51 pounds

“We’re having a problem with the weight distribution of the luggage on the plane.” On the overhead speaker, the Captain was kindly informing the passengers as to why the plane still had not pushed back from the gate.
“My bag is probably weighing down the wrong part,” I thought to myself, partly amused and partly regretful about how much I had packed. 51 pounds. Yes. Somehow I had jammed 51 pounds of stuff into my suitcase for my three month trip to Nicaragua. Indeed, three months is considered by most to be quite a long trip, but 51 pounds borders on ridiculous.  As I thought about it, it seemed to be symbolic of the ever present need of material things exerting its temporary comfort in my life, but remaining ultimately unsatisfying. This temporary material compensation gets worse when I’m stressed. Leaving home for several months has its challenges. Hence the fifty-one pounds. However, I have found that the more stuff I have, consequently, the more stuff I have to worry about. It’s a strange addiction….or maybe it’s more of a habit. It is a part of our culture, certainly.

Galatians 6:7-8  Make no mistake about this: You can never make a fool out of God. Whatever you plant is what you’ll harvest.  If you plant in the soil of your corrupt nature, you will harvest destruction. But if you plant in the soil of your spiritual nature, you will harvest everlasting life.

That fifty-one pounds gives me a fleeting satisfaction with here and now. One thing about the joy that comes when I am certain that I am doing what God calls me to do is that in service to Him, I become truly satisfied. It is enduring and gives joy when I revisit those memories.  It is easy to forget what that joy feels like, though, and if I’m not focused on God, then I have trouble knowing where to go and what to do next to find it again. Fear and worry then come to the forefront and I quickly attempt to muffle them by, metaphorically speaking, packing an extra jacket or shoving more outfits into my suitcase. I don’t just use material things for distraction; food and entertainment also have their place. What I should do is take a minute to pray for peace and guidance. I know God will prepare and provide for what comes. My little discomforts will not even be noticed or remembered.

People ask me if I’m worried about traveling to another country. Yes. But I am more concerned about losing my way in the world and being wrapped up in my own selfishness. Sometimes it takes the physical challenge of dragging 51 pounds around and a reminder from the Captain overhead that I might need to re-evaluate.

Tonight I landed in Managua, Nicaragua. When I was looking for the address of the hotel where I will be staying the night, I came across a Yelp review that essentially compared the hotel to a North American or European standard with a searingly negative review. I suppose it is all about perspective because I thought this hotel was exceedingly nice especially given that it is located in the second poorest country in the Western Hemisphere (…although it is rich in spirit and culture…). I’m glad I’m coming from that perspective and again I will make a conscious attempt to let go of all the things I “need” that I don’t truly need. For the most part, I need faith, my basic daily needs met, safety, purpose, and the ability to sustain old relationships and build new ones. I think that’s a good start. We will see what tomorrow brings.

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Flying into Managua at night.

Back to Delhi

 

 

Trust in the Lord with all your heart
and lean not on your own understanding…

~Proverbs 3:5-6

Yesterday I went up to ICU to see the baby that had the heart rate of 20 who had been resuscitated after birth by c-section. It was a dreadful sad thing to see. He was on a ventilator and he had only minimal response to pain. Still I prayed that he would get better. Usually, when bad things happen in a medical situation it is multi-factorial, but I felt ultimately responsible. Although I could never have known that the outcome would be this tragic, many “I should have” thoughts kept surfacing in my mind and “what if” questions that had no answers. Scribbled in the chart were the words “Family wants to wait two more days”. They were holding on to hope that their son would get better.

I stayed a little longer watching the machine-assisted breathing. I placed my finger in his tiny palm, said one last prayer, and said goodbye.

The night before I hadn’t been able to sleep so I stayed up reading a book that one of my attendings gave me called “On Call” to completion. It was about a surgeon who had served as a missionary in Africa. In the dark, under my mosquito net, reading by flash light, I found some comfort in the struggles he faced and his ability to rely on God for unanswerable questions. “Lean not on your own understanding…”

In one day I would be leaving. The other girls in the house and I went up to the rooftop and looked out in the evening over Raxaul Bazar. There were lights and colorful banners hung up across the town for a ten day Hindi celebration. All night there was music blasting, people singing, and parties everywhere. Motorcycles careened around the corner along side bicycles that maneuvered skillfully out of head on collisions at the last minute like a never ending game of “chicken” over and over. The sun was blood red in the sky, hanging just over a smog layer in the distance. Then it faded into night. Only men were out in the streets now, a dim glow from fluorescent lights spilling onto the streets. People stood idly talking. Men washed their hands at a water pump. The music played on.

