Category Archives: Asia 2012-2013

New Beginnings (the journey ends)

20130416-104147.jpgMy journey in Asia has ended and I have returned to the United States where I am currently visiting my parents in beautiful Sedona, Arizona (of the countless countries and places I have visited, Sedona continues to be one of the most beautiful and special places that I have ever been. I feel so blessed to have grown up here). In total, I traveled out of the country for six months and 10 days although I could have gone on indefinitely had money and time allowed. What an amazing trip! I spent roughly a month in Nepal, three and a half months in Southern India, one month and a half in Cambodia, ten days in Thailand, and five days in Singapore. I have finally caught up on sleep and have recovered from my long and sleepless flight from Singapore, to Tokyo, to Los Angeles, to Phoenix, followed by a two hour drive north, to Sedona.

In Singapore, people were surprised that I traveled so long—especially when they found out that I did so alone. “Wow!” they would say, “did you have any moments of amazing insight?” “Shouldn’t you have those everyday?” was my reply. And I did. And I still do. But I will say it is so much easier to be “gifted” this wisdom and intense appreciation for life while traveling.

So, of course I had many eye opening experiences on my travels. Far too many to count and probably far too many to even remember! But, they were all meaningful and all served to help me stretch and grow as a person.

Now, what are these insights you might ask?

Firstly, my work in India (especially) showed me something that I already knew—that I need to spend my life working for the improvement of health and happiness in others, particularly women. We women are such incredible creatures and while the world has made enormous strides in helping to better our lives, we still have a long way to go and I would like to be part of this push. Thus, spending so much time with women in need made my conviction that I need to be a doctor even stronger because, as a doctor, I can combine all my passions and, in doing so, do so much more to improve the lives of others.

13919_10200340754134414_1825709756_nSecondly, the world is a strange and beautiful place—and my traveling days are far from over. I had so many beautiful experiences and exchanges that I cannot even begin to capture in words. However, I will try: Eating corn after a long motorbike ride on the side of a dusty dirt road in rural Cambodia while attempting to converse with the seventeen year old girl tending the shop. A little boy using me as his pillow on a bus ride while his grandmother gave me apologetic glances. Stumbling on places of such intense natural beauty that my atheistic mind declares—“Alas! God must exist!” The realization that there is just so much more to discover…

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A morning prayer

Thirdly, the sentiment that I literally constantly felt flowing through my veins of—“How lucky am I?” On my entire trip, I had next to no bad luck or unpleasant experiences. Even when it appeared that disaster struck (the loss of a rented motorbike) redemption followed (it miraculously was returned). I am incredibly lucky to have the opportunities and experiences, good and bad, that I have had and I absolutely love my life. I am incredibly grateful to be alive.

The next portal?

The next portal?

Lastly, the journey didn’t end when I stepped foot on American soil. I feel as though my life is a (nearly) blank canvas that I can fill and consciously create whichever way I choose. I am so lucky to have the opportunity to create the life that I want for myself and plan on taking full advantage of this rare freedom. I will continue to live honestly, continue to grow and expand… I have so much life and learning ahead of me—it will be exciting to see where it all takes me.

Note: I have been asked by several people if the end of my trip means the end of my blog. In case you haven’t noticed, I love writing so the answer is probably not. Anyways, I have at least two more posts about my trip that will come out at some point in the future so look out for those. Also, thank you all for your continued support!

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Cambodia, Cambodia!

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How can one put experience to words? This is what I must try to do in writing about my six weeks in Cambodia. I sit writing this piece crouched in the last seat in the back of a Cambodian bus–leaving Sihanoukville for Phnom Penh…departing Cambodia for Thailand in the morning. I am thinking–“Is there a way to capture it all?” Definitely not. But I hope to retain the feelings, sights, and experiences in memory, and perhaps in a few words as well. But what an experience it has been.

I started my journey to Cambodia with a red eye flight from Thiruvananthapuram, Kerala, India to Singapore, to Phnom Penh. Being the sleeper that I am not, I was awake for at least forty hours when I finally arrived in Phnom Penh in the early afternoon–only to discover that while I had arrived, my baggage had not. I perhaps managed to leave my information with the “baggage officials” at the airport and set off for the only guest house I booked during my time in Cambodia. I showered, changed into the running clothes that I thankfully bought in the Singapore airport, and went off to hit the city. I wandered here and there, sweat some–and then some more, and then asked an ex-pat where I could find authentic, affordable Khmer food. He sent me somewhere near the night market–I could identify it because it had the number “18” encrypted into the Khmer script of its name. I wasn’t sure what I had–I ordered and pointed to the picture of something that looked like it didn’t contain pork. I wandered back, sought company, and introduced myself to a group of backpackers staying across the way. We had a beer or two (or three) and I managed to convince a small crowd to come check out the “girly bars” with me as sex-work is something that has always fascinated me.

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Typical

So, with two boys and one other girl…we hit the clubs. We followed a solo, older, western man to a bar with a tame sounding name—“Oasis”–to be greeted by young, beautiful, and unhappy looking Khmer girls wearing next to nothing–tight, cleavage revealing red “dresses.” We chatted with the girls for a bit, finished our pitcher of beer, decided to be a bit brave, and next hit club–“Sixty-Nine”. We danced–the other girl wandered off to bed–and we were given some dirty looks from the mama san as I guess we looked like unlikely customers. We bought a few drinks for the girls to make mama san happy, got everyone dancing, and explored the underworld (perhaps tamer than what I could have found) of Cambodian “girly bars.” While not all of the girls were actual prostitutes, they were all looking for “western boyfriends” which many of them found as you could see by the many aging, mostly overweight, western men walking around Phnom Penh with potentially underage and skantily clad Khmer girls hanging off their flabby and often tattooed arms.

