I have felt quite disturbed the last week or so realizing that the Sri Lankan know very little about the world, past and present. When asked about my religion (since people have noticed my interest in Buddhist shrines), I talk about being raised Jewish and they look at me with blank faces. Few of the staff including RNs, know what Judaism is . I had one of the staff who did know say the word in Sinhalese and still nothing. I went into Hitler and the millions killed. They had heard of Hitler they had no idea about what happened. I felt somewhat eased when someone pointed out to me that I probably hadn't learned that much about Asian and African history and I think that is true. I wonder if now kids are learning in school about the horrible massacres that have occurred and continue to occur in Africa or events in Asia.
Last weekend I went to Ella and it was glorious. There is a huge Gap (think much larger then the Delaware Water Gap). There are two landmarks when standing looking at the Gap, one is a mountain on the left called Little Adam's Peak and the other is called Ella Rock. Ancy and I climbed both, one on each day. I was so proud, LAP is not very difficult but Ella Rock requires a guide and is very difficult and steep. It took 5 1/2 hours with a rest at the top. I was very proud of myself and pleased with my accomplishment. Of course when we got back and went to eat Ancy asked me what was wrong with my feet. Before I tell you this, I had been reflecting during my hike up the mountain, on my childhood days at Camp Weetamoe in Center Ossipee, New Hampshire. There we had climbed Mt. Shikorawa and that's probably the last time I climbed a mountain of this magnitude. The other thing that used to happen in the lake at camp is that we would come out of the water with leeches on us and we would be squealing and yelling while the counselors would have to put salt on them to get them off. You got it, I had had leeches on my feet from going through the forest that had dropped off somewhere but had left holes that were bleeding all over..ugh..gross huh?
This week I went on a bunch of home visits with the 2 psychiatric nurses. The purpose was to give Modicate which is equivalent to our Prolixin, an antipsychotic med. This is good. There is a system to medicate chronic patients who wont come into the clinic. The staff of the inpatient unit are the ones who do the home visits, also the ones who run the clinic..The location of where we visited is amazing. many people live in the tea estates which are up mountains with switchback roads, back and forth, a very long time to get up there. Apparently there is no health accommodation on the estates to cover medications. An issue is that there is never a reevaluation of the patient to see if they continue to need this drug, many of the patients seemed misdiagnosed, there is no system to get in touch with the patient so if we show up and the patient isn't there they don't get there injection unless a family member can get them into the clinic, some months apparently this drug and others just aren't available in the country so they have nothing or something they have never had before, and so some end up back in the hospital. The hospital is supposed to be acute care but if there is a family or placement problem they just keep the patient until they have straightened it out yet because they don't have time supposedly to wait while patients improve on drugs they use a lot of ECT to create a "cure".
I have read the ten year mental health plan for the country which is now half over. It is a good plan with the idea that the patient is central and a move toward community mental health and less in-patient. However the entire plan hinges on the consulting psychiatrist to be involved in every decision in every area of the plan for the entire district which is huge. Badulla district for example is one of two districts in Uva province. We are talking the equivalent of states, so one psychiatrist is in control of half of Massachusetts (Ma. being Uva Province). A huge issue also is that the patient is not at the center still. As I said this is a huge hierarchical system and from what I can see the patient is at the bottom. Anyway, I shall slowly see where I fit. I asked for a meeting this week with 5 key people which happened around planning what is possible, like setting up various groups that might be useful to patients on in-patient, rehabilitation unit, out patient settings and I felt good about that. What I don't feel good about is the number of patients who seem to have head lice..I am sceeved about that and am encouraging the staff to do something about it...I am so itchy now!! It does seem that the majority of time spent with patients is with the attendant staff. I am definitely going to try to work with them. The language problem however is huge..only one attendant speaks English and he is in the clinic..
Patients carry their records with them. They have a notebook that they bring to the clinic and when they get admitted. Nothing is wasted anywhere, nurses' journals, logs, planning whatever are in books made of cardboard that are taped together to make a front and back. Nurses give medication right out of the bottle yet everyone is very concerned about washing their hands before eating and using the right hand!
I think I'm ranting.
I just left to wash and hang up my towels. I have spent the morning washing clothes and putting them out on the drying rack. I finally washed my sheets having only bought one set, I needed to wait until a beautiful day when I knew they would dry. I also went to make a cup of French Roasted, french pressed coffee..anyway, have I mentioned the weather. I have lucked out, it is so lovely here sometimes at night and in the morning it is breezy and cool and it's rarely very humid even when hot during the day. We have some rain but less then I expected. Today and tomorrow I am cleaning and washing and writing this but I have lot's of time because we (VSO volunteers) have been ordered to stay indoors on Tuesday and Wednesday due to the election. Previously there has been some violence around elections and they are being very, very cautious with us which I know will please my sister Roberta immensely. I have been cooking a little and trying things with chilies and chili powder which I love. I have discovered however that it is much cheaper for me to buy my meals which range between 80 SLR (78 cents) and 140 SLR ($1.37).
I bought a beautiful shiny red motorcycle helmet so that I can ride on the back of Ancy's cycle. They are very strict about helmets here as they are about smoking on the street. It is so unpaved here yet I have very little if any dust in my home. This is very nice. I have been thinking however about this push for tourism now. I know the NYTimes is writing a lot of articles about SL. I really wonder if the country is ready for tourist and if the tourists are ready for SL. I don't picture most of the people I know using toilets that are holes in the ground, maybe having some hot water once a day for a shower, eating in restaurants were the norm is to use your hands etc. I am sure the touristy places will be more "westernized" but you still have to travel for many hours on terrible roads to get to your destination, private driver or bus or train. It takes forever to get anywhere. I am trying to arrange to get to Kandy for next weekend. It is very complicated.