I was getting eaten alive by mosquitoes despite having sprayed myself with DEET. The mosquitoes didn’t seem to care, and especially had no mercy for the inside arch of my foot, which is needless to say a terrible place to have mosquito bites. While suturing up a vaginal laceration at one point during my day, they kept landing on my face and I couldn’t wipe them away. I was wishing I could twitch my skin like animals do. Not everyone was so unlucky to have so many bites and react as badly. Sometimes it’s the little things that can drive you mad!

One day, the girls wanted to go to the fruit and vegetable market so we went by the back way of the hospital. There is a very tiny gate you have to squeeze through and a small path to walk on. We had been warned to stay on the middle of the path because the sides of the path were actually the toilet. We walked mostly single file. We approached railroad tracks to walk down. Most of them had never walked on train tracks before–probably a wise decision. We were almost to where we turn off on the main road that leads into Nepal when we heard the train coming. It wasn’t close enough to hurt us but we ran laughing to the other side, well clear of it. Sometimes you do things here out of necessity that you would never do at home.

At the closed gate around the train tracks a pile of motorcycles and trucks piled up immediately. Despite the closed border of Nepal, the traffic was still hectic. Men turned their motorcycles sideways to get them under the gate. I weaved through the traffic, turning sideways to fit in between the vehicles at times. There are so many sights and sounds and throngs of people that everyone gets sensory overload. Inevitably when you aren’t used to it, just an hour outside walking around plus the heat and humidity make a person tired and ready to rest. We got to the market and it was beautiful and filthy at the same time. It was alive and dead simultaneously.

All around me were sacks, baskets, and piles of vibrantly colored spices. Sellers sat amount big piles of fruit and vegetables. There was a sweet block of something that I can’t remember the name of that attracted so many flies that it was more covered in flies than not. There was a rancid rotting smell sometimes and and at other times a delicious smell would waft through. I really wanted to try or smell all the spices. I had a silly fleeting vision of throwing all the spices and watching it color the air. It probably would have been too hard to buy much of anything without having someone who spoke Hindi with us so I didn’t try. The market went on and on but there wasn’t need to go further since it was all about the same. There were so many repeats of the same thing being sold that I wasn’t sure how anyone made a profit at all.

Some of the girls needed to go to an ATM so we found a bank. The rest of us stood outside. At one point, a man came up to us, stood about five feet away, and just stared. After he had satisfied whatever curiosity he had, he turned and walked away. We shrugged. We were, after all, a rather odd sight in the middle of Raxaul in the most lawless state in India.

When we got back to the guest house, it felt like a quiet sanctuary. Everyone was tired. I was still thinking about the baby. I went to take a nap and escaped my thoughts for three hours in a restless, tossing sleep.

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I was to leave soon and it was time to make travel plans back to Delhi. Because of the elections, no hospital vehicles were being used to transport guests because any private vehicle if out driving in the streets could be suddenly recruited to help in elections and then returned weeks later regardless if the person wanted it to be used or not. Therefore the safest thing was not to drive your vehicle. I would need to get a ride from a taxi company, however in a fortunate turn of events, two other guests were leaving at the same time so I was able to ride with them. One of the guests also spoke Hindi, making our travel even easier. Because of the strike and closure of Nepal border, half the road was taken up for miles and miles by trucks parked on the side of the road. This was to our advantage in the end because the overall traffic was less. This meant that a normally seven/eight hour drive to Patna took about five and a half hours. There is a giant bridge we had to cross that people joked we had about 75% chance of getting across alive. Apparently, when it was built maybe ten years ago, it’s infrastructure was never meant to carry the heavy overloaded trucks. All the drivers had to do was pay the man at the front a little extra fee to be allowed drive their overloaded truck across. The result of that was that parts of the bridge were ruined and everyone had to jam into one lane on parts of it or face certain peril. No one seemed to mind, though, as long as they got across. Again, we met less traffic that usual and we made it without trouble.