It was an interesting time in Phnom Penh.  I loved it.  I stayed four or five nights waiting for my baggage to arrive before heading to the beautiful and relatively peaceful Kampot (read Blaming the Victim for more on Kampot). I stayed at Bohdi’s Villa in a rooftop bungalow overlooking the river. For a few nights, I had my own palace.

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After a few days of lazing away between motorbike adventures, I headed off with an American girl I had met to Otres Beach where I continued to laze away–letting the warm sea, gentle waves, and soft sea breeze blow what little cares I had left away. Several days later, I chased my bus to Pousat down on a motorbike. I stayed there just two days and had an experience out of a Salvador Dali painting–a visit to the nearly untouched floating villages of Kampong Luong. Then I was off to Battambang, where I climbed up to the killing caves and saw ten million bats fly out of another cave. In Battambang, I looked at my calendar, had a near panic attack, and immediately booked a ticket to Sisophon where I planed to visit Bantey Chmar, a long lost jungle temple well off the beaten tourist path.

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Crickets with the groom

Sisophon was an experience. More so than Pousat, I was the only westerner and felt like I had the small city to myself. While wandering around, I stumbled on another westerner who happened to be taking part in a traditional Cambodian wedding (a joy of being a solo traveler!). I was invited by the groom to stay for dinner and any and all of the next few day’s ceremonies. While I didn’t want to impose (but I actually really did), I joined them for dinner that evening where I avoided pork but tried the Cambodian delicacies of whole baby frogs and crickets.

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My time in and around Sisophan was magic. I found my favorite Bahn Chev (savory pancake) place at the market where I had a blast each visit trying to communicate that I wanted a vegetarian pancake by the chef’s wife and I making animal noises and faces at each other while laughing. I had many delicious (and vegetarian!) pancakes at this stall for just twenty-five cents. I was completely satisfied and didn’t even get sick from the accompanying basil leaves and lettuce (my stomach is getting strong!).

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Giant helmet

In Sisophan, I created one of my favorite memories that I have had in Cambodia (but my oh my there are just so many!). I rented what I now call the shittiest motorbike in the world and drove it over 120 k down one of the world’s worst dirt roads. On this road were Lexus (plural) speeding past, semi-trucks that would fly by creating giant dust clouds and complete white out conditions, and the occasional Cambodian family tightly packed onto a motor bike. With no suspension and little motor biking experience, I did my best to dodge potholes and sandpits. In areas where there was “road-work,” I learned how to handle hydroplaning and driving through mud. (Don’t worry–my helmet was huge!). It was a long rough ride and I realized how important it is to live in the moment while motor biking (and otherwise as well!). The minute that I slipped off into a sweet daydream, I hit a combination sandpit-pothole and went down hard and fast. Lucky for me, I fell to the left and I didn’t suffer and burns from the exhaust pipe. Alone and in the middle of nowhere Cambodia, I struggled to lift the bike off me and managed to get to the side of the road with the bike. I observed the damage, which was really not much more than ripped and blood stained pants (my spoon was in my pocket–which ripped through the pocked and into the surface of my thigh) and some probable (and rather terrible) bruising. I was lucky. While I could have hailed a car to get me back to Sisophan, I decided to get back on the bike, this time really aware of living in the present, and headed towards that temple. But, my bike wouldn’t start so I hailed down the next Cambodian that passed–who gladly fiddled with my bike and got it started again. And I was off. (Despite the little mishaps I have had motor biking, I am seriously considering trading my station wagon in for a 500 hp Royal Enfield…)

The temple was incredible and I had the 9 km grounds more or less to myself.  As I signed the tourist register, I noticed that about five other tourists had visited in the last week. I spent a few hours wandering in awe before I started the long and rough journey back to Sisophan. I enjoyed another dinner and dance in excellent company at the Cambodian wedding (and was even dragged up to dance on stage with the band!) and went off to Siem Reap early the next morning.

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Angkor Wat was, is, and forever will be amazing. You can read better writers writing about it so I won’t say much here other than I loved it. Seriously. I think everyone needs to go. I also enjoyed great people watching in Siem Reap’s night life. I met great people in Siem Reap and really enjoyed my time visiting the temples.

From Siem Reap, I went straight back to Otres Beach. I spent just three weeks there but feel as though I created a small life for myself. I went on early morning beach runs and in the afternoon helped a friend facilitate donation-based yoga and meditation classes on the beach. Yoga and mediation have been an important part of my life since the age of sixteen and, while I am still very much a student myself, I love sharing the little bit of knowledge and my love for these practices with others, especially if they have never done anything like it before.

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Every Saturday, Otres Beach has a little “hippy market” with live music, cold drinks, and food stalls. Here, I tapped into my long-lost creative side and got into making chocolates (first “bark”, then truffles) and sold these at the market with a friend who made delicious chocolate balls and (later) epic veggie burgers. We also offered tea and “almost raw” salads. While I love Otres Beach and the community of people it attracts, a lot of life there revolves around drinking and drugs. While I am not a judgmental person, my friend and I thought it would be nice to offer something a little more healthy to balance the lifestyle of the average Cambodian beach goer (hence the yoga and dark chocolates that both get you high–naturally!). The next week we expanded the offering into veggie burgers which flew off the six-dollar gas-powered range. I had the pleasure of taking part in three of these markets–it was nice to do something so lovely that I will probably never do again. I am a chocolate lover to the highest degree and really loved watching peoples faces explode in pleasure as they tried the chocolate truffles and “sophisticated snickers” I made using just a metal bowl and a three-dollar hot pot as my instruments. With both the yoga and market, I made some money and really enjoyed doing so. I rediscovered my love for creation–this time in cooking–and am looking forward to continuing these delicious creations with more tools in the US.

