Rest In Peace

This week we lost another mother. This one from a throat/lung cancer combo. It's the fourth parent my small office team of 20 or so associates has lost in the past 6 months. We have another dad, facing his second round with mouth cancer who is likely to be leaving us within the next month or so. The doctor's say there's nothing they can do. It's tragic. It's incredibly sad, and it's completely inexcusable. While I have yet to face the loss of a parent, it doesn't seem right that so many, at such a young age are facing such a situation.

It lead me to believe, and wrongly so, that India somehow had a higher than average mortality rate. So I researched it. According to the CIA World Factbook (www.cia.gov), India experiences 7.48 deaths per 1000. It surprised me to learn that this is less then the rate experienced in the US at 8.38/1000, the UK at 9.33/1000, and Germany at 10.92/1000. The same countries claim the following at birth life expectancies: India at 66.8, the US at 78.37, the UK at 80.05, and Germany at 80.07. Indians can expect to die more then a decade before many in countries with even higher mortality rates. Maybe that's why I'm seeing a concentration of it impacting my young team.

I've heard many claims about the Indian medical system. A US friend had appendicitis and subsequently required surgery while travelling in India. At a follow up visit, her US doctor told her that if you have to have a laparoscopy anywhere, India's the place to do it. Elective centers are on every corner, specializing in cosmetic surgery, weight loss options, and fertility treatments, yet we can't keep our parents alive long enough to see their grandchildren grow.

Indians are dying every day from seemingly preventable diseases such as Malaria, Dengue, Typhoid. Diabetes, Cancers and heart disease are going undetected due to lack of affordable health care and as a result, the belief that symptoms can be controlled through self medication and natural/traditional healing options, without proper diagnosis.

Here, you can just walk up to a medical shop and get everything from laxatives to thyroid medication. What used to require me to go to the Endocrinologist twice a year for lab work in order to squeeze a prescription out of the doctor, can be procured by walking up to the closest medical shop (there are four on my street alone) and asking for the drug by name. If you don't know the name of the drug, you can just explain the symptoms to the person behind the counter, which results in them handing you an often unlabelled strip of tablets. No dosage info, no ingredient info. The only numerical information on the package that anyone seems to heed is the expiration date. Exchange the unknown strip of tables for a few rupees and you're on your way. No prescription required.

I don't know if it's the cost of consultation and treatment, the cost of procedures, the self medicating option, or genetics/environment that are forcing us to lose our parents early, but I don't accept it. I can't. My great grandmother lived to be in her nineties. My grandmother (her daughter) turned 87 last week and still lives on her own, drives a car, and works part time because it's a nice way to get out and meet people. I wish I had half the energy she does. Yet I see folks much younger, twenty years younger in fact, that are dying at an age that I just can't comprehend. I refuse to accept it. While my heart is breaking for those I know dealing with the loss of a loved one, I find myself incredibly angry that it ever had to happen. People here just accept it. It's all they know. Why? Why does it have to happen? Why is it acceptable just because this is the way it's always been? Somethings gotta change.

Bottle It Up

The concept of turning a blind eye is an art form in India. Let me give you a few examples:

Public urination - Traveling just a few kms down any road and you'll spot at least l person, any time day or night, relieving themselves. That's a fact. If you don't see one, your eyes are closed.

Bathing in public - You gotta be clean right? No matter who's watching you soap up.

With an estimated 2011 population of 1,189,172,906 people are makin' babies....somewhere, at some time. 

Comparatively, in the US: 

We close the door to our private bathroom when we need to go 1 or 2. Well....most of us. I even know a few folks that will hold it until they get home to use their own bathroom because the thought of going into a public restroom, complete with latching door, is more exposure then they can fathom.

The shower curtain industry is alive and well. I'd venture to guess ALL homes in the US have either a curtain or a door on their shower.
Fewer babies are conceived per capita, with the US population somewhere around 311,800,000 in 2011. Western prudish ways, including indecency laws, prohibit public procreation.