We stopped at a KFC, which does far better here than McDonalds (beef…). It wasn’t my choice, but we knew it would be safe to eat. It was empty and very fancy; probably too expensive for most people to spend on lunch. I wondered if it picked up at dinner. We made it to the airport early and I had three hours to waste. I can sleep anywhere and sitting up so that’s what I did. Soon I was on a flight to Delhi.img_0053

 

Crossroads

Come to me, all who are tired from carrying heavy loads, and I will give you rest.  Place my yoke over your shoulders, and learn from me, because I am gentle and humble. Then you will find rest for yourselves because my yoke is easy and my burden is light. ~ Matthew 11:28

Stand at the crossroads and look. Ask which paths are the old, reliable paths. Ask which way leads to blessings. Live that way, and find a resting place for yourselves. ~ Jeremiah 6:16

Crossroads

It was time to do my first Caesarean section as primary surgeon. A week prior my attending had said, “Your first c-section will be a breech baby with a head too large to come out. Next week there will be one.” Indeed, she was now here on the operating table. My attending was standing across from me guiding me through steps I had observed at least twenty times before, but now I was actually doing them. When we had incised down to the uterus, I reached with my right hand into the uterus, grabbed onto the baby’s bottom placing my index finger into the fold of the hip and when I pulled the baby out, I pulled it so that it’s back was against the mothers abdomen (it’s feet pointed at mom’s head) and my attending gave fundal pressure so that the head finally came out last. Baby saved.

Two days later, I was looking over a patient’s chart when one of the nurses called me over. A laboring patient in her first pregnancy was having decelerations, which are signs of fetal distress, however these decelerations were what we call “early decelerations” and were not as concerning as “late decelerations”. Late decelerations occur after the mother has had a contraction. We watched the baby’s heart rate and response to the contractions closely, but the baby wasn’t responding well whenever there was a contraction. After two late decelerations, we decided she needed a Caesarean section and ordered the trolley (stretcher) to come. I checked the heart rate just before she left the labor room for the OR and the baby’s heart rate was reassuring. I changed and scrubbed for surgery.

I thought everything was going fine because we were about to do a C-section to get this baby in fetal distress out and so I was discussing the case with the medical student while we scrubbed and the OR staff was bringing the patient back to the operating table.  I was wrong.  Suddenly, I became aware that the OR staff could not locate a heart beat. We took an ultrasound and could see it beating at 20 beats per minute when it should have been well over 100. Immediately, we proceeded to the get baby out in probably less than five minutes.

The baby was rushed out of the room to be resuscitated. It was a boy. He was pulseless now. Chest compressions went on for 15 minutes and he was intubated. They could not get a pulse.

Meanwhile, I was in the OR starting to close the uterus. I was praying in my head. I was praying that the baby was okay. I was praying I would close the uterus properly. The uterus was bleeding and I couldn’t see well. The assistant knew me well and she said, “Don’t panic and just go on. It will be okay.”

My attending returned and she said, “The baby is dead.” For a while we continued on suturing in silence and then she said, “What do you think?”

I was thinking a lot. And praying. I said, “I’m thinking about what happened, replaying everything in my mind. I’m wondering what I could have done better. I wonder what the patient and family thinks. And I wonder what I’m supposed to learn from all of this. I don’t really know the answers to these questions.”

We finished in the OR and walked out to do paperwork with heavy hearts. The Australian medical student saw me and said, “The baby is alive.” I had her tell me again to be sure I was hearing her correctly.

Apparently, just as they had given up hope, the medical student had seen a heart beat. They had taken the baby to ICU intubated. Unfortunately, on the way there it accidentally got extubated and had to be reintubated.

I prayed some more. I can’t begin to describe all the thoughts I had and the weight and feeling of responsibility. I thought to myself several times if I was capable of bearing that weight. I have thought about it all day today. Surely, if it is the burden that God wants me to bear then he will equip me to handle it. The last I heard, the baby was alive.