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In Otres, I stayed in a lovely but very basic room above a Cambodian owned and run bar and restaurant called Sunshine Cafe. The family who runs the place wakes up early every morning to start serving customers and works late into the night, every night, for months and months on end. So, at the suggestion of a few westerners who work at the bar for food and accommodation, we closed the Cambodian kitchen for one night and took over the restaurant and bar. I was in charge of veggie burgers and dessert, and the other two “chefs” (one actually was a chef from Ireland) were in charge of everything else. Things got off to a rather rough start–the supermarket in town was out of lentils so instead they bought beans which wouldn’t cook in the few hours I had to prepare the veggie burgers. The others were also dealing with shortages of this and that and we had to borrow pots and pans from various other beach restaurants. However, we got over the bumps and actually put on a great meal for at least fifty-five people (despite it all–the veggie burgers turned out great!). For dessert, I made my first ever rice-pudding. It was flavored with palm sugar and mango and topped by a choice of warm mango or banana sauce. I loved watching the faces of those that tried it and hearing the satisfying “mmms” and “”yummms” coming from the mouths of happy customers. While the five of us worked hard (two bar/server girls), we made over $400 that night. When we gave the earnings over to the family, their faces lit up in gratitude. They had a night off from working (although they seemed very skeptical and perhaps a little afraid of what we were doing) and I think made at least one hundred dollars more than they make on an average night (which goes along way in Cambodia—especially if you are Cambodian…).

Well, once again I have fallen in love with another country. Cambodia truly took care of me and blessed me with many beautiful and enriching experiences. I immediately felt at home here and, since my arrival, have had many people (including ex-pats and Cambodians), mistake me for an ex-pat! I have been touched by Cambodia deeply and hope that one day I will have the opportunity to return to this country and explore more of its beautiful countryside and lovely people. Cambodia, Cambodia…. What will I do without you?

(I will find out tomorrow!)

The Solo Traveler

On my travels, I have met and connected with many many wonderful people–both locals and other travelers. While forming connections with locals is somewhat difficult, it is especially easy to connect with and relate to other travelers as it takes a certain breed of person to travel, particularly when someone travels solo.

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A strange and “fragrant” Cambodian Market

In general, travelers are curious and open-minded individuals who enjoy the stretching and twisting of the mind and self that occurs when one is exposed to new and strange cultures and environments. They are often seekers of knowledge and experience and use travel as a means to expand, explore, and satisfy curiosity. It takes a certain type of person to travel, especially when one gets off the beaten path of the average packaged-holiday-tourist. Thus, when fellow travelers meet, they often have an instant, if somewhat limited, understanding of each other. After all, something drew each traveler thousands of miles away from their comfort zone to the same remote place.

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A solo motorbike ride to a remote jungle temple

While it takes a certain type of person to travel, the solo traveler is a whole different breed of person. They are fearless, and especially not afraid to be alone–quite the contrary, they relish it. They may love the company of others but traveling is almost a selfish act–and for the solo traveler–it must be. Others sometimes don’t understand us and, on many occasions, they feel sorry for our aloneness. I have been asked hundreds of times why I travel alone–as though my aloneness is perceived as a bad thing. I try to communicate my insight, telling them that traveling alone allows me to be selfish in a good way–I never have to compromise and can easily get whatever I want out of my travels. This explanation misses some of the reasons we travel alone but offers a glimpse of our mentality. However, other solo travelers understand and require no explanation. Thus, we have an instantaneous, mutual, and somewhat deep understanding and respect of each other. When I meet other lone travelers, I often feel like I’ve found kindred spirits.

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The wild and beautiful Ta Prohm Temple–Angkor Wat, Cambodia

In contemplating my “aloneness”, it occurred to me that I have never really thought about traveling with others simply because it has never occurred to me. (Despite having a blog, I am a somewhat private person. I love people, but also love retreating to my stillness.) My first trip abroad was to Spain when I was seventeen to study Spanish for six weeks. My sister participated in a similar program in the same city but I barely saw her. I have also always been somewhat of a loner and so while I did connect with a few of the other foreigners in my program, I preferred to spend my time alone, wandering through the streets practicing my Spanish. I loved the freedom afforded to me by my aloneness. If I wanted to, I could sit all day in front of a Dali painting and no one could complain. And I could also simply sit in uninterrupted silence and contemplate my life and self in new and changing surroundings. I quickly found that I could connect with and experience people and places in a way that would be inaccessible to me if I traveled with a group.

Addiction hit (rather hard) and seven years, later my passport is now full of stamps and visas of places that I have visited mostly alone. I’ve met many, many beautiful and wonderful people and my only regret is that they cannot all live in Portland.

Blaming the Victim

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The river in Kampot

A terrible thing happened last week near Kampot, Cambodia: the body of young French woman was found in the river. Her body showed signs of sexual assault. Terrified (for I too am a single girl traveling and was in Kampot just a few days ago) and curious about the atrocity, I spoke with others to find out more.

I was shocked and a little disgusted at the replies and opinions of my fellow travelers for they all blamed the victim. I don’t know if they did this out of an unconscious fear for their own safety and a thought that, “well, I’m smarter so this couldn’t happen to me” or if they actually believed their preposterous assertions.

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Sunset on the streets of Kampot

When asking about the details of the crime, I heard several different stories. One person told me that the victim was riding her bicycle, maybe in the evening or at night, when she was attacked. This man commented on how stupid the girl was to be out alone at night and how the rape and murder was “kinda her own fault.” Would I be out on the streets alone at night if I could help it? No, and I am sure that this victim wouldn’t have either (e.i. could this girl have had a flat tire that prolonged her return home into darkness?) because as solo female travelers, we have to watch out for ourselves and realize that the world, however wonderful, has its faults.

Another woman told me that the victim was cycling out to a remote beach to sunbathe nude. Someone might have seen her, alone and exposing her body to the world, and took “the invitation” to rape and kill her. “She was kind of asking for it because it’s really stupid to be naked in rural Cambodia.”

