Healthcare and India

"Grishma?"

I usually don't wake up in the middle of the night when someone tries, but I'm glad I did this time, because I could hear pained groans coming from her side of the bed.

"Yeah?" I ask, eyes still closed.

"I have vertigo."

She's trembling. I check her forehead--no fever.

"What should I do?" I ask, still not completely awake.

"I need to go to a hospital in the morning."

She begins sobbing, and I can't think of what else do to, so I roll over and hold her.

"We'll go to a hospital in the morning," I reassure her.

I had gone to a hospital in Hyderabad two weeks ago when my foot started misbehaving. It's a fun new travel game I get to play every summer called Spin the Wheel of Foot Injuries (this time, it was a blister that kept doubling in size each day). I was a little worried about cost since I don't have Indian health insurance, but I was surprised to find that, even without insurance, my exam and medicine cost about 600 rupees (which is around $12). And it's not like the hospital was shabby. It had marble floors and a giant chandelier in the waiting lobby, and their system was fairly organized for walk-in appointments.

My friend's blood test, IV, medicines and checkup cost around 1300 rupees, or a little over $23. The doctor told her that she might have a combination of dehydration and spondylitis. She herniated a disk in her neck years ago, which seems to have become agitated from traveling (specifically, I think, from sleeping in a sitting position in cars, buses, planes, etc.) and it started causing vertigo and nausea. To check, she needed an MRI, which would have cost her $1,500 in the United States after insurance coverage, but cost her less than $200 in India. The facilities were just as good as any American hospital I've ever been to.

While she was vomiting every trace of matter in her stomach and saying things incoherently ("I really wish I had two lizards with me right now" or "Kendon, your leg-hair is really fun to pet"), I kept wondnering why healthcare is so cheap in this country. The facilities are good, at least in the two hospitals I've been to. Does it cost less to maintain these hospitals? Does the government fund healthcare really well? Is it because they use reusable materials where possible--bedpans instead of vomit-bags, for example? Is it because there are no insurance middle-men to pay?

I realized that I can't answer that question until I know what my American insurance does pay. Who is getting all this money, anyway? And why?

These questions remained unanswered today, but her health improved tremendously by the end of the night. And while I watched people move in and out of the hospital, I felt comfort when I thought about all the people who wouldn't have to worry about having access to healthcare because of cost as much as they do in the United States.

This isn't saying that the system here is perfect, I've heard stories of corrupt Indian doctors who recommend tests patients don't really need to make more money, and I have no idea how efficient the emergency rooms are here, but I do find it remarkable that the same procedures and tests are so much cheaper.

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Floating Towards the Sea (Or Maybe Away from it, I'm not Entirely Sure)

The water looks like mercury from where I'm sitting. The currents of the Arabian Sea don't make it far enough into the Keralan backwaters to jolt anything, so this silver water moves slowly. Our houseboat glides across the water, passing rice paddies and farms and goats and the occasional couple on their honeymoon. 

"What a polite afternoon," I say, having just read that word about four times on my current page of Bill Bryson's adventures in England, entitled Notes From a Small Island. He had just talked about polite ticket collectors who thanked you on trains, and how there wasn't any pushing or shoving while people boarded or exited the platform on his way to Wiltshire.

"What polite air," I say, still savoring the word. The air is just dewy enough to let you feel like you're near water, but it's nowhere as imposing as ocean-air.

Our next hours become instinctive, not a calculated move on what's the best use of our time while we're here. Kendon chooses to fish--first with dough, then with live bait. Bianca chooses to take photos and admire the local fauna. And I choose to find out how Bryson felt returning to his old town in England years after he had moved away.

Hyderabad Traffic: A Lesson for Beginners

Hyderabad traffic, like most other things in this city, appears chaotic when you're first introduced to it. But it has an organic flow, and once you see that, it becomes easy to maneuver through it. At this point, it seems silly that I was ever startled by the traffic here.

And that's because with Hyderabad traffic, like most other things in this city, you have to carry yourself purposefully. Here's a fundamental truth about Indian drivers--they are all defensive drivers, just not courteous ones. And once you figure that out, nothing they can do on the road will seem intimidating anymore.

Don't jump. Don't be startled. Don't wince. Stare at the driver and walk across. What are they going to do? Run you over? Oh, they're in a car? Carry yourself like you're driving a tank. They will stop.

And they'll honk, sure. They're in a rush, but so are you. They can wait, because you certainly aren't going to stand here all day. You just have to remember that they're not honking because they're angry at you, like in the United States. No one is going to pull out a shotgun and shoot you if you honk at them, like in the United States (it's kind of delightfully ironic that Indian traffic seems much less likely to injure you than American traffic). An Indian driver honks to let you know he's there, as if he's in an existential crisis and needs to remind himself that he exists. He honks, therefore he is.

Existential crises breed emotional vulnerability, and there's no room for pansies on your schedule. 

Mr. Grishma Singh

The sign on the placard waiting for us when we arrived at the Hyderabad airport read "Mr. Grishma Singh". Then, when we were driving to the hotel from the airport, I sat in the front seat and was the only one speaking to the driver. The driver didn't speak English, so I spoke to him in Hindi. When my mother's friend called the driver to check in on us, the driver handed the phone to the white male in the back seat who has been speaking in an American accent the entire time and hasn't spoken a word of Hindi.

My mother's name is technically a male name, which she attributes to the commonly used "Mr." with her name in India whenever a driver comes to pick her up from the airport or the company makes a hotel reservation for her (similarly to "Kyle". I assume it's a male from the name each time, but I have met a couple of females with that name). But that's not true with my name. Can you even think of a male name that ends in an 'a'?

