pie (don’t ask) when it was our turn to cook. To burn off the damage, we went on some half-day treks. Dry and hot! One started with some dodgy path advice from a teen monk who sent us through the back yard of his monastery, up a cliff, under a fence, past some portaloos and under some flags surrounding a semi-burned monk’s habit. The path got painfully steep towards the top but the views were phenomenal and we had the best seats in the valley for a local cricket match happening a couple of hundred metres below us.

Mane is a small village made up of whitewashed, flat-roofed houses. It’s a couple of thousand feet below Spiti and actually has trees!! Bright yellow poplars, to be specific. We travelled there for the weekend to give our hep b talk. We spoke in English, Laji translated to Hindi and then Jeet (whose house we stayed in) translated into the local Spiti language. We were excited to see public health progress in action: after our talk, the locals had a long discussion about how they were going to club together to buy a solar-powered fridge for the Hep B vaccine. Everywhere else in India (technically) gets free hep b immunization from the government, but the lack of reliable electricity has left the Spiti people deprived of their right. The hope is that Mane will become an example to other villages nearby with the same problem.

‘Shame the government!’.

Figure 13 - Hepatitis B talk

Figure 14 - Mane from above

They say you must pick carefully who you travel with. We discovered why‌. see picture of toilet situation in Mane. Giggling while squatting side-by-side is not a successful endeavour. The hospitality we received at Jeets house was extraordinary.

A true Indo-Tibetan home, the animals live on the ground floor and the kitchen is the living room and also the only heated room in the house. Mats surround the warm hearth and the most enormous kettle known to man. Continuous offerings of sickly sweet chai and meals that are fit to be served in the best Indian restaurants. I have never been served on hand and foot, quite literally as everything operated at ground level‌ the wife offering more and more to us over and over. Butter tea was given to us at lunch, described by laji to us as soup in an attempt to mask the fact that if is quite disgusting, literally butter emulsified in hot water. We tried to stomach it but you must understand it had a whiff of Stilton and you could see the floating butter. Sitting in that room that evening warmed and sleepy in the comforting, dim silence was heaven. We were wearied by our 3 hour trek up the mountain to a hill station led by a rather resentful guide, the adopted daughter of the family, who stubbornly kept a decent distance away and looked disparagingly at us puffing along and delighting in the spectacular view. We saw the most incredible stream coming out of a deep crack

in the rock and experienced bitter mountain weather. Sitting up there gazing down the valley with peeping rays of light scattered across the softly coloured mountains is hard to forget, a world away from the speed and stress we are to go back to.

It was also a world away from the experience we had that night. There was a friendly rat living above our heads on the plastic tarpaulin sheet covering the ceiling. It definitely found it hilarious to play with our paranoid minds. When helping us to find blankets the mother of the family heard it and broke into hysterical nervous laughter, and hastily explained `rat rat` while practically running out the door. The worst but most hilarious night’s sleep of our lives was punctuated by sleep-shattering donkey debates across the valley. We got up to another feast (we are now subtly fighting over who gets the smallest plate of food when passed round to save our still stuffed stomachs). It strikes us how limited these women’s lives are, chained to the kitchen to cook continuously for the stream of village guests and labourers who tend their fields and animals. Clearly such sadness yet they still have the heart to invite us warmly back with a big smile and warm embrace.

That evening when back in Kaza we went to the Spiti festival. Some of the most boring traditional dance in the most exciting costumes (to compensate i guess!) while the Spiti young folk joined in after what was clearly a large tipple. Monks big and small joined the party too. Big goodbyes to the darling dolma and Jo and the team, how did that week pass so fast!?!

So now we are back in Manali. During the long journey, Laji casually acquired an old nunnery to convert into a school. While this serious meeting was going on, we sat in the van outside the convent with Deepak’s mixed music tape blasting the best of Bieber and some suggestive Indian rock music…I’m sure the nuns loved it. So now clean and thankfully sugarless tea-ed up we go to Delhi on the overnight bus tonight.

Slightly dreading it but Chennai calls!

I commend you if you’ve got this far. And this isn’t even the half of it. Hope you are all well! love the Arabian harem. xxxxxx