Indian Train Experience to Goa

December 23, 2011

The hospital arranged a vehicle for us to get to the train station in Chiplun… and we’re off to the beach for Christmas! Working at the hospital for the last 5 weeks was an amazing experience and 100% glad we took advantage of the opportunity. We all said we may not have had all the opportunities to polish our clinical skills, mostly due to the language barrier and extremely different protocols, but we now see healthcare and life in general with a whole new perspective.

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Well we finally got train tickets at the last minute after spending 3 weeks on the wait list. The day before we left the hospital helped us out and found 4 tickets for us. The only catch is that these tickets were not exactly in the same class as the ones we’d been waiting for… so we had absolutely NO idea what to expect. But regardless, we have tickets to Goa… point A to point B was all that mattered. The tickets we were originally wait listed for were class 2AC, pretty much the class right under first class. But since those did not pan out we were stuck in the sleeper class. This is the bottom of all classes. We avoided this class in the first place not because of luxuries or even the AC, but because it’s not typically a car taken by travelers and there was greater potential for being haggled by street vendors and street children that would come on the trains to sell goods or ask for money.

So we get to the train station and wait and wait. Our train was actually supposed to leave at noon, but of course, as with everything else, that means 12:30-1pm. Finally, about 12:40 our train pulls in and here goes nothing… (here you must picture 4 very white kids, each with a backpack and large wheeled suite cases, packed like a boy scout prepared for anything getting onto this $6 train ride. We step onto the train with our gigantic luggage and work our way down to the appropriately numbered seats. We find our seats and they were open, so things are working out so far… and our luggage tucks nicely right under the benches, another plus. Maybe this ride won’t be so bad after all! So we get settled in for the 6.5 hr ride.

The train is interesting. Not having AC wasn’t too big of deal, the windows were open and the small ceiling mounted, oscillating fans kept the air from being stagnant. The seats are situated like bunk beds – three high. But the middle bunk folds down to make a bench seat out of the bottom bunk. That’s where all three people sit during the day (unless you want to nap, which then you can climb onto the very top bunk). The three bunks on one side sit facing three on the other side. So it’s kind of like a booth in a restaurant only with a bunk above you and no table between. The benches are fairly wide allowing 3 people to sit relatively comfortably. I say comfort really only in regard to space, the seat were hard, extremely upright and covered in a dirty blue vinyl.

We are all settled in, great our neighbors and we’re off! The three of us girls have seats next to each other and Jeremy’s seat is in the next bunk over. The train is a much smoother ride than any car ride we’ve taken. No bouncing around, weaving in and out of traffic, dodging goats or cattle, or concentrating on keeping your lunch in place. We were all actually even able to do some reading without becoming carsick. I get carsick as the passenger even if I try reading direction for the driver! Being able to switch between my surgical recall book and “House Rules”, the 6.5 hrs passed pretty quickly. Napping was always an option but difficult with so many people walking up and down the aisle selling goods… Peanuts, samosas, fruit, meals, chai, etc… Beth described it as feeling like she was at the Circus… “Popcorn!!.... Peanuts!!.... Cotton Candy!!...”

Later in the ride there were beggars and street children that began to become overwhelming. This was part of the reason we originally did not book this class because they are not allowed to enter the upper class cars. We never could figure out why or how they got on the train in the first place or if they were just people’s children from the train that they told to go make a couple extra rupees while riding. It’s a little hard at first to say no to them (with their little sad eyes) but you know they have other intentions and probably make more money in a day begging than others do trying to sell goods. These children would keep coming back like we were going to change our minds from the first two times we said no. Then there was this one little boy who was the worst of them all… He came around and held out his hand, then when we ignored him he started poking me in the leg. We continued to ignore him, but then he would shake my foot and started poking me in other places. I continue to ignore. Then he reached over me and starts poking Beth, grabbing at her bag and book. That was too much for Beth and she pulled out her stern NO voice and a dirty look, and he still hung around for a bit before realizing he wasn’t going to annoy us into giving him money. We ignored just as we were told, but that kid was just too much for me. After bothering us he went to the next bunk where Jeremy and Julie were and started poking and slapping them. It’s unfortunate, but it was after a few experiences such as this that you begin to lose compassion for them and just become cold toward them. But in India there are SO many people on the streets looking for nothing more than to cheat and scam, so those that truly may make use of a donation don’t get one. In the end we have to look out for our own safety.

The train ride wasn’t so bad up to this point, but by the end it got long, but like I said, the ride was $6 and carsick free. Another thing is that there really isn’t anyone manning these cars and you can go between cars and completely lean out of the train and watch the scenery go by, no chain or gate across the stairs. Holding the bars and leaning out a bit made me feel like I was in an old western looking for a soft landing!

