The end and the beginning...and some things that happen in between

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March 31st. YWCA Guest House, Madras.

For ten weeks now I’ve been telling people that “March end” is when I leave. And March end always seemed so far away; until one day one of the aunties in my hostel asked me when I would be leaving (something she liked to keep tabs on but could never quite remember) and I realized that March end was no longer an appropriate response. Because it was March end. And somehow between then and now time compressed and sped up and did all kinds of strange things, because right now its 10:51 pm on March 31st and I’m still trying to figure out how that happened.

The last few weeks have been busy and hot and full of work, friends, errands, dinner dates, interview transcripts. Although I doubted at times that it would ever happen, we’ve finally reached an almost-finished point in our research. Between three interviewers we have completed approximately seventy-five usable interviews with TB patients, treatment providers, and general community members. Most encouragingly I have seen a huge improvement in the quality of the interviews from the beginning of the project to now, though I would be hesitant to call our interviewers fully skilled in the art of qualitative in-depth interviews. But I’m happy to think that the past two and a half months have been a productive learning experience for everyone on our mini-research team.

I, for one, was taught (and re-taught) the difficult lesson of time flexibility in India. Translated interviews sometimes came to me four weeks after the interview was actually conducted (despite initial promises that everything would come back within a week) and there were uncountable occassions when meetings and pick-up times were arranged and then completely tossed out the window. And for his part Muniyandi—my counterpart at the Tuberculosis Research Center, Chennai—likes to tell me that he learned just how obsessed Americans are with quick turn-around time, deadlines and appointments. “Everything is so hurry-burry with you” he likes to tell me.

I was also (re)reminded that plans are kind of a futile venture in these parts, and that just about anything unexpected can and will happen. During our weekly visits to Vellore I was consistently surprised by the number of strange interruptions and detours we encountered. Our auto driver was never less than fifteen minutes late, and people always thought it was strange when I asked if we could call him to make sure he knew to come on time. No matter how late we were or how long of a day we had had already, when we were out in the field we always made some detour. We stopped to go to temples, to watch sugar cane juice being made (in a hut on a plot of land that looked like it was covered in the snow of pulverized sugar-cane), see fish farms, eat tender-coconut, visit our driver’s wife’s maternal uncle, and to buy everything from mattresses to watermelons to ten kilograms of jaggery (raw sugarcane sugar) and rice-sacks full of tamarind.

The field work process in Vellore (a mere 36 hours every week) was the most educational part of my whole two and a half months. We bumped around all of rural Vellore in an auto rickshaw, driving past rice paddies and coconut palms and grazing cattle. We met patients who welcomed us into their homes, and we spent a considerable amount of our time refusing offers of tea, coffee and “color” (the rural Tamil term for soda, with “orange” being Fanta, brown being generic Coke, white being some version of Sprite, and green being god-knows-what). We also met patients who were hesitant to interact with us. One patient, upon finding out why Rajamma had come to his house, rolled over and pretended to sleep on his cot so that he wouldn’t have to answer any of her questions.

Many of the patients who didn't want to talk to us were concerned with what their neighbors would think if we visited their houses. Stigma for TB patients is much greater than I would have thought, with most patients opting not to tell anyone other than their family members about their disease. Some patients even kept their condition secret from their mothers, children, and siblings. On a few occassions we managed to catch a patient at the local PHC (Primary Health Center), and the patient would insist that we conduct the interview in some secret location so that they wouldn’t be seen talking to outsiders (as this would prompt curiosity and rumors from neighbors and friends). In one case we found a 26 year old unmarried patient who hadn’t told anyone but his mother about his disease. When we asked to interview him he led us from the PHC to the dried out rice field across the road, around the edge of which we made our way until we reached an unused plot of land off of the main road, where we conducted our interview under the shade of trees that dropped bugs on us and in the company of grazing goats. In another case a patient led Muniyandi on an hour-long walk through fields in the heat of the afternoon in his best effort to not be seen with Muniyandi anywhere near the main village.

