Monday, October 17, 2016

Savan Durga

Wildflowers lining muddy paths to the Savan Durga foothills
We went to the Savan Durga hillock some weeks back. SD is supposed to be the largest granite monolith in South Asia. RK has been traveling there from the time he was a child because there's a temple to Narasimha,  who is the family deity on his mother's side. Even just 40-50 years ago, you could only reach the place by a bullock cart trip that lasted a few days, while praying that tigers didn't try to leap on you.

The tigers are non-existent now, and the forests severely cut back. But the place still retains a rural, isolated air, despite the concrete roads and the large number of shiny cars racing up and down.

We went there for hiking and birding. I thought the monolith would be great fun to climb, having some memories of traveling there soon after my wedding, and trying to climb the rock in my pattu padavai (silk saree). I was sure the kids would love it.

However, some earlier this year, some love-lorn couple committed suicide by throwing themselves off the rock and since then, all hiking and trekking activities around the monolith have been suspended. In a way, it's a good thing- fewer cars, small amounts of trash, fewer people. Not good for the local economy, of course.

But fortune favors the bold and we found many treasures in the foothill forests, crumbling walls of long lost temples and the smaller rocks scattered at the foot of the monolith.

Location of Savan Durga
Ani enjoying the monolith from his vantage point

Interspersed between the rocky facades are grassy niches like this one, fed by hidden rain water streams. They form the home for many small animals and pastures for grazing goats. 


Inside that thick crop of trees lining the foot of the monolith live a multitude of spectacular birds, including those that are found nowhere else on the planet. 

On the road to SD itself are lots of beautiful birds, but of course, given the traffic, it is hard to stand in one place and view them. Among the birds we saw on the way to SD were the coppersmith barbet (barbets are birds that I have not seen in the US. These are about the size of a myna, but green in color, quite difficult to distinguish within the foliage of the trees they usually hang about in. If you have spent any time at all in an urban park in India, I can assure you that you would have heard a barbet many many times). The coppersmith barbet leaps into view when it shows you its head. The rest of the body blends into its leafy surroundings perfectly, but stare into the tree long enough and there! You'll see a flash of red and yellow, gone before you can process it.
Another bird we noticed was the crow pheasant, also a very common denizen of urban parks. Check out the devilish eyes!
Crow pheasant or the Greater Coucal.
It's crow! It's an upside-down myna!
No! Itttt's crow pheasant! 
Coppersmith barbet. Pic from
 http://www.besgroup.org/2009/05/08/nesting-of-the-coppersmith-barbet/















The Yellow Throated Bulbul: on the endangered species list. Seen in Savan Durga.
Picture from http://orientalbirdimages.org/images/data/ytb.jpg

A couple more birds I have never seen before:
The tawny bellied babbler.
Pic from:
http://www.flickriver.com/photos/tags/tawnybelliedbabbler/


The Small Minivet- look at those colors!
Pic from : http://www.birds.iitk.ac.in/wiki/small-minivet
List of birds, insects and animals seen at Savan Durga:

Crow pheasant
Coppersmith (crimson throated barbette)
Yellow throated bulbul
Red whiskered bulbul
Red vented bulbul
Indian make robin
Pied bushchat
Sparrow hawk
Babbler?
Tawny bellied babbler
Kingfisher 
Small minivet 
Sunbird: purple and purple rumped
Malcoha 
White eye
Jungle crow
Jungle mynah
Indian mynah
Brahmini starling
Monkeys
Three striped squirrel 
White cheeked barbette 
Snails and water skaters
Fish
Mongoose 
Mosquitoes 
Ashy prinia 
Ladybird 
Cows
Bulls
Horse
Caterpillar
Water skaters
Durga atop a tree
Ani and RK atop a rock




An old pond by an older temple
Watching the antics of water skaters

All in all, a beautiful day in a beautiful place!

Time and Life

We live longer today than ever before in human history.

Yet why is it that we feel we have less time to do anything? Why do we push our kids into school at earlier and earlier stages, why do we prod them into achieving various milestones at a younger age? What are we in such a hurry for?