Was she really?

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Canals in rural Kampot

What happened to this poor girl is terrible, under every circumstance. No one is asking to be raped and murdered and dumped into the river. Clearly this girl’s unfortunate end was not of her own doing. It shocks me to hear “open minded” individuals, including women, suggesting that crimes like these are the victim’s fault. Yes, perhaps her sexual assault and murder could have been prevented had the circumstances been different. We will never know. The fact is that men still view women as objects for the taking–completely disregarding their beautiful existence for a few seconds of selfish pleasure.

Shouldn’t men learn self-restraint? Shouldn’t they learn to be human?

Why do we continue to blame the victim?

Note: I have received a few comments that rape isn’t just a few seconds of pleasure. I realize that in most cases it is not and personally believe that rape stems from insecurity. Please read my post titled “Rape: Women and Society in India” for more thoughts on rape.

A Keralan Holiday

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Tourists on the beautiful Varkala beach

After three months of service oriented work with women in India, I have treated myself to a vacation in one of India’s supposedly most beautiful states, Kerala (and I might have to agree on its beauty). It’s been brilliant and relaxing but strange to feel like a tourist. It feels as though I have gone from the minority to the majority–tourists–and have left the “real India” behind.

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Is this more “real” than the tourists on the Goan beaches?

A certain breed of tourists, myself included, is always searching for the essence of the country toured–“the real such and such”–not processed and packaged for the undiscerning tourist. Unfortunately for me and people like me, Kerala, while still absolutely gorgeous, has been processed and packaged for tourists seeking beautiful beaches and cheap thrills. It also caters to the spiritual tourist with yoga classes, visits to ashrams, and Ayurveda.

But its beautiful. And although not the “real” India, I love it.

And what is the “real” India anyway? My experience here hasn’t been “fake,” the opposite of real or inauthentic (although I have found that with most beach towns around the world, they could be anywhere–Spain, Portugal, Cuba, Florida, India….). It has just been different from my visits to village India and non-tourist centers.

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The Allepey backwaters-touched by tourists yet unchanged?

India is changing. As it grows economically, it has been attracting more and more attention from both media and tourists. And I also think that more and more tourists of all ages are seeking more adventure, so tourism is expanding quite quickly. Whatever India is or becomes is and will be the real India. It will change and grow into something that will still be India as India is and can be so much. But enough “philosophy” and back to my holiday and experience of India.

Not to be a hypocrite (from my Driving in India article), but I have enjoyed my rides on local buses in India immensely. My first ride on a local bus was a five-hour trip from Cochin to a village in the Keralan hills. I’m not much of a sleeper to begin with and was out the night before socializing. So, when I arrived at the bus station at 6:30 am to embark on a bus journey to a village that I couldn’t pronounce (and still can’t), I was tired. But I was also happy to be the only white person again. I somehow found the bus towards Kumily and managed to lift my 20k bag onto the bus to the seat next to me.

And then we were off. And I loved it. Tired as I was, it was so much fun. As I boarded the bus when it was empty, it slowly began to fill and soon the seats next to me where my bag was became the only space left on the bus to either sit or stand. Half passed out from exhaustion, a woman tapped my shoulder and gestured for me to move my bag so that she could sit. To where? I had to quickly figure as the bus started rolling. I had both my fully stuffed day pack and a protective sack filled with my 20 k backpack, my trekking boots and of miscellaneous items that I was too lazy to find space in over-packed bag. So both bags went upright on my lap for a few hours as my two-person seat became a three-person-and-then-some seat.

The woman next to me spoke no English but we were able to communicate about our lives–she had been married two years and had no children. She got off before I did so again I had the seat to my self where I collapsed on my filthy bag, too tired to care that my face was probably touching particles of human shit (my oh my has India been an opportunity for growth, especially when it comes to perceptions and obsessions around cleanliness!).

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I got off in Kuttinanam village and spent five wonderful days in the hills doing yoga and mediation and walking through tea fields to receive Ayurvedic treatment and massage (my brief stint as a spiritual tourist). I ended up having a bad allergic reaction to one of the herbs used in my treatments and, consequently, all over my body broke out in hives. So I was miserable for a few days but still managed to enjoy myself and the beauty of Kerala.

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I then decided to take a taxi to Allepey instead of braving the bus with hives and no sleep. I survived and even in my hot, itchy, and exhausted misery, the backwaters were gorgeous. I took a local ferry and had a lovely time drifting throughout the backwaters as locals hopped off and on as they required. Then, I took a bus to Varkala et voila!

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I’m here and leaving India tomorrow. Varkala is a beach town that could be anywhere but its beautiful and I’ve met many interesting and wonderful people (other travelers mostly). I’ve enjoyed the sun and the waves, the seafood, long conversations about everything and nothing, and riding around on a Royal Enfield through Indian villages. I’ve had so much fun.

India, India. I’m not ready to leave. It’s been wonderful and raw and I can’t wait to come back. Overall, it’s been a trip full of intense romance with this incredible country and with myself.

India, I love you. And I will miss you more than most.

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Sunset in Varkala

Thoughts on the Future of Healthcare in Countries with First-World Problems

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Problems of the developed world

The developed world and countries with first world health problems face  difficult challenges in the future of healthcare. I believe that both the task of doctor and patient must change in order to face these current and growing challenges. Some of the major problems we face are those having to do with metabolic syndrome, including obesity, hypertension, high cholesterol, and diabetes. Other major problems I see involve issues with our mental state, including stress and fatigue (this can be both physical and mental). In most cases, these problems can be prevented and avoided completely with a healthy lifestyle. Millions of people around the world are facing these problems in record numbers and it is literally killing them–isn’t there something that we should do to change this?