One particularly funny occurrence on the train was when we were stopped for a little while at one of the bigger stations. Beth was on a top bunk resting, Julie and I were below her and Jeremy was still in the other bunk next to us. He was sitting with his elbow resting on the window sill while reading. While just sitting there, he felt something warm on his arm… then he noticed this warm feeling had a wet quality to it as well. He looks over to find a huge cow RIGHT next to him… licking his elbow. What we would have given to see the look on his face… and the cow’s!

We arrived in Goa, got our taxi and were off to our hotel (Somia Guesthouse), which turned out to be an old home in the heart of Pajim that a nice little Portuguese family rents out. Chiquito and his wife were the owners who were very informative about the area, and the only complaint was Chiquito’s habit of chain smoking in the front room of the house. The rooms were not exactly what we expected, definitely nothing special, but for $10/night on Christmas in Goa, it’s not a bad deal. Fits the budget perfectly! No hot water, but the toilet at least was “sittable”, aka western toilets, and the sheets and towels were clean.

We found a nice restaurant around the corner, had a little dinner and walked around the area a bit. This area (Panjim) is less touristy than the other areas closer to the beach more north of here. So you really get the feel for what the capitol of Goa is like. A lot of old architecture, churches, temples, houses, with extremely narrow lanes that barely fit a car down. Occasionally you’ll find a restaurant or a tour agent tucked into one of the holes in the wall on the streets. During the day we would take a taxi north to the beaches and markets and on the final day we took the government bus (city bus) to Old Goa to look at all the old churches, chapels and to get a fantastic view of the city.

Final Days in Dervan

December 21, 2011

On our final day scheduled at the hospital, Beth and I joined the TATA cancer team on their mobile screening day. We ended up going to the nearby city of Chiplun among a few apartment complexes. They set up all the equipment on the first floor veranda of an apartment building, where cars and motorcycles are usually parked. The three cancers the team screens for are oral, breast and cervical, these are the three most common cancers in India. There was a little station for oral screening, which included a thorough examination of the mouth, tongue, cheeks and neck and also counseling on tobacco chewing and mouth care. Each person, no matter what age or sex, went through the oral screening. Then there was the breast and cervical screening room. Every woman, aged 35-65 had these screenings. Their breast exams are exactly as they are in the U.S., but for the cervical exams, they do not use PAP smears like we do, they use an acetic acid stain to view any lesions that may be on the cervix, if anything shows up, they do a biopsy right then and there. They take the biopsies back to the hospital to be evaluated, then contact the patient with the results. They have found this is a much more effective method than doing a PAP where the patient must be contacted days later with results. The team found it difficult to contact women to return for a biopsy, or women would not come because there is a stigma about going to the hospital. The disappointing thing for us as students was that we were unable to participate in any of the screenings because it was being used for research. So we basically shadowed and learned about the research.

The other disappointing thing was the turnout. The team goes into the area several for 2 days before the screening to educate and determine the number of people eligible for screening. After the prior 2 days of work they expected about 50 people to come to the screening, but only about half that number showed up. It was explained to us that there was a quarrel going on between the two apartment buildings (the one we were in, and the one next door). Therefore, since we were set up in the one building, the residents of the other would not come. It was very disheartening to think that people would put trivial things like that in front of their health.

Well the occupants of the building we were in were extremely nice to us. We were fed and fed and fed (and of course it’d be rude to say no, so we HAD to eat everything). Chai and coffee and oranges and candy and banana chips… guess not being around for the holidays doesn't mean I won't find those extra pounds!