Have I mentioned the women's clothing. Some women wear Saris, Indian type or Sri Lankan type. Some wear Shalwars which are long tops with matching pants, most wear skirts, below the knee or long with a blouse type shirt. Tops are made without darts for the breasts and bras are like we wore before seamless was invented. Men mostly wear slacks and a regular button shirt but many men wear sarongs on the bottom either full to the ankles or half to above the knee. Women do not wear makeup here and nails are kept short. I have seen a few women with toenail polish on. Everyone uses umbrellas, they are carried at all times, if it is sunny it is open, if it is raining it is open.
I keep having this experience where I think myself and another person, anyone, a colleague, a trishaw driver, anyone, have an understanding, we know what each other is saying, we have a plan and then the Sri Lankan will repeat the original question all over again as if we hadn't just gone thru this process. It must be a cultural thing.
Friday, January 22, 2010
Friday, January 15, 2010
Just a few things
I think I mentioned that my camera had fallen in the Indian Ocean but then worked for a while..well it now seems to be on life support. No pictures til I can get it fixed. I am somewhat in awe of myself, I have to say, I am washing my clothes in a plastic bucket and IRONING them when they have dried on my clothing rack outside! I even bought a big new iron! Yes this is really me. I put music in my ears via my ipod and I'm off.... Oh, I have to explain about this toilet paper situation. They sell toilet paper here in the supermarket. The issue is that they don't put it in the public toilets. The toilets are either holes in the ground with a place to squat and then a tub of water and a pitcher to rinse yourself off or a western toilet with a bucket of water and a pitcher to rinse off. Sometimes as in my own bathroom, there is a hose in the wall to use to rinse off. I have taken to carrying toilet paper folded up in my bras.
So, Ancy arrived, I was very excited. The poor woman had been away for many weeks, had much to do and I felt more lonely than when there was no one here. I had a good cry, felt awful for a few hours, laughed at myself, I must have been holding my breathe waiting for her to come. Anyway, we are going to Ella tomorrow for the weekend. Ella is supposed to be a beautiful little hill town people visit to hike and relax in. Ancy is from southern India which she says is very different then northern India. She is 36, lovely and a highly trained psychiatric social worker. My experiences here are mimicking hers according to her. I can see where the country mental health system wants to go but there are no resources to get there. Health care is free for all but there just is no money. Wednesday I had a very nauseating (motion sickness) ride to Meedumpitiya Rehabilitation Center. The Psychiatrist really wants us to work on getting the place truly functioning as a half way sort of house for chronic psychiatric patients. The problem is that patients and their families don't want to be there, families are willing to take them home, patients are not required to do anything to stay there and mostly they have no resources, not a stick of wood to build a bookcase or a shelf..nada. They grow vegetables but half the time don't have enough water to keep the garden going. Right now there are presidential elections happening, lot's of campaigning, lots of promises so who knows. Have I mentioned that I do not have a translator for work which is making communication fairly difficult. What complicates matters more is that even those who speak some english can't understand my American accent. I know it's just the beginning, and besides I need the time to investigate this entire new destination country. As they say here, I shall go and come. (never goodbye)
So, Ancy arrived, I was very excited. The poor woman had been away for many weeks, had much to do and I felt more lonely than when there was no one here. I had a good cry, felt awful for a few hours, laughed at myself, I must have been holding my breathe waiting for her to come. Anyway, we are going to Ella tomorrow for the weekend. Ella is supposed to be a beautiful little hill town people visit to hike and relax in. Ancy is from southern India which she says is very different then northern India. She is 36, lovely and a highly trained psychiatric social worker. My experiences here are mimicking hers according to her. I can see where the country mental health system wants to go but there are no resources to get there. Health care is free for all but there just is no money. Wednesday I had a very nauseating (motion sickness) ride to Meedumpitiya Rehabilitation Center. The Psychiatrist really wants us to work on getting the place truly functioning as a half way sort of house for chronic psychiatric patients. The problem is that patients and their families don't want to be there, families are willing to take them home, patients are not required to do anything to stay there and mostly they have no resources, not a stick of wood to build a bookcase or a shelf..nada. They grow vegetables but half the time don't have enough water to keep the garden going. Right now there are presidential elections happening, lot's of campaigning, lots of promises so who knows. Have I mentioned that I do not have a translator for work which is making communication fairly difficult. What complicates matters more is that even those who speak some english can't understand my American accent. I know it's just the beginning, and besides I need the time to investigate this entire new destination country. As they say here, I shall go and come. (never goodbye)
Tuesday, January 12, 2010
Work...
I don't know why I feel so reluctant to write about work. I have so little and yet so much to say. I don't know anything yet. I have no idea what I am doing, what I shall be able to do, what is needed or wanted of me. I have a million ideas and no ideas. I mostly work on Ward 12 of the General Hospital. It is over 100 years old and the psych. unit was adapted supposedly to accommodate psych patients. I think I described it in another blog entry. It is out of the dark ages. It is clean though. A cleaning team is there daily washing and dusting and completely cleaning one time week. They also do the gardening. The thing that is interesting to me, coming from another culture, is that the patients don't seem bothered by the age or lack of accommodation . Women and men are used to bathing with others and doing their own laundry by hand on the cement. It is noted if patients are not washing or doing their laundry as a symptom. It is just expected they will do their washing. Patients seem very well behaved compared to American patients and demand nothing. Manic behavior is like a mild temper tantrum. It is just not done here I guess. That is one of the many cultural things I need to learn more about, the behavior of people, on the street, in the hospital, at home, toward parents. I am baffled by how much ECT they do here, almost everyone, no matter their diagnosis, get's ECT and is put on antipsychotic meds. They use our newer antipsychotics but not our newer antidepressants.
