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You just can't judge. And Blogger is down.

Jan. 26th, 2006 | 04:37 pm
mood: blahblah
music: Random dance CD

Random thoughts:

- There is no real epidemiological reason that Southern Africa has such a high HIV rate compared to, for example, West Africa where it originated where people are just as promiscuous, or SE Asia, which had a huge problem with it not so long ago.
- Given how careless people are with condom use in Australia, it's surprising we don't have more of a problem with HIV.
- This really means I sympathise with people here a lot. It's kind of scary.
- Kaposi's Sarcoma is gross.
- You can't study HIV medicine from most textbooks because half the stuff you see in the field is either new or contradicts commonly held opinions.
- Given that they know they have HIV, some people here should bloody well use condoms. You know they don't, because they turn up with multiple gross STIs. Like syphilis.
- HIV medicine is just like normal medicine- in that there are exactly the same topics except that HIV rewrites all the rules.
- There is a heap of office politics going around here. It leaves an unpleasant taste in my mouth.
- I haven't written on here in a very long time.

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Swaziland! And some other random notes.

Jan. 19th, 2006 | 03:43 pm
mood: contentcontent
music: Random Swazi music

So, here I am in Swaziland. One of the countries with the highest HIV rates in the world. One of the richest countries in sub-Saharan Africa. A very different place than I would ever have expected from that description!

The people are... hot. And friendly. And very funny. I think... you can stare at pictures of orphans with HIV all you like, but nothing will prepare you for, well, dealing with people. Individuals. Or a country rather than a continent. I was fully preparing to NOT be facing a stereotype. But I didn't realise it would be as idiosyncratic as it is.

This place is so quiet that the headlines here scream of the drabbest stories. "Man has sex with dog", "13 year old girl reduced to ashes". Everyone smiles at you and says hello. In a sincere manner. Amusing things happen on a regular basis. The doctors tell jokes about sex and religion. Children waste away because of HIV, and there you are, writing a prescription for HAART (combination therapy for HIV), thinking "there is something wrong with this". Babies gurgle, relieved after the doctor has, with difficulty, taken some blood for a CD4 count. It hails, and a girl working in VCT (HIV outpatients) accompanies me with an umbrella to where a research project is based, while we hope to avoid the lightning... Lightning causes a ridiculously high number of deaths in this country.

It's a good place. I could work here. People are overworked, but relaxed. It's depressing but fulfilling. It's... somewhere where I would be needed. Though, definitely a temporary stop on the way to the grave. But I really like it here.

My cousin and her family are very cool. I'm having a great time, and I'm not lonely at all! She's a bit... homophobic though. But in a way, to say that would be looking for things to be wrong with being here. Which there really aren't :).

Oh, and I went shopping in Singapore. Yay!

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Last day...

Jan. 13th, 2006 | 08:51 pm
mood: nostalgicnostalgic
music: The Thrills - Just Travelling Through

This is my last day in Sri Lanka, or to be more accurate, my last few hours. I shall be leaving tomorrow morning at a “sprightly” 7am.

Do not be fooled, dear reader, for I have accomplished much over the past two weeks, despite my lack of diligence in regards to posting on here…

My last 2 weeks in Sri Lanka were made a lot better by the appearance of a class full of local final year students, as well as two Melbourne Uni students in my year who were similarly on elective! They were fantastic, funny, good company, full of life, great translators and even better friends. If it were not for them, I would have been homesick and unhappy over here. I now have several email addresses and postal addresses shall soon have, hopefully, a copy of a photograph of 20 or so beaming medical students, all in their shiny white coats!

I had a great time over here. From the sibling rivalry and mock fights and banter and random tickling with my little cousin Sasika, to the herd of buffalos that randomly grazed on our road, to the chaotic bus changes every day, to the lunchbox filled with delicious rice and curry and lovingly wrapped in a checkered cloth square by my Aunt, to the chocolate milk that tastes far better here… I have had what can only be described as a vivid and unforgettable elective.

This morning, I arose from my bed in Kandy for the last time. My bags were packed meticulously, all my clothes (for a change) pressed neatly. We ate quickly before setting off. It has been raining, on and off, rather heavily, and the sky was heavy with thick grey cloud. We drove through the city of Kandy, which I now know well, past Mahaiyawa train station, over the hill, past the clock-tower, past the Kandy train station. Followed the tracks that ran alongside the new road to Peradeniya, and I saw the University and the hospital for the final time, as we turned away from the city. Down the famous road that winds down to Colombo- a heavy fog clung to the mountainside as we left that mountain citadel- and past the many stalls selling clay pots, then wickerwork, then cashew nuts, then (oddly, bizarrely) blow-up cartoon figures, empty because of the Poya day (Buddhist full moon holiday). Finally we had descended the mountain, and the road drew us closer and closer to Colombo. Heavy traffic went the other way, Colombo-dwellers heading through Kandy to Bandarawella, Nuwara Eliya and other places for the long weekend. Finally, as the numerous small towns we passed merged together into big city, we entered Colombo.