I've been staying at this hotel for about 2 weeks, but the room is still booked under a "Mr. Grishma Singh".

And this shows up at our doorstep every morning with the newspaper:

(I thought it was a poorly written 's', but compare it to the 'r' in my first name)

Mumbai Train Station

I was told that it's impossible to get train tickets last minute in India, and that they fill up a few weeks in advance. But I've been to enough train stations in enough countries to know that there are always open seats. It was difficult to imagine why India would be any different.

We started with Counter 1.

"We need tickets to Hyderabad for tomorrow."

Some clicking on a computer made in the early 80s ensued, and the elderly woman told us there are no seats available. She was plump, but not in a cute or hearty way--her age made her look like a melting candle.

"I can put you on a wait list," she offered.

"No, we'll keep trying."

We try Counter 7.

No seats.

We try counter 3.

"Just be really angry. If we're difficult, they'll have to cave," I whisper to Bianca, who was already in battle mode.

I saw two Japanese tourists who were being pushed further and further back in line by Indian men who kept cutting in front of them. The two women asked them to stop going in front of them, but the men just said something about how they needed tickets. The Japanese are truly one of the kindest people I've been around, and I thought it unfortunate that no one would ever think that of Indians.

Then again, I don't think Indians care. Much like the Greeks, Indians have a strong sense of patriotism completely independent from international perception. They don't care how you feel about them, because they already know they're the best.

Still, I wanted to help those women. I wanted to at least tell them that these men aren't worldly travelers like them, and by the looks of their attire and demeanor, they look more like the type to sit with the luggage and drink whiskey all night. They weren't exactly marked with signs of success or well being.

But we had our own battle to fight, this time with Counter 14. Counter 7 had told us about a tourist quota trains have. I don't know if that's a real thing or something the attendant made up to shut us up without feeling like she caved, but either way, we used that reasoning to get two tickets to Hyderabad in 2nd class. We got one on waitlist, expecting to have to bribe the conductor, but none of that was necessary. The three of us just sat together until the conductor came to check our ticket, and he just told us he'll let us know if a seat opens up. Kendon found a seat within the hour.

There are two pieces of advice I'd like to give anyone traveling by train in any country:

1. There are always seats available, just keep asking.

2. Attendants get flustered if you yell at them in a foreign accent, use it if you need to--they will be much less likely to argue with you if they don't perceive you as their peer/have difficulty understanding you.

Keralan Typography

If you ever want to simulate being on an alien planet, the closest thing you can do is go to a place with a language you don't understand, as long as the language doesn't use the roman alphabet. Those languages make you feel tremendously more foreign, no matter how similar you actually are to the local culture. Take Poland--I couldn't read or understand any of the writing, but it felt less foreign to me than Kerala. At least I could read Polish (while butchering words with my "You speak Polish like a Russian" accent), even if I didn't understand what it meant. But everytime I look at Malayalam, I don't even know where to begin.

While driving around Cochin, a lively city in this otherwise relaxed state, we stopped inches away from a bus at a red light. When I looked over at the bus, I noticed something peculiar. Brushstrokes. The labels and numbers on this bus were hand painted.

I can see the brushstrokes when I'm inches away from them. Stop signs, speed limit signs, license plate numbers on autos and buses... they're all painted by hand! I hadn't been this excited about finding out that something is actually painted since I was in Rome. They were painted precisely and neatly, and I only noticed the subtle differences between identical signs when I was looking for them.

Look at the impeccable Arial on this bus:

And this, the seal of the state of Kerala. Is that Impact? I can't tell:

The tricky thing about painting things, I imagine, comes when you're advertising. Logos and brands must stay precise and identical, but I don't think Vodafone will be disappointed at these:

Because the actual logo of Vodafone looks like this: 

It's All in Your Head

It was when I wished I had taken up my mother's offer that I became anxious. She wanted to call one of her friends in India to take us to a grocery store that was just down the street. I refused, in part because it felt patronizing ("you've traveled without us so many times, but let me send someone to hold your hand and walk you to the end of the street") and because it felt ridiculous to ask someone to come all the way to our hotel to, you know, walk us down the street.

We walked around for thirty minutes, but still couldn't find it. So we just went back to the hotel and went to bed.

And now I'm lying on a hard mattress under numbingly cold air, wrapping a blanket around my body as many times as I can.

Sometime in March, I had warned Kendon and Bianca to take what I say with a grain of salt, because my experience growing up in Hyderabad was atypical. And I didn't mean it in a "we all have unique perspectives so you may have different opinions than me" kind of way. My experiences fostered an ignorance which is now making itself increasingly apparent. Hyderabad is intimidating me. It's nothing like London or Rome or other big cities where I still felt like I had a lot of control over my environment. I feel like I'm caught in an ocean current.

I roll onto my right, facing Bianca's sleeping silhouette. A lock of hair falls forward, resting on my nose. I leave it there, refusing to take my hands out of the blanket burrito.

There's a certain kind of sadness that materializes when you realize that, out of all the places you've been to in the world, the one that takes you most out of your comfort zone is the city in which you were born.

And it's not that I'm helpless here. People are calling in to check up on me every day and I have a list of phone numbers of people who want to help me while I'm here. I know I can call them at any moment. But it's not about that.

I want to be able to sustain myself here. I want to be able to visit without having to know people or having them arrange things for me. This is just a city. Just a conglomerate of earth and people. It can't be that difficult.

Everything is matter. It's just atoms. No big deal.

Exhaustion overpowers the chill, and I finally close my eyes.