The staff has been amazingly welcoming to me. The nurses, there are 8 of them altogether, notice my presence or absence, what I am wearing, the fact that I went to the dedication of the hospital. The attendants (also about 8 of them) also are attentive but less so. It has been very hard to set up a meeting time with the nursing staff where we can talk about what they need, want or are interested in. As of now, one is scheduled for Thursday at 10AM. That is a holiday but the best day for the most of them to be together. There are 2 Social Workers plus Ancy who I am finally meeting late tonight or tomorrow. One of the Social Workers is outstanding and works wonderfully with patients and their families. There is an Occupational Therapist who has only been employed there for a month and a half and is young, eager and speaks good English! Then there are the Medical Officers, 4 of them, with some Mental Health training and the Consulting Psychiatrist who is eager to bring Psychiatry into the 21 century. When I arrived, Dr. K. the psychiatrist, sat with me and some of the staff and confronted me with what I felt I could bring to improve things. I made a few observations which he didn't seem to think much of and then proceeded to list all the things he felt I could accomplish in the next 11/2 to 2 years. Some of it would not be in my knowledge base and some of it scared and overwhelmed me and some was exciting. The point was though that it was enough to fill 10 years of work! I went home that day and read over my notes (which I take constantly) and felt I was out of my league, got kind of glum, frightened I suppose. Dr. K. had asked me to summarize my career for the staff and I think I said to much because if I heard about that person, I would think she was capable of doing anything including writing workshops and proposals and all sorts of things I've never done. Anyway, the other part of this is that I really have nothing to do yet. We were told to basically, hang out, observe, watch, let the staff get to know us for a month or 2 and don't expect too much. I am having a hard time with this also because I don't know where to be, where to put myself, I want to be active and feel funny not being. I really have no boss, no one watching what time I arrive or leave or what I do in between. So here I am feeling weird about sort of just floating around, listening, hanging out with the patients, going over to the clinic, hanging out there, talking to staff, asking a million questions but generally aimless and at the same time I am feeling overwhelmed that too much will be expected and I won't know what to do. Anyway, it took me about a day to talk myself out of my gloomy feelings. I keep thinking of more to know and ask. I question a lot about patients and was asked to consult on a teen age boy who I didn't understand being there. There is really no psychotherapy here. There is no time to explore people's lives and social situations. The stories are horrible, lot's of alcoholism, spousal abuse, many things that people don't talk about like homosexuality in one member of a heterosexual couple, some people don't seem but momentarily psychotic to deal with issues no one is talking about. I am not judging this, I don't think it is that different at home, just handled differently. Anyway, Dr. K. seems thrilled with my big mouth and has encouraged me to see as many patients as I choose to help the team better understand a patient. The problem of course is the language. I have to work thru one of the staff who speak English and they of course are giving me their interpretation of what the patient is saying and of course don't translate everything. I love the patients though, I just smile and hold hands or put an arm around and it's good.
A big problem for me though is language. Part of it is cultural I am sure. I am not told a lot. Even if I have made it plain that I would like to know something, I won't be told; or I'll be told a piece of something. I sort of accidentally have to learn things like if a meeting is happening or the consultant isn't coming.
The thing that is most disturbing to me and this may also be cultural is that there is absolutely no privacy at almost any time. 4 MO's interview patients at the same time, in the same room, before one patient leaves the next one is coming in and the MO's are talking about the patients. Patients sit and wait until spoken to even if the staff member is having a conversation about the weather! I think people are just very respectful of authority here and just accept the way it is. Did I mention this is the same room ECT is done in! During ECT which people line up for and carry their own sheets for, staff walk in and out having all sorts of conversations. Hopefully we shall be moving into a brand new just being built building in 3 months. I went to see the space and see that all the men and all the women are still all in one room. There is indoor plumbing. What is not there right now which is the other thing that I feel disturbed about for the patients is a room for meetings and therapies, OT, RT etc. The patients do nothing all day. They hang out all day. The amazing thing is that patients sort of take care of each other, they are kind to each other, especially the women. They really have their own Therapeutic Community, a milieu created by them that is soothing to each other.
The equipment is very, very old, the ECT table has rips in it. The Blood Pressure monitor and cuff are what we got rid of in the 60's. We are so outrageous in the west and so fortunate. This is definitely third world in terms of availability of goods. The social worker told me his family does not eat pineapples because they are too expensive. I eat one every other day, they are 80 cents! Despite this, the Sri Lankan, including patients and staff, are always trying to share food. People share lunch and breakfast with each other, it is a communal kind of thing, so wonderful, no one would not ask me to join them to eat if they have food.
So to go back to what Dr. K wants. He wants all staff to have knowledge, skills and the right attitude toward patients. He wants it to be patient centered. He wants people to have better counseling skills. It is a bureaucracy , a hierarchy and very paternalistic and he wants a multidisciplinary team of professionals pulling together for the patient because right now the patient is at the bottom of the hierarchy. He wants trainings and lectures and rehabilitation and a Day Center and non professional local community teams trained to work with the Mental Health population in the communities all over the district. This is some of what he wants. I shall know more about nursing and attendant staff after I meet with them. Did I explain the system here. NOBODY, NOBODY chooses were they want to work. MO, RN, Aide, get assigned when applying or graduating to were the need is. The only exception is if you have had special training in a field you were interested in after graduation. On top of that, once assigned a unit, you stay there and can't request a change for 2 years. So, I can try to teach an attendant not to shove or yell at a patient. Will I be effective, who knows.