I have seen my relatives in Colombo for the last time. As usual, I regret the brevity of my stay here. “Next time”, is what we always say.

Tomorrow I shall be having a 12 hour stopover in Singapore during which I am likely to go shopping. In roughly a day and a half, I will be in Swaziland, meeting my cousin, for one of the first times in my life…

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A Day in the Life

Jan. 3rd, 2006 | 03:18 pm
mood: cheerfulcheerful
music: Katrina and the Waves - Walking on Sunshine

My shoes shined to a full gleam, my trousers pressed, my shirt ironed. Face scrubbed, teeth brushed, hair combed and tied up. Bag packed- rice and curry in my lunchbox, an apple, two notebooks, a bottle of water and an umbrella. This is how I started the day. I said a rushed "good morning" to my uncle, aunt and cousin Sasika. I sat to breakfast, ate my bread and cheese hastily, knocking back a couple of glasses of water. My uncle quietly read the paper, and my aunt rushed to get things ready. Sasika and the servant, Arungam bickered as usual, a strangely comic banter. My uncle, aunt and I exchanged a look of amusement and could not stop ourselves from laughing heartily. I finished eating, said a quick "see you later", and stepped out the door...

Our house, a new, affluent one, sits on a hill, overlooking an area that sits on the borderline between slum and poor neighbourhood. A designation of "slum" is, I believe, somewhat suspect, as most of these cobbled-together dwellings in fact have a television, all of them have electricity, and there is ready access to clean water and sanitation.

(A side note: Interestingly, Kandy is a racially diverse area. There are large numbers of Tamil and Muslim people here- Muralitharan (who is a Tamil) is probably the most famous alumnus of St Anthony's College in Kandy. I have several half-Tamil half-Sinhalese second cousins in Kandy, even!)

I walked briskly down to the bus-stop. The buses here, noisy, hot and packed with commuters, run every minute or so. I waited for a bus that was fairly free of congestion, then hopped on. I managed to squeeze myself into a seat within a couple of minutes. I got off near the clocktower, caught another bus that was heading to Peradeniya, and daydreamed some more.

Soon I was at the hospital. Today was the second day that the final year students would begin the last of two medical professorial appointments. We had a brief tutorial about pyrexia (fever) of unknown origin while we waited for one of the students to interview a patient with chronic renal failure. I surprised myself by knowing many of the answers. I was on fire! The student finished writing his history up, and we proceeded to the tutorial room...

"So, tell me what else can cause loss of appetite, nausea, vomiting and malaise."
The registrar, our lecturer, narrowed his eyes, focussing tightly on the student.
You could almost see the beads of sweat on his brow. The student fidgeted nervously. His history was not up to scratch and the attention of the class was upon him.
"Anyone else?"
The classroom was almost silent, nervous whispers of thoughts passing back and forth like ripples in the current. Tension so thick you could cut it with a knife. A thousand answers rose in my head and fell back again, defeated.
The creak of the door opening. We turned to see that it was none other than...
"Brendan Whiting?!?! What are you doing here?"

So it seems I am not the only Melbourne University student in my year doing an elective here- who would've thought?

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Various things

Dec. 29th, 2005 | 10:33 am
mood: boredbored
music: Teen Girl Squad Theme Song

OK, so the weirdest thing just happened. Apparently Suji, the Canadian elective student who's here with me was trying to take a photo of the hospital and ended up getting chased by the hospital guards (who, by the by, carry guns). She just came in here, visibly shaken and crying. How absolutely bizarre. I mean, I guess they would have misinterpreted what she was doing as a security risk, but it seems rather callous of them. Suddenly I feel a lot less happy to be here. Things like that just end up increasing your sense of alienation.

So, in Sri Lanka, there is often overcrowding in hospitals, and patients end up with no bed, either on the floor or in chairs. A couple of days ago, a man who was in the "local ICU" (like a Coronary Care Unit, but in the ward itself) who had had a heart attack was moved to one of the beds in the ward, thus replacing a patient with valve disease. A loud argument erupted between the two patients when this happened, the man who was losing his bed accusing the other man of deliberately taking his bed and being ungrateful.

I now also understand why they have male and female wards. It's because rather than having rooms of 2-4 patients, basically the whole ward is open, with many beds and pretty much zero privacy. There are also mosquito nets above each bed, to prevent the spread of diseases such as dengue and malaria.