From my observations of healthcare workers and their patients, I have seen many people come to the doctor complaining that they are obese or overweight, can’t get pregnant, are depressed, and feel too tired to do anything but eat and watch TV (and many are young or raising families with similar habits and problems!). I will offer my readers a common scenario of a consultation in India to demonstrate the situation (we can assume other countries with first-world problems have similar scenarios).

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Observing a consultation at a women’s health camp

The doctor looks at the patient’s chart, complete with various test results. She sees that the patient has high blood pressure, high cholesterol, a BMI of 33 (the same as the patients age), and is borderline diabetic. The patient also complains of fatigue and depression. The doctor then asks the patient, “What do you eat? And what do you do for exercise?”

The patient replies with pride, “I have Kelloggs cereal for breakfast–the advertisements on TV say that it’s a balanced breakfast and a great way to start my day and might even help me lose weight (with 45 g of refined sugar and less than 1 g protein)! Then I have fried such and such for lunch and then go with my family to the buffet (oil, fried food, starches, fatty meats, sweets) or order pizza for dinner. I sometimes skip breakfast or other meals as I am trying to lose weight but I know that I am eating a healthy diet.”

Right.

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A 1998 Kelloggs ad (above) and the actual “Fat Controller” (below)

The doctor then has a difficult task of trying to re-teach someone to eat as many people, including many doctors, don’t actually know what healthy eating is. And, the doctor must do this in a way that both does not offend the patient and encourages the patient to actually take action. Unfortunately, this task is made more difficult because the patients receive their education on “healthy” eating from advertisements that try to sell them processed chemicals instead of food, with images of smiling, happy, and healthy families. And Kelloggs even tells them that eating their processed starchy and sugary cereals will help them lose weight. But the doctor says–“Eat fruits and vegetables–five portions a day!” “Cut down on processes carbohydrates and starch.” “Stop eating so much meat.” “One liter of oil per person per month.” “No sugar!” “Get your friends and go walking for half an hour a day.” “Get some exercise, you will feel much better!” “By this time next year, with healthy eating and exercise, your weight will be normal and we can see what sort of problems you DON’T have.”

The patients almost uniformly reply:

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“Doctor, I have no time for exercise or healthy eating (with a maid doing all the house work and the patient getting in no less than five hours of quality TV a day). I’m overweight, tired, and depressed. Isn’t there some sort of pill you can give me to help with all this? Or maybe some kind of surgery?”

I was shocked to hear that patients would rather suffer the risks and recovery of surgery, let alone the side effects of drugs, than make simple, healthy changes to their lifestyle. Then I realized that the majority of patients view their own health as completely out of their control or responsibility.

At this point, I remembered that I was once in a similar situation with depression (another complex problem that I believe can be solved with a great amount of effort and lifestyle changes). In my teenage years, I was deeply depressed and perhaps jealous of all the drugs that my friends and classmates were taking. The depression was so bad that I didn’t sleep for days and couldn’t attend school for a semester because I physically and emotionally couldn’t. I was fifteen and begged my parents for drugs. But, they didn’t believe in psychiatric medications and no matter how hard I cried and begged for a pill to make all my problems disappear, my parents didn’t budge. They did, however, settle on a two-week prescription of Ambien to restart my sleep cycle (which worked and was actually a key part of my road to recovery). But, without the intervention of allopathic medicine, somehow (with a lot of contemplation and exercise), I came out of the depression and spent the next several years of my life learning how to never let it happen to me again.

From this personal experience, I learned many things including these three points. One, it is always easier not to take responsibility for our problems and much easier to take a magic pill that “makes everything go away” rather than put in the effort to actually make our lives better. Two, drug or medical intervention is sometimes necessary (or even a key part of the solution). Three, good health (both physical and mental) takes effort and there is no magic pill (allopathic or otherwise) that can make everything better.

This experience also caused me to empathize with the patients that I saw and with people around the world facing similar problems. I understand that change is hard and it is difficult for us to accept that we haven’t always been making the best decisions for ourselves. But, instead of taking responsibility for our own lives, we make excuses and try to place the burden of our problems onto someone else (in this case, the doctor).

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Some people actually view this as the solution to obesity and diabetes!

Doctors exist for a reason. They are meant to listen to our problems, identify the underlying causes, help us find solutions, and guide us on our journey to better health. However, in the majority of problems that we are seeing today, doctors and the drugs that they prescribe are (often) not the solution. Thus, our idea of healthcare must change to include and emphasize the responsibility the patient has for their own health–and not just in the sense of drug compliance (will the patient take this drug 3x per day after food as prescribed?). Patients must learn to take some responsibility for their health in terms of healthy eating, exercise, and preventative medicine. However, in order to do so, patients (meaning the general public) must to be educated in such matters by someone other than advertisers. This is where public health must make an effort. Parents should be educated on healthy eating and raising a healthy family, and schools and hospitals should be required to serve actual food (and the government should stop subsidies to shit and instead support small farmers who deliver fresh and nutritious fruits and vegetables). People should also be encouraged to look at their lives and look for areas where they can simplify and reduce stress, which I believe is a root cause of many of our health problems (including depression, insomnia, hormonal changes, stress eating leading to obesity, high blood pressure…) And, our doctors also need to set good examples for the population by living healthfully and avoiding (at least visibly) living out of the vending machine.

People need to learn that both health and happiness take effort, at least at first. Patients must realize that to some degree, their health is in their own hands–and the doctor must be used as a tool rather than as the solution. This proposed change in the way healthcare operates takes effort on both doctors and patients. Doctors must learn to think beyond drugs and learn how to reach patients in a way that encourages them to lead healthy lives (and public health must help support the doctors!), and patients need to start looking inward for better health. Medicine isn’t just about tablets and surgeries, and its time we realized it.

