Meditating Fishermen

It is dawn on the shores of the Indian Ocean. The eastern sky has developed a deep shade of orange in preparation for the sun to peek above the distant clouds on the horizon. The sea has taken on steel hue of morning twilight. Down the beach, the fishermen stir. In a short while, they will board their boats, surge through the surf and head out to sea for the day. A few squat in a row, looking out to sea. (Westerners and upper class Indian sit cross legged. Working class Indians squat when they wish not to stand) It is a romantic scene in this land of spirituality. Are they praying, meditating, contemplating the day or simply enjoying the sunrise?

Then they leave and you look down…

Why They Meditate

The Hospital

Now the hospital. A few things stand out.

My first impression of the hospital was the crowd. The main lobby is always busy… always. I wonder what they are all waiting for.

There is a huge Ganesh idol in the lobby, but I have not actually seen any of the multitudes of people in the lobby actually doing any poojas at the idol.

There are separate pediatric and adult emergency rooms.

There are LOTS of nurses. The nurse to bed ratio was 2:1 in the emergency room and close to 1:1 in the normal rooms. Sammy was checked on by four different nurses within a few minutes of arrival. During the stay, he was often checked on; much more often than would normally be the case in an American or German hospital.

The quality of care was certainly on par with an American or German hospital. Unless the American health care system gets overhauled soon, expect to see more and more medical tourism.

The doctors seemed less pompous and friendlier than American and German doctors. OK, they were no more forthcoming with information unless pressed, but their bedside manner is certainly warmer.

The décor was a funny mix of modern luxury appointments and what I call the military base look. By this, I mean functional and well worn with little expenditure on making it look fancy. If I had to guess, I’d reckon that the hospital was being remodeled on a department by department basis; possibly with an eye toward medical tourism.

The pricing structure of everything follows your choice of room. If you take general (several patients per room), then not only is room quite cheap, but the pharmacy costs, physician consultations, lab tests, MRI/Ultrasound, etc. are all scaled down. Moving up to semi-special (2 patients per room) and special (1 patient per room) increases the cost of all of these things; as does moving on the luxury rooms, executive, deluxe and ultra-deluxe. At first, we considered the possibility that the quality of care would scale with the room. After all, privately insured patients in Germany get clearly preferential treatment over those using the public insurance corporations. The administrator that checked Sammy in was adamant that the room choice did not affect the care and told us to only take the luxury rooms if fancy décor, air conditioning (not needed at this time of year) or broadband internet were important to us. We had Sammy in a special, so that we were alone and had a place for the staying parent to sleep. Daniela and I agree that this is an interesting and fair way to scale the cost of health care; charging the high end patients more and giving them a reason to feel that they got something for their money, while subsidizing the bottom end of the scale.

An interesting thing on the pricing scale. We paid for Sammy’s post discharge prescriptions after he had been cleared for discharge (and we had paid up). The prescriptions, some of which were the same, were a fraction of the original cost, post discharge; using the same hospital pharmacy. I have to conclude that the default price is general and everything scales up from there.

One thing did give us consternation; though it was the only thing. On the first evening, Sammy was X-rayed. We laid him down on the gurney. The technician moved him into position and moved the dolly with the photographic plate under him. A tech on the west would start laying lead shielding mats over the other areas of his body and shoo us to a safe area. After all, x-rays are not exactly healthy. Instead, this one asked Dani:

Could you please hold him in this position?

On a final note, the orthopedic surgeon, Dr Chakravarti, is awesome! He is competent and very, very nice. He even stopped by our house the other day to check on Sammy and see how he is doing.

Out

Sammy has been discharged. Dani spent Sunday night with him and I took over yesterday afternoon. We were discharged about 5PM today. The pain has subsided and the ultrasound shows extra fluid in the left hip joint, but much less than initially expected due to the pain level. He has to be bedridden for ten days and take a regimen of antibiotics. How in the world will we keep the boy still?
I have a lot of observations about the hospital, but I’m too tired to think now, so I’ll post them tomorrow.

