Maud & Me

12. GUIDE Leadership Meetings

2007-03-03T16:49:00.000-05:00

Early in our stay at the beach resort, I wake from slumber to hear Phil and Maud at the door of our cottage. They are returning from a GUIDE leadership meeting for Dalit women.

Phil barely opens the door when Maud shoots past him to the bathroom. He is next in line.

Whew! I couldn't hold it any longer! Maud exclaims as she emerges.

No one warned me that Indians use squat toilets, she says. I studied that hole in the floor for three seconds and said, I don't think so!

Some people say that Asian squat toilets are ergonometrically superior to European toilets and can help to prevent many kinds of disease.

For more about it, read this:
http://www.relfe.com/toilet_seat_constipation.html

They can promote greater cleanliness, providing water for people to wash their bottoms--always with the left hand.

But they require perfect balance and are not handicap-accessible, which leaves me out.

I don't know how they do it! Maud continues.

And then they sit on the floor all day like yogis!

Phil downloads his photos of the meeting.

Leaders discuss their outreach to surrounding villages. In the center of the floor, stacks of beautiful posters designed by the artist Sathyan (whose name means "truthful") illustrate the issues women are raising with their government. Vasantha stands in the doorway.

Hours before we had flown to India, people who worked for Plan International put us in touch by email with R. Vasantha (left) and Gilbert Rodrigo, who founded GUIDE in 1985--the Gandhian Unit for Integrated Development Education. All these years they have been working on problems confronting poor people in this region.

When the tsunami struck on December 26, 2004, Asian governments had no warning.

GUIDE had already been organizing Indian villagers to demand better government responsiveness. The aftermath of the tsunami brought new awareness that poor people--especially women--needed to confront official failures at every level.

Relief funds had disappeared into the pockets of those who were politically connected--which entirely excluded women and children. Many men drank or gambled away the relief funds intended for their families.

This poster says in Tamil (the predominant language in the state of Tamil Nadu): "It is the right of women to be treated with dignity and honor in times of natural disaster."

It exhorts women and government: "Act now!"

GUIDE focused much of their early attention on water rights along the Palar River Basin, where water is being drained away for urban use. It is not only that women spend hours hauling water to wash, cook, and care for their families.

Much more than that, women are the unrecognized farmers who grow most of the crops and who suffer from loss of food and income when water is not available for agriculture. This has induced many poor women to sell their land to wealthy coastal developers.

One of GUIDE's posters explains how 85% of the Earth's water is used by only 12% of its people--who are not from developing countries. According to the World Health Organization, the lack of safe water kills twelve million people a year, including three million children. As for Earth's energy resources, 58% is consumed by only 5% of the planet's population.

How can we correct this injustice?

GUIDE says: Put land, water, and other resources in the control of local women.

The unity salute, with fingers united and fists raised, signifies solidarity with those from other villages, cultures, and religions who demand gender justice.

"Let us make a society without violence against women." declares this poster. "Act now!"

In their leadership meetings, women share their success stories visiting villages and starting discussions about these issues.

What happened?! Girls and women learn to talk about painful experiences . . .

about the unrelenting needs of children . . .

about feelings of grief and loss . . . about needs of older women . . . ,

about the search for income, dealing with disabilities, supporting families, facing new challenges . . . .

Who are most affected by disasters?

Act now!

In leadership meetings, women discuss the steps required to protect women physically.

As always, they listen and write notes about each other's concerns.

Refugee camps must have women doctors.

Pregnant and lactating women must have adequate, nutritious food.

The government must monitor and prevent child marriage. They must provide counseling for survivors of disaster, along with access to current news and information.

GUIDE presents these concerns and others in attractive posters for women to take into hundreds of villages.

These leaders raise awareness about women's issues throughout the region.

Another poster identifies concerns about government housing that has proven unsafe for women and children. Survivors of disaster need medical services, security, privacy, basic supplies, education, and information.

Women help other women claim these as their own rights.

Young women are also leaders.

They become role models for younger girls.

These young women speak about the right of all girls to have:

•Free, high-quality education
•Preparation for disasters
•A supportive environment at school and in the community
•Concerned, knowledgeable officers
•Appropriate help for the physically challenged
•Sex education
•Safe playgrounds
•Training in children's rights
•Free bus passes for school and
•Mental health services

When government and other organizations built new homes far away for survivors of the tsunami, GUIDE recognized this as a strategic evacuation of fisher people from valuable coastal real estate.

GUIDE secured machines for women to go into business making bricks.

Since they are only permitted to live in the narrow land along the ocean shore, they must dig deep foundations, as shown in this GUIDE photo.

But they are succeeding in rebuilding their fishing businesses and homes on the coast where they can conveniently manage their families and jobs at the same time.

These GUIDE photos show homes being built.

Their houses must be strong enough to withstand ocean storms.

Four generations share this home, including the young mother in front of Vasantha. She had a baby just ten days ago!

Within seconds from their doorstep, they can reach the shoreline and the fishing boats that sustain them.

But developers constantly try to lure fisher people off their land.

Morning and night, GUIDE works with the fisher people to figure out ways to stay and make their living here.

Now GUIDE is working to purchase a truck, a store, and a refrigerator. It's a sound business venture: Fresher fish will command higher prices at greater distances than women can carry their product on foot.

On January 29th, two days before we leave India, I am able to attend a GUIDE leadership meeting with women from farming villages.

It is not easy to clear this land of its rocks,

to irrigate it,

to transport supplies,

to build farms.

The role of women is essential.

At the leadership meeting, one group presents skits they are performing in villages to prompt discussions about domestic violence.

A family is forcing a young woman to marry her uncle,

who drinks and grows increasingly violent.

The audience feels her anguish and despair. Finally she tries to hang herself.

The story opens up deep feelings.

Some men also participate in the dramas. GUIDE runs experimental "gender labs" where men spend 36 hours at a time, sharing personal experiences and getting in touch with their feelings about patriarchal traditions.

This helps to build greater awareness of men's emotional needs and increases their affirmation of women's equality. GUIDE hopes it will reduce violence against women.

At today's leadership meeting, men show their support by serving a delicious lunch--

nutritious rice and meat sauce with spinach on a plantain leaf and a banana with sweets for dessert.

(We are becoming experts at eating with our fingers--always the right hand!)