In the last few weeks of our interviews we came across more and more HIV/TB patients (which is not that rare since HIV patients with their weakened immune systems are more succeptible to the TB bacteria that are endemic in India). On International Women’s Day we happened to be in Vellore doing field-work, and we had managed to track down a husband-wife TB couple that we had identified but failed to reach in previous weeks. Muniyandi interviewed the husband outside while Rajamma and I interviewed the wife in her home, and we quickly found out that both were joint TB/HIV patients who had defaulted from their TB treatment. Although the couple had two small children (who I spent most of the interview making faces at and playing with), the husband had resigned to dying and saw no need to take seven TB tablets on alternate days when he was already taking three ART tablets every day. So he stopped picking up medicines for both him and his wife from the nearby PHC. The wife pretty much said that if her husband stopped, she would stop. But she also had her own reasons for stopping the treatment. TB drugs, especially at the initial phase, can have serious side effects like dizziness, nausea, vomiting and fatigue. The wife found that when she took TB treatment she was unable to go to work as a wage-labourer because she suffered from these side effects. Because her husband had stopped going to work some months earlier she decided that it was best if she didn’t take TB treatment anyway; at least this way she would still have the energy to go to work and continue to support her family.

We never knew whether patients were also HIV positive until we interviewed them. In our first interview with an HIV/TB patient the patient was very open about both diseases, and when we asked him about his TB treatment he produced treatment cards for both ATT (TB treatment) and ART (HIV treatment). Muniyandi, who was conducting the interview and translating for me, immediately turned to me and (with his eyes bugged and eyebrows raised in a look of terrible shock and fear) whispered “The patient has HIV.” After the interview was over and we had walked back to the main road through several layers of rice paddies and banana fields Muniyandi told me he was worried that he might have HIV now. “We drank tea from his tumblers, no? I’m worried I might get HIV now.” This was when I realized the true state of HIV/AIDS awarenss in India. If Muniyandi—an educated, middle class employee of the Indian Council for Medical Research—thinks that HIV can be transmitted by sharing drinking glasses, it’s no wonder people with less exposure to health education haven’t the slightest clue about how to prevent or deal with the disease. Despite the fact that I told Muniyandi HIV/AIDS could not be spread that way, throughout the entire forty-five minute drive home from that interview herepeatedly stuck his head out the side of the auto and spit effortfully (in some desperate attempt to purge himself of HIV germs).

Working with Muniyandi added a whole extra layer of challenge to my experiences here. He is a short balding man with hair growing out of his ears and a very excitable laugh. He likes to talk and is quite fond of dramatic facial expressions and, when he really gets going, he likes to get in your face and challenge you with “Huh?! What do you say? What do you say?” Most of the time I had no appropriate response to this challenge because I had stopped listening to what he was saying fifteen minutes before; as a result I became rather skilled at crafting the kind of ambiguous answers that would calm Muniyandi down and give my ear a break for awhile. There were times when he talked so much and so passionately that he complained of chest pain, and Rajamma and I quickly learned that if he was talking too much for our taste we could threaten him with “Muniyandi! Stop talking so much. You’re going to give us all chest pain!” Most of the time when we travelled in the field I managed to climb into the rickshaw first with Rajamma behind me, thus guaranteeing a barrier between me and Muniyandi’s slightly-too-loud voice. There were, however, two weeks when Rajamma did not come to Vellore and it was just me and excitable-Muniyandi bumping around in our auto. There were times when I wasn’t sure I would be able to make it ten more minutes.

And of course there were times when I found Muniyandi very endearing, like the time he did his best to immitate the coquettish glances of the police officers that we had just driven past. Or very helpful, like when he rushed to the hospital (and made Rajamma come with him) when he heard about my bus fall. And above all Muniyandi is a man with very good intentions, even if he likes to talk too loud and sometimes lacks the leadership qualities to stand up and get anything done. As much as he seemed like an obstacle to efficiency at times, without him I don't know how much I could have accomplished as a solitary confused young foreign girl.

