I guess my airways were not too pleased by the temperature changes they were subjected to during last week. Weak from the ups-and-downs from comfortably cool airconditioned laboratory environment to the sweltering high 30s outside, they surrendered to viral attack. I couldn't have asked more of my immune system until then though. Anyway, I'm already on the recovery path.
I spent this weekend in a beachside village south of Chennai, about 4 hours by bus from here. Mamallapuram, is famous for its stone carvings. It has some amazing carvings from gigantic granite boulders dating from 670 AD that were unearthed only about 250 years ago- the moving sand dunes had claimed them only for the British to re-discover (Unfortunately, i still can't post you pictures...)The Shore Temple, apparently the most photographed monument in India (i'm slightly sceptical about this) is also there and does make some very photogenic pictures from afar- a closer inspection only reveals the prominent unsightly wrinkles from 1300 years of exposure to the salt, sand and winds (it faces the Bay of Bengal, only about 50m from the seafront)- most of the details have been polished smooth by time.
The beach stroll in the morning at sunset was as awesome as the sunset there, with a backdrop of fishermen sorting out their nets and getting their colourful boats ready for the sea.
I met quite a few guys in Mamallapuram who had just finished their 'Process' at the Oneness University. Its run by someone called Bhagavan and a female avatar and they receive hudreds of people (rich mainly as it cost $5000) who live together for 21 days and learn about cleansing the mind of negative thoughts and thought processes and learn how to become more spiritual and lead less stressful lives. I also learnt about 'diksha' which is a way one person can 'transfer' energy to another and spread this spiritual enlightenment aimed to make the world a happier place. Fresh from this experience, the guys I met seemed to be on a higher, more 'peaceful' level certainly. Fear not! I'm not a convert to this, but it was certainly interesting to meet so many people who felt this had changed their lives in a positive way and the mesage does seem a genuine one. http://www.onenessuniversity.org/oneness/cms/home/movement/ for those interested.
I'm reading an autobiography of RK Narayan. I also bought Forster's 'A Passge to India and 'A fine balance' by Rohinton Mistr. RK Narayan's pivotal years were based in Mysore and that's where I'm heading next weekend.
Some comments about food: i've been eating all my meals so far with my hands- much more tasty- randomised control performed to confirm this fact- must have an effect on the appetite and taste centres!! The Thalis are delicious and fairly varied. They serve meat at the hospital mess, which adds variety. Vadai and Dosas for snack and breakfast with coconut chutney and sambar when I do have breakfast. Amazing kerala fish curry so far was the best! This morning I had toast and jam and butter, the first western meal I've had for a long while! Papaya and mangoes and custard apples are my favourite fruits....
My flat: Moved in last week. Settled in smoothly and getting used to the toilet facilities. I've got 20 litre water dsipensers that my landlord kindly placed for me. There is no hot shower but there's a heater that's connected to one of the taps. The truth is there's not been a single moment in Vellore that i've longed for hot water!