While the women resume their meeting, we visit the GUIDE offices

Outside, their sign provides a constant reminder of the values and goals of GUIDE.

Gilbert says that nothing restores him like a green field!

So the seedlings are neatly bagged and ready to share.

Vasantha says she draws nourishment from the people!

For us this has been an unforgettable privilege and an invitation to lifelong friendship.

GUIDE's vision of Peace, Justice, and Equality is one we will carry with us.

They call for:

•Establishing village and block-level committees to monitor and confront violence against women
•Developing effective means to investigate domestic violence
•Creating new awareness in government polices that respond to disasters
•Initiating government action immediately when decisions are made
•Assuring that women participate in these decisions and
•Securing disaster compensation for women

Act now!

We wave goodbye knowing that the people of GUIDE are building a better world with gender justice for these children and many more to come.

11. Blessing in Disguise

2007-02-22T23:31:00.001-05:00

Surface-hippies usually follow their stay at Apollo Hospital with another week of recuperation at a top-rated beach resort on the Bay of Bengal, about an hour's drive from the hospital. But those resorts have been completely booked.

Not to worry! We have met new friends who say it is a blessing in disguise, for they can find us less expensive accommodations farther south, where we can visit their projects along the Palar River.

On January 23rd, we head down the well-paved coastal road.

Traffic still is scarey.

We settle into an oceanside cottage at the Shelter Beach Resort on the East Coast Road, Vada Nemmeli, Kanchipuram.

Stunted palms on the beach remind us of the terror that struck just after Christmas two years ago in 2004, when the ocean mysteriously receded, gathered its forces, and struck like a wall of fury.

Finally new fronds are beginning to sprout inside the old ones, bruised and broken.

(Little do we realize that, half a world away, another new frond, our granddaughter, Sofia Kathryn West, is preparing her own grand entrance!)

Diligent as always, Phil sets out to find water that is safely bottled and sealed. While searching for a shop on the main road, he passes a school.

He is strange-looking with his pale skin and camera, and these are very observant children.

Laughter is a universal language.

On the 24th (Sofie's birthday forever after) Phil goes with our friend Vasantha for an inspiring introduction to GUIDE, which we will tell you about in our next posting.

I stay confined to our cottage, unable to make our phone work. Nor can I get online. All I want to do is sleep, read Indian newspapers and sleep some more. My body is healing.

When I sit on the porch, a young man who works here comes over to practice his English. He teaches me words in Tamil. He says his God-name is Saran, and I should call him Kailash.

Smart and personable, Kailash is earning his diploma at the Indian Institute of Catering Technology and Hotel Management at Thanjavur. Throughout the week he appears at our door to take our orders and help us understand Indian culture.

Soon he hopes to visit Sweden, where a prior guest has invited him to further his studies. Like so many Indians, Saran Kailash has big dreams. He is eager to see the world.

On our porch, Phil and I laugh as crows compete for lumps of sugar from breakfast trays, and do their victory dance.

Indian crows proliferate here and inspire good writers to tell stories. Check this out when you want to learn more about them:
http://www.author-me.com/fict02/crowtalk.htm

We appreciate the beauty and strength of coconut palm trees that flourished here since pre-historic times.

What perfect pods for carrying life through tumultuous oceans to reproduce on distant shores! (Have you ever seen a tropical island without a palm tree?!)

Indians thrive on coconut water (perfectly packaged and sealed antioxidants with medicinal power). They crack the pods to eat the meat, then carve the pods or turn them into bowls and ladles.

And look at those fronds--a natural shelter!

Woven fronds make walls and rooves that last a year or two.

From our window, we can see the women who work on the gardens . . .

often under the boss' watchful eye. (This body language makes me worry for her. She and I often smile at each other and nod, but I cannot speak Tamil to get acquainted.)

Sometimes the women haul big plastic garbage bags of dead palm fronds to the beach and burn them. Ocean breezes carry the smoke to our cottage, where it chokes us. Why?

Why not bury the fronds instead? Why not feed the soil? Why not use them to fertilize the evergreen seedlings that the women water every day? Leaders here struggle to teach environmental principles.

But India also has much to teach us about environmental principles. For example, Indian showers generally have a collection of buckets, whether in a home, a hospital, a beach resort,

. . . or a 4-star hotel. In India we learn to use water much more sparingly.

The bath mat reminds us that sometimes, in the face of unrelenting climate, all you can do is laugh.

On January 26th, a man comes to our porch. He tells us this is a national holiday and offers us two wrapped sweets.

Indians won their independence from Great Britain sixty years ago on August 15, 1947. Their Constitution took effect January 26, 1950.

Today is their 58th Republic Day! India's tricolor flies on flagpoles everywhere.

On the beach, vacationers walk in the surf. Some talk on cell phones.

(And bourgeois me--I dreamed I walked by the Indian Ocean in my TEDs!)

Indians play catch

. . . and volleyball

. . . and cricket (having kept some parts of British culture).

They pose for pictures.

Here it is easy to tell the difference between the privileged and the poor,

who work unacknowledged in the margins.

Just beyond the beach where people play, we see those who could never afford to stay at this resort and who get no vacation.

We watch the fisher people and realize how dangerous their work is.

Along the road we pass survivors of the tsunami, still living as refugees two years later on government land with nowhere to move.

Wealthy developers are buying these coastal properties. What can poor people who have lost their homes do about that?

10. Room with a View

2007-02-04T05:41:00.000-05:00

Maud stands at the window and weeps.

They work so hard, she says.

Wherever you look, it takes time for your eyes to adjust--to figure out what is happening.

But no one seems angry. Maybe they have no energy for it.

Maybe they hold it in until they get home.

Maybe they do not want strangers to know what they are feeling. Or to risk losing their jobs.

Maybe they think, What's the use? It is God's will.

Old and young, with shoes or without, everyone works.

A subcontractor brings heavy blocks of stone . . .

to build a jersey barrier by hand, no matter how long it takes.

They are determined to make their roads safe--even though they, themselves, are not safe doing it. No flaggers to slow the traffic whizzing by on both sides.

They build jersey barriers more beautiful than ours.

How long will it take to haul all these mounds of garbage on tricycles?

How many expertly woven garlands, how many perfect stacks of fruit will it take to overwhelm the poisonous stink of pollution?