Note: I understand that many people have problems that do require drug intervention, including people with problems related to metabolic syndrome and depression. I am just hoping that the future of healthcare places more emphasis on health and education as I believe that in the majority of cases these problems can be prevented or, in some cases, solved with a healthy lifestyle. Change is hard and patients need empathy and help (from a knowledgeable source) along the road to better health.

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Driving in India

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Everyone who travels or has friends who travel has most assuredly either lived or heard about the experience of vehicular transport in other countries. Whether it be the confusion of driving on the other side of the road in the “civilized” United Kingdom, the frightening but exhilarating taxi ride through winding cobble stone streets made for horse carts (and certainly not two way automobile traffic) somewhere in Europe, or the near death “spiritual” experience of navigating through traffic in India, these stories and experiences nearly always create fond memories (provided there were no deaths involved). As I have spent the last four months or so in Asia, I have had many such experiences and will attempt to share my tales of horror and joy and driving in India.

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I have had the fortunate pleasure of avoiding buses thus far in India (soon to change in the next few days). When I arrived in Hyderabad November 1st, a driver met me at the airport and drove me the seven or so hours south to the BIRDS farm in Muthyalpadu village. My– was I in for a shock! Yes, I had been Nepal for a month or so, had seen chaotic traffic without any sort of direction, and had been warned (and seen the actual bruises) about driving in India. And I drove along a road (National Highway 44?) at a time with relatively little traffic—looking back–hardly any at all. But, there was a cyclone and–my god–was it raining! (Before this story goes any further let me announce that I am a backseat driver to the highest degree). And we were going so fast zooming and swerving around traffic, trucks, and police barricades–honking all the way—in a car with “Jesus Loves You” plastered all over the exterior and a wobbly bobbing Mary glued to the dashboard. When I could manage to read the painted script on the colorfully adorned Indian lorries, to my terror I read “Honk Please.” And honk we did.

All of this was happening without the use of headlights. In the rain. And then it got dark. And we still didn’t use our headlights. Finally, when the driver started to use his lights sporadically, he used his brights and didn’t switch them off for on-coming traffic! This portion of the drive took all of my will power and then some to bite my tongue. But I did, and I survived.

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We then moved to a highway in dire need of repair and, as we swerved around potholes and oxcarts or to quickly make the “diversion”, every few seconds I would find myself lurching from my seat and blinded by the oncoming traffic’s high-powered head beams kindly turned to bright. Finally, I resolved to put the front seat all the way back to avoid the headlights (I may have even dug out my eye mask), closing my eyes to the chaos over which I had no control, and tried to quiet my mind for sleep that never came.

Besides the headlight situation, another wonderful safety feature found in the majority of Indian automobiles that makes driving all the more frightening is that the majority of cars here have been cleverly designed (or rather redesigned) to contain no seat belts. So, I often find myself imagining flying through the windshield when we come to an abrupt stop. I also think about what a killing American traffic police would make with their $2500 seat-belt fines if American automobiles were similarly redesigned….

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Now that the initial near-heart-attacks have ended and I have resolved that I cannot always wear a seat belt, I have come to find driving through both the Indian countryside and city traffic to be wonderfully meditative. It is absolute chaos and there is nothing that I can do but laugh and smile to myself. At any moment, a herd of buffalo or a motorcyclist could appear from nowhere and… I guess this is why driving in India is so often called a spiritual experience.

In the last three months my perceptions and reactions have changed drastically (on many things, not just driving but that is another story). For example, if I find myself in the backseat of a car driven by a more timid driver (but still exceedingly aggressive by Western standards), I find myself thinking, pleading—Why doesn’t he just go?! The road was clear (with only two or three cars coming and twenty or so motorcycles)! Really, man, really?! Can’t we just GO!?

Note: Many young travelers take pride in sleeping in the dingiest of  places and taking the cheapest/longest/dirtiest bus rides imaginable. I will agree: these experiences do make for great stories and can be character building. I too have had these experiences (eaten alive by ants while attempting to sleep on a street in Havana, contracting some unknown skin infection that may or may not have been MRSA on an eighteen hour bus ride, sleeping in the putrid slums of a Mexican border town…) and thus try to avoid them wherever possible. In doing so, I in no way feel that I am missing out on an “authentic” experience.

Redefining Sex-Education

Kama Sutra Statue

Kama Sutra Statue

Unfortunately for India’s youth (a huge proportion of the world’s population), India is afraid to teach her children and adolescents about sex or anything remotely related to sex. Due to this fear, sex-education here is non-existent (even though the majority of sex-education has nothing–or next to nothing– to do with actual intercourse). Thus, the vast majority of Indian children learn nothing about their bodies and how to properly care for them, or even about the changes their bodies undergo during puberty. When India thinks about sex-education, she miss its significance and utility, and instead thinks that her children will be taught the sexual intricacies of the Kama Sutra and other perversions.

Due to the unfortunate title, “sex education,” children all over the world are missing out on learning important and necessary material. Thus, for India and other parts of the world (including the American South), sex-education should be renamed (taking sex out of the name) to something like “Health and Personal Hygiene.” And, as these classes would be of major benefit even without the mention of actual sex, sex could be taken out of the lectures in countries with both conservative thought-processes and conservative sexual practices (the South does not align). This modification would allow children access to pertinent information about their health and bodies.

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The consequences of not having proper sex-ed in the US…

The United States has a very different sexual culture than conservative India (with the average age of first having intercourse at 17, which is much later than I thought) and thus requires a different sort of sex-education class that does involve sex, especially focusing on the importance of safe sex. (Sex education classes need to be catered to the actual sexual practices and culture of each community rather than the conservative thought processes that outline how things should be.) I remember my first sex-education class at the age of twelve while attending a boarding high-school in rural Arizona (as a day student). Luckily for the students (and completely necessary for a boarding school environment), we were all required to attend a gender specific sex-education class where were learned about our bodies (which was a review for most of us, ages 12-18), were shown slides and given graphic descriptions of STIs, and told that if we had sex without a condom, we would both get pregnant and contract STIs. Unfortunately, I still carry those images and descriptions in my mind (it forever destroyed my enjoyment of cottage cheese)…but it worked! Even at the age of 12, I knew that in the future, when I had sex, I would not do so without proper protection.