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On the way home from the screening that afternoon Beth and I jumped off the hospital bus with the CMOs in the nearby market of Savarde. We were finished with our shopping well before the CMOs and decided to walk back to hospital (about 2 miles). Since we felt like all we did was sit and eat and drink all day, the walk would do us some good! About ½ mile from the hospital a rickshaw drives up from behind us, pulls over onto the shoulder and sort of cuts us off. We thought this was odd but just continued to walk around and past it. It wasn’t until we were about 15 ft in front of it that I heard “ma’am, ma’am!” With a sigh, I turned around and walked back to the rickshaw, with Beth looking at me like I’m nuts for going back. But it just so happens to be my cauda equina patient! It was pure coincident that we ran into each other but it just so happens that he’d had a follow up appointment with the surgeon earlier in the day and all went well. He is continuing to improve and said he was glad he ran into me because he was hoping to see me earlier at the hospital so he could wish me a Merry Christmas. It’s having patients and experiences like this that make up for all the less enjoyable experiences.
-On this evening we were invited to the MICU charge nurse’s house for dinner (non-veg!). Apparently her “house” is also a restaurant about 500 feet from the entrance of the hospital. So we had a very nice meal of chicken curry and fried fish. Wish we would have known about this sooner. We would definitely have come there more often had we known there was meat so close by! Oh well, we still survived without it.
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December 22, 2011
This day was given to us as a free day to do any work we needed to wrap up and to prepare for the presentation we were asked to give to the physicians, nurses and nursing students before leaving. The hospital, staff and all the people in the villages we met during our time at the hospital were all so gracious and open with us so we were hoping to leave a gift for the hospital on our departure. For the last 2 weeks Beth and I had been sending emails to MULTIPLE medical supply companies looking for ANY sort of donation for the hospital, even just a few stethoscopes would have gone a long way, but even up until this last day we were receiving rejection emails. Unfortunately it didn’t pan out for us, but we will certainly pass down the idea to the future classes that they consider organizing a fundraiser for future visits.
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We wanted to give our presentation in our saris that afternoon, but unfortunately we could not figure out how those girls whipped and tucked and twisted that fabric to appear as a dress on our bodies. So with jeans on and saris in hand, Beth, Julie and I went to the hospital early looking for someone to dress us. We walked into the large conference hall where we were to give our presentation and all the nursing students were there already. I asked the girls if any of them could help us put on our saris for the presentation, and they all just stared at me. So I held up my sari in its clear, neat little bag and said I need volunteers to put on 3 saris. Then they got it! One girl jumps out of chair and says “me, me, me” and 5 others then follow. Well the girls got us dressed, and the presentation went well. We shared a little bit about Chicago, Rosalind Franklin the person, Rosalind Franklin the University, about the PA profession, some barriers we encountered while working at the hospital, things we learned and experienced and then a slide show of photos. We finished of the presentation with a group picture with the physicians, many thank you’s, well wishes and goodbyes.
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That night we were invited to have dinner with the CMOs Beth and I had worked with at the cancer screening the day before. Unfortunately Jeremy was unable to join us for this dinner since it was in their room at the female hostel, no boys allowed! So we sat and visited while they were cooking and preparing dinner. Once everything was prepared they laid out a mat on floor for us to sit on and some newspapers to place the dishes on and catch the crumbs! We sat down to eat and they were not joining us. Turns out it was a day of fasting for them, so they made all this just for us and it was the most AMAZING veg dinner we’ve had on this entire trip. They did it all their cooking on a gas hot plate and w/o running water to their room. (they normally have running water, but there was a problem with the pump at that time). We felt bad that we were not having dinner with them, but they were just so excited to cook for us and see how much we enjoyed it. They told us they’ll remember that night forever.

During dinner they were having a good time picking on Julie for the way she was eating her dinner. She couldn’t do ANYTHING right! She either had the wrong form of bread with the wrong dish or was doing something in the wrong order. The funniest part was that Beth and I were doing the same things but only Julie was getting in “trouble” for it. We had a good laugh as Beth and I learned what not to do. After dinner we did as girls do and we talked about boys and differences between dating and marriage in the US and India. We had a lot of fun and laughed a ton! After dinner we had to head back to our own apartments so we could finish packing because our train was scheduled to leave at 12:30pm the next day on a train to Goa for a few days in the sun before changing into our tourist hats. 

Best Veg Dinner!

3 of the CMOs Beth and I had worked with on at the cancer screening camp invited us over  for dinner on our last night on the hospital campus. The food was AMAZING!! 

Saris at Dinner with the Guru

Night with the Guru
Tuesday, December 20, 2012

Ok… I know this story is long after the pictures, but better late than never, right?

Good thing we had taken our last day off to go shopping for saris for Priya’s wedding one day, because just 2 days before the dinner we were told that it would be appreciated if we wore saris that night. We thought sure, we just bought them, but wait … it’s just yards and yards of fabric right now. When you purchase a sari it comes with a portion at the end of the fabric that is of a different design or no design at all, meant to be cut off and made into the blouse. Ok, so now we have 2 days to get a blouse made. Well, this is India and everyone around here seems to wear a sari, so there must be a tailor nearby. We asked around and found out that there were 2 tailors nearby, BUT the turnaround time is typically 1 MONTH! Whoa… a month?! But we don’t have a month. THIS is where it pays to be having dinner with the guru, because the anesthesiologist went to the tailor with us to explain why we need these done, and suddenly, like magic, she is able to have them done for us in 2 days.

We returned to the tailor on the afternoon of the day of the dinner. They were all done and ready to go. We paid her for her work and then took them back to our rooms to see how we’d look in them. Well… they were pretty once we were able to get into them because, oh my, were they TIGHT! At first we thought “these cannot be right! We are not tiny little Indian girls and she MUST have gotten our measurements wrong”, but no, apparently this was correct, so we squeezed in. We just prayed that the little hook and eyes would hold! After a good laugh at the fit of our blouses, we proceeded to get cleaned up and ready because at 6:00 someone will be coming to wrap us in our saris.