How can he feed his family by repairing shoes in a land where so many don't wear them?

How does she find water to wash all those clothes?

Is she too tired to think of lifting the basin up on a stool for the sake of her spine?

Where can they find a place to make their homes?

How many squatters can live in abandoned public housing

. . . beside the stench of open sewers?

Look! Maud says.

They are building a luxury hotel by hand.

Can you believe it?

Scores of workers seem to know what they're doing, pulling order out of chaos.

All ages eagerly join the cement line to build the hotel.

There is not men's work, or women's work here, though women are paid much less than men. But everyone needs a job.

So labor is cheap. And the shareholders demand their profits.

Did you read Mohan's book? Maud asks. The one where North Americans write their comments after hip surgery? They are thrilled to finally be able to resume their hiking, biking, skiing, squash, tennis, golf, swimming, dance, yoga and taekwondo.

Before they do that, they should westle with their conscience, Maud says, barely containing her own anger.

They write in Mohan's book: Keep the price down!

Can you believe it?!

It makes me want to give back my ticket to America, she says. (Her ancestors came on the Mayflower nearly 400 years ago.)

Do these Americans see how hard hospital staff work to serve them, how many hours? Do they see these tiny nurses hoist big American bodies without even back braces to protect them? With only the flimsiest canvas shoes?

Keep the price down!? Can you imagine?!

Do Americans see anything at all, but our own advantage?

"Do you think it was wrong for us to come?" I ask Maud.

No, she says. If our $7,000 helps them serve the people who need it most, that's a good thing.

If our money helps make it possible for Dr. Bose to go to government hospitals and operate on those too poor to come here, then more Americans should come.

It's a good thing, she decides, wiping tears from her cheek, biting her upper lip.

"Are you ready to go now?" I ask.

Where?

"To the villages where the tsunami struck two years ago."

Yes, she says, turning from the window. I'm ready.

9. Apollo Hospital

2007-02-02T13:13:00.000-05:00

Two days before we fly to India I feel a tickle in my throat.

Dr. Bose has warned me to stop taking aspirin or pain-killers a month before surgery. I try homeopathic remedies, but nothing works.

My cough grows worse, compounding the discomfort of 22 hours flying 8,380 miles as I stifle coughs and worry about infecting other passengers.

Will an American germ scuttle all our plans?

Fits of coughing disrupt our first night in a Chennai hotel, finally giving way to deep sleep interrupted early on January 17th by a phone call. The hospital wants us in today for surgery tomorrow. Dr. Bose has been asked to lecture in Mumbai tomorrow evening.

It’s just as well. Let the experts decide what to do about my throat.

Later I am relieved to learn the throat will not interfere with surgery. Treatment is a strong gargle and steam inhalation therapy. No antibiotics means no superbugs, remember?

In addition to Dr. Bose, our first contacts at the hospital are the international coordinator Ms. Shoba Bhasker (left) who made all advance hotel and resort reservations for us by email long in advance of our arrival, and the program administrator Mr. Mohan Kumar (right) who coordinated our journey once in India.

Mohan sends their driver to bring us from the hotel, greets us at the entrance to the hospital and takes us to the 4th floor.

Indians often identify their family name first--which some people call their "God-name." Receptionist Ms. Hamom Maria shows us our accommodations in the recently opened “Platinum Ward," where eight rooms and highly attentive staff cater to us spoiled international patients:

She teaches me to operate the new electric bed that earlier patients only dreamed of. Phil will enjoy the comfortable day-couch that serves as companion-bed. In contrast to us international patients, nearly half of Apollo's hip resurfacing patients will use stationery wooden beds.

The toilet is English-style, with a riser attached for hip-resurfacing patients.

The room is equipped with a refrigerator and restocked with water that is bottled and sealed--a particular concern for international patients who have not built up immunity to local microorganisms.

We never use the microwave, since meals here are frequent and generous.

Nor do we use the plasma TV, which offers programs in Tamil and the BBC in English. Indian newspapers provide fascinating news stories and editorials in English.

(By the way, most Indian women never go sleeveless. Although no one makes me feel inappropriate, I learn to cover up.)

As we unpack and get settled, a steady stream of staff introduce themselves. We will see them again throughout our stay.

Dietician Ms. Manju P. George comes to check on my preferences. The hospital offers Continental European or Indian cuisine. (I soon develop a preference for lightly spiced Indian dishes. It is easy to understand why children raised on these spices soon find other food bland.)

Mr. Reegan Prabhu and others from Food Service deliver meals on a British schedule, beginning about 6:30 a.m. with coffee, tea or milk served in bed, followed by breakfast about 8:30, a mid-morning fruit shake about 10:30, a generous lunch about 12:30, tea about 4:30 p.m., and dinner about 7:30. Every dish and glass is tightly covered with plastic wrap that displays beautiful presentation while protecting against germs.

Housekeeping staff appear at least twice a day to sweep the room, remove trash, clean the bathroom, empty my urine bag in the days following surgery, and push my wheelchair when that is needed.

This particular gentleman, Mr. Sabari Raman B., had already worked his usual six nine-hour days, when he came in an even longer seventh day to fill in for an absent employee.

Now he wisks me off in a wheelchair while still in my street clothes, down a busy elevator, to other floors, where patients wait in rows of chairs. Staff in modest rooms administer my electro- cardiogram, echo tests and x-rays using well-worn equipment.

Eventually I change into a hospital johnny, and deliver a urine sample. A nurse draws blood and starts inserting the needles and tubes that will make injections effortless. I am here to stay through six days that proceed like clockwork.

The anaesthetist, Dr. Bapuji, comes to examine me in preparation for tomorrow's surgery.

That evening Dr. Bose explains what he will do the next morning.

He shows us a cobalt-chromium prosthesis like the one that will be inserted in my femur. (I'm holding it upside-down. The post at top will extend down into my femur, which is the strongest bone in the body; The cap at bottom will be cemented up into my hip--the "resurfacing"--and the thinnest film of water will form between them, permanently lubricating the already smooth action and eliminating the locked and painful joint I now have.)

At left is the prosthesis for a total hip replacement, commonly used in the U.S. This device requires extensive cutting of the femur and too often gets dislodged from its plastic casing in the hip, so that it may require repeated operations. Once the femur has been cut, it is impossible to revert to hip resurfacing.