Phheww! Finally the bus ride ended. My ears were ringing with echoes of the bus horns (cumulatively, they were sounding for roughly 40% of the journey) and of tiny babies with loud screams (a survival advantage no doubt in this noisy part of the world) , my head pounding and a slight nausea was only starting to settle.
My day trip to the barely pronunciable holy town of 'Tiruvannamalai', about 85 km south of Vellore was thankfully over! I had intended to give myself an immersion into the Hindu spiritual side of India by visiting one of the holiest temples around in Tamil Nadu, the evocation of which alone, the rubric had mentioned, would be enough to bring one closer to a higher state of being. The Arunachanaleswar temple complex(named after the fire form of Shiva, who is said to have appeared at the hill overlooking the temple in the form of a column of fire to defy other deities like Vishnu and establish himself as supreme) is undoubtedly very impressive- covering about 23 acres at the heart of the town and with massive 200 foot Gopurams (pyramid-shaped pillars at each corner). Scattered around the entrance were sadhus, invalids (lots of polio, blind prople and many without limbs) asking for alms and women and children. The atmosphere was indeed electric. After the short moment of panic regarding where I should leave my sandals, my eyes fell on a sign saying 'chapel stand' which initially I did not register as a grammatical error for 'chappal (sandal) stand'. Stalls selling various items like coconuts, bananas, limes, ghee, incense, milk, flowers, etc for offerings were shouting out for business and some were even offering to look after my shoes! Some of you may know about my mosque experience in Rabat Morrocco....no way was I going to risk walking back bare feet. I settled for the safer-looking 'chapel stand' for a rupee...a great deal for safety of mind! The next obstacle was the fiery hot basalt stones....my virgin soles are still stinging from the caloric trauma they were subjected to for a good half an hour! Next I decided to experience dharshan...or prayer. There were 2 queues- one for 'general' dharshan and one for 'special' dharshan. For a mere Rs 20, you get to get face to face with the holiest of the holies at this temple- an ancient shiva lingam from before the 11th century, The general crowd have to make do with a quick peek from a narrow doorway, whilst the paying crowd get to squeeze into small room filled with greasy fumes from burning ghee and incense and with dharshan performed by no less than 3 priests. Funny how you have to pay to reach sublimation I thought...Anyhow, may the mercy of Shiva be on me for the rest of the trip...
Next I tried climbing Mount Arunachaleswar, the 800m high hill overlooking the town and temple and from where great views are to be had. In soaring 39 degree temperature, and with only a litre of water with me, I started feeling slightly hypovolaemic (dizzy) about a third of the way up and had to content myself with the views from here. There were also a couple of refreshing meditation caves on the way where I stopped to cool down- I'm not sure my troubled phycical state allowed my soul the peace needed for it to reflect on itself.
The return trip by bus was as described above. Imagine 2 hours on a bus similar to those 1970s model United Bus Service buses that they used to give us at Royal College Curepipe (my secondary school in Mauritius) to avoid the hefty costs of troubled tenager-induced property damage....those with 2 seats on one side and three on the other, except here there was no defined number of 'standing' places...people were literally hanging from the doors! I was lucky to have a seat I suppose....
All in all, an exciting day!

Cochin reminded me of my childhood, when, on Saturdays, I used to go to my grandfather's wholesale business on Royal Road in Port Louis. The 'godowns' in Mattancherry (a suburb of Cochin) with their spices and grains spilling on the road with their unique smells and the patiently confident looks on the face of the owners sipping tea or smoking a 'bidi' refreshed those memories. It was National Day and maybe the activities were somewhat toned down, but it was a very pleasant walk, to which the Monsoon rains only added character. The more touristy Fort Cochin itself is desperately trying to retain its unique colonial character (influenced in turn by the Portuguese, Dutch, French and British like Mauritius) in the face of a booming tourism industry, which made it slightly less appealing.
I'm back in Vellore and to its routines. I managed to find a flat to rent for the next couple of months instead of staying in a hotel. My registrar knew this Gujarati businessman whose sons apparently have a prosperous diamond business in Japan and Hong Kong. and who himself has a clothing retail shop on one of the busy shopping streets in Vellore- he knew another Gujarati guy whose brother owns a new complex about 10 minutes walk from the hospital: he asked Rs 3000 per month and the deal was made.I like the flat except for the squat Asian toilet- I thought I have to overcome this cultural obstacle, which might come in handy during my future travels in less 'civilised' parts of India- practice makes perfect eh! I'm moving in tomorrow night.
I'm moving to the laboratories next week to learn some practical aspects of laboratory haem, which will be useful. This week was a moving one for me on the ward - one of the 4 year old kids I had grown very fond had not responded to his chemotherapy and it was thought futile to carry on with 2nd line or aggressive treatment given they don;t have much finances. He went home and will be seen at his local hospital. He probably won't be alive by the time I leave India...
This weekend, I'm planning to visit some towns around Vellore...

