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Posts Tagged ‘medicine’

They were four little words you definitely do not want to hear while living in India:

You. Might. Need Surgery.

It’s bad enough to be lying in a fetal position after spending your day taking tests. It’s another to contemplate having your body chopped into while living in a foreign country. I was not a happy camper.

It probably started with me boasting that I hadn’t gotten ‘India sick’ yet. I like to say this to people a lot – to be fair, it’s mostly to try and comfort people who are visiting. Such as, “Oh, you won’t get sick from the food. I’ve lived here six months and I haven’t gotten the notorious ‘Bombay Belly’ yet!’ I think I do better than my friend D who just likes to declare that she has a stomach of steel.

But I think there was a little bit of karma involved when I started to feel ill. It was as though the India gods were saying, “ok, you don’t need to get sick from food. We’ll give you a good-old-fashioned-regular-illness instead.”

I felt a bit ill on Friday but I only started to worry in the evening, when I took my temperature and it was above 100. I called my friend A.

“I have a weird question to ask you,” I began. “I have a fever. And Daniel is out of town. If this was America, I wouldn’t be nervous…”
“But it’s India.” she responded, clearly understanding where I was going.
“Right, so maybe you could spend the night over here in case something happens in the middle of the night?”

She, of course, said yes. You see, there’s an interesting thing that happens to all expats who live here: you get paranoid. And it’s justified. You hear too many tales that begin with, “Oh I thought I had a cold. But really it was dysentery” Or malaria. Or dengue. Everyone has horror stories about eating the wrong food or drinking the wrong juice. And these horror stories are much worse than your average food poisoning tales. So even the smallest hiccup or cough suddenly starts your brain ticking. What did I eat yesterday? Did I see a new mosquito bite on my ankle? Did I really wash that apple enough? You could go crazy worrying about getting sick – which is why most people stop obsessing over the small things after they’ve been here awhile. We start brushing our teeth with tap water and accepting ice from places that say they use mineral water. But it always lives in the back of your mind, the fear that India’s many health scares are coming your way.

I thought about all of this as I tossed and turned throughout the night. I couldn’t get comfortable no matter which position I picked. At 2am I looked at WebMd’s symptom checker. Bad idea. Once you say you’ve travelled to a third world country it starts giving you even more ideas. At 4am I wikipedia’ed dengue. That was comforting – apparently I would have had a rash, so it couldn’t be that. At 6am I took my temperature for the 20th time and was nervous to see it had gone up to its highest point so far. By 8am I woke up A.

“I think it’s time to call a doctor.”

My symptoms sounded bad- pain in the abdominal area on the right side of a female usually means appendix or ovaries, neither of which should be left unchecked. So we headed over to a clinic the doctor had recommended in order to get an ultrasound.

As I waited my turn in the plush waiting room I thought to myself, “This isn’t so bad.” It looked nicer than any clinic I’d seen at home. I was able to stretch out on a leather chair while a flat-screen tv showed the day’s cricket match (not my cup of tea, but interesting enough). Even with the nice setting the whole ultrasound only cost 1,200 rupees, or roughly $26. That’s before I even submit it to my insurance. For all the things to complain about the on the potential-diseases-you-could-get spectrum, I also had to be impressed by the low cost of everything. It’s not a low cost relative to the average income in Mumbai (where a large percentage of people only make a few thousand rupees a month), but compared to American health care, it’s a steal.

However my initial optimism soured a bit with the results of my ultrasound. I had “edematous gall ballder walls with sludge’ and ‘enlarged lymph nodes with fatty hila’. How was I to know what that meant? Sludge certainly didn’t sound good. Most annoyingly, they unfortunately they couldn’t get a close enough shot of my appendix to tell if it was bursting. So it was off to a CT (which, just as an FYI, cost around $120).

I’ve never had a CT before, but I can assure you that it is all the more unpleasant when 5 out of 6 techs in the room do not speak your language. They didn’t really understand that I was in a lot of pain, and therefore was having difficulty lying in one position. I couldn’t explain that my elevated fever was giving me the chills, which was also making it hard for me to not shake a bit. Finally a woman came in who spoke English and put a few blankets on me. I thought she might be my savior until she informed me that I would need an IV that would pump warm contrast into my veins as well as a tube going into another area (which I won’t go into depth describing here, since this blog aims to remain family friendly!). Needless to say, by the end of the CT I was feeling worse for wear.

