Gracias a Dios (Thanks to God)

The twin engine plane at the Puerto Lempira Airport.

I sat inside the twin engine air-plane with not more than 15 people in it. The size of the air-plane itself had spooked me and I immediately reached for the seat belt although no one demonstrated its use or asked me to buckle up. It was a struggle since the seatbelt was worn down with marks of scratches from the panic and joy that many might have experienced before me sitting in that very seat. Within the few minutes we were in the air; strangely though as I wonder how those small fan engines will ever get such a plane in air. With air pockets and turbulence, the air was bouncing the plane around and my heart along with it, coming to my mouth often. Luckily we had a clear sky at take-off but not for long; as tropical countries go, the clouds seemed to stretch to eternity and the plane dived and rise to avoid them, further adding to the already shaking experience. But as all things that end, this rolling around in high air finally culminated as the air-plane literally grinded to halt on a sand and mud airstrip. If I called my journey to Puerto Lempira eventful, I had spoken too soon.

There were no plans for travel to work but a meeting in the week brought out some startling questions which could only be answered by going to the La Mosquitia, a rain-forest area in the east of a country called Honduras in Central America. Within a couple of days the arrangements were made and on Monday morning the following week I was standing at the airport ready to take my flight to Puerto Lempira, the capital city of the state called 'Gracias a Dios'. Seeing the small twin engine air-plane with fragile looking wings I immediately wanted to take the road, no matter how many hours it might take to reach the place. Unluckily, air was the only way to reach this remote place on earth besides the sea, which seemed more unappetizing than air thanks to my experience just a couple of weeks back. I had then gone on a small boat to an isolated beach in Punta Sal despite rains and winds marring the whole trip. The return journey was on the same small boat along with rains and wind too but this time the sea was not in a giving mood. My friends and I, all were holding on to whatever little we could get but still knew it was futile as the waves picked us up and threw us around. Even the ardent atheist would be made to believe; I had a new found respect for the sea and could agree with people who worshipped it!

Back at Puerto Lempira, as the plane landed and I got out, and witnessed what I had only seen in movies till then. Although there were no air towers, no check in bags, no immigration, no airport security but all of this was made up for by the few army men standing to do this all. The sand and mud airstrip was actually the most advanced part of the airstrip. Within moments I was in the back of a pick-up truck hopping along towards the hotel as I had a full air view of the city, just as everyone else had of mine! All during my stay here I have been a head-turner, literally! If I accidentally did look into someone's eyes I would see him/her staring at me blankly. To some I would be the first and the only person they would ever see wearing a turban in real life.

The unpaved roads in Puerto Lempira town.

The roads were all unpaved, but I can only wonder how they could every get tar to such a place to make a road in the first place, forget the gigantic road-roller. The town however had a laid back slow life so characteristic of such an inaccessible place and I liked it immediately. Work too happened at the same pace; I finished lunch within 15 minutes and was forced to sit and wait for others to arrive after an hour. As I sat along the street I watched people moving around at their slow leisurely pace and ogling at me blankly as I caught their eyes once in a while. Meanwhile, at work it was all Spanish and my little over 2 months of training was helpful in using the same verb 'make' for everything from deciding, talking, exploring, and studying to listening, thinking and other –ings. How people could understand and relate with me is a puzzle I am still trying to solve. The safety net of a fellow English speaker, at least beyond hours if not at work, was also not there and so I was immersed completely in the cosmos of listening-translating-understanding-thinking of a reply-translating-talking exercise for every single word I spoke or heard. It was no surprise that people thought I was a shy character as I totally shut off going through this intensive exercise once work was over.

The single engine plane at Wampusirpi Airstrip.

In two days I was again at the airstrip to take a flight to Wampusirpi, another municipality town in the state. If the air-plane to Puerto Lempira defied logic, this one was a gem: run-down, ram-shackled with strings and ropes being used to keep things in place. The five of us sat down and I my hand reached for the elusive seat-belt which was never to be found. I guess people must have panicked a little too much in this plane and someone must have taken it as a souvenir for the adventurous trip that he/she must have had. But then why do you need security as caution was needed more on the outside; the air-plane started rolling out from the hanger to the airstrip and the traffic stopped while a man riding a cycle made a desperate sprint to the other side in front of the plane. As the plane started running on the airstrip, the air blowing in from the open windows conditioned the air within and prevented people from sweating out of fear.  

