India Trip: Leaving Empire

FROM 1/24/08:

And before you know it, it's over. Or so the CMC - Vellore portion of my trip is at least. I am actually currently in Delhi, but just this post we'll pretend I'm still back in Chennai awaiting my flight out of the south and into the north.

So three weeks is done and it feels to have been all of three days. I imagine that's the expected response isn't it? Well it's a good response because as it is true for many parts of life it is certainly true for our trip to South India. I'm not leaving India entirely, of course -- I will spend about a week traveling about with Kristen and Kathryn to Delhi, Jaipur, and Agra next -- but this will certainly be the end of my time in Tamil Nadu (the state Vellore and Chennai are cities in.)

Reflecting on the experience to date here and there I have felt that, in as much as the two time periods can be similar and relatable, we have lived as good Western imperialists. Truly in a country such as India it is almost impossible not to live a significantly wealthier life apart coming from places like the United States or Europe, but I feel our stay went beyond even this. I am not saying "imperialist" in the sense that we adopted official honorifics, practiced mercantilism, and attempted to restructure Indian society, but rather in a simpler, more modern touristy way our stay was leisurely, luxuriant, and apart. Our extended contacts were primarily with the highly educated while our interactions with the "common" Indian were almost always either through acquiring services and products, necessitating their friendly disposition, or as speechless observers tailing various nurses and doctors, necessitating no interaction of any sort. Our living quarters, described in earlier posts, further emphasize the point. We were housed in old stone buildings far larger and magnificently built than the most of the housing of the rest of the populace. We lived in a sprawling, landscaped compound in a country where most people do not own their land and live in a density not seen much elsewhere. We had a host of Indian guards constantly on watch and always ready to greet us with a smiling "good morning." And we were so isolated that the world around us could be erupting in civil war, and we would be unaware of it save some curious sounds in the distance. I do not know how the experience could have had any more the feeling of empire without a group of natives waiting to carry us about in litters. Maybe a parasol for the ladies?

Anyways, to the point of all this. Well, honestly, I do not currently have a point. It is just a feeling I have that I currently do not know what to make of or do with if anything. Maybe it's just a superficial similarity. I have always been aware, I feel, of the disparities of the Western world and the rest of the world, but that has always been in a mostly intellectual sense. And this is certainly not the only time I have witnessed first hand the differences as I have seen and felt them many times before. This is the first time, however, that I have felt myself to be a major character in that story. I am not saying that the West currently practices a modern form of imperialism or that anything in the West is necessarily good or bad or right or wrong -- that is an overwhelming conversation for another time -- just that I am much more of a participant in it all than I ever would have cared to imagine.

Sooo....

This last week in Vellore has been uneventful. I joined up with the Internal Medicine I team this week which specializes in infectious disease. Or so they say. Truly, aside from the HIV clinic on Wednesday afternoon, there was less infectious disease on this service than on the Internal Medicine II service specializing in rheumatic diseases. Oh wells, thankfully the HIV clinic was pretty great. In addition to seeing a variety of unusual cases like isosporiosis, meningeal syphilis, and tuberculosis lymphadenitis, I was also given a brief but succinct explanation of how AIDS is dealt with in India.

The physician I worked with, Dr. Abraham -- whose name I remember only because it is not Indian and could actually understand it when it was spoken to me -- explained that while the US generally practices a patient specific form of HIV treatment tailoring medications to the patients other conditions, tolerance levels, and the virus's genetic resistance, in India such care is simply not feasible. Instead the government simply provides a basic triple medicine cocktail that is potent and cheap. The side effects are often significant, including hepatotoxicity, lipodystrophy, peripheral neuropathy, and lactic acidosis, but they are powerful and efficient uses of the government's limited resources allowing the government to pay for AIDS medications for anyone requesting it. If the virus is or becomes resistant to any of these medications or the patient cannot tolerate them, well, that's life. Currently the government provides this one line of treatment and that is it. As such they do not check viral load or CD4 counts or anything because it would not alter care. In the future they are planning on developing a second line of medications to augment the first line, but that is still in the works. At CMC they provide a level of care intermediate to the US and Indian government. It, unfortunately, is not free, but still considerably cheaper than the average cost of care in the states. I very much wish I had a better understanding of health care systems in differing parts of the world. If anyone has any reading suggestions let me know!

Ok. Enough for now. I had a lot of time to write today because the National Museum here in Delhi was unexpectedly closed for Republic Day. But that's a post for later....