The staff has been amazingly welcoming to me. The nurses, there are 8 of them altogether, notice my presence or absence, what I am wearing, the fact that I went to the dedication of the hospital. The attendants (also about 8 of them) also are attentive but less so. It has been very hard to set up a meeting time with the nursing staff where we can talk about what they need, want or are interested in. As of now, one is scheduled for Thursday at 10AM. That is a holiday but the best day for the most of them to be together. There are 2 Social Workers plus Ancy who I am finally meeting late tonight or tomorrow. One of the Social Workers is outstanding and works wonderfully with patients and their families. There is an Occupational Therapist who has only been employed there for a month and a half and is young, eager and speaks good English! Then there are the Medical Officers, 4 of them, with some Mental Health training and the Consulting Psychiatrist who is eager to bring Psychiatry into the 21 century. When I arrived, Dr. K. the psychiatrist, sat with me and some of the staff and confronted me with what I felt I could bring to improve things. I made a few observations which he didn't seem to think much of and then proceeded to list all the things he felt I could accomplish in the next 11/2 to 2 years. Some of it would not be in my knowledge base and some of it scared and overwhelmed me and some was exciting. The point was though that it was enough to fill 10 years of work! I went home that day and read over my notes (which I take constantly) and felt I was out of my league, got kind of glum, frightened I suppose. Dr. K. had asked me to summarize my career for the staff and I think I said to much because if I heard about that person, I would think she was capable of doing anything including writing workshops and proposals and all sorts of things I've never done. Anyway, the other part of this is that I really have nothing to do yet. We were told to basically, hang out, observe, watch, let the staff get to know us for a month or 2 and don't expect too much. I am having a hard time with this also because I don't know where to be, where to put myself, I want to be active and feel funny not being. I really have no boss, no one watching what time I arrive or leave or what I do in between. So here I am feeling weird about sort of just floating around, listening, hanging out with the patients, going over to the clinic, hanging out there, talking to staff, asking a million questions but generally aimless and at the same time I am feeling overwhelmed that too much will be expected and I won't know what to do. Anyway, it took me about a day to talk myself out of my gloomy feelings. I keep thinking of more to know and ask. I question a lot about patients and was asked to consult on a teen age boy who I didn't understand being there. There is really no psychotherapy here. There is no time to explore people's lives and social situations. The stories are horrible, lot's of alcoholism, spousal abuse, many things that people don't talk about like homosexuality in one member of a heterosexual couple, some people don't seem but momentarily psychotic to deal with issues no one is talking about. I am not judging this, I don't think it is that different at home, just handled differently. Anyway, Dr. K. seems thrilled with my big mouth and has encouraged me to see as many patients as I choose to help the team better understand a patient. The problem of course is the language. I have to work thru one of the staff who speak English and they of course are giving me their interpretation of what the patient is saying and of course don't translate everything. I love the patients though, I just smile and hold hands or put an arm around and it's good.
A big problem for me though is language. Part of it is cultural I am sure. I am not told a lot. Even if I have made it plain that I would like to know something, I won't be told; or I'll be told a piece of something. I sort of accidentally have to learn things like if a meeting is happening or the consultant isn't coming.
The thing that is most disturbing to me and this may also be cultural is that there is absolutely no privacy at almost any time. 4 MO's interview patients at the same time, in the same room, before one patient leaves the next one is coming in and the MO's are talking about the patients. Patients sit and wait until spoken to even if the staff member is having a conversation about the weather! I think people are just very respectful of authority here and just accept the way it is. Did I mention this is the same room ECT is done in! During ECT which people line up for and carry their own sheets for, staff walk in and out having all sorts of conversations. Hopefully we shall be moving into a brand new just being built building in 3 months. I went to see the space and see that all the men and all the women are still all in one room. There is indoor plumbing. What is not there right now which is the other thing that I feel disturbed about for the patients is a room for meetings and therapies, OT, RT etc. The patients do nothing all day. They hang out all day. The amazing thing is that patients sort of take care of each other, they are kind to each other, especially the women. They really have their own Therapeutic Community, a milieu created by them that is soothing to each other.
The equipment is very, very old, the ECT table has rips in it. The Blood Pressure monitor and cuff are what we got rid of in the 60's. We are so outrageous in the west and so fortunate. This is definitely third world in terms of availability of goods. The social worker told me his family does not eat pineapples because they are too expensive. I eat one every other day, they are 80 cents! Despite this, the Sri Lankan, including patients and staff, are always trying to share food. People share lunch and breakfast with each other, it is a communal kind of thing, so wonderful, no one would not ask me to join them to eat if they have food.
So to go back to what Dr. K wants. He wants all staff to have knowledge, skills and the right attitude toward patients. He wants it to be patient centered. He wants people to have better counseling skills. It is a bureaucracy , a hierarchy and very paternalistic and he wants a multidisciplinary team of professionals pulling together for the patient because right now the patient is at the bottom of the hierarchy. He wants trainings and lectures and rehabilitation and a Day Center and non professional local community teams trained to work with the Mental Health population in the communities all over the district. This is some of what he wants. I shall know more about nursing and attendant staff after I meet with them. Did I explain the system here. NOBODY, NOBODY chooses were they want to work. MO, RN, Aide, get assigned when applying or graduating to were the need is. The only exception is if you have had special training in a field you were interested in after graduation. On top of that, once assigned a unit, you stay there and can't request a change for 2 years. So, I can try to teach an attendant not to shove or yell at a patient. Will I be effective, who knows.
Saturday, January 9, 2010
The day I was a rock star..