So that brings me to my point. Things happen here. In public. People see no shame in letting it all hang out. No one looks around sheepishly if they experience a bodily function in a crowd of people. Very few apologize for letting out a loud belch, or other gastric murmurings within earshot of others.

Additionally, what many US citizens would only say/do in the privacy of their own home, or at least behind closed doors in frantic whispers, is done in wide open spaces here. Or at least the space that's left after you crowd 1,189,172,906 people into a single country. I have been appalled on a few occasions to witness parents whooping their children, husbands whooping their wives, men whooping one another, verbal whooping between day laborers, you name it. Daily I'm a whooping witness.

While many people fantasize about having that public catfight and really calling someone out in the hopes of humiliating them in front of a crowd, I see it here ALL THE TIME. Yet no one seems to care. If I hear shouting going on outside my door, I go stand out and watch the action. And everyone else just passes by. Auto's just simply drive around them. No one stops. No one seems to notice.

I don't know what shocks me more, the fact that people feel it necessary or acceptable to carry out such behavior in public or the fact that none of the public seems to give a damn. Perhaps it's my prudish Western mentality that finds it so disgraceful. I feel the need to control myself in these situations because my instinct is to tell them to shut the hell up, or at least  to carry out their business in private.

I have been trying to convince myself that perhaps this is a better way. Get it out there. Air your grievances. Make sure there are several witnesses...let off some steam. But I just can't shake my prudish American instincts of feeling that it's demonstrating a lack of class, education, and is just down right rude and disrespectful. Not only to the person you're shouting at, or those passers by, but disrespectful to yourself as well. I couldn't look my neighbors in the eyes of they overheard between myself and ANYONE else like I've seen/heard too many times to count. Bottle it up.

Typhoid With a Side of Viral Fever

I got to experience my first ever overnight hospital stay......anywhere. I've never had more then a simple day surgery in my life. I'm relatively healthy and the only significant time spent in a hospital room was while visiting loved ones. All that changed recently.

On Monday I had a normal work day. I felt fine and worked my "normal" Indian 10.5 hour shift. When I got home from the office around 5am, I had a little pain in my neck and a slight headache but thought nothing of it. I woke up around 11:30 that day full of body aches and all the symptoms of the Western Flu. Upon taking my temperature, it was 101 so I figured it was just a slight bug and a few more hours of sleep would do the trick. Around 4 o'clock I woke up and realized I'd be calling in sick to work for the first time. Throughout the night, I tossed and turned, each time I'd wake up I'd take my temperature which seemed to be coming down, at least as low as 99.

Around 5am Wednesday morning, I work up, took my temp and was a bit alarmed to see it at 103.4. I decided I better see a doctor. Luckily, in such a largely populated city, there are hospital every few kilometers. I can go to the end of my road and take a right and find a hospital or a left and find a hospital the same distance away. As all good insured persons do, I opted for the one I knew was in network. After a short wait in the lobby, the doctor was ready to see me.

The triage here is much different from what I'm accustomed to at any doctors visit. Naturally the doctor asked me my symptoms, which at that point was just a headache, sore throat and fever. The first thing they did was a quick blood sugar test to rule out diabetes, as it's an epidemic here in India. That came back normal. Then they took my temperature and when it came back at 102, the doctor explained that with a fever like that it's no wonder I was feeling weak. She asked if I had my malaria vaccination, which I told her had lapsed. And she asked if I had my seasonal flu shot, which I informed her I just had last month with zero side effects. At no point during the consultation did the doctor ask any of the typical questions I'm accustomed to answering: Are you taking any medication? Is there any chance you might be pregnant? Are you allergic to any medication or to latex? Do you smoke, and if so, how much?The doctor looked at my throat, stated it was practically closed it was so swollen and that I'd need to be admitted. My understanding at that point was a quick round of fluids, break the fever, and I'd be released.

There were three options for room accommodations. I could have paid rs1200 for the general ward, which is like you see in those old war movies where you have a room with rows of cots and has a common washroom. I could have gone semi private for somewhere around rs2500 per day. I opted for a private room at a staggering rs4000 per day but I wasn't in the mood to be stared at so it seemed like the best option.