Hi from Kerala! Uli (the ID Lecturer from Brimingham), Chad (an American nurse from Kansas) and myself hopped on the Chennai-Allepey 'Express' at around midnight on Friday. Uli had three first class sleeper tickets, though on a 'waiting list', which I was slightly suspicious about but Uli guaranteed me that that would not be a problem. I was right. My train experience in India continues to be a colourful one- all three of us could not find any free compartment and.... ended up sleeping on the floor in the corridoor outside. The newspaper I had packed and my towel came in real handy! My first experience of Indian first class travel was even worse than the one I had on the General Coach on my way to Vellore!! We eventually managed to find a free compartment when people got down at a stop at around 5 am. By then the train was already 2 hours late and we still had about 7 hours to go to Allepey, where we had arranged a room.
Among the interesting sights on the way were watching the locals perform their early morning squatting toilet duties on the side of the railtrack! In fact the whole railtrack smelt like a latrine (given that there are no septic tanks on the trains) and each time the train slowed down or stopped, ammoniacal vapours would permeate the air. The image of India criss-crossed by rail-tracks spewing these odours is one that is hard to get rid of. The lush tropical greenery of Kerala on the other side of the chain of mountains that separates it from Tamil Nadu (the Western Ghats) was a striking contrast to the more arid TamilNadu countryside and the more pleasant side of the trip.
On reaching Allepey in Kerala, we realised that we'd been duped into thinking the room would be at the hotel we would be staying at. It was instead going to be a someone's house, converted for the busy race boat weekend into a makeshift hotel! We left fuming to look for another more suitable accommodation, which was in fact not too much of a problem.
The boat race itself was a crowded affair not for the faint-hearted. We managed to get in the middle of the crowd (rowdy but surprisingly well behaved) and caught some glimpses of the 30 foot or so long boats with their tails shaped in a cobra-head, with 2 rows of twenty men frantically rowing at the pace of the rhythm-setters beating their drums. Loudspeakers bleated out live commentaries in Tamil and there was a strong Police presence which made us slightly uncomfortable.
The next morning, we took the 8 hour long ferry from Allepey to Kollam, where I am presently. The ride on the Kerala backwaters was pleasant and the Monsoon had kept tourist numbers down and a fair few locals were also holidaying during this long weekend (tomorrow is National Day). It has been raining heavily intermittently but this hasn't really affected our plans. Food is great here, with lots of excellent fish curry and tasty meals served on banana leaves. We're heading north to Cochin in a couple of hours. Will be staying in the Fort itself and lots to visit around that historical port. More about it later.

PS: Unfortunately I've forgotten the USB cable for my camera to upload my pics. Duh! I'm trying to find one or a card reader that will let me upload my pics. Will post some of them as soon as I can.

It's stifling hot here. In the day, the temperature reaches 38 degrees in the early afternoon, and dips down only to the high and moist 20s at night. It doesn't rain a lot in Vellore- the newspapers are full of pictures of Monsoon flooding and submerged cars and houses in Andhra Pradhesh and Mumbai. So far blue skies over here, but the monsoon apparently gets here late.
No problems with food-related upsets so far, but I have been fairly cautious, drinking only water from the hospital mess which the supervisor assured me has been 'microbiologically tested'. Indeed, I don;t think any bugs could survive the chlorine content, which hit me when I first tasted it, though I'm now getting used to that. There are no mosquitoes around although Chikungunya outbreaks have recently occurred in surrouding areas.

My hotel is conveniently located at less than hundred yards from the hospital. It's plush enough and not having air-con has not been too much of a problem. There is a functional (enough power I mean) shower, the bed's clean and comfy and the room is spacious enough with a TV with foreign channels- what more can you ask for? A fridge would have been useful I guess.

The hospital mess is great- you get fresh fruit juices, snacks, and all 3 meals, and they maintain a certain diversity to the menu which has kept my tastebuds enticed so far (so I'm not yet dying for a steak or burger!). I haven't become a fan of the spicy idly breakfasts though.

I've met a couple of overseas doctors here. Uli is an Infectious Disease registrar in Birmingham and has taken a one-year sabbatical to work in Ghana and here. I might be joining him for a trip to Kerala this weekend- Tuesday next being a holiday (india Independence day) I will take monday off. The other is an Israeli doctor spending a few months here who lives at the same hotel as me.
PS: I hope all is ok in UK and Mauritius- do send some news from 51c Edith Road guys! Has Fakhru moved into my room yet?