That didn’t compare to my doctor’s visit after it all, where the idea of surgery was finally raised. As I lay curled up, exhausted from tests and fever and an unflinching pain, I listened to what the doctor had to say. You see, my appendix was fine. But that darn gallbladder was indeed inflamed and it would either need to respond to multiple medications or it would have to come out. A surgeon was lined up and at the ready in case I needed him. I suppose that was supposed to be comforting. We would just have to wait and see whether the inflammation and infection could go down before surgery became necessary.

Luckily the combination of the largest antibiotics I’ve ever seen, anti-inflammatories, pain medication, and an anti-nasuea medication normally reserved for chemo patients (the antibiotics apparently can be too strong to handle without some other medication) has made me start to feel like a new person (and all the medications together cost around $5). Within a day my fever went from almost 103 to almost normal. I’m certainly not at my best (those antibiotics are really not making it too easy on me), but at least it’s looking like I can keep my gallbladder.

So what have I taken from my few days of true illness in India? Well, firstly I will never make the silly claim of not having been ‘India sick’ again (although technically, lets be honest, 6 months of no food poisoning is pretty amazing in here. Knock on wood). I’ll also appreciate the cost of medicine here; it’s really something we Americans forget when we have insurance and something we decry when we don’t. If India can do it this cheaply why on earth can’t we even lower our costs a bit? I alternately appreciate being able to see a reliable doctor here and having the means to pay for it. I couldn’t help thinking of all the women I’ve met in Dharavi who clearly can’t afford to even get the kinds of tests I was able to get. It’s scary to think of how much pain I was in and the idea that someone couldn’t get the right diagnosis to lead them to the proper medication. It’s certainly something to be reminded of.

Mostly though, I’ll just appreciate (almost) having my health back. I’ve been lying around thinking of writing and being sad that I have no stories to tell other than the woes of a nauseous person with an enlarged gallbladder. It’s time for me to get better and back to everything I enjoy about living in India. Other than, of course, its predisposition for making us foreigners ill.

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I have to be perfectly blunt and say that I can’t possibly fathom what it is like to live in a 10-foot by 10-foot room with one window and one stove and no bathroom with my entire family.

In fact, I don’t really know how to realistically process and respond to my first foray into residential Dharavi without falling into the trap of minimizing, dramatizing or romanticizing the experience.

All I can really say is that now I have seen with my own eyes the living standards that I have heard so much about since moving to Mumbai. And there are a lot of impressions and thoughts that came with my first visit.

I went back to the hospital to meet up with the supervisor who I had been shadowing. He informed me that today, instead of a group meeting, he and his field workers were going out into the community to distribute information about hygiene. This monsoon is the worst in five years and there has been a serious outbreak of malaria and dengue.

I tried to ask in the most polite way, as I had every day, what this had to do with curtailing domestic violence (since that, ostensibly, is their main mission).

“It has nothing to do with violence. But we give information, which is good. Then some people will come to meetings about health care, which they are interested in. Then, once they are involved, we can talk about ending violence. If we start with violence, nobody cares.”

I followed him out of the hospital wondering how he and his field workers get the energy to go out every day when they can’t even raise the topic that they are interested in. It just seemed so daunting.

He informed me that we had to drive to the area we were going to (Dharavi is, after all, very large. At least a million people live here). As we drove he tried to warn me.

“Just… be aware of your feet.”

“My feet?”

“Yes, your feet. They will get dirty. I hope that’s ok.” He didn’t elaborate, but I got the general gist.

We pulled over once we’d gone as far as we could go – I very quickly realized that walking was going to be difficult, let alone driving.

The method for the day was to go “door to door” (I put that phrase in quotes because most of the homes did not have physical doors beyond a makeshift bed sheet).  We walked in from the street and it immediately felt like we’d entered a maze.

They path between houses

Walking into a residential section of Dharavi is actually kind of reminiscent of walking through the tightest alleyways some small European town – if the town were made of poorly constructed cement structures and if you’d been transported back to a time with little plumbing and amenities.