Here is a photo of Mr. Sammy in traction.

Sammy in traction

A housecall… and a trip to the hospital

Yesterday, Sammy woke up with a terrible pain in his leg. He experienced excruciating pain every time he moved it in the slightest. By late afternoon, we became concerned that it was not just a pulled muscle or a bruise. We needed to speak with an orthopedic specialist or take him to an emergency room. The problem was that we have never used a doctor here in Bangalore and don’t really have an idea which hospitals were good and which ones were not. There are world class medical institutions here as well as places where the care is substandard. Added to this was the fact that this was a Sunday on a long weekend (today is Republic Day). I started to google, but that was just added to the confusion.

So at Siva’s suggestion, I walked next door to Raju, our neighbor. Although a researcher, he is an MD and might at least know who is good and where to take Sammy. Raju immediately picked up his cell phone and called another neighbor a couple of streets over. This neighbor, Dr. Chakravarti, is a well known orthopedic surgeon here.

Dr. Chakravarti, or Chukie as Raju calls him, stopped by our house to take a look at Sammy. He told us that he could not be certain without a battery of test, but Sammy likely had an infection in his hip. He picked up his cell phone and contacted a physician on duty at Manipal Hospital. He ordered blood samples taken, an X-Ray and ultrasound. He then told the fellow on the other end of the line that we’d be there in 45 minutes. We quickly packed – including Sammy’s toy leopard – and took Sammy down to the hospital.

We got into a minor fenderbender in front of the hospital gate (an idiot T-Boned our car, but that is another post for another time). I did not care and just pulled into the hospital parking lot anyway. We carried Sammy in into the front door, past the Ganesh shrine in the main lobby and into the pediatric emergency room. As we waited for the colleague that Dr. Chakravarti had called to come down, several nurses (called “sisters” here) stopped by Sammy’s gurney to check on him. This impressed the little guy:

This is a good hospital

The duty physician quickly came to the same initial assessment as Dr. Chakravarti. They drew a blood sample from Sammy and sent him for an X-Ray. We left Daniela with Sammy overnight as the nurse was off getting pain killing syrup for him. Apparently they had a full program. He had an ultrasound at 11:30 PM and Dr. Chakravarti called Dani at 3AM in the morning to give her a status update. At around 4AM, they started him on antibiotics.

He has fluid buildup in his left hip, possibly from an infection. His blood seems relatively normal and according to the X-Ray and ultrasound, there is less fluid buildup than expected. This is good news. In the worst case, they might have had to open the joint and use a syringe to drain it. I’ll be going to the hospital in a couple of hours to take over from Dani. I’ll post an update later.
The irony here is that we had planned to go down to Nagarhole National Park this weekend and do a jungle safari. I had called around to the various lodges and everyone was booked out. We had been disappointed, but now we are sooooooooo glad that this did not happen while we were in Nagarhole. This was serendipity. For that matter, it was a huge help that Raju knew who to call, that Dr. Chakravarti stopped by and that he took the case seriously enough to call Daniela in the middle of the night.

I think we have to send flowers to a few people when this is over.

A “simple” Jump Start

We had planned to do a bit of hiking in Bannerghatta National Park on Sunday. Bannerghatta is a park just outside of Bangalore that is best known for its zoo and safari park. It has a large rehabilitation center for wild animals and the safari park is something of a retirement home for circus lions and tigers. It also has dozens of square miles of uninhabited and virtually unused land; complete with trekking trails.

We had planned to set out at 9AM, but only managed to get started shortly after ten. Then it happened… dead battery! We had gone to a shopping mall on Saturday. I had turned the lights on while pulling out and then forgotten them in the daylight. The trick of pusing the car into a good roll and then popping the clutch to start it would not work. It was stone cold dead. Now in Germany or the US, we’d just dig out a set of jumper cables and be set to go in five minutes. Nobody in India (mechanics included) seems to have jumper cables and it is certainly not on any expat “things to ship to India” lists. That was the end of the hiking trip right then and there. “Sunday Hiking” turned into “Let’s see how they get dead car batteries running in India”.