In about two weeks time, I have seen and learned an incredible amount from a medical perspective in high risk obstetrics.  That is certainly a privilege.  The knowledge drives me onward…

In church today, a missionary/pastor named Mike talked about the restlessness we have in our spirits and how the paradox of Christianity is that God gives us a burden to carry and offers peace within that burden. He said that “God’s yoke fits you” and “His character is revealed in you”.  The question is, ‘How do we labor with a refreshed soul?’ If we leave the burdens that are fickle and take up the task God gives us, then he will give us His grace in which we can rest.

I feel as I near the end of my residency that I am at a cross roads. What is my purpose?  What do I do from this point?

“With pain there is growth. The threat can become an opportunity.”

All I know to do is pray…and then listen.

Little Flower

My thoughts are not your thoughts, and my ways are not your ways,” declares the Lord. “Just as the heavens are higher than the earth, so my ways are higher than your ways, and my thoughts are higher than your thoughts…My word, which comes from my mouth, is like the rain and snow. It will not come back to me without results. ~Isaiah 55: 8-11

Today we went to Little Flower Leprosy Hospital and the village for the leprosy families. It is only a fifteen minute walk from Duncan and it is a beautiful, peaceful walk through the rice fields. It is quite a contrast from the bustling streets a few minutes away that are lined with merchants and full of honking cars and motorcycles. The hospital is a 140 bed hospital. We were to meet a girl named Anita who lives in the village, talking care of her parents who both have leprosy. I had met her the previous day at Duncan as she was going to have an interview for nursing school and upon finding out that she lived in the village, I asked if she could meet at 11:00am today. She said she would.

The five of us (two girls from Germany, one from Australia, M and myself) walked to the front of the leprosy hospital and waited under the shade of some flowering trees. Three children came up to us and posed for a picture, acting shy at first. Nearby there were people doing laundry outside near a water pump and other little children running around, some without clothing. A young boy walked by and I saw that his hair was lightened from malnutrition.

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Little Flower Leprosy Village

Anita was late, but not really late by Indian time so we decided to walk around for a bit, then come back and see if she was there. We walked down the Main Street and noticed that Sunday must be laundry day because everyone was washing and hanging up the laundry to dry. We walked into a silk scarf building where the scarves were hand made and sold. It was closed because it was Sunday, but we could still see where people worked. It looked like it was set up through Fair Trade organization. The village was nicely put together with a road and good drainage system in place. There were people all around with various wounds from the leprosy, mostly deformities of the feet. I particularly saw one man who was walking who had shoes in both feet but it didn’t seem that he had much of a foot to bend the shoe when he walked.

We continued on and walked right to the border of Nepal with a river separating the two. On the other side were some guards in uniform with guns slung around their shoulders. They were laying down under the shade of a tree and when they finally noticed us, they all sat up. There wasn’t much to see and it was hard to imagine that there was so much turmoil surrounding the border. We had noticed people coming to the hospital from Nepal in bad condition due not being able to access healthcare earlier.

When we returned to the leprosy hospital, Anita wasn’t there so we started to walk home. A few minutes later she came running up behind us, apologizing profusely. We didn’t mind. I felt bad in a way. She was the only girl of the family and the youngest so she was left to take care of both her parents. Later she showed us her home which for her mother, father, brother, his wife and their baby was two rooms. I’m not sure that she even had a bedroom. The one nice room was given to her older brother and her father was bedridden. When we walked in to the room a very thin woman looking to be about 80 (but she wasn’t) was sleeping on the concrete floor next to a bed (I am not sure who the bed belonged to if it wasn’t for her) and this was Anita’s mother.

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Anita took us to a very nice building that was a community building where people could eat. They made tea for us which we at first had said no because we were late for lunch but I think in India you must stay for tea and this is no need most of the time to worry about being late. It was excellent chai. Then they asked if we wanted to buy silk scarves and that they would open the shop just for us. There were so many beautiful scarves that it was hard to choose. I felt strange, as I always do, spending thousands of rupees on scarves after just having seen the living conditions of Anita and her family. She stood next to me, so kind, intelligent, and helpful. I hoped that she would enjoy learning and be able to pursue her dreams despite being a girl and in the face of all life’s challenges. A woman at church shared a testimony tonight where she said they had some girls they were working with who did not only have no dreams or idea of self worth for themselves, but they did not even know what it was to have a dream. It is important to let people know that they have worth, that they are loved.