Thursday, October 13, 2016

Memorable Patient Encounters 2

There are good days and not-so-great days. Last month, I got a bit of a shock when two of the mothers I had counseled admitted their kids to the Neonatal ICU (NICU) for dehydration, hyperbilirubinemia and excessive weight loss. Of course, all these are direct causes of inadequate breastfeeding.

I had seen one of them once briefly and the second one, about whom this post is about, I had counseled extensively and multiple times, along with her whole family. To say that I was dismayed to see her in the NICU with a sick baby would be an understatement.

Sometimes issues with language, understanding, culture etc are vast, or they seem so. This lady came from a very poor family. That per se doesn't mean anything. Intelligent, capable women are found everywhere, regardless of their family situation.The language of communication was Hindi, not my strong point; the differences in education, financial situation, family stability etc were of course clearly present. But these I have been able to overcome before, but somehow was not able to do so in this case. There was no rapport. Usually, if I find it difficult to communicate with the patient, I turn to her mother since she will be the one who's helping the new mom. Speaking to this patient's mom was just as difficult. There was a brother as well, and he was actually easier to talk to. Very interested in his sister's ability to breastfeed and the suckling ability of the baby. Usually when a male family member interests himself in the breastfeeding process, it's the father of the new mother or the father of the baby. Having a brother so keenly asking questions was surprising, but who am I to judge? I actually was grateful that someone in the family seemed to understand and respond to what I was saying. Many times I wondered if I was getting through to them, despite the head nods and the smiles, but then I dismissed my concerns, assuming that everything would be fine. She had an inverted nipple, but was feeding the baby through a nipple shield. She seemed comfortable, the baby appeared to be feeding well, was peeing well and there was a slight weight gain by the time she and the kid were discharged.

And then of course, a week later, she turned up with her little baby to the NICU.

Anyway, counseled her again in the NICU; she was defensive, not willing to think that there was a problem; and then all of a sudden, burst into tears about her father... she sobbed and spoke through her tears. I was unable to understand if her father had recently died or had abandoned them, or if all these events were in the past which she was still grieving over. At the back of my mind were all these questions: where was her husband? What was the brother's role? What was going on?!
Very confusing. And it happened right in the middle of the NICU; all the sisters stopped, stared, exchanged bemused glances, whispered among themselves and I was trying to console this lady and was wondering what I had said that set her off.

After some time, and a lot of coaxing and fake cheerful-talking, things returned to normal, or as normal as they could get. Turned out she wasn't eating properly- they were keeping her on rice and dal because she had had a cesarean section (were they punishing her or were they simply misinformed? Usually maternal diet after childbirth forms a pretty key part of my standard spiel... did I somehow miss talking about this with these guys?), she was not eating or drinking properly. Imagine- 3 meals of just rice and dal; not even with ghee. Restricted water. How is anyone to survive on this nonsense, let alone make enough milk to feed a newborn?

Later I found her brother in the vicinity and questioned him. And he said, "Yes doctor, you had told us about what to give her and what she should eat" (ok. good. so at least I hadn't missed that) and then I reiterated again about what she should be eating and how important that was.

God knows what happened after her discharge from the NICU. I hope she doesn't turn up again at the NICU and that baby grows a bit and this whole breastfeeding thing resolves without any more issues.

Ideally, I should have asked her to come meet me on an OPD basis to follow up with the lactation. But I was frankly very reluctant. I am a simple lactation counselor, that too with no qualifications other than an LCCE, a bit of experience and a true desire to do this stuff. All the psychiatric stuff, the financial stuff (they might feel obligated to come see me, but may not be able to afford the OPD fees), and most importantly, the getting-through-to-them stuff was too overwhelming for me. So I gave her my card with my number on it and asked her to get in touch in case of any issues, but didn't set a time.

Reading this account over makes me realize how out of control I felt. Most of my decisions were made based on a desire to get out of the situation rather than meet it head on. This is something I will probably come across again. So I must learn to become more aware of these obstacles. I must talk to Rk and other doctors about how they handle difficult cases.