So Siva called her driver as he lived just a few minutes away. He then set off to find heavy enough wire to use to jump the car. He came back with a low gauge wire that was about half as thick as the wires on jumper cables. He then removed the battery from her car and wired it up to our Innova.

Not enough oomph! For the record, the Toyota Innova has a much bigger battery than the Honda City.

Then he put the battery back in the Honda and we tried a traditional car-car jump start approach. This time, the gauge of the wires was too small and they were too hot to hold in place while cranking the Toyota over. We almost got it though. Luckily, there was a family at the corner with the same kind of car as us. They kindly let us borrow the battery so we could take ours to a mechanic and have it put on a charger.

The repair shop on Whitefield road did not have jumper cables, so the mechanic did something breathtaking; something that would give any OSHA inspector palpitations. He had me start the car on the good battery. Then, while it was running and feeding off of the alternator, he removed it and put the dead battery in.

WHILE THE CAR WAS RUNNING!!!

There were pulleys pulling belts and fan blades all over the place and this guy is changing batteries. He then had us drive it ten miles to recharge the battery and all was well.

WHILE THE CAR WAS RUNNING!!!

The moral of this story: Ship the jumper cables

The Fogger Dude

Every night at 7PM, we have a visitor on our street. A man rides a bicycle along every street curb in Palm Meadows. On the back of his bicycle is an insecticide fogging device which he uses to fog up the neighborhood. An American neighbor two streets over refers to him as the “fogger dude”. The kids have learned to drop everything and come inside when he comes around. A couple of weeks ago, Sammy took half an hour to put on his safety gear for skating. He finished putting on his gear and went out with his skateboard. Two minutes later, he came running back in.

Fogger Guy!

The fogger dude never wears a mask. Daniela told me about a thirdhand story that she got from another German expat who spoke to an Indian who was familiar with the fogger dude system and heard a shocking line; one that seems to be handed down trough word of mouth:

They usually stop coming after a little while. Then a new one takes over.

Pic of the Day – The Pee Man and the Monkey

I took this shot in the old city of Jaipur. Yes, they have public urinals up there that are open for the world to see. No, they do not lead to the sewer system. (they just seem to be aimed that proventing men from peeing just anywhere) No, they don’t seem to actually prevent men from peeing just anywhere. I saw a man urinating ten meters from one of these rows of public urinals.

And yes, it appears that monkeys are more common on the streets of Jaipur than Bangalore

Monkey

Architecture II – The Bathroom

On to a much earthier subject for today; with an appropriate warning that this entry is not for anyone eating lunch.

When you enter an Indian bathroom –that is their take on a modern, western style bathroom, you notice a couple of oddities. Firstly, there may not be a bathtub. In fact, here may not even be an enclosed shower, but rather a part of the bathroom that can be curtained off. It is actually quite practical as the whole bathroom floor has a slight downward slope to the shower and you can hose down the whole bathroom floor if you want. It is all much easier to clean than a western bathtub or shower stall.

Where would you find such a hose you might ask… well right next to the toilet of course. There always seems to be a hose with a flip trigger right next to the toilet. Indians don’t traditionally use toilet paper and in fact hotels sometimes tell you not to flush toilet paper down as it can clog the pipes. Whatever they do with Lincoln log situations, I do not know and I’m not sure I want to know; though I’m pretty sure the kids would be fascinated and there is probably a profession of people who stand around all day, waiting to hande such situations. For this reason, the toilet paper roll (if available) is often in some ergonomically impoverished location (such as smack up against where the shower curtain meets the wall), almost as if the bathroom designer wants you to use the butt hose. This is not the kind of wimpy little hose jet that you see on American kitchen sinks either; it is a full bore industrial strength sprayer. Imagine for a moment that you are sitting on a toilet and you need to clean yourself. Now as you are sitting, it is the bottom side of you bottom that needs a good hosing; which naturally means the hose needs an upward angle. The kids tried this a couple of times; until we banned them from using the hose.