I know, I shall write about work tomorrow definitely. Today though, I woke up, felt lazy so stayed in bed until 7:45 decided not to go to the opening of the new hospital wing which was at 8:30. I figured I'd go when the new Psychiatric wing opens in a few months. I got up and found my garbage turned over in my kitchen, no evidence of an animal still in the house but felt odd about the secret intruder. As I pondered this, the door bell rang and Caru, my landlord asked if I was going to the hospital that day. Apparently a bunch of monks or priests as they call them were going to be there and Charlotte was going. I said I would go then and rushed to get my clothes washed (it was finally sunny out). This by the way took a lot of effort because I had to figure out where to do it, how to change the water, if I needed to boil some water, how to rinse the clothes and so forth. Anyway, Charlotte had previously told me that when you are going to the temple or an event with priests to wear white, which I did although as it turned out, most people weren't but Charlotte was happy. So we walked to the hospital and Charlotte it turns out is the yenta of the neighborhood. She had been a nurse at the hospital for about 30 years and knows everyone. The other thing is that I did not realize that I was her prize. She took me by the wrist, for most of the day and dragged me from one person to another introducing me as the psychiatric nurse from America who lives at her house. I of course being the only westerner and only caucasian present among what seemed like thousands of staff and visitors was looked at and smiled at constantly. Interestingly, I feel very happy with this and not self conscious. I of course was thrilled to see some of the Ward 12 staff there, they were surprised and seemed overjoyed with my presence. I had accidentally done the right thing, an important thing, by going. I had previously met, then saw here and shook hands with the Director of the hospital who invited me to lunch, my boss the Consulting Psychiatrist, the Provincial Health Minister, the doctor running the show that day who also invited me to lunch and I was introduced to the Health Minister of Sri Lanka who was there to officiate. Through all of this as I was being schlepped around by Charlotte, (she is the champ at getting through crowds by the way, she just pushes through, all 4'10" of her) I was told that there would be 500 monks attending. I thought they got their numbers wrong because at any given time there were around 20 monks sitting on a podium. It is now about 2 hours after we arrived and I have no idea what is happening because no one tells me. All of a sudden Charlotte and all her friends, they are a group of 80 year olds who worked at the hospital together, get up, pull me with them and stand by a new gate. After trying to figure out what is happening I look down the street and there are some musicians and a long row of orange slowly moving in a line...it was true, 526 monks proceeded to march onto the grounds and into the first floor of the new hospital. Charlotte and Caru later told me they had never seen so many monks in one place at one time. Charlotte was now holding onto me but I wanted to follow the monks inside and thought I was missing lunch, I finally got her to start toward the door but there were dozens of people clamoring to get in the doors and they now had guards keeping them away, it looked like the evacuation of Saigon! I being lacking in something, thought this was about people wanting to be fed. I knew that if I could get to the door, I would be let in, Charlotte knew it too. She shoved her way all the way to the door with me in tow. When I was seen they signaled me to come forward and now with Charlotte in my clutches I was pushed thru the door like a star, Charlotte did not get in. I was told to sit and sat down with hundreds of people, the highest ranking people who were listening to the prayer of the monk. The clamoring was to be present for this. As I looked around there were long tables, one after the other set up with a feast for the monks. When the praying was over, Charlotte got in and again started schlepping me. I took pictures (on Facebook) and waited. The priests were served by anyone who could get a bowl to serve them as this is a great honor, I was going to do it and didn't but later I was given a book and told to bow and present it with 2 hands which I did and the monk and I smiled at each other. Then there was a ceremony where the Health Minister presented gifts to all the monks. After all of this, after the monks started to leave and I had been told to join the Director on the 2nd floor, Charlotte wanted to go eat with people on the ground floor. I kept saying no I was going to the 2nd floor and Caru kept asking why but didn't understand my explanation. Finally I went to the 2nd floor and Charlotte followed. No one was there, that I could see, so defeated, I started downstairs. At that moment the Director was coming up the stairs and on seeing me said "come up". Charlotte grabbed my wrist, was glowwwwwwing and off we went to lunch with the Health Minister of Sri Lanka. It's not even necessary to say that we had a feast. The other wonderful part of this was that just yesterday our Occupational Therapist had taught me how to properly eat with my hand, you use your fingers like a scoop and then your thumb to shovel the food into your mouth. It works like a charm and I felt like a Sri Lanka.
I can only imagine what Charlotte said to her friends when we saw them downstairs later. They had been given lunch packets for lunch. 3000 people were fed lunch today at the ceremony. Quite an accidental Saturday morning when I ended up feeling like a rock star (I know it is all politically incorrect but I loved it!).
I can only imagine what Charlotte said to her friends when we saw them downstairs later. They had been given lunch packets for lunch. 3000 people were fed lunch today at the ceremony. Quite an accidental Saturday morning when I ended up feeling like a rock star (I know it is all politically incorrect but I loved it!).
Thursday, January 7, 2010
Last Night
I was in bed at 11pm last night, pretty quiet outside for a change. I was reading my book and falling asleep. Suddenly I heard a loud bang and some noise, I did feel frightened because it sounded like it was in the apartment. I made myself get up and as I started to leave my bedroom, something rushed by! It was a little grey and yellow cat! It and I were so frightened we both jumped. I ran to the front door and opened it and ran for a broom in the kitchen, it ran into the office, I ran into the office and it wasn't there. I searched the entire house. I guess it found it's way out the front door but I have no idea how that cat got in here. I closed the doors in case it was hiding somewhere but when I went to close my bedroom door there was movement. It wasn't the cat it was the lizard that is living here with me. I guess I moved in on her so we live together although I don't think she appreciates having a roommate. I left my bedroom door open.
Wednesday, January 6, 2010
More on Badulla
This will be briefer tonight because I am tired and have a bit of a cold..I wish I could share the sounds of Badulla with you, morning and night there is this mixture of Buddhist monks chanting and Imans calling people to prayer...I keep thinking people are annoyed with me and have to check myself not to react at all because I know it is really their translation of our language. Their language is very practical as I have said, so translated it is: where are you going, what do you want, where did you buy this. The shopkeepers will eye me and look at me and talk about me to whoever else is in the shop, then I shall pick up a sponge and ask the price and they will smile and everyone will get friendly and it's OK. Today I got the "where did you buy that top" from one of the nurses, the one that seems pretty outspoken. I said in Colombo and would be happy to get her one the next time I am there, her reply, "oh no, I don't like it". Today I went around the town on my own, without Nilantha who is the Social Worker who has been kind enough to get me to appointments in various places. So today I was on my own to go to the various bureaus that basically control my fate meaning my work visa. I needed to bring gifts from VSO to 3 different doctors at 3 different locations,they were very lovely to me and couldn't believe I was walking, people take trishaws here mostly. Anyway I was very proud that I found my way all around Badulla and located some stores with stuff I have been looking for. Later I went back and also took pictures of some of the people I talk to in the course of the day. Sri Lankans love to have their pictures taken.