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Little Flower Scarf Shop

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We said goodbye to Anita and she gave me her number and told us to call and visit any time. She didn’t have much, but she was happy to give.

The bible verse was discussed today in church and it made me think about how we do make a difference in seeking and doing God’s will. Through many people working together, this beautiful village for the outcasts of society was built and is still there today.  Likewise, Duncan Hospital serves so many in need.  Sometimes we struggle and we can’t see results until later, or maybe we never see it in our lives, but perhaps what we do today will give an opportunity for a girl to fulfill her dreams or a safe place for someome to stay or educate a healthcare worker to save a life.  You can’t see the end product of what God is weaving, but like the silk scarves in Little Flower, God promises something beautiful will be the result from the work we put forth in serving Him.

Morning Rounds, Day 1

After breakfast, Dr. Christo stopped by to take us on rounds and show us the hospital. There are two parts of the hospital, an old and a new part. The older part is made of red brick and was built in the 30’s. The newer part was built sometime in the 2000s. It was funded in part by a loan that the hospital took out and secondly by a generous donation from a Scottish orthopedic surgeon who was aware of the need.

Our cases today included discussion of a child with pulmonary TB with 200cc hemoptysis. We had a woman who had been turned away for c-section due to there not being enough room at the hospital so she went somewhere else, then returned septic with an abdominal infection. When we pressed on the abdomen, pus came out and there was tracking a bit deeper. With ultrasound we could see she has only a small amount of pelvic fluid and it appeared that the infection was mainly within the fascia, not deeper. She would be taken to surgery later by the German OB doctor to debride it.

In ICU we had a woman who had AMS and fever for two months who presented 40+ weeks with child who was dead upon arrival. Her creatinine was 4.0 and she was anemic. They worry about central venous thrombosis due to the level of dehydration and in pregnant women the elevated risk of thrombosis. They might see one per month and if they continue to have AMS after delivery then they will get CT looking for that.

There was a baby with neonatal sepsis. We did another ultrasound on a woman who came in with an O2 saturation of 68% and we were trying to see if she had evidence of PE. On ultrasound we looked for right ventricular enlargement and there was none. Her inferior vena cava collapsed down when she would breathe, indicating dehydration.

Another woman had placenta increta that went past the bladder wall and her ureter had to be taken out, she was in post op. She came in hemorrhaging and had to get eight units of blood.
Here the way the blood bank system works is that if you take one, you have to have a family member give one unit back to the hospital. There is reluctance to do this, though, because people believe that their vitality is being taken from them. Many times, they won’t give blood for a woman because they are not considered valuable enough, so the patient will end up dying.

In the postpartum area, one doctor will round on anywhere from 175-250 patients and currently due to lack of help, they are on call ever other day. I met the junior doctor on that service and he was happy and smiling, even laughing! After one year here, they will have done maybe 200 C-sections on their own and all things here are high risk because if they could deliver at home, then they will. They have an area of eclamptic women and there were four in there. The hospital is maybe 230 beds and they have 80 nurses, so they are functioning about half of what they need. In labor ward the nursing ratio is 3:40.

The next patient was a suicide. It was from zinc oxide and he was doing fine. Suicide attempts are common and it is a compulsive thing, so not necessary from prolonged depression. People here are “living on the edge”. There was also an 11 year old boy who was recovering from organophosphate poisoning suicide attempt. He had been given atropine and was doing better. The atropine was making him hallucinate.

We did a lumbar puncture in a woman who we thought may have scrub typhus, which is common here. They get thrombocytopenia. I checked for papilledema with a fundoscope and actually saw the optic disc well with the help of Dr. Christo guiding me. My skills that I have learned in medical school and have not used in the states can be important here. You have to be very good with physical exam.

There is some kind of infection that is also common that they cannot figure out what is causing it and a few years ago they lost 800 children. It is cyclical but no pathogen can be found.

There was a little girl with creatinine of 9, and a Hgb of 6.

There was a woman with a Hgb of 3, HR 140’s and hypotension, clearly septic. Dr. Christo offered to give one pint of blood if the family would show interest in giving three more pints to save her, otherwise we will need to discharge her to another hospital because she would surely die and be taking up an ICU bed. When they ask family members, they may say they are sick or weak and can’t give blood. She hasn’t had any urine output. It doesn’t look good even with transfusion. We prayed at the bedside for her.