Each home is directly connected to the home next to it, and you maneuver through the area with only a small 2-foot wide pathway serving as your sidewalk. In the middle of this pathway is a hole running the entire length that serves as both a place to lay small pipes and as a moat of sewage.  This is the part that really gets to you if you’re not used to it – there’s a constant pervasive smell of garbage and sewage, which is only exacerbated by the lack of fresh air making its way in. The lanes are so narrow much of it is covered with tarp, so the smells and the heat combine together throughout.

This also creates a trap for the heat– so even though I hadn’t been too hot before we entered the slum, once I was inside the narrow pathways the stale air, confined quarters and number of people surrounding me ensured that I existed in a permanent sweaty state.  But, on the other hand, it started making me cognizant of the small victories: every time a breeze came through I felt it was the coolest moment of my life. I quickly appreciated every wisp of the wind in a way I never had before.

The scene that was laid out in front of me at each turn of the corner was similar– every home had one room, the structure was made of some combination of cement, brick and wood, the roofs appeared to be made of a kind of sheet metal.  Inside every room there was usually a stove, some mats for beds, and a few personal items. A good number of the rooms had televisions – one of the many contradictions that existed in the slum. When at one point I found myself standing at a vantage point where I could see above the structures, I noticed that every third home appeared to have a television dish.  And for every person watching television there were five more staring down at his or her mobile phone.

Color along another path between houses

There was also color everywhere – walls were painted in bright hues, varying clothes dried on the outside of every single house, and children in school uniforms were always running through, brightening the alleys. I don’t know whether it was purposeful or not, but the constant explosion of color gave the slum a vibrancy that seemed to defy the darkness that pervaded in each of the individual rooms.

I mostly just watched as the field workers approached each home and handed out pamphlets  (which had words and text depicting healthy bathing habits, proper garbage disposal and boiling water properly). Some people would only politely accept the handouts without any discussion. Others would take more time and ask questions.

I asked the supervisor what sorts of questions were most common. He said that some people couldn’t read the pamphlet and so they needed to understand the content. Others wanted to know more about the organization. It was in these instances that the field workers could try to encourage the residents to come to a meeting (and they were going to hold one directly following their leaflet distribution). It was their first stage in getting people involved.

Sometimes the discussions took longer – a few people wanted to share their difficulties with the field workers and they would stop to listen and encourage. One woman got angry. She started yelling and talking very animatedly. I had to ask again what was happening.

“She thinks we are useless,” the supervisor said matter-of-factly, “She says if we really wanted to help we would bring medication and other supplies. She says no one will help her and her family.”

“How do you answer that?” I asked.

“Well, we gave her information on clinics that she could go to and places that do give out medication. I understand why she is angry though.”

I didn’t respond. It was still hard for me to shake my previous thought: how could these people be strong enough and motivated enough to do this work every day? These community workers were standing there being yelled at, and instead of being frustrated they were sympathetic of where the anger came from.  I was constantly struck by their enormous patience.

I felt pretty useless in the whole endeavor, but the women kept nudging me along and helping me find my way. They still seemed to accept me, and I felt sort of flattered that they’d actually let me come along for the task. The Dharavi residents themselves mostly just stared at me. Since the pamphlets we were handing out were from Unicef most asked if that was where I was from. It usually started with pointing towards me and then I’d heard the words “gora” and “unicef” thrown in until the field workers responded with “Ali” and “film”. I could usually tell once the conversation had ended because they’d all stop paying attention to me.
The only people who never stopped staring were the children. Every single one, from toddlers to teenagers, looked at me for however long I was standing in their doorway. At many points children would just appear, clearly after having heard that a white person was in their midst. The ones who were learning English wanted to practice. They’d ask to shake my hand and they all wanted to know my name.   When I tried to respond to them in Hindi (saying what my name was or letting them know that I spoke only a little Hindi) they laughed and tried to repeat what I had said in my clearly very foreign accent. But their laughter filled up the constricted alleyways and brought it to life.

The only difficult point for me came when I almost fell headfirst into the narrow sewage stream in the middle of the pathway. Every time I walked I had to focus on putting one foot in front of the other – the pathways were certainly not paved in any standard way and there were often steps or cracked tile or a steep inclines. One turn that looked like a path ended up being mud and I started to slip. But I quickly had at least 10 pairs of hands on me – every field worker and every woman they were talking to had reached out instantly to stop my fall. When I didn’t fall in they all smiled and patted me on the back.