To be continued......

Prabhjot

Another day...

After having successfully decoded the Spanish language (atleast 50% of the times), I thought I was accomplished enough to consider myself fit for providing training. Little did I know what was to come ahead.

As the training session commenced and went on, people uncomfortably shifted in their seats and soon one hand was raised. As the senior trainer went on to answer the query, more hands started rising in quick succession and then I decided I would chip in. I approached the first person and she started off in her coded language, ' a que #$%^ !@## @##! $%#$%!'. I replied back, 'Perdona senora, pero mi espanol is muy limitado, sin embargo let me try...'. I could immediately realate to that first batch of Call center employees in India answering American calls. They were all raised on hollywood movies and English songs, but the first words of an American speaking directly to them must have been as incomprehensible to them as was the query in Spanish to me even after reading the 'Bible'- Spanish for dummies. However, years of intensive Indian education topped with understanding of American psyche and my knowledge of Spanish I rolled out the mantra to her, 'Click aqui (click here)' and boom, the problem was solved!

The questions kept on coming and with equal fervor my answers, the Spanish inquest was not able to break my resolve of answering and answering back in Spanish. Each and every of my answers, actions and emotions were expressed with my repertoire of 50 Spanish words. Sometimes when I failed to do so (75% of the times), I created my own Spanish words, eg, for renaming a file or folder I used renombre which actually means renown in Spanish, or to remove a certain variable I used removar which actually means to stir in Spanish. These words were still close than others: Maso (Add), Drago (drag) or Press teclado (Type).

As the training went on, the questions became more and more complex and required multiple lines in any answer. It is one thing to be interacting with Windows and calling Bill Gates names when you recieve error messages, it is another when the error messages itself are in Spanish! I was at loss of words when I met my first Spanish error message, I didn't even know how to curse back using my 50 words.

The first day of training ended and in less than 8 hours I had spoken more Spanish than I had in my entire life! The synapses of my brain were all sore from the workout and I slept off the whole evening and night as soon as I went back to my room.

My misadventures kept on all during the week but the choicest ones were when I went out to see the city. I thought I was going to see the city, but it turned out that the city was seeing me. The eyes were glued on to me, although I still can't figure out what made me feel so out of place, I thought I looked one like them but just with a bandaged head. If my looks weren't strange enough, the refined spanish I spoke definitely turned a head or two. Some fellow participants were mighty impressed with my interactive skills and started looking towards me for translation which I did promptly and aptly. In a large group, when we were trying to decide who was going and where, someone said,'$%@@# @#@@# cambiar $%$%$'. I immediately turned and translated it for my friends from Suriname,'I think its a good idea, lets go with him.' We joined him but only to be surprised when he went to the hotel lobby, exchanged his money and headed up for his room. Later on I found out that a long walk (caminar) is different from exchaning money (caminar).

At another time I asked about a place and was informed that the place is 'muy lindo', I took a cab to the place from the hotel but the cab hardly drove 5 blocks. I learnt that day that lejos and not lindo means 'far'. But not all was lost, even with the limited vocabulary and near 0 understanding, I was able to haggle for prices in true Indian passion.

In the end, with all my misadventures and adventures, it was infact a pleasant stay and a learning experience for me. Looking forward to my next...

Prabhjot

As easy as Spanish.

The waiter arrived with food and started asking if it was ours. In the melee of crowd present in the bar, it was hard to hear him but I could make it out that someone must have ordered food among our group and so I responded, 'Si, Si Senor!" The waiter immediately shot back saying, "What!" and his confused and irritated voice shook me up and made me realise that I was sitting in USA, not Peru anymore! The strong hangover is testimonial to how intoxicating it was to be in Lima, Peru's capital, for a week.