Next was a girl who had tetanus. She was not very old and was twenty days out from a burn on both her feet. She had three days of tetanus symptoms of trismus and when we raised her up, she was stiff like a board. She couldn’t open her mouth to cry but instead had a grinning expression where the mouth was drawing back. Dr. Christo said the later onset was a good sign because it was less aggressive.

We turned to see a boy who had just come in with SJS due to ibuprofen. His oral mucosa was bloody, but otherwise no other sloughing of the skin.

A baby returned with family s/p surgery for intussuception. He was fine.

We were consulted for one more woman in the OB department who had gastritis and then morning rounds were over by 1pm.

I met the OB I will be working with. She was hoping I had more experience than I did so that I would be of more help to them. Unfortunately, as soon as I get trained in C section enough to be more independent, then it will be time for me to leave and they really need more help. Actually, the orthopedic surgeon did the c-sections for a while when there was no one else. I will try to learn quickly!

Already so much to see and learn.  It is definitely a strong supportive atmosphere for learning.  We try to lift one another up…I don’t think we would survive without it.  Chapel every morning at 8, then 8:30am is morning report where all cases are discussed.

Please continue to pray for us here!  I will write as I’m able but from here on it will be very long days.

Holiday Morning

The view from M's room at the YWCA hostel.
The view from M’s room at the YWCA hostel.
View from the Western Guest House at Duncan
View from the Western Guest House at Duncan

This morning we had cereal, toast, a small omelette, and an orange for breakfast. I slept very well. We pulled our mosquito nets over our beds and we were asleep fast. The morning came fast but it is leisurely here today because of the holiday in celebration of Ghandi’s birthday. Christo will come by this morning and orient us to the hospital. I spent the morning discussing the difference between OB in the US vs. Netherlands with M. She is a mid-wife. Very interesting! As you probably know, they routinely get three months of maternity leave for women and for men they also have paternity leave, but that is usually three days to one week.

The food tastes really good here. I’m not sure if it’s just me or if it is the freshness. It is hard, though, knowing I’m eating so well when I just saw all the malnourished people.  It will be a challenging month in many ways.

They drank from the spiritual rock that went with them, and that rock was Christ. -1 Corinthians 10:4

The Little Engine That Could

Where to even begin?!

I will begin where I left off, which was landing in the New Delhi airport. I wasn’t sure what to expect, but it was very nice and modern. It was air conditioned except for in the bathrooms. I got through customs just fine, in fact the customs officer didn’t ask me a thing. Then I walked out through the crowd of people waiting for their family members or assist travelers to an open area just before the airport exit.  My friends from the airplane at that point met their contact and so we split ways, saying good bye and promising we would stay in contact through Facebook and maybe later meet up again in life if our plans coincided.

Never fear! I was not alone for long! There was a coffee shop right near the exit so I decided that since I would be waiting for another three hours until 1:30-2:00am for M to arrive, I could use some caffeine…after all, I had no one to watch my bags.  The cashier was on the phone when I went to order and he made me wait for several minutes until he finished his conversation.  I wasn’t sure if that was because I was female or if it was because there was no competition, but I eventually ordered an iced coffee of sorts which turned out to be what seemed like three shots of espresso (stronger than US) and a few ice cubes. Now, I was at one point a barista and I definitely can handle caffeine but that was so strong that I got a little shakey!  And I was wired.

At the same time I was paying, a very tall Asian guy in his 20’s with trendy black thick rimmed glasses and a hiking backpack came up to the counter and tried to ask the cashier if there was Wifi but in the middle of his question the cashier just walked away. I guess it wasn’t just me! So I started talking to him and said there was no wifi. He looked disappointed; he was going to try to blog.  He just barely had some sort of accent I could make out but sounded almost like he could pass for American.  All the seats were taken in the shop so we sat down on the ground and I used my suitcase as my chair.  His flight wasn’t until 6am so we had time to kill.

