2/4/11 Mur Name Kakoli

Stephanie, another MPH strudent, arrived Monday and Tuesday was a free day so the team went to visit the Hindi temple Kamakhya Mandir. The story is that Sati’s body parts fell throughout India and her womb or genitalia fell on Guwahati where the temple is. So there’s actually this huge festival in June/July called Ambubachi Mela where they celebrate the goddess’ menstrual cycle and dye the river red. The temple is made to look like a womb too, dark red cavern like rooms. We had to take off our shoes to enter and there are roaming goats everywhere. We walked in a room and got tikas on our foreheads (red chalk dots) from the priests. Then we sat on some steps overlooking the sacrificial pavilion and saw 4 baby goats get beheaded. It blew my mind. Families would come up to the priest and I guess pay them to sacrifice on their behalf and then they’d put some of the goat blood on their tika. Wow! Sometimes they even sacrifice buffalos. I saw them capturing pigeons too and putting them in boxes. After, we went on a little cruise on the Brahmaputra River and ate lunch. The locals have told me the smallest river island in the world is right off the shore of Guwahati called Peacock Island which we went by and where sits the Umananda Mandir temple. Hopefully we’ll get a chance to actually walk on the island. I took some nice pictures of people along the shore washing their saris.

Today is the third day of surgery. There are 1 ½ more days. The surgeries are from 8am to 8pm. On Wednesday, they did 36 surgeries at 10 tables. I can’t imagine how tired the medical staff is! Minh and I on the other hand usually survey for about 4 hours in the afternoons. Our population is limited to only those who have qualified for surgery so since they came the afternoon before the surgery day, we have set up a station to call those patients up after they arrive and check-in for surgery. Later in the evening they are admitted into the hospital to their respective beds. So then we move our station inside and call them out one by one from their bed. Minh and I have seriously revised our questionnaire probably 10 times. The first day we finished 12 questionnaires and yesterday we finished 16. We don’t have one student translator assigned to us, so we rotate through the ones that are free. The days have been hectic because not only is surgery going on, but screening is too! Medical staff also needs to be available to screen! Most of the busloads are from the tea plantations, which are the poorest populations of the state of Assam. Some don’t speak Hindi, Assamese or English and there are limited translators that speak Bengali and none that speak the tribal languages! Some translators are out because of university exams so basically resources and time is short right now. Alison (who helps manage the mission) says things should get less hectic and we’ll be able to complete more questionnaires. The first day we had them sign an informed consent, but then realized since most of them are illiterate, verbal consent would be better. So now the translator just explains who we are, what we’re doing and that the questions may be uncomfortable and that participation is completely voluntarily. This is a requirement of the Institutional Review Board (IRB). Our study’s application to them has actually been returned with 23 changes. So Minh and I spent the morning at the hotel revising the application. It’s ready to re-submit, I hope the IRB accepts it!

So the student volunteer translators are great. Most of them are 18-22 so I call them my vaity (little brother) and they call me baa (older sister). We also call each other bondhus (friends). They usually come hang out at our station and will cycle in and out with helping us translate, since there’s such a small supply of them. They’ve been teaching us Assamese and even gave us Assamese names. Mur naam Kakoli (my name is Kelly) is what I tell everyone. Also, my name is similar to Kali who is the goddess of eternal energy and destruction. However, Kakoli is prettier one who preaches to the birds. I like birds. They also really seem to want to learn Spanish, so I’ve been teaching them Spanish also. To each patient we interview I say “Subheshya thakil operationer bhaba kali” which means “Good luck with your operation tomorrow” and of course “dhonyabaad” and “Namaste” as you put your hands together like you’re praying and bow. A couple times I’ve felt emotional seeing the patient’s reactions to our questions. The one that is the hardest is “What do you think causes cleft lip/palate in general?” A lot of them think it’s their fault or they did something wrong so they feel really guilty and struggle admitting to the answer. Some of the answers have been superstitious like the woman walked outside at night when pregnant or ate something during the solar eclipse or cut the betel leaf, which is used in Ayurvedic medicine by chewing. Another interesting answer is that when we ask “What places do you avoid because of cleft lip/palate” they respond “wedding parties. We asked the translators what’s the significance of wedding parties and they said they are the biggest parties of your life basically. You invite everyone you know (friends and family) to your house for 2 days and it’s a common place to meet your own suitor. So, therefore marriage-ability seems to be a big concern to the parents. It’s beautiful to see how much these parents love their children though, no matter what. Only one person responded they hide their child, but most say they are happy and just want them to be happy. The bias here could be they know they are getting surgery the following day, so don’t feel as helpless. Our study is one of the first of its kind though, so we’ll be able to improve it in the future.

I can’t wait until we can scrub in to surgeries. We’re hoping one of these mornings. We’ve been surprisingly busy most of our mornings either fixing the IRB application and now we’ll begin data entry using Qualtrics, which is an online survey/database system at USC. I’m excited to see what we find. The team has been very supportive in helping set up our stations and fitting into the patient flow. They also are curious to the responses patients give us. It gives such great insight into the culture and their perspectives which will really help Operation Smile’s permanent center they are opening here in Guwahati to provide more culturally competent care to their patients.