After midnight I can have no more food or water. By 10:30 a.m. Thursday, January 18th, I am wheeled down in the elevator to the operating room where Dr. Bapuji appears reassuringly at my side and skillfully dispatches me.

Later Dr. Bose gives us a DVD showing a similar hip resurfacing he performed. It helps us understand how, within one hour, he slices, spreads the flesh and muscle, dislodges the femur, saws, drills, hammers, glues, and sews to install the implants--none of which I recall from his surgery on me.

Along with the barcodes of these implants, he provides notes to document the entire procedure, how he determined exactly the right size implants for me.

Surgical experience makes all the difference. My implants do not come from Birmingham, England, that gave this process its name, but from Leeds, where DuPuy manufactures a greater variety of sizes suitable to smaller bones. Before he ever made his incision, Dr. Bose had the full range of options lined up to make the best possible decisions.

Next thing I remember is trying to open leaden eyelids, and hearing enthusiastic voices exclaim: "Excellent!" "Perfect operation!"

This is a good sign, I decide, and go back to sleep.

POD 1 January 19th

On my first post-operative day, the nurses gently wake me for pills and a sponge bath, then put on the white elastic TEDS stockings I must wear to avoid clots forming. I am puffy and completely askew, but the staff (left to right: Receptionist Harmom, Nurses Rajeswari and Sasikala, who are called "Sister" in the British tradition) treat me like a star.

I hope they do not remember that I am supposed to stand up today. If Dr. Bose has gone to Mumbai (formerly Bombay), the others may forget.

I am wrong of course. Another member of the surgical team, Dr. Biswagit Dutta Barnah, arrives to check on me and remind me that everything is proceeding perfectly on schedule.

Then I meet yet another of Apollo's stars, senior physiotherapist Mr. S.K. Pandian. He is quiet, clear, respectful--the gentlest of teachers. He reassures me that moving will not do any damage to the implants in my hip. They are there to stay.

The only thing I may not do is cross my legs, and that is easy to avoid by keeping a pillow between them.

He teaches me exercises I must repeat several times a day: pointing and flexing my toes, turning my ankles, pressing my knees down into a pillow, tightening my buttocks, inhaling deeply and exhaling. Then he and Sister Jemy John help me stand.

With a walker I reach the chair.

They knew I could do it!

POD 2 January 20th

Day and night as I struggle to get comfortable, I repeat the exercises, knowing they will hasten the healing. I realize what a privilege it is to have this bed, and wish all hip patients could have one.

Discomfort? Yes. Pain? No. The pain is perfectly managed with a round pump at my left side the size of a small rubber ball that dispenses painkiller.

Always, there is more food than I can eat. We are spoiled.

On the second post-operative day, I navigate the hallway with the walker, helped by another physiotherapist.

POD 3 January 21st

On the third day, Dr. Biswajit removes the two drains and covers the wound with a waterproof bandage so I can shower.

Finally I learn to use elbow forearm crutches--a light, excellent design, made in India by Vissco.

POD 4 January 22nd

On the fourth day, I learn to climb stairs.

POD 5 January 23rd

On the fifth day, we are ready to leave. Dr. Bose presents me with my post-operative x-ray and a plastic file documenting all the medical reports and procedures they have performed.

The most amazing thing in the file is the itemized bill, accounting for every cent of my $7,000. The most expensive item is the implant, imported from England for $2,475.

Dr. Bose' fee comes to $1,028. Dr. Bapuji's is $182. The cardiologist's is $11. The entire bill for nursing is $100. An additional charge of $29 covers Phil's meals and laundry for the week.

The bill reminds us of the Canadian couple who arrived the day before we did.

They had called a surgeon in Seattle, who agreed to perform the same operation for $35,000 up front and non-refundable before the first consultation. When they asked about his experience with hip resurfacing, the doctor's answer seemed disturbingly vague. So they chose to come to India instead.

Remember Dr. Koen DeSmet's study of revisions that showed a direct correlation between surgical inexperience and lack of success? Perhaps surgeons seeking experience with hip resurfacing should pay their first hundred patients to practice the procedure on them.

(We are also astonished at the long hours staff work here in every department. I hear that three years working in an Indian hospital give staff the equivalent of six years elsewhere because of the sheer volume of patients they serve.)

Maud has been pressuring me to ask Dr. Bose a question:

"Are there any women surgeons doing this procedure?"

"No." As far as he knows, there are none in the world. But there should be, he says.

"Some people think it takes physical strength to do this kind of surgery. But that's not true," he insists. "It takes finesse and precision."

Maud beams at his answer. She laughs delightedly when he says that he comes from a family of doctors, including several women--his mother, auntie, wife, and sister.

My kind of doctor, she grins--brilliant and humble! He sees women as his equal!

Then he explains the regimen of pills I must take for the next thirty days. I realize the little plastic box with a tiny spoon that nurses have been using to dispense my pills is also a teaching device that will go home with me as a reminder to stay on schedule.

I will see him again in a week for a final checkup before we leave India.

Another patient will soon move into our room. I hobble around packing our bags and notice Maud standing at the window, watching the street below. She is weeping.

"What is it, Maud?" I ask. She shakes her head, unable to answer.

Later, she says. I'll tell you later.

The complexities of India are more than we can absorb.

So I am leaving the hospital with a shiny new hip joint.

I am learning the surface-hippy dance.

But we are being changed in other ways, too, by the people we meet here.

And we have so much more to learn.

8. Daredevils on Board

2007-02-02T05:10:00.000-05:00

Landing at Chennai’s airport in the southeastern state of Tamil Nadu on January 16th brings our first exposure to India's most pressing problems: population and pollution.

Beyond white-washed blast walls of hewn stone topped by concertina rolls of barbed wire, stretch vast, long-established shantytowns that receive the full exhaust of planes day and night as they idle on the runway waiting to take off. Bordering these runways, acres of rusted scrap and splintered wood form ragged rows and piles of attached huts covered by corrugated metal with occasional patches of blue plastic tarp.

Clothes hang to dry in murky grey smog that blankets the airport in this bone dry season. Scrawny goats nose through rubbish to nibble grass growing in the effluent from a large sewer pipe. Children scamper barefoot in rubble that dominates the squatters' city lining the runways.