While perhaps India is not quite ready for such “forward” classes, India is in dire need of something to take its place. While studying thoughts and practices regarding menstruation in India, I came across several shocking journal articles regarding knowledge and beliefs about menstruation. In one study involving girls in the state of West Bengal, India, about 30% of the girls did not know about menstruation at the time of menarche (their first period) and a very small percentage of girls (<10) knew the source of the menstrual blood. Also, a dangerously high number of girls attributed menstruation to such things as curses from God or disease. Studies like these demonstrate this dire need for “sex-education” aka personal hygiene classes where girls are given the opportunity to learn about their bodies and dispel dangerous beliefs regarding menstruation.

The Saranalaya Home for the daughters of prisoners

The Saranalaya Home for the daughters of prisoners

Some of the little girls

Some of the little girls

I have had the opportunity to offer a few of these “modified sex-education” classes smartly titled “Health and Hygiene” to girls in orphanages in Coimbatore, Tamil Nadu, India (with the help and support of the Womens Center). My first class was at the Saranalayam home for the daughters of prisoners. I was originally told that I would be speaking to girls ages ten and up, however, when I arrived I was shocked to see that about half the girls were under ten and many were as young as five or six. As I had planned my presentation around the central theme of menstruation and still really wanted to give the older girls the opportunity to learn about their bodies and how to care for them, I had to quickly consider my options. Do I teach the five and six year old girls about menstruation even though they won’t understand it? Will I scare them if I do? They probably won’t ever have this opportunity again… These were the thoughts running through my head in the few minutes before my scheduled talk. After consulting the nuns in charge of the house, I restructured the presentation so that everyone learned about general hygiene including toilet hygiene, nutrition, “bad touch,” and exercise. The little girls then went downstairs and I spoke with the over ten crowd about menstruation.

hanna 012After the general talk, I noticed that the nuns were shuffling out adolescent girls that should be staying to listen to the talk, leaving me with just a few of the oldest girls. The nuns told me that these younger girls hadn’t reached menarche (though by the looks of it many would within the year) and therefore didn’t need to stay for my talk. With some passionate convincing, I was able to have a few more girls added to the talk. I told them that menstruation was natural and actually a sign of good health (and showed them a drawing of the uterus!), told them things they could try to alleviate menstrual cramps (exercise and avoiding salt and sugar), and about the proper care of their bodies both generally and while on their periods.

hanna 013Next, we had a question and answer session where a nun who helped care for the girls asked me many questions about normality–and thank god not the Foucauldian sort (she was probably in her late 30s, was educated enough to read and speak English, but had next to no knowledge about  menstruation). The girls themselves asked me a plethora of questions regarding menstruation and what was normal, about pimples and shampoo, weight loss and weight gain, how to grow taller, what to do for cracked heels and cracked lips… Everything. It was actually really fun.

I was able to reassure them that menstruation is normal and calmed many of their fears about their own bodies and cycles. I ended up leaving the printout outlining the key points of my talk with the nun. She was very thankful for the talk and ensured me that she would teach the younger girls about hygiene and their bodies as they came of age.

As my readers can see, my talk was completely innocent and nowhere did it mention or even allude to sex. And it didn’t need to. Yet there is a huge resistance to providing education like this as the public believes that it will corrupt and pollute the innocent minds of children. I have several more talks scheduled for orphan girls at different orphanages throughout Coimbatore. The idea is to give these girls lessons that their mothers would be giving them if they had mothers. However, many girls with mothers do not receive this information either because 1) many of mothers simply don’t know, and 2) many people are too shy to discuss such topics with their children. Thus, I am also scheduling talks at English medium schools to both provide wealthier school girls the opportunity to ask questions about their bodies and to show that “sex-education” doesn’t need to be about sex.

Note: This talk at Saranalayam was covered by The Hindu. Yet, you can see from the article that even the media is a little afraid to mention that my lesson contained a modified version of a sex-ed class (no mention of menstruation), but instead labels it as I did–Health and Hygiene.

Arranged Marriage: A Western Perspective

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My first encounter with arranged marriages (excluding story books and historical accounts of royal and political marriages) occurred about a month into a past relationship with a man of Indian origins. We somehow got to talking about the topic of marriage and how, shockingly to me, arranged marriages still sometimes happened in India (though I don’t think either of us knew to what extent). He then told me, jokingly, that he was betrothed to a girl in India whom he had never met. At first, I didn’t realize that he was joking and felt a little upset, the romantic in me thinking–why was he spending time with me when he has another (perhaps I experienced for a few short seconds the way a woman feels when she discovers that she has been seeing a married man)? I then realized that he was joking and we had more than a few a good laughs…

As one can assume from this anecdote, the concept of arranged marriages has always been foreign to me. Like many Westerners, I was brought up on fairy tales and Disney and always had the notion that people fell madly in love, dated for a while, and then married. And, if for some reason their parents didn’t approve, the couple would run off to Las Vegas or Niagara Falls to elope. The couple’s parents would eventually come around, and everyone lived happily ever after.

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A Western perspective of arranged marriage?

With this mentality, arranged marriages happening in this day and age seemed so bizarre and almost impossible. I know arranged marriages happened historically, and could accept that they happened in backward villages in developing countries (usually involving children, of course), but today?– amongst middle and upper class individuals? Doesn’t everyone want to fall in love?

When I arrived in India, I was in for quite a shock as nearly everyone that I met either had or was going to have an arranged marriage (I could accept members of my parent’s generation having arranged marriages, but my own?!). As this topic fascinated me, I questioned and probed into the lives of as many people as possible to find out the procedures, customs, and thoughts regarding arranged marriages. In this post, I hope to provide stories and share my changing insights and perspectives on the practice.

