Pralad

He cooked and cleaned at our Old Aged Home. He brought us chai when we had visitors and snacks when meetings went on late. He brought replacement gas bottles round to my house on his cycle. He wielded a extra long handled brush for cleaning the wings of ceiling fans. He was due to get married in December. A quite small man, physically lithe and full of energy and action, he was always on the go with big wide eyes and a constant smile.  He was 28.
My VSO colleague Gina was here on Tuesday and Wednesday this week to help us build our new web site. During our training session on Tuesday, something was not as normal, there was no chai that afternoon. I noticed it but then forgot about it until I came into the office early on the next day. Pralad had it seems gone down with fever on the Sunday, taken malarial medicine but had succumbed to coma and died at 4AM Wednesday morning.
Pralad had  worked at Shakti for over 7 years. Sadly I don’t have a picture – he was always there, behind the scenes, never in the photo! Pralad’s family come from a village only some 40miles from Rayagada. The vehicle wanted 4000 Rupees to transport his body back for burial. An exorbitant amount of money in local terms Shakti paid for this. There was a post mortem on Wednesday  morning and funeral arrangements had to be made. As per local tradition this happens very quickly. It was all over by Wednesday evening.
Malaria is endemic here in this part of Orissa. In the two years I have been here there have been regular instances of people getting malaria. Our field staffs are particularly prone, but office based staff have also succumbed. Everyone else has come through it. Pralad was unlucky he didn’t just get malaria caused by Plasmodium vivax, Plasmodium ovale, and Plasmodium malariae , he caught the cerebral malaria form caused by Plasmodium falciparum  which is a horrid, swift, effective killer – fever, enlargement of spleen and liver, coughing up of blood, renal failure, brain damage, unrousable coma. Fatality rates are over 20%.
As a volunteer we all get mosquito nets and antimalarials.  Pralad had a net. If you live here you cannot take these malarial medicines all your life, they are strong drugs. But as a temporary resident why not – the old adage of prevention being    better than cure certainly applies . I know some volunteers do not take their antimalarials. Readers will remember my dilemma last year when I was suffering from the side effects of my original antimalarials. In the end I stopped in May 2010 hoping the Hot season was too hot for mosquitoes, and started back on a different regime, Larium, upon my return in August after my trip home. Monsoon and post monsoon seem to be the worse periods. So far I am safe and well.
Not so Pralad, even with malarial net, he was bitten by an infected mosquito sometime  over the past couple of weeks. He went from being a healthy young man to dead one within 3 days!  A salient lesson for us all.

From Health Care

Some Orissa Malaria facts (Source)

Orissa reports

23% of all malaria cases in India

40% of Plasmodium falciparum  cases in India

50 % of deaths from Plasmodium falciparum  cases in India

Photo “Awareness raising re malaria and the proper use of mosquito nets”

courtesy of Shakti Organisation

For how long should a bar of soap last?

This isn't an idle question!

Exclude detergent usage in the kitchen, the washing of  clothes, shampoo to wash your hair, and just concentrate on how much soap a person uses to wash themselves. Take me for example, at home I tend to buy in bulk, buying large bottles of body wash, value packs of several cakes of soap at a time. I usually have several different types of body wash on the go simultaneously.  Then there is the soap, hard or liquid,  located in the bathroom and in the kitchen for hand washing.   At home I shower once a day. If I am going out, have been to the gym or have been working in the garden or the like, then there would be a second, and rarely a third . Additionally, I would wash my hands after a toilet visit and probably several times more in the course of an average day. But all that said, I have never actually calculated how long one bar of soap lasts.

Here in India, it is different. The biggest I buy is one bar of soap, and that is a small size compared to the standard size in the UK. I don't have a spare one in the house  but  I checked on the side of the Lux body wash container - it is 125ml. Now I tend to keep the body wash for traveling, and as emergency supplies, so my normal daily washing tipple is my bar of soap.  I reckon, barring the odd one which has slipped out of my hands to go flying off down the squat toilet, that I get through one bar at least every two weeks, give or take. It was definitely more in the hot season when I was showering 4 times every day at least!

Anyways, after the last flying bar episode I had been thinking I was using a lot of soap. But was I really using a lot or just thinking I was? Was the soap remaining wet in the humid atmosphere making it not last as long? Was I using more soap to work up a lather here than at home?   That train of thought parked up until this week when I am doing some work to help with fund raising for an emergency response to the rising numbers of deaths from diarrhea and cholera that are being reported in the rural KBK region of southern Orissa. Fellow volunteer Nikki suggested approaching Hindustan Unilever re soap supplies. So we added this to our short but growing list of corporates to approach for emergency supplies as we try to get oral rehydration kits, water purification tablets etc into these very remote areas. 

When compiling a list of things we need to know when approaching these corporations for assistance, one thing is to have worked out just how many bars of soap we need.  I've read that a person infected with cholera produces about 15 litres of diarrheic fluid per day! Everything has to be washed. Every time a non infected person touches anything belonging to the infected person they should be washed. So there is quite a lot of washing. Hence the question how long does a bar of soap last?