Apollo Hospital’s driver waits outside Jet Airways with my name on a sign. Loading our luggage in back, he does not notice Maud slipping into the passenger seat to the left of the steering wheel. Moments later, with both hands covering her face, she surveys the tumultuous highway through cautiously spreading fingers.

Great Britain persuaded some colonies like India to reverse prevailing wisdom and drive on the left side of the road as they do in England.

Learning to drive here requires keeping your hand on the horn as much as your foot on the gas. Both must operate in tandem.

Streets pulse with every possible wheeled contrivance: bicycles, motor scooters, curvy little white taxis, three-wheeled yellow taxis with hugely polluting 2-stroke engines. In the distance I see a legless man pedaling a tricycle with his hands.

Ancient government buses boast layers of paint and not much glass remaining in their windows. Poison pumps from their tailpipes. Pedestrians and bulls join the melee of motors.

An entire family rides a single motorcycle. Seated side-saddle behind drivers, women--often wearing sarees--sometimes hold babies. I wonder how they keep their long scarves from getting drawn into the spokes. Toddlers and older children, cling to the motorcycle in front, leaning into the wind.

Drivers ignore traffic lanes painted on the street as if they are merely a bothersome bureaucrat's bad idea.

In the city people sometimes wear helmets, but seat belts are hard to find. Everywhere I look, accidents are waiting to happen.

A physiotherapist later tells us that traffic mishaps account for most of their patients.

You might think police concerned about public safety would be the first to protest such derring-do. You would be wrong.

The Hindu Times shows a photo of police officers—at least eleven, two of them hidden from view--balancing at odd angles on a single motorcycle at the All India Police Duty Meet held at Chennai’s Rajarathinam Stadium the week before our arrival.

Specially selected police teams from various cities and states completed three months of rigorous training and then competed for medals.

It appears to be an advertising gimmick to attract recruits to a new image of police work-- finally liberated from bureaucratic wimpishness to competitive opportunities that display a “touch of bravado.”

Like so much in India, the conflicting messages here seem counter-intuitive: Is the idea inspired or bonkers?

[Photo by R. Ragu in The Hindu Times, Sunday, Jan 21st, 2007, p. 4.]

Maud studies the caption: PROVING THEIR PROWESS.

What does PROWESS mean? she asks.

“Foolishness,” I suggest, but she is not convinced.

No! What does it really mean?

“I guess they think it makes them look good,” I suggest.

Oh, she says. Like the American doctor wearing penny nails for shoes?

“Exactly,” I say. “Prowess."

7. Surprise!!

2007-02-01T09:57:00.000-05:00

Back in the hotel for our last night in Chennai on January 30th, we finally log onto the internet again and discover an astonishing message sent by Lars nearly a week before:

Sofia Kathryn West
Born 12:51 pm
Wednesday January 24th, 2007
19.5 inches
7lbs, 5oz.
Congratulations, Grandpa and Grandma!

Phil and Maud dance around the hotel room while I send our congratulations to Allison and Adam.

They had kept her name a secret till the last, calling her only Surprise!! She lived up to her advance billing and arrived two weeks ahead of schedule just to let us know who is now in charge: a woman on a mission!

So the future rushes into our arms, full of needs and full of promise.

Next morning we wake up early and set out for home at 5:30 am in southeastern India on Wednesday, January 31st. We chase the sun through ten and a half time zones in a car, a bus, three jet planes, and numerous wheelchairs.

After 26 hours it is still January 31st, 9:30 pm, when Kerrie and Lars greet us at the airport in Boston, holding our winter coats. We are tired and very grateful for the journey that still has much to teach us.

In the next posts, we will try to tell you what we have seen and learned as if it is just happening now.

Great great grandma Maud, grandpa Phil and I dedicate this blog to a better future for the world and especially to Sofia Kathryn West, who brings together many races and cultures in a little body that is ready for the road!

6. Body Parts

2007-01-30T17:25:00.000-05:00

Have you been waiting, wondering what happened when I limped off to India?

While I have been unable to access the internet, life has been full and miraculous.

I am absolutely fine! The incision has healed perfectly. My bones are fusing into the porous portions of the ball and socket that now bear my weight with the help of hand-held crutches.

I am amazed at the smooth precision of this process carried out with enormous human kindness, expertise, and humility by dozens of skilled team members. I will give you more details later.

But something more urgent has been unfolding.

An hour before we were due to leave Apollo Hospital, we were asked if we would like to meet a team of Canadians who have been investigating medical tourism in India.

Vijay Bose, the surgeon who operated on me dislikes the crass commercialism of this term, “medical tourism.” He insists: “It’s medical care, plain and simple.”

Nevertheless, here’s what the Canadians tell us:

“We are so impressed with the 99.2% success rate in India and that their infection rate in these Indian hospitals is only .003% because they sterilize everything. In the USA and Canada, people are being overexposed to antibiotics, which now has created these “superbugs,” highly resistant to antibiotics. So you go into hospital with one thing, and there you pick up a superbug and must stay a long time. In Canada we have had to close hospitals because of it. But in India this doesn't happen.”

He mentions that North Americans are now flying to India for cancer treatments, heart surgery, and even kidney transplants. His words reminds me of our friend, who urgently needs a kidney transplant. A long line of friends want to donate that kidney. Each has been slowly studied and rejected with exasperating loss of time and discouraging expense as our friend grows steadily weaker.

“Which hospital are people going to for kidney transplants?” I ask the Canadians.

“Miot Hospital, here in Chennai.” They give me the website at http://www.miothospitals.com

Is this about faith or foolishness? I wonder. Could he even make such a trip?

And what about the ethics? India’s national newspaper, The Hindu, is running a series on unscrupulous, well-connected dealers who entice the poorest of poor with promises of roughly $7,500 for a kidney--a fortune to them!

Then, after taking the kidney, the dealers refuse to pay. The donor not only has been robbed, but often is unable to work like before.

The next morning, I write a message to our friend, which Phil carries off in his cruzer to find a way to send email.

Even if the low infection rate is true, and even if the hospital takes every precaution, would he ever consider buying a kidney from an impoverished stranger?

Phil spent the next inspiring day at a village among Dalit people, formerly called "untouchables"-- impoverished, but getting empowered since the tsunami burst into their lives. Some have personal knowledge of selling kidneys.

That night Maud keeps waking me up:

Maybe the hospital would let him meet his donor!