I was sent to Peru on an official trip to train people coming from all over the American continent, but I think I must have heard it wrong as at the end of a week it was I who felt had been trained. Prepared as I thought I was, after having read quite a bit of the 'Bible' for all spanish learners- 'Spanish for Dummies' and armed with a Spanish to English dictionary, I landed at the airport at Lima. All my way through the airport I read signs in both Spanish and English, the forms were all in two languages and immediately I thought this is going to be easy, even the person who recieved me and drove me to the hotel spoke both Spanish and English! I was relaxed, this is going to be not as harsh as I had imagined.

The next morning I had a sobering experience as I found my nealty pressed clothes all wrinkled up after the journey and called up the frontdesk to ask for an iron. This is how the conversation went:

Frontdesk: Buenas dias

Me: Buenos dias, Por favor senorita a Iron para ropas? (Good morning, I need an iron for the clothes)

Frontdesk: ^%&((&#(#_@($ ropas ^(*(_)_)_*_()(_ laundry @$@%$%^ (............... Clothes.... laundry...)

Me: Si (yes)

Frontdesk: $^@*&(*!)( @!*(@  #&#*^$ &*

Me: Si (yes)

(Pause from other side)

Me: (sensing the conversation has ended) Gracias! (Thank you)

After a while I heard a knock on my door and upon opening it I found a lady standing in front of my room and asking me for the clothes that I wanted to give for laundry. A little late but finally I understood what the receptionist at the front desk was saying and what had I said a 'Si' to. In my broken spanish and vivid hand actions, I explained the lady standing in front of my door that I wanted something to iron my clothes with. She repeated something in her coded language and left. After a while I got a call from the frontdesk, the person this time chose to speak in English and confirmed that it was infact an Iron I had wanted. Enough said and done, although I didn't want to be late on first day of training, my training had already started.

 

As if my first encounter was very successful, I called up the frontdesk again, and started asking for the room in which the PAHO training was going to take place. They had booked me in the same hotel in which the training was going to take place, I realised that this was delibrate attempt to keep me in time as I came to the PAHO office everyday according to IST- Indian standard time to others, Indian stretchable time for me. In my Spanish, and since I didn't recall the spanish word for room, I asked her again:

Me: Buenas dias senortia, por favor a que piso es reunion de la OPS? (what floor is the PAHO meeting on?)

Frontdesk: %^&&*()) &^*&^&* @#$@#@%$ doce &)*&( 0*()#$%# (Mumble-Jumble, 12th floor)

Me: Gracias! (Thank you)

I was sure that if I knew the floor, I would find the room anyhow. Armed with the knowledge and confusion, I took my chances of going with the understanding of what the receptionist must have said. I took the elevator to the 12th floor and got out, looked around and realised that I had just hit the home run:  it was the room where the PAHO training session was going to take place!

(...my travail continues, later....)

Buenas Noches (Good night)

Prabhjot

Lovely love

Love is a feeling generated by excess release of endrophins upon mental stimulation provided either by sensory stimulus (tactile, visual, aural etc) or due to activity in frontal cortex with electrical energy being routed through specific synapses channels.

-Prabhjot, 2010

For your eyes only and of course gossip beyond that....

Sometimes you have no reason but you feel nice and you smile, some other times you have all the reason to feel happy but you don't smile and then of course there are occasions when you have reasons and so you smile. Sometimes you want to stay in the present cause you have many things on your mind, sometimes you want to be be reflective of the past as there is not too much in the present and then there are times when you have a lot on your mind in the present and still want to think of the past. Walking back from office today I found myself smiling, pleasantly and I had no thoughts on my mind. Just the general feeling of being here in WHO, of having dreamt it always and being here, of having wanted to work in malaria and in public health and feeling I have achieved some of it. Just the reflection of my past 7-8 months brings back a smile on my face!

On friday evening, my regular first friday of the month bhangra party, and I was there right on dot in the party. I am a small celebrity there for obvious reasons, one I sport a turban and bread and I can dance well. So this weekend I was on the dancing floor and went to the bar to get a drink. There were many girls, many guys, some couples, some seemingly single. A pair of girls sitting in front of me, one simple and good looking, the other better than average but very done up with (if only I could either one of them, especially the simple one); another couple walks in and I know, the girl talks very courteously to me (cause she recently realised I work for WHO and she wants to get into public health); there are many more on the stage, some walk up to me to let me know that they remember me from last time when I taught them to dance, AWESOME!!! So I meander through the crowd teaching some, learning from others, making others enjoy and getting my enjoyment from them.