I did finally have my computer hooked up, but of course not so quickly because they came when they said, looked at my computer and popped in this teeny disk that I knew was not for my computer but helped them do it anyway! Of course then it was stuck and wouldn't come out; without telling you the entire 3 hour saga let me say, seven people standing in my office and one little boy who was the only one who had ever seen an Apple computer before, it got connected. For those who have the urge to locate me on a map, there is a map of Badulla in the Lonely Planet and at the top of the map it says Badulla, I live where the A is! Favorite meal so far, String Hoppers, Daal and Sambol and Hoppers which are like their equivalent of a pancake. I actually don't get to eat Sri Lankan food daily but sometimes I go in for lunch at a hotel which is a cafe and ask for the lunch packet which is rice and some kind of curry. I believe I explained to you that I am now eating with my left hand which I have to announce is because I am left handed, well, the other morning the nurses insisted on sharing breakfast with me as they all do with each other. I made my usual announcement and we ate and after we were talking about it and I said well it is OK isn't it and there was a hesitation and a nurse said well, no...giggles...another nurse said, you use your left hand for the toilet...giggles..I had to really think about it and they were rolling on the floor. Needless to say, I now use my right hand to eat. Another thing not done here is nose blowing. I don't know if it is because they don't have paper products like tissues. My friend Roger keeps asking about the toilets so here goes: In my apartment there is a regular western style toilet, very noisy but usual. Many places have western toilets but many have the porcelain foot stands with the hole in the floor which I first encountered in Paris in 1966, that is what the staff have at the hospital. The bazaar thing to me is that no matter what kind of toilet they have, there is no paper available and frequently no soap to wash your hands. What there is is either a bucket with a pitcher to wash yourself off or a hose to wash yourself off and I'm not talking about your hands. This I think is the way it is and the lack of paper. When you are finished eating in a cafe they either provide a sink to rinse your hand or they rinse it in a bowl at the table and give you a little piece of cut up paper to dry your hands. At work when they bring in tea and cake, it is covered with used newspaper and plates and silverware are not provided. Actually, when you buy food in a cafe, it arrives on a plate covered with some thin paper so that when you are finished eating, the leftovers are rolled into the paper and it is disposed of, no wasted water. The doctors write their medical notes on each patient in little composition books, some with Tweetie on the cover. This is third world. The next time you waste paper, think of Sri Lanka, everything is precious and used over and over.
A major product all over being sold is this little packet with beetle nuts and chewing tobacco rolled in a tobacco leaf. It must be addictive. Which reminds me that it is dirty in terms of not being paved everywhere in Badulla but there is little trash. Smoking is not allowed anywhere public and no one eats on the street! If someone has an ice cream they stay in the shop, if you buy a snack from a vendor, it's in a bag eaten at home. The hospital is supposedly only 20 years old. It looks 100 years old. In the middle of each ward area are gardens that are being tended but on the edges of the gardens are troughs, in these troughs the patients or staff wash their clothes and bath. There is no privacy, women wear a shmatah type thing and bath as best they can. All psych patients do their own laundry and it is draped over the bushes and gates. There don't seem to be doors, only curtains. The ward #12 where I work has 20 beds for women and 20 beds for men, rows and rows of beds, no privacy. So I need to write about my new work, my colleagues, my feelings, but not tonight I just spilled water all over my extra bed and have to figure out what to do....
I did finally have my computer hooked up, but of course not so quickly because they came when they said, looked at my computer and popped in this teeny disk that I knew was not for my computer but helped them do it anyway! Of course then it was stuck and wouldn't come out; without telling you the entire 3 hour saga let me say, seven people standing in my office and one little boy who was the only one who had ever seen an Apple computer before, it got connected. For those who have the urge to locate me on a map, there is a map of Badulla in the Lonely Planet and at the top of the map it says Badulla, I live where the A is! Favorite meal so far, String Hoppers, Daal and Sambol and Hoppers which are like their equivalent of a pancake. I actually don't get to eat Sri Lankan food daily but sometimes I go in for lunch at a hotel which is a cafe and ask for the lunch packet which is rice and some kind of curry. I believe I explained to you that I am now eating with my left hand which I have to announce is because I am left handed, well, the other morning the nurses insisted on sharing breakfast with me as they all do with each other. I made my usual announcement and we ate and after we were talking about it and I said well it is OK isn't it and there was a hesitation and a nurse said well, no...giggles...another nurse said, you use your left hand for the toilet...giggles..I had to really think about it and they were rolling on the floor. Needless to say, I now use my right hand to eat. Another thing not done here is nose blowing. I don't know if it is because they don't have paper products like tissues. My friend Roger keeps asking about the toilets so here goes: In my apartment there is a regular western style toilet, very noisy but usual. Many places have western toilets but many have the porcelain foot stands with the hole in the floor which I first encountered in Paris in 1966, that is what the staff have at the hospital. The bazaar thing to me is that no matter what kind of toilet they have, there is no paper available and frequently no soap to wash your hands. What there is is either a bucket with a pitcher to wash yourself off or a hose to wash yourself off and I'm not talking about your hands. This I think is the way it is and the lack of paper. When you are finished eating in a cafe they either provide a sink to rinse your hand or they rinse it in a bowl at the table and give you a little piece of cut up paper to dry your hands. At work when they bring in tea and cake, it is covered with used newspaper and plates and silverware are not provided. Actually, when you buy food in a cafe, it arrives on a plate covered with some thin paper so that when you are finished eating, the leftovers are rolled into the paper and it is disposed of, no wasted water. The doctors write their medical notes on each patient in little composition books, some with Tweetie on the cover. This is third world. The next time you waste paper, think of Sri Lanka, everything is precious and used over and over.