The room was sparse, one bedside table, one rolling tray, a cot for a guest, a TV mounted on the wall, and the most ancient hospital bed I'd ever seen. No gown change was required, as they don't provide them. Zia went home to pick up a few things: my favorite quilt, pajamas, toothpaste/toothbrush, hairbrush, towels and dishes. Why towels and dishes you ask? There are no showers, so it's back to the bucket bath, and there is no food service, therefore no need for dishes. If you want anything to eat, you can either have the ward to fetch it for you, which results in a discussion over how much he should profit from running your errand, or you find someone else to get it for you at no charge. It seemed odd that anytime someone is suffering from any ailment, one of the first questions asked is "Did you have any outside food?" meaning, unless you're eating home cooking, it's no wonder you got sick; yet the hospital doesn't provide food during your stay so the only option is to order out from local establishments.

Shortly after getting settled in my room, I came to realize how much Indian hospitals respect your privacy. If I left my door closed, the Sisters (nurses, not to be confused with Catholic nuns) would knock, and wouldn't even enter at my prompting, but instead, required me to get up and open the door for them. That lasted for about three visits before I finally told them I wasn't getting up every time they wanted to come in. Quite a difference from the states where your door is kept open at all times and you have a myriad of people coming in to check your vitals, monitor IVs, and generally poke and prod you, meanwhile listening to every moaning patient down the hall preventing you from getting any rest at all.

I was set up with an IV of general fluids infused with antibiotics, given a few painkillers and additional antibiotics in tablet form, and had a few vials of blood drawn to try to get to the bottom of what was causing this.

I don't remember much that night. I pretty much slept and didn't give a hoot about what was going on around me. By the next morning my fever broke and I was feeling much better. The doctor came and saw me and after a brief chat, said she saw no reason I couldn't be released. Zia left the room with her to check and quickly returned to inform me I wasn't going anywhere. My blood test results showed a white blood cell count triple that of a healthy person, a hemoglobin count lower then it should be, and an iron deficiency. She said until they got that under control I couldn't leave. So day 2 commenced with a lot of laying around. Zia opted to sleep on the floor as it was more comfortable then the cot they provided and the poor guy ended up using the dress I was wearing when I checked in as a pillow and the bath towel he brought from home as a blanket. The hospitals are not built for comfort!

That night Lakshmi and Leila came by for a visit with some home made food. I also had my good friend Rupert, and my boss, and super boss come by to say hello. I was getting pretty antsy by that point as there's no reading room, gift shop, cafeteria, or fountain to go meander around.

By Friday afternoon, the blood test results had improved, although not in the normal range, but the doctor relented and sent me home with a robust series of medications and strict instructions to avoid anything cold to eat or drink. Before being released, we had already received confirmation from the insurance company that my claim would be paid. The entire visit, which included the private room, IVs, medications, blood work/labs, etc came to a whopping rs17000, which translated into dollars is somewhere around $378, which is less then I'm currently paying monthly for rent.

The insurance we have here will only pay in the event of a 24 hour minimum hospital stay and it will only pay for one stay per year, up to 1 lakh rupees, or around $2200 USD. After spending three days in the hospital with all of that blood work, antibiotics, and room charges, I can't imagine what kind of surgery would be required to max out the annual insurance benefit.

Overall, I have no complaints about my care. The doctors I saw (five in total in three days) were all amazing. The Sisters were very sweet and I'm better now, so no complaints from me. After I got home, I was looking through the medications they had given me and realized one was for the treatment of Typhoid fever. While I don't recall any specific diagnosis as such, it seemed to do the trick. I'm also starting a multivitamin, which I was so good about taking when I was stateside, to help with iron levels. The doctor says she's not concerned about my WBC counts or hemoglobin and didn't request I get it tested regularly so that's a relief.

Thanks everyone for the kind words while I was incarcerated. It was certainly a new experience in many ways.