4 PM, April 1st. On the Coromandel Express in a state where I don't even recognize the language on the signs (Telugu? We must be in Andra Pradesh)

As the research came to a close there were other signs that it would soon be an appropriate time to leave. For one, the heavy hand of summer was no longer deniable and as temperatures rose (increasing people’s reliance on their fans and causing me to finally make use of my AC) power failures also increased. It had long since gotten too hot in Vellore to sleep comfortably (with our pathetic excuse of a fan), and I was not eager to start walking up in the sweat of a Chennai power failure. Climate and food being two important factors in my comfort abroad it is of considerable note that in the two weeks before I was to leave I reached the bottom of the jar of Skippy that Nancy had left with me and my supplies of Odwalla bars and granola (heaven sent by the Gods that are my mother and Max, respectively) were dwindling. All around the signs were clear: it was time to “push off” (but not without the Madrasi English that I had adopted) in search of cooler climates, new foods, new adventures.

The last few days in Chennai were more stressful than I knew how to handle (I think that after graduating college and moving back to a California-paced life style I fell out of the practice of being stressed out and sleep deprived). It was becoming increasingly clear that by the time I left, the number of uncorrected or untranslated interview transcripts would be far beyond desirable. My interviewer from Vellore had disappeared to work on another project in Orissa (an entirely different state). Despite his promises that he would send me at least a dozen long-overdue interview translations bfore he left he absconded (and you can blame our translator for my recent adoption of that word) with no less than fifteen unfinished interviews. In the end the situation at the TRC wasn’t much better, where Muniyandi and Rajamma managed to clear much of their back log in the last two days, effectively transferring the duty of correction and processing to me and my April holidays.

At the same time (and in addition to the regular final-days business of trying to pack and say goodbyes) my hostel was doing its best to complicate the process of me getting my $900 security deposit back. Five times I went to work late or left early to try and retrieve my money, and five times I was told it wasn’t ready (or I hadn’t submitted the right paperwork or the accountant hadn’t shown up for work today). As one of my friends had warned me early on in my stay, “This YWCA place, na. It’s hard as hell to get in and nearly impossible to get out.”

Friday morning—at the peak of all the insanity—my travel agent called to tell me that he couldn’t actually get me the flight to Dubai that he had promised. At this point I was sure that my brain—if not the entire world—was going to explode. But this is India, and thought I always seem to forget it in the idle of whatever craziness I am in, things tend to just work themselves out here. By Friday afternoon I had $900 in rupees in my wallet, a ticket to Dubai, and the hope that I might still be able to get some of those interviews finished. To celebrate the (sort of) completion (more like a pause, really) of our project, Muniyandi and I slipped out of the office Friday afternoon and walked to the nearby posh and very famous Sri Mithai sweethouse. We drank badam milk (sweetened and flavored milk with almond slices in it) and tried not to be intimidated by the overwhelming selection of barfis and laddus stacked in pyramids (orange silver and white) behind the display cases. We bought 1/4 kg each of two kinds of barfi (coconut and mango) and two kinds of laddus (rumored to be the favorites of the endearingly pudgy god Ganesh). Back at the TRC we distributed sweets to all the people who had helped us with our project (or people who I just liked), and I began to say my goodb yes with less than forty-eight hours left in the city.

By the time I left the office that night it was seven thirty--at time when, according to the routine I had developed, I should have been leaving the gym to board a bus back to the hostel just in time for dinner. Not wanting to miss one of my last chances at a gym workout--and needing the stress release anyway--I decided that if I changed quickly and took an auto instaed of the ubs I would have just enough time to workout and come back before my 9:50 curew. A fortuitous decision for several reasons.

Earlier in the afternoon, when Muniyandi and I had emerged from our self-imposed isolation of translating and correcting to distribute sweets, we had been informed that a bandh (a state-wide strike) had been called by the Tamil Nadu government to protest the state supreme court's recent decision allotting 27%!o(MISSING)f higher education reservations to Other Backwards Castes (OBCs). It is unclear what the supporting government wanted instead (reservations for Scheduled Castes? No reservations at all?) and I got a different story from everyone; most people seemed more concerned with the practical than political effects of the bandh.