It turns out that he was an English major in Japan and taught English there. He had an around the world ticket and he was hoping to get into Columbia University in some sort of post graduate English teaching program and then go back to Japan to teach. He was extremely good at speaking and that explained why he barely had an accent. He said, “I’m gonna go grab something to eat.” I smiled and said, “You are good at using American slang!” He bought two muffins and shared them with me while I did an impromptu English slang lesson and helped him sound as American as possible. He had this thing that he did with the long “o” sound that made him sound British, which I actually thought sounded nice, but I helped him shorten it like Americans do and I’m pretty sure we were amusing (or confusing) to the onlookers.

It was was time to start watching for M.  My Japanese friend was tired so he went up to a lounge to sleep.  I waited a while for M, watching the stream of people, but she wasn’t there. I went outside to the pillar where the driver was supposed to meet me and he was there in a few minutes. A worker offered me his stool and I used that  while driver went back to his taxi and I waited some more.  Finally she came through the crowd.  She was a little taller than me, fair, with light brown hair and blue eyes–easy to spot!  We hugged like we knew each other and she thanked me for waiting.  Little did we know we were going to fear for our lives several times together!

Our driver, Mr. K, is an excellent driver…because we didn’t die or get in an accident somehow. On the roads there was usually someone two inches away in the other car and if there was the slightest opening, a motorcycle would slip through. I couldn’t make sense of when was appropriate to use your horn because it seemed like everyone just slammed on it all the time.  People routinely step out into traffic as well.

We made it to the YWCA which is in a nice area of town.  I should mention it was probably in the 80s at night. We were escorted to our room which consisted of a bathroom, single bed with sheets and an optional comforter, and a TV. It was very clean. There was a unit air conditioner right over my head when I laid down.  I kept it on for a while and then got too cold amazingly.  I hardly slept at all because it gets light here at 5:30am and there were all kinds of sounds like the birds, insects, and traffic noise.  I think that espresso was still working, too!

I got up early and showered. I had to turn the water heater on and got through about half of a shower with hot water. People regularly take bucket showers so that’s how I finished up.  M was still asleep in her own room down the hall so I decided to venture to breakfast on my own (I had already read the Indian newspaper that was slipped under the door at about 7am).  There were two men eating in the well lit dining hall and three men serving a  buffet style breakfast (which is too many so they just stared a lot). They didn’t speak too much English so I tried to figure out what to do.  It seemed kind of humorous to me that I would have trouble just fixing breakfast. You really do have to keep your sense of humor.

There were were four bowls, one had butter, another jam, another some pickled vegetables, and the last a red kind of sauce. The server put in one slice of white bread to toast. I took two slices of naan and a little of each topping, as I wasn’t sure what was further down the buffet. The rest was a hard boiled egg and a white porridge. I chose delicious tea over coffee.  I liked everything except the spicy pickled vegetables and figured out which condiment to use.  Again, I felt very strange being female among all the men and by myself but I just ignored it and drank my tea as I looked out at the tropical plants.

After M ate, we were taken to the main office of our organization. I never would have found it alone.  We walked down a series of dimly lit hallways and got on a very very old lift that went up several floors and we were in the heart of New Delhi. It’s like the kind of scene in a movie where the drug deals go on…but apparently this is just normal. The office itself though is very nice!  There we met Mr. A who was very very stern so as to convey all bad things that could happen to us because he said safety was his biggest priority.  M and I had moments that we questioned if we had made a mistake coming after we spoke with Mr. A.

We were going to be going on a 24 hour train ride during which time we would need to buy chains to lock up our luggage.  I had to exchange a good amount of money there, too, and I was glad I had a way to conceal it.  Mr. A was not happy with our amount of medicine in case we had diarrhea and now I realize that 24 hours on a train with uncontrollable diarrhea is why he sternly made a shopping list for us before we got on the train. I had cipro with me, but he added norflox 400mg, and immodium.

At the train station we had ten minutes to inhale some Indian McDonald’s…it was the only food guaranteed to be safe to eat. Again, residency training helped out: I got a spicy McChicken sandwich, fries, and a Fanta down no problem! People were everywhere. Many people were just laying on he ground. There were countless number of big blue trains. We had to walk over a bridge to get to the far one and as one of the cars jam packed with people sweating in he sun and 90 something degree weather with their arms hanging out through the bars on the window pulled in, Mr K said something about that being our car. Then he looked at me and laughed, saying he was just kidding.  When he said that to a previous doctor once, the doctor flat out refused to go.  M and I were mentally prepared for pretty much anything, or so I thought.