I don’t want to extrapolate too much from one isolated incident, but it certainly made me feel the sense of community that existed there. Maybe that’s my outsider desire to see the good in a dire situation, but it appeared to me that everyone’s instinct was to protect even the visitors. It’s a difficult life and it seems like everyone has accepted that they all need to come together to co-exist.  And maybe it’s from there that the field workers keep the momentum to do the difficult work that they do.

I don’t know if any of these instincts are right. But I’m certainly looking forward to delving in further and trying to tell these women’s stories.   Watching the number of people who showed up for the post-distribution meeting I certainly started to feel more empowered. I sat in a schoolhouse – one room with a broken fan with one chalkboard and no chairs – as the field workers gave an in-depth discussion of disease prevention to the fifteen women who’d showed up. It’s slow work, but little by little they are enacting changes in their community.

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I started missing Western hospitals right around the moment that I was standing in a thin hospital gown with my face against an X-ray machine while a small man steadied my head so that my nose was touching the right spot on the panel.

This adventure had begun about an hour and a half earlier. My ‘birthday’ sickness hadn’t gone away, and a full week later I had started to wonder whether it was time to finally let a professional have a look. I’m usually a wait-and-see kind of person – if it sounds like a cold and feels like a cold, I usually assume it’s just a cold. But I’d had a low-grade fever every day for 8 days and my coughing was starting to scare small children, so I ventured out to a hospital.

We were lucky that a colleague of Daniel’s had recommended a doctor at Lilavati Hospital, one of the supposedly better hospitals here in Bandra.  We made an appointment for today (shocking) by talking to the actual doctor (also shocking) and we were on our way.

All my payment paperwork

Right off the bat we learned that the most interesting difference between an American hospital and an Indian hospital is that in India (or, at least, at Lilavati hospital) you pay up front.  There’s no “We’ll bill you later” and there’s certainly no chance to see the doctor and then pay.  You go to a desk, tell them what you’re there for, they give you a plastic card that’s wired with your information, and then ask for your credit card.  It’s also shocking that to see the doctor only costs about $17.

We waited for about half an hour. I sat and watched the crowd as everyone sat there patiently. There were men and women of all ages – some were dressed in modern clothes like button down shirts and jeans and others in full-length saris.  But the one commonality was that everyone turned their heads sharply to stare at me every time I coughed.

When we went in to see the doctor he went through the basic procedures – although the light to look at my throat was an actual flashlight. He had a desk that he sat in when he wasn’t examining me. There was nothing on the walls and no windows – it was an odd room to spend your entire day in with people coughing and sick all around you.

When he was done looking he immediately diagnosed me with a chest infection – the doctor said it’s been going around in the monsoon and he’s seen a lot of people with it. Apparently it mostly just manifests itself as the bad cough and cold I’d been experiencing. He assured me that some antibiotics should do the trick, but he also wanted me to get some blood drawn and take a chest x-ray just to be safe.

I had to go back to the front to pay for my new procedures before I could continue. It was 840 rupee combined for my x-ray and my blood tests (Divvied up that meant my blood test cost about $5 and each of my two x-rays would be about $6). I took my payment slips and walked over to the blood lab – it was in and out, very efficient. It certainly seemed like this private hospital had found a good system for getting everyone from one treatment to the next.

A jarring sign...

I went and waited for my x-ray. I sat next to a woman in a burqa on one side and an entire family surrounding one seemingly sick person on the other. It was two microcosms of India in one waiting area.

I looked around at the signs on the wall to occupy myself while I waited. One stuck out to me: “Determination of the Sex of the foetus is not permitted in this hospital. It is legally prohibited.” Apparently there’s been a problem with sex-selective abortions in India, and this is the only way to curb it. People told me later that it got to be such a huge problem here that they just outlawed allowing people to know. It’s signs and notices like that that sometimes jar me into remembering how stark the cultural differences can be here. While I was sitting around marveling at how modern and Western-seeming the hospital is, that sign was a poke in the arm telling me not to get too comfortable.