Maybe we could build a relationship with the donor’s village, so he doesn’t feel like he is just taking advantage of their poverty.

“Adopt a village?!” I exclaim.

Even $10 a month would make a big difference! Think of all his friends who would want to show their gratitude for that kidney. Maybe they could help build a school or dig a well.

First I want to talk with doctors at Apollo whom I have come to trust.

As usual, Maud wants the last word:

Remember! This is not just some sordid business of body parts! she insists.

This is a relationship!

A week later we return to Chennai for my final hospital appointment on January 30th. I explore Maud’s idea and learn that Apollo Hospital will only perform kidney transplants with organs donated by family members. Great controversy swirls around the issue. India's government is investigating and establishing strict regulations.

Still, I like Maud’s idea.

When I reach the hotel, I send an email to Miot Hospital and later receive this response:

From: chief
To: grant275@cox.net
Subject: Regarding your enquiry - Ms. Anne Grant

Dear Ms. Anne Grant,

Greetings from MIOT Hospitals, Chennai.

We perform here related renal transplants only i.e blood-related donors only will be accepted as donors.

We screen the donor including HLA and tissue typing for donors at our centre itself. The receipient's fitness for surgery will be checked by a panel of doctors.

You also need to bring the embassy clearance of your country for donation of the kidney and accepting of the kidney before arriving here. You need to get an affidavit from your country of domicle for the same on the prescribed Indian Government Formats.

The patient will be required to stay in the hospital for 3 weeks. It will cost US $13000 (US $ Thirteen thousand only). This covers room rent, pre-operative investigations (except C T Scan & MRI), medicines, blood, post-operative intensive care, physiotherapy and rehabilitation, including food. (Laundry, telephone and attendant food are extra.)

The patient is most welcome to come to MIOT Hospitals, Chennai.

With best regards,
Yours sincerely,
Prof.Dr.P.V.A.Mohandas

It is good to be on the internet again, where we learn some amazing news. I haven’t time to tell you now, since it is nearly 4 am in Chennai, and we must get ready for the trip home. I will tell you when we get there.

5. Googling

2007-01-10T00:44:00.000-05:00

Middle of the night, and Maud is at it again.

Are you awake? she asks in a stage whisper.

"No."

Of course you are, she persists.

Phil sleeps peacefully beside me in the king-size waterbed that solved all my back problems for $50 after Kerrie found it for us a decade ago.

"Go away, Maud."

I need you to google, she pleads.

"Google yourself!"

I can't!

I groan, sit up in bed, and take my laptop from the nightstand.

Maud is all smiles.

Now google: women's rights + chennai, india, she commands.

"Got it," I yawn. A list pops up, and we scan it together.

The same name appears in several stories: Fatima Burnad, or sometimes Burnad Fatima.

She works with Dalit women (desperately poor . . . many survived the tsunami but had little access to relief funds . . . suffer routine discrimination under globalization . . . forced into trafficking . . . devote themselves to farming, fishing, demanding clean water for their families . . . are ready to form their own political party . . . .)

We search for her email address and send a message.

Eight hours later a reply appears in my mailbox:

"Greetings!
You are most welcome to visit us in Chennai at the following address. We
can discuss more about women's rights and about the movements in Tamil Nadu.
Kindly let us know the date of your visit . . . .
Thanking you,
With warm regards,
Burnad Fatima. N.

Glad I woke you up? Maud asks.

"Yeah," I grin at her.

Stick with me, kid, Maud promises. You'll be OK.

4. Top Docs

2007-01-10T00:23:00.000-05:00

On Sunday afternoon, March 19, 2000, a new yahoo group appeared with a question mark: Surface Hippies?

The first posting reads: "Hello out there! My name is David. I am 46 years old, with a wife and three small children (6, 4, and 9 months). I am three weeks and two days post-op . . . ."

He describes his experiences in recovery from hip resurfacing and concludes:

"This is not a very large group, so it should be easy to remember names.
Let's hear from everyone.
David"

Today 5,547 members post well over 2,000 messages each month at
http://health.groups.yahoo.com/group/surfacehippy/

One of those members, Vicky, instantly takes me under her wing. She has returned from India enthusiastic about Dr. Vijay Bose and offers her research to other prospective surface hippies. She responds to my email in less than an hour and sends spread sheets comparing eight doctors: their prices, the number of procedures each had completed, the length of their incisions, and their rate of "revisions"--operations needing correction. Vicky offers to share this with other prospective surface hippies at
vickymm@comcast.net

Following Vicky's advice, Phil puts x-rays of my hips and knees on a glass table with a fluorescent light beneath. He stands on a ladder and shoots digital photos. (You could also photograph x-rays against a computer monitor. Some radiologists will save you the trouble and deliver your x-rays on CD.)

I email these to four doctors using the addresses Vicky provides. Within an hour my first response comes from Dr. Koen De Smet in Belgium. Credited with 2,107 resurfacings, including Lisa's, he is author of the informative report on the metal-on-metal Birmingham hip resurfacing prosthesis (BHR) that is now state-of-the-art in Europe and Asia:

http://www.hip-clinic.com/assets/downloads/BHRlagomaggiore.pdf

Dr. De Smet writes:

Dear Anne,

Looking at your x-rays you certainly are still a candidate for resurfacing!!!

You have osteoarthritis of both hips.

Right one is bone to bone, left still is not so quite bad yet.

Your right knee has also started arthritis, but mainly at the patellofemoral side (after kneecap)

I think that mainly the knee problem will be from the right hip!

Good bone quality, so best thing to do is resurfacing!!

If you require any further information?, just ask,

Greetz
KOEN

With the intimacy of the internet, we are already on a first name basis. I welcome his lack of pomposity. But his price, while far less than in the U.S., is still twice that in India.

Besides, Phil and I have been to Europe already, but never Asia.

Every few hours I check my email to see if Dr. Bose has responded. I hear from two American doctors, agreeing that I may be a little old for the process, but both consider me a likely candidate.

Where, oh where, is India?

Vicky sends off an email on my behalf to the Apollo Hospital in Chennai, guessing that Dr. Bose is off teaching other docs the procedure. Finally he writes back:

Dear Ms. Grant,
Thanks very much for your mails with the x-rays of your hips and knees.

Apologies for the late reply. I was out of chennai to do some surgeries in another city.

