Siva Sakthi Nursing Home is like a family, I will miss it next week.

I am officially able to go to KMC, the largest corporate hospital in Trichy, starting Monday!  It employs four dietitians full-time, while is rare to employee even one in an Indian hospital because doctors normally give diet advice.  I am sure it will be far different than Siva-Sakthi, which is almost like a home to the doctors.  They do everything at the hospital.  Today, someone brought some FAT (emphasis on fat) stacks into Dr. Siva’s office.  Imagine a Wal-Mart bag full of money.  These were 1,000 rupee notes, and he brought in a stack like two feet high.  I could not quite understand what the men said, but when I asked if the man was paying for a procedure (knowing that they do not do procedures at Siva-Sakthi), Dr. Siva said it was personal business.  Why this man owed Dr. Siva what would be at least one year’s salary, if not several years, for the average worker here, I cannot fathom.  He must be confident if he can do this kind of personal business in his work place.  The employees also bring me food all the time.  Yesterday they brought me kolukattai.  Today, they brought alwa and bajii, let alone all the tea and coffee they give me.  Today, I brought in some salt-water taffy I brought from home, and they went crazy for it.  They try to teach me Tamil in spare moments, and it is almost ridiculous how friendly everyone is.  They all offer to take me out when they are not working while they are working 11 hour days Monday to Saturday every week. 

This is kesari, described below.  

Me rocking my new Indian garb.

Alwa from a 107-year candy store.

Jackfruit, the largest fruit in the world, just chilling at the market.

Super small pineapples.  

Just a cow, eating trash.  

A small roadside temple.  

This video shows a dude riding some kind of a hand made elevator at a construction site.  

Street art.

Check the bananas growing over the sign.  

This is bajii, fried green banana with bengal crumbs.  

The prep for the wedding tomorrow!

In the last week, two old employees of Dr. Siva’s came in who have moved on to bigger and better tings.  They told me how they got started at Dr. Siva’s office years ago and how great of a relationship they keep.  Some other differences I am sure to experience at Kauvery Hospital include the medical record keeping.  One of Dr. Siva’s old employees who came in started as his receptionist and learned and worked her way up to recording patient information and running diagnostic tests.  She became the first (in how large an area I am unsure) person to keep medical records who did not have a degree in medicine, stating that she learned everything from Dr. Siva.  She explained to me that Dr. Siva keeps NO RECORDS whatsoever and that she now bothers him frequently to start.  He claims that the record is the patient’s, so they keep it and take it home.  They put it in their safes with their jewelry and other fineries.  He explained that most hospital-visits in India are due to infectious disease, for which patients come in, receive treatment, and leave in full health.  If they lose this record, it will not hugely affect them.  However, Siva-Sakthi is an endocrinology clinic that deals with chronic and genetic disease.  Because of this, patients keep their records near and dear.  I also asked about vaccine records.  The old friend explained to me that many people prefer to let their children catch diseases and “naturally” develop immunity.  However, colleges are starting to require vaccine records, so hospitals sometimes keep these.  At Siva-Sakthi, if a patient loses their record, the doctor can print a new one based on the child’s age since they follow a vaccine schedule.  Despite this, I am sure that children miss vaccines, lose their record, and then receive a new record stating they have received vaccines they have not received.  Dr. Siva and Dr. Sakthi also exemplify the shift in Indian healthcare.  Dr. Sakthi, Dr. Siva’s son, is much younger and newer to medicine.  He keeps detailed computerized records, while Dr. Siva does not even have a computer in his office.  It was also explained to me that patients here will not respect and visit doctors who keep too extensive notes because this means they spend more time writing and less time interacting with the patient.  Doctor-patient interaction is huge.  Not even the pharmacies are required to record who they dispense medicine to.  This is different in government and large corporate hospitals.  Government hospitals keep records to report to the government.  Corporate hospitals keep records to make sure that their budget is maintained and that they are making money.  While government hospitals are free here, they cannot do much.  Even though people pay out-the-wazoo for private hospitals (most health care here is private and there are few regulations to keep them in check), the private hospitals are able to afford all of the most experienced doctors and newest equipment.  Even if you get diagnosed for free at a government hospital, chances are you may have to drive over to the corporate hospital for treatment. 

Side note: yesterday I mentioned a woman who was referred to other hospitals to sponsor growth hormone for her daughter with Mosaic Turner Syndrome.  I realized today that she probably cannot afford treatment because her husband is no longer with her.  While I cannot be sure of this, almost every single person comes in with their husband/wife to see the doctor.  If not a spouse, they come with some relative.  This woman was alone, so I figure that her husband would have had to of taken great lengths to come that day, or that he is no longer with us. 

One crazy nutrition thing I heard today is that many patients who come in, and people in general, eat 15 to 20 grams of sodium each day!!!!  The Tolerable Upper Intake Level for sodium is 2.3 grams, meaning the more you eat over 2.3 grams, the more likely it is that you will experience adverse health effects.  While the UL is probably higher for Indians because it is so darn hot here, and we sweat more sodium over here, it cannot be substantially more than 2.3 grams.  I do not know how these people are not mummified, but I suppose this is why they have to come into the hospital.  Another crazy thing people do here is become alcoholics.  While alcoholics are everywhere, I sweat so much today just walking around that I can see why someone would have kidney, pancreatic, or liver damage at even a young age over here. 

Today, for the first time, Jess and I ventured out into the streets surrounding Bishop Heber College.  We went for ice cream (which is actually priced similarly to the US, presumably because they spend a boatload on refrigeration), and explored all of the stores. While it was a similar temperature to that which I experience working at a landscaping company in NC, the humidity is so high that I sweat far more buckets than I ever do in NC.  Also, the streets are entirely different, perhaps one of the greatest contrasts to the US.  There are piles of trash scattered around with animals fighting at who gets to nibble at the biggest heap.  Additionally, there are so many vehicles that the fumes make me feel nauseated because there is so much air pollution concentrated in such a narrow area.  It is much easier to breath in any area away from the road.  I had to lay in my boxers with the AC and fan on after I got back because I sweat so much.  I found out that petrol (gasoline) is the one thing in India more expensive than in the US.  It is $1.00/liter, and there are 3.78 liters per gallon (you do the math).  Also, I haggled for the first time today! I bought some framed pictures of local gods here, and I talked the price down 50 rupees.  Because it was just us white people (Jess and I), they charged more than they charged Jess yesterday when she was with an Indian.  This is another point the hospital staff makes to me and why they are willing to go out with me: they don’t want me to be swindled.  They are so very sweet.  Solomon also took me out this morning for more South Indian cuisine.  We had kesari, which is like grits with ghee (butter), sugar, and cashews.  He also picked a tamarind fruit off the ground and we shared it.  This was much different than any fruit I have had, tasting as if it had Indian spices in it even though it was a raw fruit.  Fruit is far fresher and different here.  The pineapples are a third the size, with three times the flavor.  The fruit markets here are lovely.