Take the Kasipur block we are working  We know the number of villages. We know the number of households and people, adults and children, in each village. So if I using a bar every 2 weeks (14 days), then 4 people would use a bar in 14/4 = 3.5 days. Lets say 4. So lets say in an affected area, if a family of 4 uses 1 bar of soap every 2 days, that's 16 for the month. So for every 1000 people, we need 1000/4 * 16 = 4000 bars of soap! Retail, a bar costs 16 Rupees. That's 64,000 Rupees! Now I can see my financial acclimatization well nigh complete because that sounds a lot of money, and it is here in India. But a change of perspective later, with a cross check on the current exchange rate ( about 71 Rupees to the GBP, 45 Rupees to the US$) I remind myself that it is only just under 900GBP or $1400.

Malarial quandary

One of the hazards of  living in this region is malaria. Two of my work colleagues have had time off with malaria since I have been here. Orissa is a top malaria state in India and Rayagada is a particularly bad area for cerebral malaria. I sleep every night under a mosquito net and try and cover up as best I can at dusk when the little blighters abound.  The worse place is actually in the office where I often get bitten on my feet, a  hazard of not wearing shoes. No one wears them here, only sandals and it is etiquette to remove footwear before one enters a building - a house, shop, office whatever it is, shoes off. The office bought one of those liquid plug in anti mosquito things that work in the electric socket but it doesn't seem to do any good. The past month or so there have been less about - more ants, more beetles, less mosquitos - go figure. I suspect it will get much worse again come the monsoon and through the winter months the mosquito numbers will rise once more.

The prescribed regime of anti malarials I was recommended was Paludrine and Alvoclor. No way was I taking antibacterials like doxycycline for two years, Larium was out, and Malarone,  my normal anti malarial of choice, is not funded by VSO as it costs over £3 per tablet per day and I couldn't afford to pay for that out of my allowance (at  a current exchange rate of around 65 rupees a Malarone tab costs about 200 rupees, that 6000 rupees a month. I get 10000 per month to live on. The maths are simple) Unfortunately it is the one antimalarial I have been able to take without side effects, but in the UK it is not advised for long term use. The most I have taken it for before has been 6 weeks. So it was back to the double whammy regime of P&A: they work at different parts of the parasites life cycle. Lucky for me, as when I tried to take then in Central America I had very irritated gastrointestinal tract and had to give up on the Paludrine. This time I have been religiously taking them with lots of food. That has stopped the gastric upsets but only when they've been taken at the same time as eating, if I forget and take them even 30 minutes later, I get nauseous and end up puking up the most acidic tasting spittle ever. But I have been persevering.

However last month I had the second bout since I've been here of mouth ulcers, another side effect of Paludrine. The first time I got these I stopped for a few days and they cleared up, but the second time they came back with a vengeance. Eating was difficult, salty foods stung in my mouth, my lips looked like I had overdosed on collagen!  This was compounded by me succumbing to yet another side effect  - hair loss!  Unfortunately it is also a side effect of Alvoclor! Now I'm not particularly vain but I can't stand it, every time I comb my hair, or wash it strands are loosened, my plait is noticeably thinner. This has brought it to a point in time when I have just had to say enough is enough and I've taken a break the drugs. These side effects are reversible I am told, and it is a risk to stop taking them, but I have definitely reached that point. I don't want to look like a female version of the man who wears his last quiff of hair across the top of his bald head

I was never happy about taking Alvoclor for two years - its long term use has more serious side effects - retinal damage with continuous high dosage use for more than 12 months, weekly use for more than 3 years, or a total consumption of 100g.  Ok I shall not be getting up to those extended periods or to those high dosage levels - I am only taking 500mg per week, but how much difference is there between 2 and 3 years? Without personalized medicine how can one tell where on the spectrum of reaction to a drug anyone is? 

Those of you who know me well will know I don't like taking any medicines and very seldom do: the only exceptions to this have been preventatives and inoculations. Many of the long term volunteers here don't take any antimalarials but I have known people who have had malaria, and recurrent malaria so I had expected to take them, so succumbing to these side effects left me in a bit of a quandary. It is a big decision for me not to continue.  I only hope that since I have been healthy so far in India, my strong immune system will see me through and I can get some further supplies of mosquito repellent before the next wave of the buzzing insects descend!

Delhi belly or just a case of a rottten egg?

Well it had to come, didn't it?

So first, a little about our eating arrangements during this month in Delhi. Through the week we have breakfast and lunch at the cafeteria in the Institute's hostel where we are staying and are left to our own devices in the evenings and for lunch and dinner at the weekends. The food is totally vegerarian and is always accompanied by a massive amount of rice and bread. Pancakes, breads - parathas, naans etc abound. Sometimes the veg dish is potato based so the amount of carbs is very high. I'm finding the cooking style quite monotonous and very liquid, there is nothing much to get you teeth into veg wise. The one delightful taste I discovered when we went out as a huge group with the office staff here on Saturday night is a south Indian dish called Rassum - it is served at the start of the meal, in a glass, to drink. Its consistency is like a clear soup. It is made from lentils and coriander and is delicious. I must try and hunt out a recipe. I managed to get some ginger tea that evening as well, served south indian style with metal cup and saucer for pouring from on high - Tuareg style to aireate the tea. The containers were extremely hot, but I proudly showed of my skills and managed to pour from about a couple of feet high straight into the saucer and back again without spilling a single drop!