As you are only 60 yrs of age, hip resurfacing would be a much better option than conventional hip replacement. Hip resurfacing would enable you to be very active after the surgery.

I have assessed your x-rays in detail. Your right hip shows bone on bone arthritis but excellent bone stock . I am happy to report that you would be an excellent candidate for hip resurfacing surgery.

Your left hip shows the changes but to much lesser extent.

Regarding your knee, both of them show degenerative changes but nowhere near needing major intervention like a knee replacment. The best option for the knees to have a conservative knee rehab programme concentrating on the patello femoral joint. The patella (knee cap) shows the max. changes especially the right side. The physio combined with a course of visco-supplementation injection would be my suggestion for your knees. Further once the hip surgery has been done, then there is a good chance that your knee may feel better as referred pain in the knee from hip arthritis is very common.

I will also need details of your medical history and the extent of severity of your hip problem. Please give information regarding the following: co-existing illness like diabetes etc/ previous surgeries/allergies/ current medications/ previous hospitalisation details (if any). Kindly add a description of your hip symptoms and how it affects you.

I have attached some information on hip resurfacing.

Currently, I do hip resurfacing for about 15 Americans / Canadians every month.

Hip resurfacing is a technique invented specifically for younger patients with hip problems. Conventional Total hip replacement, while being a good option for an elderly person (above 70 yrs) is a poor choice for young patients as it will fail rapidly. The hip resurfacing operation is an alternative to hip replacement and has 3 crucial advantages.The first is that no plastic (polyethylene) is used like in conventional hip replacement. Since an anatomical sized 'metal on metal' bearing is used it lasts for a very long time, manifold that of conventional hip replacement and is extremely popular in Europe, Australia and some parts of Asia. The anatomy and bio-mechanics after resurfacing mimic a normal hip very closely.

The second advantage is post operatively: patients are encouraged to be very active and must play some sport, do swimming etc. No activity is restricted including sitting on the floor, crossing legs etc. In short, it behaves like a normal hip enabling patients to return to their normal lifestyle. In contrast after a hip replacement one has to behave like an elderly person (for whom this has been designed) to be safe from dislocation and to prolong the life of a prosthesis. There are also other advantages in Resurfacing like preservation of bone stock (as no bone is removed in this operation unlike hip replacement where the head and neck of the thigh bone is completely removed.) Further it has been proven that bone stock actually increases after hip resurfacing due to the restoration of normal biomechanics in the hip and proximal femur.

The 3rd advantage is that the polyethylene 'wear particles' does not damage the surrounding bone like in conventional hip replacement and the quality of bone actually improves with time after hip resurfacing. This makes a revision solution (if at all needed) very straight forward surgery, unlike the very complicated revision scenario in a conventional THR.

The patient is usually made to walk full weight bearing the day after the operation and is usually discharged from the hospital at about 5- 6 days from the operation. They can resume any work at 3 weeks from operation and sport is started 6 weeks from operation.

I have also attached some details of our centre in Chennai, India. The hospital where I work is known as Apollo speciality hospital in Chennai, India, and this hospital is as good as any other facility one sees in Europe or North America. The hospital has an excellent international patients division which would help you with your requirements. Complimentary pick-up at the Chennai airport is always arranged by the hospital for all International patients.

www.hipresurfacingindia.com

www.apollohospitals.com

I have now done more than 700 hip resurfacings and have the largest series of hip resurfacings for AVN & for fused hip resurfacings in the world. There have been many overseas patients including some from Canada, USA and the U.K.

The cost of the Hip Resurfacing surgery package in Chennai, India, at Apollo hospital would be a 'package rate' of U.S $ 7,000 for one side. This is an all inclusive rate and includes the following:
Pre-op consult with surgeon
Pre-op consult with aneasthetist
Hip resurfacing implant. (The BHR manufactured by smith & nephew and the ASR manufactured by Depuy are the ones used.)
Single private suite with toilet, TV, Internet connection etc. This has an
attendant's couch as well.
Professional fees for surgeon, assistant & anaesthetist ,
All pre-op investigations (Surgipak) which includes ECG, Echocardiogram,
Liver, Renal & Clotting profiles.
Consult with cardiologist (if required.)
Diet
Pre & Post op Radiology
Nursing
All medicines
Operation Theatre charges
Private nurse for the first two post-op days. (This is very useful for patients travelling alone.)
There are no additional costs for routine hospital stay apart from personal usages like telephone, laundry etc.
Payment can be made at admission by banker's cheque, traveller's cheque or by credit card. Personal cheques are not accepted. U.S dollars or Euros are the accepted currencies.

The hospital arranges for the patient to stay in a seaside resort close to chennai by the name of Fishermans' Cove before flying back. The cost for this would be extra. The resort has facilities for Ayurveda--traditional Indian therapies which are known to rejuvenate the mind and body.

A total of 11 full days gap (Hospital+Resort) from surgery is advised (mandatory) before taking a long-haul international flight.

The person to contact regarding travel arrangements like airport pickup and resort bookings is Mrs Shoba Bhasker at shoba_bhasker@yahoo.co.in She is the International patient co-ordinator. Kindly post a copy of any e-mail to me so that I keep a track of things as well. Kindly take note that a tourist visa is mandatory to travel to India. Please do apply for a tourist visa and not a medical visa as other formalities are involved in a medical visa. A tourist visa can easily be obtained from any Indian consulate.

List of Indian embassies world wide where one can apply for a visa to travel
to India can be found in the following link
www.india-visa.com

This is the link for the U.S embassy
http://www.indianembassy.org/consular/visa_guide.htm

If you need any further clarifications please let me know.

I have attached the link to a recent article that appeared in the News & Observer published in Raleigh, U.S.A and a link to the CBS 60 mts programme which featured our facility and my patients

http://www.newsobserver.com/672/story/427249.html
http://www.cbsnews.com/stories/2005/04/21/60minutes/main689998_page4.shtml

with best regards

Dr. Vijay C. Bose
MS ( Orth); DNB ( Orth); M.Med .Sci ( Trauma) Birmingham; MCh ( Orth )
Liverpool; FRCS(Orth) U.K
Consultant orthopaedic surgeon.
Department of hip surgery
Apollo speciality Hospital
320, Mount road
Chennai-600 035
India
mobile: +91-98400-32251
www.hipresurfacingindia.com

His email relieves Phil's anxiety.

