A wake up call at 5:30 am to be informed by Ravi that I was late and the training group was already waiting for me(the fact that I was told that we were leaving at 6 did not seem to impress him). A quick sub zero shower was all that I needed to jolt me from my stupor. If looks could kill I would surely be dead with the glowering looks the group gave me. After a few quick apologies we were off! The group consisting of Prema always identifiable with her beatific smile, whiny petite Kutty Vijiya , Ambica the DJ (thanks to her micromax phone with the expandable memory) and Madesh the driver/pharmacist.(not to be confused with Big Madesh and small Madesh –Staff Nurses…. that makes three!) The expedition in the forest segment till Thumbal that we endured in silence would have put Lewis and Clark to shame. Through bleary eyes I was treated to the sight of climbing the hills and viewing the reservoir of the Kariyakoil dam, after which everyone started feeling a little peckish.
Karmadurai (base camp for the Kalrayan Hills project) greeted us as usual with large swathes of garbage strewn at its approach road.A quick stop at our room at Karmandurai for water, supplies and drugs. The ladies of course had to powder their noses and add the finishing touches…..surprised? Breakfast at the Balamurugan Hotel (Gourmet central of Karmandurai ) where I was served something called an egg roast! Which consisted of a paper thin dosa smeared with egg on one side doused in sambar…. quite yummy really. Having packed idlies for the Health Auxiliaries (henceforth referred to as HAs) we were ready to leave for Vellimalai. Sadly no early morning cuppa as the restaurants will not deign to serve tea/coffee what with the fear of angering the chaiwala next door…who had very sadly decided to not grace us with his presence that day.
The drive to Vellimali was very enjoyable with the temperature having picked up and the fog having cleared up (people staring at the hospital jeep gets old after a few days).Past the forest guard with Parkinsons disease who takes a whole five minutes to realize that there is someone waiting to enter and then sets off on a routine of robotic movements to slowly and not surely raise the barricade blocking our way. The clinic not having been used in a week is dusty and the girls start cleaning and moving the furniture, Madesh sets off to pick up the HAs while I contemplate the meaning of life by looking at the neighbour’s ruminating cow and its calf, which he had tethered outside the clinic.
Down to business! Prema and I sketched out the agenda for the training with the games that we would play and the essentials to be covered in the session. The session being based on the drugs that we are going to provide them in addition to the ones they already have (drugs are provided in boxes that are numbered, they already have box 1-4 we are going to in addition to these give them 5,6,7).The drugs are 5)Iron tablets (for anemia) 6)cetrizine tablets (for allergies) 7)Ondansetron tablets (for vomiting). We sketched out the basic mechanism of action, indications, dosing, and side effects of each with examples and case scenarios.
The HAs arrived in a few minutes and greeted us with beaming smiles giving you the impression that they were really happy to see you .They seemed to enjoy their breakfast of idlies in spite of the cold sambar. A casual roll call showed us that we were short by three, further investigation revealed that they had migrated to coffee estates near Mysore(?Coorg ?Chickmagalur) for the coffee and pepper picking season .The incidence of migration seems to be rising with people preferring to come back with a cash pile and not have to do intensive labour in their own fields. They would rather plant tapioca and not tend to the fields for a whole season…. But our own HAs? Et tu Brute?
The ice breaker was a game where a person picked a paper chit with a random participants name on it and had to enumerate three features that they admire in them which cannot be repeated by any other participant again. It was a little hard to get past the…. she looks pleasant , she works well etc. Vellachi was of the opinion that Shanti works very well with the crops! The initial hesitancy was soon overcome with Ambica getting compliments on her figure and Sharada was praised to the skies for her fashion sense while Dhanalaksmi was complimented on her toe rings! (Tha usually has us do a short jig before we start but I guess no one really felt like dancing…. )
Onto Iron ,with a mutual discussion on anemia its features , diagnosis treatment and prevention by the team, we drove the message home. Kutty Vijiya being a strong supporter for prevention was quite fixated on the idea that everyone should eat animal livers on a regular basis, Rukumani was of the opinion that livers do not come for free though they should be. I realized we had digressed when I pictured myself holding a toast with liver pate and shook myself into the real world.( Kutty Viji being one of the casualties of Premas anemia eradication program at THI had to have an Injection of Iron intramuscularly that hurt her for a week! She served as an example to all the other nurses and students who promptly piled on the greens and lentils habitually thereafter.)
Cetrizine was a little harder as we had to get the concept of nasal and respiratory disorders before going ahead. Dhanalakshmi took this opportunity to grab her forty winks and was promptly chided by Prema and the whole party was forced to stand for the rest of the drug discussion.I moved on to discussing the general principles of skin allergies when I started talking about parthenium only to receive stolid silence in return . I kept emphasizing the role of parthenium pollen in air borne contact dermatitis to still be stared at. Prema very politely asked me what in god’s name I was talking about and I told her in English, after which she laughed to the point of tears. I kept saying ‘vella poond’ which means white garlic instead of ‘vella pooh’ which is white flower.(Crazy city folk rubbing garlic all over themselves)
The Tea Break was spent in trying to keep Susheela’s one and a half year old daughter Reena occupied with a flashlight (of which she bored soon and preferred my ear lobes) while looking benignly at Dhanalakshmi sleeping.
Ondansetron was pretty clear with the only indication being vomiting…. The important message to drive home was when to not use it. Short detours into the presentation of meningitis , intestinal obstruction to make them realise when to not overzealously use antiemetics.
Role playing with Kutty Viji as an anemic person (no prizes for guessing) , Prema as a person with a cold and me as a person unable to keep his breakfast down. With real life situations such as breathlessness , ‘Sali ,irumbal, vanti, vaytal’ and a host of other doozies thrown in to help them cope with different situations.
Prema would have put Sneezy from Snow White to shame with her role as a patient with allergic rhinitis , a heart rending performance that left us in tears empathizing with persons who suffered from this terrible affliction of a runny nose.
It never ceases to amaze me that these women with no formal medical education can grasp so well the concepts that we tell them and apply them so well in treating patients they have seen. They always seem to know of someone with a remarkable likeness to any symptoms that we discuss in their villages as well as we would know a family member. The closely knit community life of the Malavasis is evidenced by these sessions.
Lunch though not the 7 course luncheon of the Hyatt was quite ample with 2 veggies and sambhar and pappadom (courtesy – Balamurugan hotel) and mountains of rice. Susheelas baby Reena having become worldly wise stared at me suspiciously as I ate my sambar rice in silence.
Rest of the afternoon spent in tending to the myriad symptoms of the HAs , Trying to with no avail convince Malliga that she must see an Ophthalmologist as I cannot prescribe the Californian treatment for Glaucoma. Vellachi was sadly discovered to be a hypertensive and seemed quite peeved at the news.
A refill of their quota of drugs for the month and having their stipend paid they were all ready to leave. Tearful farewells and many goodbyes later we were done for the day! The girls busied themselves in preparing the clinic for OPD the next day while I observed the inside if my eyelids on the veranda outside on a conveniently placed mat.
Uneventful journey on the way back with a stop to replace the lost electrolytes, raise the blood sugars and gawk at a group of rheuses who seemed to quite enjoy the attention they were receiving.
In short a very very well spent day …tiring to say the least but totally worth the effort!
Thank you for reading.