The better than average but very done up girl appears from somewhere and starts dancing a step away from me, I take the step and join her, trying to complement her western moves with my desi ones. She responds and faces me, and we start moving in a rhythm, getting closer. I see her friend is also there moving a bit but alone in the corner with no company, yet not more than a step or two from me. I see her from far but don't move in sensing that she wants not to mingle and will not respond. I keep dancing with the other friend, and then leave for some respite and a drink. On my way back, my friend standing by the side of the floor points towards the simple girl still trying to move around on her own. I decide to move in, walk close to her and just stand there looking at her feet and as planned she gets conscious. Now that I had her attention, I started moving my steps in whatever rhythm it is that she was doing. After all these weeks of dancing, I know how to get people to dance to my tunes. After a while she gets conscious enough and to break the ice I say that she could probably move out of the box. She was consciously trying to dance in a particular block of the disc floor and I had noticed that, something she wouldn't have expected I would come out with as an opener. Soon enough I had her attention and she started following me as I led her through a mire of bhangra steps. Strangely, she picked on very well!

While my friend swooped in for the other girl, with whom I had already created an opening. More bhangra, some songs, more steps later she left the floor to go out and sit with her friend. After taking my sweet time, I went and introduced myself to her and got on talking. If I should say I wasn't wooed by her beautiful eyes, perfect features and not a tread of makeup, add to it her a bit reserved nature.... ooooohhhh I was getting smitten by her....

This girl was a psychologist from Moscow, yes she was russian. Bollywood was not new to her and so she caught on bhangra well. Favouraite actor: Mithun of all people! More talks, some uncomfortable pauses, my desire to head back to floor and no twing to be noticed in her blue eyes. I wnet back with to the floor and taught her some more, finally I was able to get her to the center of the floor- a sort of couple dancing while the rest watch kinds. She feels great, a smile on her face is evident and as if she wasn't glowing before- she glows some more. More time and we head out again, she goes alone watching portraits hanging in the club, I get some water: I want to talk to her, but don't want to seem desperate or coming over too strong lest she might run. I have given her enough evidence that I am interested, I assume. Still I walk up to her and strangely she asks for water, I get it for her (its a task to get water in a pub where alcohol is flowing and water fetches the bar-tender no money!). I get back to her and her friend asks for water, I get one for her too. Meanwhile, my friends from previous parties, acquaintances and others keep on pouring in and I can't help but talk to them. I go on the dance floor, hoping she will come. After I while, I leave the floor and she is nowhere to be seen- she left I guess- my heart sank. I went in thnking that perhaps it was for the best. I make new eye contacts and keep sweating. Soon enough though I notice her walking back into the dance room/floor. Voila, I approach and soon I am again with her. From then on till 1or 2 whnever the DJ finally said it is over I was with her. I did leave her sometimes to go in the center and put up a show indulging in dancing duels but strangely I get no response from her (no you  were awesome or great), I should have felt bad but instead I got more smitten by her simplicity and aloofness.... She appealed to me somewhere deep....

After a good last session of dancing where I was litreally flirting with her in all manners possible, getting as close to her, touching her on every occassion possible, holding her hands while saying you are doing this step wrong etc etc... The songs ended, the dance floor vacated and the DJ called me for the last song (a slow Kishore number) to sing along with him. But I had more pressing issues, like she should not leave without me.. I had to say a rushed bye and off I went behind her. Luckily I didnt have to force myself again, I had taught her a step and she just couldn't get it out of her mind or her legs. As she kept jumping over and over again, her friend asked me what I had done to her that she is dancing around!! Totally hinting, and I thought I am in now as her friend too is on my side. Soon out in the open, her friend walked away leaving me alone with her- AWESOME!!! What more would I need than absolute support from her friend. Some talks later I tried not to sound desperate and ask for her number but did open a possible channel of communication through the facebook Bhangra group. I gave her the name of the group and thought she would join it- and then I would befriend her and then.... A long circle of thoughts ending right upto taking her to India one day. They don't say that mind travels faster than the light for no reason. Here is this girl meeting me for the first time and already I have thought about eons ahead.