The Butt Hose

Now this hose carried over from the more traditional toilet. Most lower and middle class homes still have the traditional one and our house has one as well behind the kitchen. It amounts to a hole in the ground with footholds that you squat over. That’s right, you squat. You never squat with western toilets. Even in makeshift backcountry outhouses in wilderness areas of the Adirondacks, you sit on a wooden plank with a hole in it. Even in the more makeshift (read wall-less) outhouse that I encountered at a campsite in Algonquin Park in Ontario, Canada, you sat. Sure, there was something gigantic (a bear? a moose?) moving in the brush less than a hundred feet away. Sure you had a flashlight in one hand, TP in the other and a gigantic Bowie knife between your teeth; but you sat by golly! Traditionally, Indians have found western style toilets uncomfortable.

I’m still puzzled as to how you avoid brown slurry wall painting disasters in traditional bathrooms.

Jelly Belly!

We managed to get sick for the first time. No, I don’t mean the nasty head cold that I caught at the start of the monsoon (the monsoon is the cold and flu season here), but the throwing up, running to the toilet kind of sick.

It started yesterday morning at the lodge in Bandipur (which I’ll write about tomorrow). Already on the morning jeep safari I felt a little sick, but not enough to interfere with my enjoyment of the outing. At breakfast, Daniela asked me “do you also feel sick”? I answered in the affirmative. We were scheduled to go take a forest service elephant ride, which is what we had promised to Sammy for his birthday. We wondered if it would be better to pass on the elephant ride and do it again sometime at Bhannergatta National Park near Bangalore. After all, Bhannerghatta is a day trip excursion from Bangalore. We decided in the end to go ahead and do it anyway, mostly because sick or not, doing it during the off season at Bandipur would be more pleasant than doing it along with the crush of humanity that would be guaranteed at Bhannerghatta.

While we were waiting for our ride, Daniela wandered away a bit. She was on the verge of vomiting. At first, she thought that she would just watch us from the ground, but eventually decided to go with us. The first rule about riding elephants is that is that it is a low-G variant of a roller coaster ride. Elephants don’t move smoothly. They wiggle their butts from side to side and up and down. They also get annoyed when told that they can’t stop and browse on a tree. Annoyed elephants make a lot of noise and wiggle even more. Suddenly, she passed Sammy from her lap to me as she was on the verge of throwing up… from the back of an elephant. She managed not to. I told her that would have been a story worth telling and retelling for many years.

When we got back to the lodge to check out, we both vomited. I also had the runs and paid three visits to the toilet within a span of five minutes. Then we set off on the six hour drive from Bandipur to Bangalore with queasy stomachs and holding back the runs. I managed to hold back the runs for six hours; a very uncomfortable six hours. For a good portion of the trip, I was on the lookout for a suitable roadside place where I could go behind the bushes. Such a place never turned up. It seems that wherever you go, there is always someone around. Between Mysore and Bangalore, we had to pull over to the side of the road so that Daniela could throw up into the bushes. That was a pleasant ride! Luckily, the kids caught a milder form.

Today, we feel better, though not 100%. Dani is working from home. Sammy stayed homw today and Charlotte went to school, but with a not excusing her from gym class.

Cola, the heathly alternative!

There is something that really stunned me after arriving. I read a statistic somewhere that 10% of Indians have type II diabetes, the world’s highest rate of incidence. I understand why. I though Americans had a sweet tooth. It pales in comparison to Indians.

At the kids’ school, they serve breakfast. When the teachers offer to put sugar on the kids’ cereal, it is not a dash for flavoring; it is a big, heaping spoon.

If I order a coffee somewhere and I say “just a little sugar”, I get a whole packet. I try to add my own sugar if given the chance.

They do the same with tea. Admittedly, it is delicious. It is also a ticket to obesity and diabetes however.

In the juice section of the supermarket, it is hard to find 100% juice. It is easy to find sugar water laden with some juice (nectar or “drink”). Alarmingly, many of these “juices” push 20g of sugar per 100ml. That is TWICE the sugar content of Cola!