A major product all over being sold is this little packet with beetle nuts and chewing tobacco rolled in a tobacco leaf. It must be addictive. Which reminds me that it is dirty in terms of not being paved everywhere in Badulla but there is little trash. Smoking is not allowed anywhere public and no one eats on the street! If someone has an ice cream they stay in the shop, if you buy a snack from a vendor, it's in a bag eaten at home. The hospital is supposedly only 20 years old. It looks 100 years old. In the middle of each ward area are gardens that are being tended but on the edges of the gardens are troughs, in these troughs the patients or staff wash their clothes and bath. There is no privacy, women wear a shmatah type thing and bath as best they can. All psych patients do their own laundry and it is draped over the bushes and gates. There don't seem to be doors, only curtains. The ward #12 where I work has 20 beds for women and 20 beds for men, rows and rows of beds, no privacy. So I need to write about my new work, my colleagues, my feelings, but not tonight I just spilled water all over my extra bed and have to figure out what to do....
Sunday, January 3, 2010
Every day an adventure
So much happens every day that even though I am sitting in this sleezy, dirty internet place filled with dirty keyboards and dirty boys looking at God knows what on their screens, I must post something. I can't keep it in my head or in my notes anymore. The last few days in Colombo were fine with shopping and packing and saying goodbye to my 5 compatriots and the staff. The staff of VSO are like very concerned mamas. They want to make sure we are ready, know they are there for us and sent me off in a van with Upali the most wonderful person and our driver Mohanda. By the way, it turns out Mohanda can be hired at 6000sr or $60 a day to drive anywhere around the country. He is very knowledgeable and speaks English so that part of our trip is taken care of for anyone who is coming! Anyway, on the day of departure I awoke feeling teary and sad and missing my mother who died 25 years ago, shock of shocks. I would love to hear her talking about this adventure and I know she would visit. So with mixed feelings on this very special day after finally getting out of Colombo, we are going along and there is an elephant walking down the road. We stopped for a meal at a real beside the road Sri Lankan food place. Have I shared that in Sri Lanka people eat with their right hands. They do not use silverwear. Well I now eat with my hand but my left hand. In order to do this without people being disgusted with me, I have to announce that I am left handed and then it is ok. Badulla is in what they call hill country, well these are not hills as I know hills, these are mountains! Actually I think Sri Lanka looks something like Hawaii. The whole ride (7 hours) was beautiful with tropical fruit trees and palm trees and lushness everywhere. The mountains are covered in tea plantations and I saw many tea pickers on the way. I have lots of pictures which I shall upload when I have my own computer set up. Tea pickers are usually what are called hill Tamil people, they were brought here from India to pick the tea. They are exceedingly poor and treated poorly. They work 7 days a week and make about $4 per day. As we neared Badulla I noticed that more men were wearing Sarongs and women more Saris or skirts and tops of various kinds. I shall talk more about the dress at another time because the clothing and products available in Sri Lanka are very poor quality..things we wouldn't put in a garage sale are expensive here like plastic jars..remind me another time..Anyway Badulla, an interesting, busy place, people selling fruit, veggies, clothing, plastic products, brooms anything along the road or in a storefront stall. After a day I discovered some of them where actual shops but there are no lights on so it's hard to tell. Need I say that within a day I had walked all of Badulla town, found the Buddhist temple and located stores I liked although I still can't find out where to buy things like matches. I did find an envelope today. The Sri Lankan money is so old and dirty that it is surprising that it stays together and it does and it looks ironed! I digress however. So we enter Badulla and go to Cargills Food City so I can get some essential items (essential to me are coffee and red wine neither of which are available just then). Then a bread store then a quick tour of the town, a ride by my workplace the huge hospital in town with over 1000 beds and finally my new home. more next time........
just kidding..lol as they say. So we drive up, open the gates and there are these two elderly people who jump up and greet me with kisses and big welcomes. This is the landlady and her husband, Charlotte and Caru who live downstairs from me. We must have tea and biscuits and I get introduced to Prema, Charlotte's sister and later others who come. I am told that for this first night they will provide dinner because I won't have time to cook probably. We then go upstairs to the flat. Initially I had little reaction then slowly as I took in how dirty it was and how much it needed a painting I felt my heart sink a bit. Upali stayed and negotiated or talked for me with them. The hot water heater was in and Charlotte very proudly mimed how to work it. She is very animated and cheerful. The first thing she told me very proudly was that she was a nurse for 30 years and is now retired. She was pleased that I too was a nurse. The internet was not in but would be put in within a few days which is why I searched out this place I am sitting in. Upali got them to agree to a paint job. Later they approached me and asked if I really wanted it painted as I had said earlier, they speak some english so it is that and facial expressions and hand gestures which are used to communicate. I defininitely wanted it painted but I don't think it will be the entire apt. Anyway I must admit, that night and the next morning I was in a bit of a funk. Everything I tried to do like make hot water for coffee or plug something in didn't work. I now have the right adaptors and plugs and all sorts of things. You see, some plugs are 2 pronged, some 3 square, some 3 round more common so you need adaptors for all these different configurations along with anything I might need an american 2 pronged square thing changed into a 2 or 3 round..see? Anyway, I then blew a circuit and Caru had to come up. I did finally manage to make coffee in the morning and could feel myself welling up, feeling old and overwhelmed and then I sat, drank coffee, looked around in the light of day and just started cleaning and now I am home, plastic bottles of all sorts of colors and all. I am quite happy to have my hot water heater, very few people here have hot water for their showers and they don't want it. I offered a hot shower to my Charlotte and she refused! Anyway, it is lovely and it is luke warm and not powerful and I am grateful. Now you must be wondering about drinking water. The water is not drinkable here. I started with a big jug from the supermarket and then had to prepare my new water filter, which was a several step process, to make fresh water. To make fresh water you boil water, wait til it is cool then pour it into this huge filter thing and wait til it drips thru. I now have fresh water! Of course this was not without discovering that sometimes when I want to turn on the sink water the spout comes out of the wall and water just pours out of a hole in the wall and I have to get the spout back right thru the downpour of water in the wall. I have to say more about the Sri Lankan people, Charlotte and Caru are a perfect example. They came up to discuss the painting and as they walked thru looked and read everything lying about. They then saw my bottle of wine and asked about it. I offered them a glass and they accepted, or he did if it was sweet. It wasn't ok and he didn't like it but they are very open and direct. Where are you going they ask as I leave. The weather here is in the 60s and just lovely. This afternoon it is softly raining but everyone always carries umbrellas for the sun and the rain, so no problem there. Have I mentioned the noises? Well this is probably the noisiest place I have ever encountered. In the early morning from 3 or 4 there are the calls to pray, Moslem and Buddhist, there are dogs barking there are loud things on the tin roof there are people talking and bathing and something about the way it all fits together it is very loud. Also if I use the sink in the bathroom which I must at times, the water flows out the back of it by a pipe onto a groove in the floor in the bathroom and the toilet flush is unbelievable. So this morning, probably around 6 am I hear what sounds like loud thunder only hitting the roof only it sounded like it was in my apartment and I kept thinking that the neighbor was taking a bath and I can here his pipes but it all sounded like it was in my bedroom, so I got up and went toward the bathroom where I saw water pouring from somewhere overhead into the bathroom! Of course when I tried to call the Landlord the number didn't work.....