Finally she says she would have to be with her friend and I also take the clue that enough is enough and that to meet tomorrow we need to part today. So here I go wishing that tomorrow would be as hormone pumping as the night has been. Meeting more people pouring out from the club, hailing a cab and reaching the confines of my home all happened in a different era thereafter where I was intoxicated and hung-over with the strongest addiction of all!!! Before I could have seen outside my window to see the fabulous morning, my laptop was up and running and me on facebook. I sifted through 200-300 odd members of the bhangra group dilligently looking at each one of them. I remembered her first name vaguely and used it to search members: there were more than 500 girls with that first name. I used my google skills to narrow it down but none of those profile pics was even closer to what she looked like. My heart sank but it was also restless and hopeful, that sooner than later I will be able to get her... Shifting on the bed, going through emails, calling people, and checking facebook every other moment became a norm but time just would not pass...

At 3 pm that fateful Saturday, I saw her face on the list of bhangra group followers.... I was looking at her for the first time with no alcohol to modify my senses and I can only say that I know not how many moments I spent looking at her profile picture. SHE WAS BEAUTIFUL!!!!

I could feel my heart stopping and then beating erratically, smitten by her beauty my heart itself was forgetting how to beat- its head dizzy from this sudden assault...

I sent her a friend request but that would not be immediately accepted- DAMN it these slow times where people are not 24*7 connected to their facebook accounts!!! Waiting for her to respond I exhausted searching for her on google and going through every trivial detail available via her limited facebook profile accessible to me!!! I knew she supported same sex marriage, supported Iceland's recovery, wanted to get into George Mason University's psychology programme, and cross-fit fan...

The more I looked at her.. the more I..... On and on my flirtation with her limited profile went on. Adding a direct bookmark to her profile I ensured that I was just one click away from her. Her profile was always open on my page. Eating, Sleeping, Talking, Working and looking at her profile... Aaaahhhh....

The day passed off, the morning came and passed and my restlessness kept on waxing and waning but finally finally she had accepted and the Gods had shined upon me!!!! On and on her I went through her pictures and I knew already: 'She is WAY out of my league..." 

AAAAAHHHHH....

Can I say that I could have not been in any way avoided getting more and more intoxicated by her looks.

But then... I went through her profile and... my jaw was left open. This couldn't be true, she couldn't be... OH NO. Damn, here I was cooking all this in my mind, but!!!! I had asked her if she had a boyfriend BUT BUT... she HAD said a no. OH, I can't believe it. She was not wrong but... But she WAS

MARRIED!!!! 

Her sweet beauty and simplicity had left me bitten!!! 

Now everything felt into place, her nonchalant attitude, her simplicity, the openness and yet her closed nature... It took me a while before I could smile and still more before I could write this to you...

Hopefully it was a good read!!!

Laughing on my luck!

But seriously I still find her very very beautiful!!

Prabhjot

Malaria Cases in select American Countries- 1982-97

Salt Fortification: Simple Solution: But is it?

A friend of mine sent me an article to read by Ramaiah et al. (2000). My friend favours the use of salt fortification but that left my mind thinking. Is it worth it, definitely- it can eliminate a disease! Is it simple: yes- just add it to salt! Is it feasible, hmm... perhaps not!

For starters the articles are pretty old (> 8 years) and therefore their immediate effect/ lessons learnt from them would be of questionable relevance. Like the Ramaiah article points out that there was good compliance in rural areas (over 70%) in people who received the drugs. The problem there was that 30% of people were not covered and of the rest 58% (which implies 70% of the people who were given drugs) took the drugs. So in case we can decrease that 30% by a margin and add to it some educational campaigns, we can go a long way. And as I can recall a near 85% coverage is enough for eradication. 