As I learned in Banaras, bandhs are to be taken with varying degrees of seriousness. Particularly sensitive issues can call for bandhs that lead to riots, burning buses and mob violence. Impotent bandhs, like most of the ones I saw in Banaras, might attract little attention from anyone. On those occassions the city would go through the motions of shutting down in the morning only to have shops open and transportation running fully again in the afternoon. This bandh, people were speculating, might actually be a serious one since it was sponsored by the state government and the also supported by the local government. Still it was unclear just how much the city would observe the strike. Would the buses be running? Would I be able to get an auto? Could I go to the post office? Nobody seemed to know the answers to my questions.

When I arrived at the gym I found out that they would be closed all day Saturday in observation of the bandh. I was thankful, then, that I had made it there one last time. Not only was I happy to have a final workout, but I had come to really enjoy my visits to the gym--the excessively nice reception boys, the bizarre mixes of 50 cent and Madonna, and most of all my brief but sustaining interactions with the changing room attendants. There were three women who cleaned the dressing room at the gym and (despite a hefty language barrier with one and a respectable--though more manageable--barrier with the other) I had managed to become pretty good friends with two of them. I talked to them more than anyone else at the gym and I am confident that if given a mutually intelligible language we could have been really good friends. As it was, however, we were limited to short (but sometimes meaningful) conversations and lots of laughing at one person's inability to understand what the other was saying.

Sharmila was a skinny little thing with a beautiful smile and a girlish giggle; she looked nothing like a 26 year old who had married at the age of 21, had a child shortly thereafter and then subsequently been left by her husband, who returned to their hometown of Pondicherry to become an alcoloholic and live with his mother. The other one (whose name I never learned) was tall, 28, and unmarried. She was, in contrast to Sharmila's sweet innocence, a bit fiesty and unconventional. She thought husbands were useless and claimed to have rebuffed countless would-bes who had come to ask her parents for her hand in marriage. "I want my independent," she was fond of saying (she was the one with the better English) and she laughed at Sharmila when Sharmila insisted that a good husband was something to be hoped for.

For over a week the three of us had been planning our final goodbye on Saturday (the tall one had b een counting down the days and liked to announce the count to me every time I saw her), so I was lucky that they were both working the night shift on Friday. By that time I had been dragging grumpiness around with me for days, but as soon as I saw the two of them I couldn't help but be happy. How does it happen that people you can hardly communicate with can have such an effect on you? It has something to do with smiles, which Sharmila and I were both able to agree on. "Madam, your smiling...I feel...make me so happy your smiling." And I wanted to say the same thing to her, but didnt know how to say it so that it came out as genuinely as I meant it to. So we said our goodbyes--their shifts would finish before I did--and I was sorely feeling my lack of a camera. Photos give me, among other things, a sense of closure; a way of feeling that I can leave something because at least I have this to remeber it.

When I finished my cardio workout and was walking to the stretching area I glanced out the double doors that lead to the changing room and saw Sharmila standing on the stairs. She waved quickly at me and beckoned me to come. She's a good Indian worker, you see, and is ever mindful of the ways that she can interact with people of allegedly higher status than her (whenever we were chatting in the dressing room, for example, she would immediatley stop talking to me if another client walked in; she wouldn't want them to think that she was crossing the limits of acceptability). So it seems that she had been standing there some time, just waiting for me to walk by because she was too hesitant to come and speak to me in the presence of the other clients. She ran down the stairs and I follwed her into the dressing room where she and the tall one were both standing with roses in their hands. They presented the roses--one pink, one red and both wrapped in a strange Indian way that involved small neon-colored styrofoam balls--meanwhile explaining that they had planned to give me a bigger gift on Saturday but, given the bandh, this was all they could come up with. Awkward but wonderful hugs followed (awkward only because I don't think they were much in the practice of hugging) and it was the closest I came to a tearful goodbye in Chennai.

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