I went for a walk around Vellore today, my first true excursion into town. It's a colourful and dusty (eye-watering!) agricultural town set in Northern Tamil Nadu, between Chennai and Bangalore. Businesses everywhere, from people with a couple of fruits or used chappals (sandals) laid out on a dirty old mat in front of them to larger retail businesses and restaurants (called hotels here). Amongst the most exotic things I saw on sale were stuffed brown squirrels (real-looking!), eagle claws and live chicken (some had a freshly slaughtered chicken carcass hanging above the live birds which pecked about ther cages totally unaware of the fate awaiting them). I bought some delicious white and red-fleshed guavas and custard apples too (sitafar/cherimoyas). As I wandered down the maze of tiny alleys just a few blocks behind my hotel, I came across a street show- a man played drums as a tiny (barely 5 years I shoudl think) anxious looking girl prepared to walk the rope that was stretched ahead of her about 10 feet above ground. Crowds of kids and adults watched on. I walked away, uncertain how to interpret the little girl's expression... I also walked on hoping to escape the smell emanating from the grey sewage water that trickled past houses and shops in that area. I could not help but cast scary glances at the curdled surface of it, almost expecting to see a recognisable form or animal- thankfully I didn't. I reached Vellore Fort, a huge monument in the centre of town dating from the 16th century and taken over in turn by invading Marathas, Mughals and finally the British. It's grounds now house decrepid looking government offices and a museum with stone sculptures depicting Hindu deities dating from before a thousand years ago and hero stones from that period from local villages which used them to pay homage to someone who had valiantly fought invaders or cattle robbers only to pay with their lives. I found the museum a calm haven away from the hustle and bustle of the town, with only occasional visitors. I now have a lazy Sunday afternoon to read and rest.

CMC is the pulsating heart of Vellore. Patients sometimes travel for days to get here, some from as far off as Assam and Bangladesh. With them, they bring the hope of relief from life's medical misfortunes that not many other places in this corner of the world can offer. And that hope is not misplaced....CMC offers the latest treatments available and haematology is no orphan area. As expected, cost is the main limiting factor and treatment here is tailored according to one's means. While we are sometimes oblivious of this in the UK, here every doctor has to know the precise cost of a treatment and a detailed income history is taken once diagnosis is confirmed. A profit is made on the treatment of 'rich' or private patients and this 'subsidises' the treatments of the poorer ones. Social justice you may call it, or just common sense that works. Charity organisations like the TATA Fund also sponsor quite a few patients, and the government pays a small contribution too. People here sometimes sell possessions, jewellery and house to fund treatment and there is no room for creating false hopes. Those are some of the most heart-wrenching moments that make up the lives of clinicians here. As a counterpoint to this harsh reality, most treatments here are at a fraction of the cost of that in the US or UK. India makes most of its own drugs and CMC having pioneered many of these protocols, it enjoys priviledged prices and stocks.
At the heart of all this, lie the stories of the doctors and nurses, whose lives revolve around the hospital. They get paid peanuts (120 pounds per month for a year 3 reg) and most finish work at around 9.30pm after an 8am start. Work continues on Saturdays and Sundays- patients don't miraculously get better on those days! The contextual perception of one's work and the satisfaction derived from it is what makes this possible. This all reminds me why I wanted to be a doctor 10 years ago- a faraway thought that for some, gets somewhat diluted as one gets through the western medical training system. I cannot generalise of course, but I feel this is a fundamental difference between the ethos of work here and in the UK, and what keeps CMC,and other hospitals like it, going.

Well, here I am in India! Amidst the crowds, the incessant traffic noise, the dust, the smells (nice and evil), the rich and... mainly the poor. For real! Yes, nothing can prepare you for it, as they said to me, yet I had tried hard to imagine it. But the preconceived myths I had have also been severely challenged already. The warmth of the people has taken over the expectation that I would feel an utter foreigner. Amidst the chaos, I think i can see some kind of order. People live here, and have been living here for centuries in these conditions that we in the West call unacceptable. For instance I managed to inadvertently get myself in board a 'general carriage' on the 'superfast' train from Madras to Vellore (yes my first train experience in India). We were 4 on a seat that consisted of solid wood, and 4 above my head! It was an overnight train, and my stop was the first, so I just imagined how these people would spend the night, some of the 'standing' ones were already making their beds on the floor. Yet no one uttered any inurious comments, most had a smile on their face and spoke in low voices. These were poor people, yet they showed an examplanry sense of 'oneness' and restraint and discipline. They even helped me with my burdensome pack off the train.
Anyway, the hospital is well set-up though hundreds lie in the shades of the banyans and more lie huddled in the waiting areas. My boss is Prof Chandy and he's an amazing clinician and teacher, one of the best I've ever met. The ward has some amazing patients. I'm having a grand time, but it's day 1 of 150! With this humbling thought, I shall end this one....S