Micro/Macroscope

While my mother, a product of the Catholic school system, vehemently affirms that Nunophobia is more powerful than any of us ever imagined, I was a little disappointed to discover yesterday that not every tuberculosis treatment center has its own resident Sister. There are many "direct observation treatment" centers for tuberculosis patients scattered throughout the country here: a somewhat self-designated "responsible person in the community" holds on to the boxes of drugs for all his TB-positive neighbors and doles them out accordingly. It's a good system, with much higher rates of compliance than when people are just given their doses for 6 months and sent along.

But before they can be treated, they must be diagnosed. Our small posse, consisting of me, Dr. Reddy, and Senior Lab Technician Miss Claramma, ventured out to two of the nearby microscopic centers, where suspicious patients are encouraged to hack up a big ball of phlegm for closer examination. It turns out that the Andhra Pradesh microscopic centers use EXACTLY the same type of microscope that the University of Chicago uses in its microbiology labs! Small world. I felt very smooth indeed checking out slides with Miss Claramma. Lots of fun little bright red bacteria to be seen, swimming in a pool of blue-stained phlegm. (Ewwwww.)

Dr. Reddy was meanwhile making his way through the line of waiting patients, dealing with them with typical Indian doctor brusqueness. I've noticed that the patient-doctor interaction style is particularly given to lecturing and exasperated sighs on the part of the physician; there's not much sympathy for patients who forget to take their drugs, can't afford new bandages, or don't understand that TB still requires treatment even if they feel better. Empathy is not high on the agenda here. It's not necessarily bad - patients expect it, really - but not exactly what they're teaching us back home in terms of Touchy-Feely Skills 101.

The other interesting part of the morning was the chance to see life at the city-countryside edge, making our way through pockets of suburban poverty. I think that my mental image of "Third World Poverty" is always something I gleaned from National Geographic long ago: women with clay pots on their heads, weaving cloth under thatch roofs. Although I was disabused of this image often enough in Tanzania, I still forget that that's not what you see out there at all.

You see plastic. Dirty plastic everywhere, in every possible use, scattered with the world's most recognizable brand names. It makes complete sense - plastic is more durable than clay or thatch, and significantly cheaper. Why lug earthen pots around when you could just carry an Aquafina water bottle for years? Steal cast off cinderblocks from construction sites, gather some pieces of torn plastic-weave tarp from truck stops, dress your kids in polyester Chinese-made tshirts, and you're good to go. When traveling through the tent cities at the edge of Hyderabad, it's much less a village built from nature than a village built from garbage. Urban poverty is much less quaint than it is in my mind's eye.

Making biriyani with Theresa tomorrow morning. Pre-purchased ingredients include ginger, chilis, some sort of dark green squishy cucumber-looking thing, and a wide assortment of leaves and teeny flowers (!). Wish us luck.