It turns out we were pleasantly surprised in that we were in an air conditioned car where we could store our luggage beneath the seats. We would be sleeping in the bottom bunks that were converted from the bench. Eight people would be sleeping in this small area of maybe six feet by eleven feet in width and length. M and I were on the bottom.  There were two more bunks over our heads and two across a little hall. The only awkward thing is that they were all men again, about middle aged except one who was probably in his early 20s. The men basically ignored us, which we were glad for that. The younger one was from Rauxal so he helped translate sometimes.

By this point I was so tired, I could sit with my back straight, as the bench forced you to do, and fall asleep. We couldn’t fall asleep too much because we still had to chain our bags. The train took off a little after 5pm and we got ready for bed around 8. It was hard to believe it has only been yesterday I was in Ohio.  Both my legs went numb from falling asleep sitting straight up and I really wished I had more padding for my behind, but I shifted around as much as I could.  M and I didn’t say too much, as we wanted to remain private and inconspicuous. Later we got more comfortable. We chained our luggage and slept lightly.

In the morning I was pretty sure my kidneys had failed…or that I was just terribly dehydrated. I hadn’t urinated since leaving the hostel so that was about 24 hours. I had rationed my water on purpose though so as to avoid having to go but it was time to face it.  I chugged a bottle of water, as I could feel a headache coming on and went back to sleep. As dawn came about, I went to the squatter. I was already fearful of falling when I wasn’t on a moving train. This was a whole new level!  The hole was open to the railroad below and I had to place my feet on either side of the hole while the train was rocking. I had joked earlier with M that the train would probably stop while I was in there, which of course it did. I grabbed onto the railing in front if me and steadied myself. I had taken off my purse but still had my other money concealed on my person so I had to hold that up and I tried to not let any of my pants touch anything. Trying to not touch anything is really difficult. This area of the train is also not air conditioned. I was breaking into a legitimate sweat and I was wondering how non-physically fit people do this.  Part of the issue was that rather than giving into gravity and doing a full low squat, I kept trying to half way squat because I didn’t want to fall backwards into the water that was pouring down the wall behind me.  I also had a large shirt on that came down to mid thigh that I was worried would fall down into it.  There was a moment where I told the germaphobe me to stop and just do my best.  Somehow a little bit of my pants got wet, I don’t know how. I did my best to clean it in case I had inadvertently peed on myself.  Next time I would do better. The train lurched into motion; I lurched into the hallway. I made my way back to my sleeping area and rested some more. We still had 12 hours on this train to go. I just hoped I wouldn’t have to use the bathroom again.

Late morning and all our bags were still there. M and I shared our food. We had bought bananas and oranges. We were told not to eat anything from the train or take food from strangers in case it wasn’t clean or they tried to drug us. There is mostly petty crime here so you have to just be cautious and alert.

The city turned into countryside with lots of green fields of crops that I didn’t not know the names. People were farming and swimming or bathing in waterholes alongside the cows. I saw blind men at the train stops running their fingers along the train. I saw children who were malnourished. I saw beautiful women in lovely bright clothing.

We arrived in Raxaul and a man came up to us with a badge that said our hospital. He said “Please.” And motioned for us to follow him. We got in the car marked with the hospital name and three more people jammed in with us. Then we drove down unmarked dirt roads with shacks and stalls all along it into a compound of the hospital. It was probably a 15 minute drive. We were escorted to the guest house.  M and I share a room. I’ll try to take pictures. We met a woman from Canada who works here and she told us what to do. Tomorrow is a holiday. We will go with her to the market to buy traditional clothing.

We had a warm meal of some sort of meat, broccoli, potatoes, carrots, and some kind of green bean. It was very good. We had not had much on he train. Then for dessert we were given frozen coconut sorbet (homemade) and I was so full that it hurt.  Dr. Christo came and said hello. He said it was a very busy time for OB. A few days ago they had 36 deliveries in one day and range from 25-30 typically and 6,000 per year.  There is a German OB here right now for the next few months.

Time to rest. I still haven’t set foot in the hospital yet!