Alas It's been a while since I have completed a blog and soooo much has happened.
I have been in India for nearly 7 weeks and have been pushed to my limits but have also had truly amazing experiences.
I have started writing this in the main hospital in Mysore. I have just come back from a four day rural village tour.
I am here with an Indian volunteer who has obviously dislocated her finger, if such an injury had occurred in my beloved Homerton she would have had an X-ray and I would have plopped it back in place with analgesia, re X-ray, neighbour strap and home. As an exposition medic I don't have the luxury of an X-ray machine in my kit and so I have had to bring her to the main private hospital of Mysore.
I'm tired from the four day trip and actually could have done without this drama but where there are people there is injury and so here I am.
I am currently reeling from an experience of super patriarchy in the form of an Indian doctor,maybe in his thirties, who decided to stop taking to me after I told him I was a doctor and gave by a precise and concise recall of my volunteers mechanism of injury, my findings on exam and my reason for bringing her to the hospital.
He didn't listen and spoke to my volunteer for the whole duration of the consultation in Kannada (the local language) and didn't consult me once.
This i didn't really mind as i realise now after many similar consultations with other Indian male doctors that egos need to be massaged and the threat of feminine intelligence can sometimes be too much and cause the opposite sex to regress into a " me man" type of figure. What made me super cross was his attempt to reduce my patients finger without analgesia. I was livid soooo livid, but remained calm, I simply asked him to do a digital block otherwise I will take her back to field base and do it myself. He eventually reduced her finger (after 3 goes), re xrayed her and discharged her.
The ronke from the near recent past would have gone nuts, in an uncontrolled manner, with no positive outcome. The new dr Ronx is a big fan of passive aggression. I refuse to rise to the super patriarchy and overt unprofessional rudeness that I encounter 70% of the time here from male doctors. I really enjoy an intellectual stand off. I have to mentally take my body out of the situation and look down on myself to
work out how to get the best outcome for my volunteer which isn't related to my ego also. Difficult.
So my game plan is to kill people with kindness and politeness. This is I did yesterday. (I am now continuing this prose in the same hospital but it is the following morning). Yesterday, I was uber polite. I simply allowed him to finish the procedure and informed him that whilst he continue to converse with the volunteer in regards to the home management of her injury, I would be giving the hospital duty manager feedback in regards to his lack of professionalism and patient empathy. He gave me the dirtiest look, I smiled hard put my hand out for him to shake it (he did limply) and I left the room. ( confident that he couldn't possibly get neighbour strapping wrong).
The manager was a female doctor. I had met her before. I had hummed and arrrred in regards to if I wanted to pursue feedback. Many people throughout my life have told me to "pick my battles". This tiny battle I thought was appropriate. The rudeness, and total refusal to acknowledge my existence - I now understand as cultural and not personal. To get the best care for my volunteers I have to ignore it, but trying to pull a bone back into place without pain relief in the " best "private hospital in Mysore? Thats a no. So the discussion I had with the manager was simply in regards to that fact. We had a chat and she spoke separately to the volunteer who also asked why the doctor was asking her medical questions when she had a doctor (me) with her.
The manager was taken aback. Again doctors are god like here so complaints are rare.
I love the NHS. I love the fact that doctors are made responsible for their actions. I grateful for independent governing bodies, clinical governance, royal colleges and auditors. I appreciate that nurses will not follow a doctors orders blindly for the fear of reprimand if they show any original thought or opinion. Only when you have to navigate through a service that is top down lead in an autocratic fashion that you learn the value of customer service and complaints procedures. From the anecdotes that I have heard from my Indian friends, the general consensus is not to go to hospital unless they are pretty much at deaths door. I have been told stories of inappropriate advice, drugs prescribed as though they are sweets, no follow up, no exam and controversial billing.
I have to emphasis that not every doctor is like the one I have described above and for the sake of balance, I met an amazing orthopod who treated me like a human being and an equal professional.
Another fact that kills me is that in a lot of cases women feed the patriarchy here. I realise that the psychology and deeply entrenched cultural norms mean that such behaviour is common place here. So the next question is how does one support such women and how do I sanely work in such a system. All my dreams have come true. So a job with MSF is in view (gotta learn a language) but otherwise working in poor areas around the world is possible reality and alongside that the reality of working in a male dominated profession. Is it really like that Ronx. I hear you say, well I believe so. I am not bound by any social norms. I have no real desire to get married before my career is at it's peak, I want to be a mother and would happily adopt or foster but again I am not in a rush, mortgage - nope. Family ties - nope. Car - nope. Relationship - nope Female medics I have spoken to in the past, have often commented on thier desire to expedition medicine, work abroad etc and then often follow the sentence with, "however I have a young family".
And so with many women not fulfilling that dream it makes sense that the speciality will be predominately male - and so I would really appreciate how to get the best out of a situation that renders me often exhausted (but not defeated) with being the type of person who is always almost fighting for equality.
Having to take a deep breath and think about how you may be perceived is a bloody bore sometimes. When I held the well beings workshop with the volunteers, I emphasised the importance of self awareness, in terms of realising that we are in a privileged position and that every thing we say or do is amplified in the villages in which we work. So being aware of western privilege (a term I coined to include people of non white heritage) and white privilege is so important. Many of British volunteers would say things like "oh my god Indian people are so nice and helpful and they love me" = white privilege (although Indians are generally very nice, smiley - I wanna help you in any way possible type of people). Then I would hear some of the volunteers say, "the Indian shopkeepers see a white person coming and over charge".