The first person I questioned about arranged marriages was an educated man in his fifties with knowledge about Western culture. He told me that in India, arranged marriages worked out well as the families would form a partnership on which they could agree. This meant that Christians would marry Christians, Muslims Muslims, and Hindus Hindus. It also meant that families would be in the same general socioeconomic class and might even run in the same social circles. There is also the idea that if the families can get along, the children (the married couple) will be able to sort out any issues that might arise. And, if the couple has problems that they can’t deal with on their own, both sets of parents offer counsel and assistance for the troubled couple. This family orientation, he insisted, is one of the main reasons that India has such a low divorce rate (divorce is also seen as incredibly taboo and, in most incidences, women cannot remarry without intense social consequences. Also, as India is so family oriented, the idea of being divorced and without a family is often worse than suffering through a troubled, unhappy, and even abusive marriage).

Next, he told me the reasons why “love-marriages” often don’t work. First, love doesn’t always follow the rules of society and an upper-caste girl could fall in love with a lower-caste boy (or the other way around) causing both families turmoil and disgrace. Similarly, a Christian could fall in love with a Hindu, and the all important extended family would argue over which religion the future grandchildren should follow, and the families would have to explain why their daughter or son did or didn’t have a Church wedding. Thus, love marriages often don’t work because the pivotal role of family in marriage. And, as family plays such an import role in the lives of Indians, eloping is often out of the question as one does not want to create distance or separation from family. Also, as parents often know their children better than the children know themselves (so the belief goes…), parents have the ability to better select an appropriate spouse than their children. Yet another problem with love marriages is that once the love runs thin and problems begin to arise, the young couple will not have the same support structure created by a partnership between two families.

So, family plays the all important role in marriage in India–and it favors arranged marriages.

After receiving this insight from a man who has arranged his own daughter’s marriage, I began probing into the lives of my Indian peers, discussing their thoughts, feelings, and experiences regarding marriage.

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Nice to meet you?! Almost…

When I asked one recently married couple about their arranged marriage, the man told me how he came to meet and marry his wife. A few months ago, the man announced that he wanted to marry a woman with an MBA degree. One of his father’s friends recalled another friend who had a daughter that was just finishing her MBA. This friend contacted the man with the daughter and gave the future-father-in-law information about his future-son-in-law. The future-father-in-law approved. The young couple exchanged photos and phone numbers, then Skype IDs, and, a few weeks later, finally met. About two months after the initial contact, the couple married. I met the couple about a month after their marriage and it was both sweet and strange to see a married couple behaving towards each other with the innocence of highschool sweethearts.

I had another interesting interaction with an unmarried Christian man of twenty-six. He was going to wait a few more years to marry so that he could settle into a career before starting a family. Discovering that Western societies had different marriage customs, he asked me how it was possible to marry without an arranged marriage. So, I censored myself as best I could to be as least offensive as possible and explained, “Well, we meet people through classes, colleagues, or friends and, if we like each other, we exchange numbers and arrange a time to meet. Then, we date for a while (generally a few years) and, if we both still like each other, at some undefined point in the future, we marry.” Knowing his conservative Indian and Christian background, I edited out all offensive and heretical topics such as pre-marital sex and living together before marriage (aka “trial marriages”). I was shocked when, after my simplistic and seemingly pious explanation of Western marriage practices, he vehemently declared that dating was a sin! I guess I had forgotten to factor in that in the vast majority of Indian marriages, couples even in their twenties and thirties go on supervised dates, thus having no unsupervised time alone until their wedding night!

However, as India is influenced more and more by the West, marriage customs are slowly beginning to change, especially in large cities and amongst the wealthy. While arranged marriages are still the norm, more and more frequently children are shipped off to other cities for university or job opportunities where they meet potential suitors. These suitors are then brought home to meet the parents, such as they would in the West. In this case, the suitor is generally of the same social class (and caste doesn’t play much of a role in educated, wealthy, city dwellers) but still has to obtain parental approval. Finally, the sets of parents meet, and, if everyone agrees, the couple is married. Someone told me that the wealthier or more educated one is, the decision to marry is made more and more by the child than by the parent, even in the case of an arranged marriage (the child has more veto power).

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Perhaps also stemming from Western influence, online dating, in the form of matrimony sites, has made it to India. These sites are very similar to the online dating sites in the West, with the exception that they are used for the purpose of selecting a spouse rather than Friday night’s date. While I am not 100% sure what happens in the selection process and after contact details are exchanged, I would not be surprised if family played an important part in both selecting and approving potential future spouses.

While I am thankful that I have been granted the opportunity to explore the hearts, minds, and bodies of potential (or not) suitors, the Indian system of marriage leaves some room for jealousy. Firstly, how many of us have dated someone our parents can’t stand? In arranged marriages where one’s parents select a partner, this nightmare isn’t an issue. Secondly, with the high divorce rates seen in the West (come on, America, over 50%!?), India’s low rate of divorce looks pretty good (although perhaps all the potential reasons behind it don’t). Thirdly, after having spent the last several weeks in and around a fertility clinic, I know more than I care to about the increasing rates of infertility and about how fertility decreases with age. As someone who might want to have a family in the future as well as a career, when combined with the elevated rates of infertility and a strong personality, the chance of finding a suitable partner during the small window between career and fertility is far from a guarantee. Where in the Western system of love marriage you may spent your life wandering aimlessly (or with unrealistic aims) never finding a partner, in the Indian system, you are practically guaranteed to find a partner by the age of thirty (or shortly after should you wish to be slightly non-traditional). Despite the advantages of arranged marriage, the romantic in me is happy to experience the ups, inevitable downs, and personal growth associated with dating.