I was encouraged by the fact that rural areas had higher compliance than urban areas as I thought rural areas will be the ones with max problem. However the article points it out well that the disease burden is higher in urban areas. The study it uses was done in 1986 though, 23 years from now, situation may have changed since then; need a more recent estimate for this urban/rural divide.

I agree that mass drug administration (MDA) of di-ethyl carbamazine (DEC) takes a longer time and also has problems of side effects and compliance which shall not be the case with salt fortification. But let me add an ethical side to it. Use of iodine in salt or of fluoride in water, are both cases of addition of naturally existing substances. People and critics can therefore not say much against it, as they ingest this item in regular quantities every day from natural sources.

A drug on the other hand is not something that you consume on an everyday basis. You take it only when you are ill, and therefore you can pressure a person to take a drug even for treatment, let alone on a prophylactic scenario. Then you can say, that this fortification will be done only in areas where there filariasis is endemic. The Ramaiah article states 18 states/UTs or 412 million people are infected (almost 40-50% of the Indian population). That would imply two types of salt, one fortificated in endemic areas (half of India) and the other normal.

If you do implement a dual strategy it falls in achieving its objective because of the high amount of migration and also people willing to cross districts to get normal unmedicated salt if they may so desire. Next up is the problem with people who are willing to take the salt, they can argue why all year long when I can make do with once annual drug ingestion exercises. Of course chronic exposure to low dose DEC could be more harmful than single high dose – at least in people's perspective. These motivated people might then also migrate towards using normal salt.

Then is the case of policy, presently iodized salt is being sold in India and it is illegal to sell uniodized salt. Suppose we plan to make such a policy to implement fortification of salt with DEC in the whole of India. But before that, why would we need such a policy? Firstly, Government of India doesn't make salt, private companies do. Yes the private sector has a social responsibility but not at the cost of their market. So until you enforce some laws, salt companies will not pick up using DEC in salt. Suppose one company does pick up this, all those consumers wanting unmedicated salt will switch allegiance to other companies, thereby decreasing sales of the company. You can argue that there will be a section of population that would want medicated salt and so start buying this company's salt. For any company, when it comes to making a decision about whether to keep loyal customers against getting new customers, they will always favour the former: keep your customers.

This was the reason why iodized salt was not working in India as there was no law to enforce it. Therefore, until you have a blanket ban on sale on unmedicated salt, there is no way to ensure that fortification of salt would meet its purpose.

Here it is worthy to point out that the use of medicated salt is also favoured because it would take much less time for us to eliminate filariasis. But that is only possible if say everyone in the country uses medicated salt for that one year simultaneously. Therefore a ban becomes all the more a necessity to get such quick remedial action on way. Without a ban, you may fortify 70% of the salt sold in markets, it reaches to 60% of people and 50% of them consume it; how different is this from MDA then.

But not just benefits, when enforcing a blanket ban or a strategy so radical so as to influence everyone in a country, the drawbacks and side effects are necessary. Yes DEC is good for people that may have filariasis, but what is more important is the fact that DEC should not be harmful in any given way to anyone in the country. Suppose someone is allergic to DEC, where would that person go if all the salt in the country is fortified. It then amount to forced feeding of the whole country with something the experts think is good for the people.

Also does fortification of salt with DEC spell some problems for other sectors or public health endeavours? Iodized salt could become a problem, given that people will start first recognising DEC as a problem of forced feeding, and then iodine. This may lead to setbacks in the goiter control programme. Also if the salt is already fortified with DEC, the place for MDA would be little. People compliance would decrease as they are already taking the drug in salt. And if the salt fortification did not work, then you are left with a depleted intervention (MDA) with little people confidence in DEC...

Just some thoughts of an overworked brain, I guess most of these things must have been discussed already and addressed in policy papers. I still have to go through them and shall write a more informed post later.

The article: 

Ramaiah, K. D., Das, P. K., Appavoo, N. C., Ramu, K., Augustin, D. J., Kumar, K. N., et al. (2000). A programme to eliminate lymphatic filariasis in Tamil Nadu state, India: compliance with annual single-dose DEC mass treatment and some related operational aspects. Trop Med Int Health, 5(12), 842-847.

Jat gets crazy paaying Bhangra