Interesting how the reference to being white was only used when the experience described was negative.
So I guess I do experience an element of privilege (although it often feels that I don't) but I am aware that being a doctor here means that I am treated with an element of respect from my work colleagues (especially Indian ones) that has a benevolent undertone but makes me undeserving.
My boss said to me that here in India Everybody has a job and sticks to it. He said that being a doctor means that is all I would be expected to do. Apparently by doing jobs that are seen as being below you, you are perceived badly. So when he said that by cleaning field base etc I would be perceived by Indian staff as not a real doctor, I was taken a back. Luckily field base is a safe zone so traditional Indian rules don't entirely apply here - that is not to say I don't respect trad Indian rules, it's more that some are a bit hard for me to abide by. There is however cultural respect and the doctors -don't -clean -rule dosnt apply here (alas).
So I've gone on a massive tangent which started as me wondering how I could combat patriarchy without being seen as an angry feminist (which I am) so there again I am confused.
I'm finding it a bit exhausting being me here. As the medic people trust you to give the best care. The English volunteers expect and know how to access healthcare the Indian volunteer usually haven't seen a dr ever and so expect magic from you, regardless of the reason for presentation all volunteers exhibit a type of vulnerability in your presence, the type that knows without doubt that you will provide or make sure that they get the best treatment. Sometimes giving the best treatment is advice. People I have noticed want something concrete, advice just ain't enough. And I give good advice, it's evidenced and in laymans terms. Drink more water is a lot of the advice I give and the most frequent diagnosis I give is - you have heatstroke. Usually to the same person over and over again. The stressful part of being here is having to fight for good health care for the volunteers. My Indian patients have high regard for doctors. And so getting the balance between ensuring that they get the best treatment and making sure that I don't destroy the respect that they have for their care givers is difficult, but not impossible. It kinda means that I have to swallow my pride and accept being treated like shit. I then think to myself at what point should I be sacrificing my self worth to ensure that my patient gets the best care? I just feel that if I was a white person that I would be treated so much more differently. I look around me and see how people fall about for the attention of a white face and almost dismiss me. I feel slightly resentful about this. Example being when I was in Bangalore a few times back with a really seriously Ill volunteer the consultant despite being asked to consult with me and discuss the patients treatment with me as I was her advocate, and although still quite junior, I really have been swotting up and actually I am alright ya know. Anyway he spoke to my boss. My boss has absolutely ZERO medical
Knowledge and clearly stated that the purpose of him accompanying me was purely to organise logistics. My boss is a handsome white man with long hair and is actually very calm and polite. Despite him asking the consultant to address me, the consultant still spoke about the intricacies of internal medicine with him. Imagine that. Blatant disregard. Pff. When I say I am resentful I want to make it clear that it is the situation I resent,
Despite all this time to think, and get cross and then rethink. I love it here.
The weather is amazing, the people are fab, the food is seriously delicious, the children are next level
Cute and I love my job.
Although I don't feel any different and possibly haven't had the epiphany that people say occurs in India but I would like to something is happening. I've also started walking tall and confidently, articulating my words better and taking more care in everything i do - I think the fear of approaching thirty and looking like and acting like a child scares me.
So other stuff. Life in the four villages I visited was tough. Kinda reminded me of my time in Kenya. Falling in long drops and pissing on my legs, pooing standing up (pure dissatisfaction by the way), yucky insects, little water and sleeping on the hard floor.
The good bits were GOOOOD though, cultural sharing and integration in the village was done so well by so many of the groups. The children (many don't go to school) were so keen to learn. One boy came up to me and pointed to me glasses. He said "English?" I said glasses. He then said "Kannada (local lang)" and then the word in the local language. Imagine that?! A five year old boy starting conversation with me, someone he met a day earlier and wanting to learn words.
Women's night was a major success. I looked extremely silly in a sari. I shouldn't wear saris. Having 5 Indian villagers fuss over me, re tying and undoing the sari was sweet, but boy did I feel uncomfortable. I had to draw the line at the potential
Attachment of a fake ponytail to my hair. No. Eventually we all were dressed and sat around in a big circle. The men brought us tea and snacks. And the villages told us about the strength of their mothers and vice versa. It was all interpreted and was so nice to watch. I watched the volunteers show the village we how to sew and make bracelets. And that particular volunteer group are going to arrange a women's night every Saturday during the 7 or so more weeks we have left here.
What else, ah I got to see my public health, health promotion workshops bloom some fruit. A bunch of volunteers had gone to a school and taught hand washing - all 7 steps. These steps were taught using a song in Kannada, and was performed to me by some of the local Children and a group of volunteers (see Facebook) sooooo cute and I was so proud. I was so pleased and chuffed to hear the ideas that the volunteers had for well being celebration days. They were all so excited to tell me about the teaching that they had done in schools about, tooth brushing, hand washing, nutrition, etc. yaaaay. And my message about keeping things simple and using non verbal communication and pictures has been listened to :)
So I've waffled on and am bloody tired.
Night