Nine days after I had emailed my x-rays, Dr. Bose puts me on his surgical calendar for January 19th, 2007. I am in!

3. Walking on Water

2007-01-08T17:36:00.000-05:00

Lisa got me started, telling me how my hip pain is common among baby boomers and that I am still too young (at 60) for "total hip replacement" (THR) as practiced in this country. She told me that a "resurfaced hip replacement" might be better for someone my age--not because THR doesn't end the arthritis pain (it does), but because THR will require another replacement in ten to fifteen years.

Furthermore, THR comes with life-long physical restrictions that don't apply to resurfacing. An avid researcher, Lisa directs me to the online support group for the tribe known as "Surface Hippy." There, she says, I will find everything I need to know:

http://health.groups.yahoo.com/group/surfacehippy/

Several years ago, Lisa established a publishing house called The Writers' Collective. She knows that people with sedentary lifestyles often are overweight. Folks with hip problems often become sedentary, because exercising on land hurts their joints. She set out single-mindedly to lose weight before going abroad for hip resurfacing.

She tried water aerobics--great exercise that imposes no impact on painful joints. But she noticed that most people in her class were not losing weight. She intended to lose a lot before surgery and keep it off.

Lisa researched exercise and the human body. She learned principles to convert fat to muscle mass and to lose weight safely and permanently. She designed her own regimen. Eventually she needed more challenge and added Water Walkers to her repertoire. This speeds up the weight loss while it builds even stronger muscles and increases her bone density.

She achieves amazing results with no special diet except moderation while converting over 55% of her body fat to muscle mass. Lisa has shed 70 pounds to date without ever sacrificing the dark chocolate she eats daily!

After 12 months, Lisa flew to Belgium in September 2006 for hip resurfacing. Initially Blue Cross/Blue Shield refused to pay, calling it "experimental." Lisa appealed their decision, pointing out that the FDA had approved the procedure last May.

She won and now predicts that insurance companies soon will offer incentives to travel abroad, where the cost can be one-third to one-seventh that in the United States, and where surgeons typically have much more experience doing this sophisticated surgery.

Lisa could turn a profit selling snake oil to those who saw her personal transformation. Instead, she contacted the Water Walkers manufacturer and asked them for a discount for hippies like herself who really need them. They agreed--as long as she put the discounted price on her website instead of theirs.

You can read about Lisa's journey and find the link to Water Walkers, including videos showing them in action, at:

http://www.writerscollective.org/whatsNew.htm

Walking on water is not the only thing I learn from the internet.

2. Infectious Diseases

2006-12-30T13:29:00.000-05:00

While the FDA dallies, the American medical establishment takes umbrage at the rapid outsourcing of its market. Doctors here are not happy with me.

“Why not total hip replacement?” they ask. “It’s so reliable here.”

“Too invasive,” I respond, “a waste of good femurs.”

“Do you know how many infectious diseases India has?”

Nothing like the epidemic of guns and hummers here, I think, realizing how alienated I feel from my own culture with its raw, unregulated greed.

The doctor at the travel clinic knows her stuff. But Maud has issues with her 4-inch stilettos and pointy toes.

What decent doctor would do that to her own body? Maud asks me.

She doesn't like being short, I whisper.

She should worry more about being stupid, Maud huffs. Does she really think those shoes enhance her stature and authority?

Maybe it's for sex appeal, I suggest. Her generation cut their teeth on MTV.

Doesn't look sexy to me, just stupid, Maud insists.

Shush, I warn. You're not sexy to her either.

Phil, ever the diplomat, says: "You have a wonderful hospital here."

"Yes, if we can keep it," the doctor replies solemnly.

She is being conservative, she says, for our protection and orders up doses of hepatitis A and B, typhoid, and pneumovax at $743 plus malaria pills and precautionary drugs for diarrhea at $81. To ward off mosquitoes: $20.

"And the water. Only drink bottled water," she warns, "With the seal intact. The bubbly kind is best." She really is good.

The medical assistant who administers the shots sniffles with a certifiably infectious disease. Should be home in bed, but maybe isn't paid enough to protect her patients.

Maud studies the assistant's long, stylishly unkempt hair and the red plastic daggers glued to her nails. Don't ask, I warn.

Three black teens in saggy jeans and bandanas pass in the corridor. The assistant mutters, "Oh my Lord," and slams her door--multiplying the likelihood of sharing her germs with us.

Racism is an infectious disease, I whisper to Maud. But I am too cowardly to say it to the assistant with her arsenal of hypodermics.

By evening, Phil is doing fine; I am not. My upper arms ache, stiff with pain-- the AMA’s revenge.

Next morning, Phil helps me put on my socks knowing we have offended a dangerous lobby. One bad hip has made us a market force.

1. Finding Maud

2006-12-28T07:54:00.000-05:00

"You should write a blog, Mom."

Our older son, Lars, says it casually, smiling.

His words warm me. I usually feel sidelined and irrelevant to his generation, a nuisance really.

Four years ago, I consciously began to withdraw from the world, narrowing my focus to those things I need to do before I die. Now my son is inviting me to venture into cyberspace.

I begin cautiously at his blog, “Bottles & Bones” at blogspot.com. The title memorializes items Lars and Kerrie found in the land they bought from her parents to build their home in the woods.

This semi-scary adventure led them to blog. From their familiar terrain, I find my way to the button that says: GET YOUR OWN BLOG.

My blog requires a name. I decide to sleep on it.

Lying in bed the next morning, I search my subconscious to see if a name is emerging. She appears, not merely a name, but a presence: Maud.

Already I have lived almost twice as long as Maud had in 1914, when she died at 31, along with her fourth baby. Two other children survived. The older one, who was 5, would become my mother.

Lars, an illustrator who specializes in ghouls and monsters, found Maud's large portrait in its gilt frame too spooky to bear. If he was home alone, he would turn it to the wall.

He says: "She keeps staring at me!"

A-ha! I laugh. Thank you, Maud.

I relent and put her in the closet. She does not hold it against me. Nor does she stay there. She knew cyberspace before we did.

Her name calls up in me a sense of ineffable kindness and hope. So we are making this journey together as Phil takes pictures and helps us reflect on larger meanings.

We'll be right here if you want to come visit Maud & Me!