Hard to know where to start with India…
We docked in Cochin, part of Kerala state, southern India. This is coastal rural India, maybe not THE India that you hear about or that I have read about over the years.
Side note: so many of my impressions of India cull from literature I have enjoyed over the years. Authors like Abraham Verghese, Salmaan Rushdie, Arundati Roy, Jhumpa Lahiri. If you are reading this and you haven’t read these authors, I would strongly recommend a trip to the library. I’m currently reading “When Breath Becomes Air” which is hitting me like a punch in the gut, such gorgeous writing by a man who IS no longer and so many pings of recognition in terms of the medical training process (can you say delayed gratification), growing up in a household with a surgeon and also having spent a lot of time on the Stanford campus over the years, but also by small coincidence the author Paul Kalinithi, is of Indian descent, his mother having been born and raised in southern India, one more literary echo that amplifies this current experience for me. I realize that through many of these books and in conversation with some dear friends over the years, I have picked up some understanding of Indian culture, especially family, household structure, religion and overall feeling of place, but it is amazing to finally be here.
In India, I was officially off duty for six days. Had I done nothing but stare off into the Arabian Sea 100 meters from the ship, it would have been relaxing but thankfully we did more than that.
We spent two days in Fort Kochi at the Cochin Club, a place suggested to us by Dan and Kate after their travels to this same town a year ago. Over 100 years since its last real renovation, it is a private club frequented by local professionals. There is a pool, bar, game room and soccer field as well as a couple places to order food. The pace is slow. There are also five or so hotel rooms and we stayed in a large one under a banyan tree with four beds in a row and a bathroom with some beautiful, huge, regal insects (this is the way I chose to re-frame my cockroach friends at 2am when one particularly loyal one kept me company during a relatively brief but nonetheless unpleasant few rounds of gastrointestinal distress).
Next we traveled to the Kerala backwaters and spent time at the beach (see G’s page for photos and details).
Despite traveling, the ship and the duties that awaited me there were still very much on my mind. As I mentioned before, our med closet on the ship is well-stocked and well-organized. However, it has several growing holes at this point; in particular we are lacking a couple of drugs that would be useful to treat conditions we anticipate continuing to see in the final 9 weeks of the voyage. Orally disintegrating ondansetron (to help with intractable vomiting) and cortisporin otic (for otitis externa). On our way from Kavakarrom to Marari beach (through the towns of the Kerala backwaters) I asked our taxi driver if he could stop at a pharmacy. Many were closed due to the Shiva Day holiday, but the fourth one we drove past was open. Pharmacies here are tiny store-fronts that sell all sorts of useful toiletries and snacks as well as medications which would be by prescription only in the US. The one I visited was like most I saw: approximately 9x4 foot rooms open to the street on one side (with a pull down metal door that seals things up when the establishment is closed). They appear to be independent, not attached to hospitals, no computer, no insurance middleman in sight.
This particular pharmacy was absolutely crammed full of cardboard boxes. The boxes were labeled roughly alphabetically in thick green marker ink:
Augmentin, Ampoxin, Amaryl, Azulix, Acucal, Autrin, Anofer; Envas, Enam, Enapril, Eneril, Emidoxyn, Ebast, Endobese, and on and on.
The pharmacist didn’t speak English and I don’t speak Malayalam (primary language spoken in Kerala state). A helpful fellow customer pulled out a pen and the shop-keeper got me a small brown bag to write on: I wrote out “ondansetron” (pantomiming vomiting) and cortisporin otic ear drop (dripping imaginary things into the ear).
In less than 20 seconds, my pharmacist friend pulled out exactly what I needed from a couple of crusty chaotic cardboard boxes.
I felt a mixture of emotions:
Triumph in finding these meds so easily and so cheaply — I got 60 orally disintegrating ondansetron and 7 bottles of a cortisporin otic equivalent and a large tube of tooth paste for 500 rupees (not even $8 by today’s exchange rate).
Despair, as I instantly felt the scope of the growing problem with highly drug-resistant bacteria. I could have gotten fistfuls some of the most powerful antibiotics out there, including some that would require ID consult in some hospitals back home. The issue is not going anywhere soon.
A satisfying feeling of connection with another medical professional.
Next I asked for the toothpaste and my pharmacist pulled two family-sized tubes off the shelf, I gestured to my mouth and said “I only have these teeth.” The assembly of men who had gathered by now - mostly waiting to buy their own meds but also probably trying to get a look at this lady who couldn’t possibly have such bad vomiting and ear problems that she needed THAT many meds - cracked up and nodded in agreement, many with dentition that made me realize in retrospect that I probably should have offered jumbo tubes of Colgate all around.
Hard to know how to process India, but I’m enjoying thinking it through.