But as I was getting lost in that thought, the x-ray technician beckoned me in. I changed into a hospital gown and he led me over to the standing x-ray. He carefully pushed my face up against the machine, seeming very concerned that my nose press up against an X in the middle. When the x-rays had been taken he handed me over my very own copy. Apparently I’m as entitled to one here as my doctor.

I picked up my prescriptions and went home – the whole ordeal had taken less than 2 hours and cost me only a bit more than $30.

Many many medications

Of course the funniest part came when I realized quite how many prescriptions I’d been given. Maybe my new doctor believed in the ‘better safe than sorry’ approach, or maybe he just wanted to be extra cautious with the white people, but I walked away as the proud new owner of a large stash of medications. He’d given me two separate antibiotics (why?), a pro-biotic prescription supplement, an anti-inflammatory normally reserved for ulcers, an antiseptic ‘germicide gargle’ (basically just iodine and alcohol with mint flavoring), and a cough suppressant with codeine.

At least he wasn’t taking any chances?  I decided to self-diagnose that I wouldn’t need both antibiotics and that the anti-inflammatory and codeine-ridden cough suppressant could be put aside.   I was going to get better and I was going to take my new Indian doctor’s advice, but I was still keeping a bit of my American sensibilities.

I’m still sort of proud that I haven’t gotten sick from food (knock on wood), and experienced the true ‘India’ sickness. But now I’ve at least been initiated into monsoon sickness and had my first dose of Indian health care – as well as my new ‘germicide gargle.’

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Before I left New York I tried to stock up on Malarone, an anti-malarial mediation. Our doctor had advised us to take it every day, and despite a lot of other people telling us it wasn’t necessary, we figured it was better to be safe than sorry.

However, the pharmacists in New York thought I was part of some anti-malaria stockpile conspiracy and they refused to give me more than a one-month supply.

I had tried to argue my way out of it, but there was no chance. Rules were rules and I just was going to have to get more Malarone once we got to India.

I mention this now, because my experience with Indian pharmacies has been dramatically different.

In order to find Malarone in the first place I’ve had to call around. As is customary here with almost any store, if they decide they don’t want to talk to you, they just hang up or hand the phone to someone else. So my conversations have sounded mostly like this:

Me: Hello? Is this the chemist?
Them: Hello?
Me: Hi. Chemist?
Them: Hi.
Me: Hi, are you the chemist?
Them. Hi. Yes.
Me: Ok, do you have Malarone?
Them: What?
Me: Malarone? It’s a preventive malaria drug.
Them: What?
Me: Malarone.
Them: Hold on

(Pause here anywhere from three to ten minutes while they ignore you or pass you off to another person)

Them: Hello?
Me: Hi. Did you find it?
Them: What?
Me: Malarone?
Them: What is Malarone?
Me: I talked to someone earlier about whether you have Malarone, it’s an anti-malarial daily pill
Them: We don’t have.

Now is the part where you hear the dial tone because they hung up.

Exciting, isn’t it?

But once you’ve found the drug you’re looking for you’ll have no problem actually getting your hands on it.

Indian pharmacy's array of medicines

I finally found a pharmacy that confirmed the existence of Malarone. I walked in and was greeted by a small woman in a lab coat over a yellow salwar kameez.

“How can I help you ma’am?”
“Hi. I called earlier about Malarone –“
“Ah yes,” she said as she turned to go looking for it. I looked at the prescription sitting neatly in my hand, waiting to be passed over. She hadn’t asked for anything. Here I was apparently not a criminal for wanting extra Malarone – on the contrary, it seems I could’ve asked for a multiple-month supply without giving any reason at all.

I stood waiting and eavesdropped on the conversation taking place next to me, between a gangly pharmacist and an older gentleman peering up at him from round spectacles.

“It’s an imported medicine,” the older man was saying,
“Ah, do you know if it’s legally imported? Because we might have it either way, but if it’s legally imported then we’re more likely to be able to get it in,” the pharmacist replied earnestly.

I turned away – I didn’t want them to see that I was listening. But soon my pharmacist came back.

“How much do you want?” she asked.

I took a three-month supply. Why not?  I’ll never know whether the older gentleman got his medicine – legally or illegally imported – but I suppose, like me, he can get whatever he wants. Just perhaps not over the phone.

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