The restaurants along our local such street are basic and I could see a few worried doubtful faces as we approached them for the first time - but before you jump to conclusions, they are not where my problem has come from! In the UK we'd call them "greasy spoons". I think the best meal we have found so far has to be the night we found beautiful large yellow fin tuna steaks in one of the greasy spoons and got the cook to fry it simply without adding curry spices to it! Otherwise everything has basically the same sauce on it. Being a bit of a foody I am so far quite disappointed with the cuisine - the range of vegetables is limited but this may be because it is winter - mushrooms, onions, spinach, potato, cabbage, peas and chickpeas - this seems to be what is currently available, along with the ubiquitous paneer, which is nice but not every day. Chicken is the only meat around and as expected quite boney, but when we have managed to get it it has been very nice, including a spit roasted / tandooried type one night. So for our dinners we have been successfully finding something locally so far but some folks have ventured further a field to the likes of Khan Market, Dille Haat etc but these are a factor more expensive and required autorickshaw/tuk-tuk rides to get there and back. These are more set up for the tourist market.

What we have found locally is a nice coffee shop for those who need their regular caffiene fix of cappuccino, expresso or the like and for me it does a passable cup of nice darjeeling tea. It seems to be run and frequented almost exclusively by Sikks with the addition of ourselves. Unfortunately it is compabably expensive with a cuppa clocking in at the grand total of 47 or 49 rupees - Exchange rate is around 77 rupees to the pound. Not a lot in Western terms, but having one's daily fix could blow your volunteer allowance for Delhi of 8000 rupees for the month. If you compare that to the 4 rupees for a chai in the Insitute's training building's cafeteria you see the difference. So comfy chairs and coffee/tea become a once a week treat.

Unfortunately, Sunday breakfast's boiled egg was, I think, the culprit and I have had today off, laid up with horrid stomach pain. It could have happened anywhere so I'm doing the usual 'don't eat for 36 hours' to fast the bug out of my system. Grumbling guts kept me awake all last night and the attempt to eat breakfast this morning was way the wrong thing to do. But I have had worse, way worse!

My room mate has returned tonight with fruit and digestive biscuits from Khan Market for me to break the fast with tomorrow, but so far is refusing to tell me how much I owe her! Clearly more than our local market street. But 12 hours after the attempted Monday morning breakfast I feel much better and am sitting up in bed scribbling this down for when I get my next turn on our shared mobile internet dongle. I hope this hasn't been too squeamish for those the sensivite amongst you but I am determined this blog will be an honest reflection of my time here.

Feet

After 8 months of only occassionaly wearing shoes in 2008 on the boat I came home to face the fact that very few of my shoes now fitted me. So they went either to the skip or to the charity shop depending on their state of being. Someone somewhere got some really nice dress and evening shoes for a good price hopefully:) The soles of my feet had harded up quite well, with all that salt water. I still prefer to be in sandals than shoes, and only wear shoes now for special occassions, trainers for the gym etc but suspect I shall be back in socks and boots come the wet and cold UK winter.

Taking about the cold,

Jags

No not the cars! The in the arm type. Warning to the sqeamish - yes, it is time to start those inoculations.

Luckily, I'm fairly uptodate, although I will be due for a rabies booster when I am in India. Having never been to SE Asia except Singapore I've never had an injection against Japanese Encephalytis, another one of the multitude of mosquito borne diseases - have you ever notice just how many diseases are mosquito borne!  So I had the first injection yesterday and need to return for the second in one month's time.

Also, I needed a booster for my Typhoid as had that at the same time. And renewed my favorite, Dukoral, which is the oral vaccine against Cholera. Interestingly in these days we don't think too much about cholera and the vaccine is not usually given except to aid and health workers but there have been Cholera cases in Orissa this year. Originally I was advised to take it several years ago as it gives you two years general protection against infestations of the gastro intestinal tract and having had both food poisoning and dysentry that sounded a good option. I am pleased so far to report that either it has worked or I have been incredibly robust or lucky - I was one of the few or only folk who did not get sickness &/or diahorrea in Mali, Central Asia and Central America and during a norovirus outbreak on the boat. So I am keeping my fingers crossed to survive Delhi belly with only minor inconvenience :)

Jags have never bothered me but drinking that vile concoction that is Dukoral is a real challenge. They make it so that folks will like it - sweet and effervescent, a sort of raspberry Andrew's Liver Salts,  - except I hate fizzy waters with a passion. Drinking the  150ml of this is a real feat - I have never managed to do it in one go, although I try, I only get about 80% of it down and then have to psyche myself up again for the last few drops. I'm the person who was pleased when they stopped giving polio on sugar cubes! Give me an injection any day, even though this morning, after having one injection in each arm yesterday, I can only just raise my right one above my head! My gym session this afternoon will be interesting :) Anyway, nothing that won't pass and quite bearable compared to falling ill with any of these diseases. I hate taking medicines but prevention is the best route.