So I had my first day of work sort of. I was picked up Friday Jan. 1 and brought to the hospital, introduced to everyone including the patients some of whom knelt and kissed my feet to my shock and I tried pulling them up, quite a scene, was part of a party to celebrate the New Year and my arrival, met the head of the hospital. It was a short day so I'll talk more about it after I really start tomorrow. The staff are trained very differently then we are including the doctors..another think for the future along with my search for a bookcase which are hard to find...please feel free to let me know in comments, email or facebook if you want to ask anything, ta ta for now. kisses
ps of course I am nervous about really starting tomorrow....
just kidding..lol as they say. So we drive up, open the gates and there are these two elderly people who jump up and greet me with kisses and big welcomes. This is the landlady and her husband, Charlotte and Caru who live downstairs from me. We must have tea and biscuits and I get introduced to Prema, Charlotte's sister and later others who come. I am told that for this first night they will provide dinner because I won't have time to cook probably. We then go upstairs to the flat. Initially I had little reaction then slowly as I took in how dirty it was and how much it needed a painting I felt my heart sink a bit. Upali stayed and negotiated or talked for me with them. The hot water heater was in and Charlotte very proudly mimed how to work it. She is very animated and cheerful. The first thing she told me very proudly was that she was a nurse for 30 years and is now retired. She was pleased that I too was a nurse. The internet was not in but would be put in within a few days which is why I searched out this place I am sitting in. Upali got them to agree to a paint job. Later they approached me and asked if I really wanted it painted as I had said earlier, they speak some english so it is that and facial expressions and hand gestures which are used to communicate. I defininitely wanted it painted but I don't think it will be the entire apt. Anyway I must admit, that night and the next morning I was in a bit of a funk. Everything I tried to do like make hot water for coffee or plug something in didn't work. I now have the right adaptors and plugs and all sorts of things. You see, some plugs are 2 pronged, some 3 square, some 3 round more common so you need adaptors for all these different configurations along with anything I might need an american 2 pronged square thing changed into a 2 or 3 round..see? Anyway, I then blew a circuit and Caru had to come up. I did finally manage to make coffee in the morning and could feel myself welling up, feeling old and overwhelmed and then I sat, drank coffee, looked around in the light of day and just started cleaning and now I am home, plastic bottles of all sorts of colors and all. I am quite happy to have my hot water heater, very few people here have hot water for their showers and they don't want it. I offered a hot shower to my Charlotte and she refused! Anyway, it is lovely and it is luke warm and not powerful and I am grateful. Now you must be wondering about drinking water. The water is not drinkable here. I started with a big jug from the supermarket and then had to prepare my new water filter, which was a several step process, to make fresh water. To make fresh water you boil water, wait til it is cool then pour it into this huge filter thing and wait til it drips thru. I now have fresh water! Of course this was not without discovering that sometimes when I want to turn on the sink water the spout comes out of the wall and water just pours out of a hole in the wall and I have to get the spout back right thru the downpour of water in the wall. I have to say more about the Sri Lankan people, Charlotte and Caru are a perfect example. They came up to discuss the painting and as they walked thru looked and read everything lying about. They then saw my bottle of wine and asked about it. I offered them a glass and they accepted, or he did if it was sweet. It wasn't ok and he didn't like it but they are very open and direct. Where are you going they ask as I leave. The weather here is in the 60s and just lovely. This afternoon it is softly raining but everyone always carries umbrellas for the sun and the rain, so no problem there. Have I mentioned the noises? Well this is probably the noisiest place I have ever encountered. In the early morning from 3 or 4 there are the calls to pray, Moslem and Buddhist, there are dogs barking there are loud things on the tin roof there are people talking and bathing and something about the way it all fits together it is very loud. Also if I use the sink in the bathroom which I must at times, the water flows out the back of it by a pipe onto a groove in the floor in the bathroom and the toilet flush is unbelievable. So this morning, probably around 6 am I hear what sounds like loud thunder only hitting the roof only it sounded like it was in my apartment and I kept thinking that the neighbor was taking a bath and I can here his pipes but it all sounded like it was in my bedroom, so I got up and went toward the bathroom where I saw water pouring from somewhere overhead into the bathroom! Of course when I tried to call the Landlord the number didn't work.....
So I had my first day of work sort of. I was picked up Friday Jan. 1 and brought to the hospital, introduced to everyone including the patients some of whom knelt and kissed my feet to my shock and I tried pulling them up, quite a scene, was part of a party to celebrate the New Year and my arrival, met the head of the hospital. It was a short day so I'll talk more about it after I really start tomorrow. The staff are trained very differently then we are including the doctors..another think for the future along with my search for a bookcase which are hard to find...please feel free to let me know in comments, email or facebook if you want to ask anything, ta ta for now. kisses
ps of course I am nervous about really starting tomorrow....
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