Well, 6:00 came, and 6:00 went, no one was there. No problem because we have now learned that everything runs late around here. Well once 6:35 rolled around we figured we could not wait any longer and we must go find someone to dress us. So we went out onto the campus and stopped the group of 3 young ladies and recruited them to come dress us. Well in no time those 3 multiplied into about 7 or 8 girls that filled our room and had Beth, Julie and myself standing with our arms at our side and fabric flying around like Arabian Nights! As they are wrapping and folding they ask us for our pins. Pins?? We don’t have any pins. Apparently these saris don’t just magically stay in place with all the fancy folding, you need pins to be sure you don’t give the guru a show! So one of the girls literally runs to the little convenient store on campus and purchases some pins so we can be properly dressed. In about 15 minutes flat those girls had us wrapped up and ready to go! The only flaw... they did not like my hair! They told me a needed a comb L I had the top half of my hair pulled back but I left it wavy, they wanted me to smooth it out. Haha… well there was no time for that, so I was going as is! With 2 minutes to spare the girls all wanted picture with us. So a snap here and there and we are off to the vehicle waiting outside our building.

Upon arrival at the temple (4 min down the road) and we are so thankful to see that the Singapore students are also there for this dinner. The Singapore students had arrived just a few days prior to this night and they are at the hospital as engineering students working on frugal innovations. The goal is to see everyday live in the village and hospital and think of new ways or new and inexpensive ways to improve daily living or activities. So needless to say we are glad to see that there are 10 other people to pull some of the attention away from us! In addition there were 5 physicians from the hospital that we knew well.

Before entering the temple there is an area to leave your shoes and wash your feet. Perfect!! I was planning to be able to remove my sandals because they did not match my sari in the least, but it was what I had with me! So we leave our footwear and enter leaving our wet footprints behind. Within the temple are smaller areas of worship. As guests we were brought on a mini tour before greeting the guru. The first thing he says to us is “Who taught you how to wear the sari?”. We just laughed and said we had Dr. Jog’s (the dentist) nurses to thank for dressing us. The four of us along with the physicians and Singapore students are directed to have a seat on one of 2 long benches placed in front of the guru. The benches were places parallel to the guru and facing one another. It was more awkward silent, similar to the first time we me the guru, and after a few minutes were invited to sit for dinner.

Now the style of this dinner is different than another I have attended. There were about 25 people at dinner and we were seated at long tables set up in the shape of a tall, narrow letter ‘U’. At the bottom of the ‘U’ was the ‘head table’ of 3 people, the guru and the 2 Singapore professors. The rest of us were distributed on the sides of the ‘U’, and we of course end up at an end closest to the guru. We figure this sets us up for more awkwardness in our future, but everyone was so focused on the food that dinner went very smoothly for us with no embarrassment or awkward moments.

Dinner itself was amazing! Still vegetarian, but really fantastic! The chef was brought in from Pune, which is about 4 hours away. There was vegetable rice, plain rice, cauliflower curry, pea and tofu curry, soup, cabbage salad, tomatoes, carrots, beets, chips, bread, crackers, chutney, strawberries, grapes, donut dessert dish, etc, etc… There were several servers that just continued to walk around the inside of our little U to serve us. The only problem with this is that they wanted to give me more of things before I had a chance to even try it for the first time! They just kept coming with more and more! But then we learned after watching others that you do not need to politely say ‘no thank you’ each time, you just need to make a motion to guard your plate. Then we realized that we were not eating fast enough either! We looked up to find the guru on dessert as we still had our plates full of dinner! So we moved our marathon pace to a sprint so we could catch up! In the end I believe dinner only lasted 15 minutes.

The funniest moment of dinner was when Beth and I looked up to see the absolute look of determination on Dr. Rishikesh’s face! He had made a bet with Jeremy before dinner over who could eat the most at dinner since neither of them had gotten lunch that day. Rishikesh totally did the “I got my eye on you Focker” motion in a very low profile manner! We almost died and wanted to bust out laughing, but we kept it together and continued shoveling food.

After dinner we were directed to a washing station to wash our hands, since we don’t us utensils, and then directed to be seated in front of the guru again. At this point my body is concentrating so hard on digesting that I just want to go lay down! But then the dinner servers come out with their arms full of bags. The guru calls us up to him, ladies first, then gents. The guru presented all the ladies with a sari and the men with a dress shirt! So this dinner we were all so worried about turned out quite well. Once everyone had received their parting gift, we were bit good night by the guru and back to the hospital. We were in our rooms again before 9:00!

We received many compliments that night on how well we carried ourselves in our saris and how comfortable we looked. Even though we did not quite have the Indian accessories like the bangles, bindi or necklaces, they were impressed with how we embraced the culture and we open to wearing the saris to dinner. For us it was almost like being a little girl and playing dress up with your girlfriends, and more than anything we were just trying not to embarrass ourselves!