It seems like my trip to Colombo might be a bit of a waste, since I won't be able to meet up with at least 3 of the people I was planning to catch up with. Stupid New Years' weekend.

I miss sushi. I I miss videogames. I miss my mum. I miss videogames. I, I, I miss my mum. (If you didn't get the reference, all I can say is, "maybe when you're older").

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Good Day.

Dec. 28th, 2005 | 01:15 pm
mood: cheerfulcheerful
music: The Dresden Dolls - Gravity

"God it's been a lovely day
Everything's been going my way
I took out the trash today and
I'm on FIRE...

...so you don't wanna hear about my good day?"

I can't get that song out of my head! Well, the whole Dresden Dolls CD in general. It's on repeat in my head, thus replacing Cake's "Haze of Love" and The Killers with "All the things that I've done" and "Love song for a girl" by Diana Ah Naid. Sometimes I get slightly creeped out when I have a series of songs in my head like that... is my head trying to tell me something?

And in other news, I'm having a good day, and I'M ON FIRE! Wow. So, ever since I worked out that I should just follow this particular registrar, who is, by the way, an excellent teacher, suddenly my life improved. I got to see some pretty interesting stuff again today and learn things. Then I went off to a lecture on Polyneuropathy (grrr... now I remember why I hate neuro so much) and got an invitation from one of the Anaesthetists to get taught intubation and spinal blocks and other kick ass things! I feel a lot less useless and overwhelmed now, which is good.

Given that I started my day with "I don't want to go to school"-itis (stomachache subtype), I'm quite happy with the way that this has all turned out.

Let me just make it clear that in my last post, I was referring to a phenomenon which only affects a minority of people- there aren't that many people who are weird and hostile about the foreign-born Sri Lankan business, it's just a few fairly loud ones more than anything. Most people are vaguely curious and very friendly.

Anyway, not much more to say. Off to Colombo this weekend. I'll try and update before that.

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First day of General Medicine

Dec. 27th, 2005 | 01:05 pm
mood: lonelylonely
music: Cake - Stickshifts and Safetybelts

I'm officially homesick. I miss my computer and my friends and drinking and good coffee and decent films and TV and the English language. So today, I'm just going to complain on here.

So, I've finally started. *sigh*. I'm feeling exhausted, and it's only lunchtime! I think I managed to join three ward rounds, during the course of which I learnt the following great lesson: Consultants make crap teachers, and registrars make good ones. For the uninitiated, consultants are specialists, and also at the top of the medical food-chain; registrars are specialists-in-training and do most of the day to day management of the ward. For whatever reason, the registrars seem to be a lot more interested in teaching and explaining and have a better grip on what sorts of things you should learn. My theory is that consultants just live in another world, really.

I suppose things will get better once there are other students around. For now, it's a bit crap because I'm the only one. I already feel very much like I'm back in the grinding mill that is my chosen profession. What does that mean? I already feel stupid, having been asked a whole lot of questions that I should know the answers to, but don't, on account of the fact that I wagged renal and neuro. It's a bit crap when you work out that proximity to your future job is inversely correlated with your self-esteem.

On the other hand, I managed to see a fair few cases of dengue fever, something I've never seen before, as well as a case of Takayasu's Arteritis, something I may never see again.

I keep getting the distinct impression of a certain amount of hostility towards foreign-born Sri Lankans here. Something along the lines of how we're all arrogant snobs with no idea of the local culture or the way in which people live. To add insult to injury, we also haven't bothered with learning Sinhalese properly, because we're "too good" for it or something. Whatever it is, it's starting to annoy me. I've heard a couple of remarks about what foreign medical students are supposedly like already, as well as managing to overhear no end of comments made by other random people in Sinhalese, a language that I can understand perfectly well. I read a review of a short story in the Sunday paper which was about how one of the characters, a foreign-trained doctor, is totally out of touch with the local culture and dehumanises the patient, who is from a remote village. I find it outrageous to assume that because I don't live here that I know nothing of the culture and have a high-and-mighty attitude. I've spent a fair chunk of time here, over many visits, I've spent a large proportion of that IN villages, and I certainly understand the culture here well, as well as being able to understand Sinhalese. To be perfectly honest, I've met many people from Colombo who have far less knowledge of the true state of this country and its people than I do. Hypocrites.

We (my uncle, aunt, cousin and I) went up to Nuwara Eliya on Sunday with Iresha, one of my second cousins. My 9-year old cousin, Sasika, kept trying to bully me the entire time. Heh. It was a fairly good trip. Nuwara Eliya is at a bit of an altitude, so is about 10 degrees cooler than Colombo. As a result, all of the European-type vegetables and plants are grown there, and it is full of pines and other coniferous trees. We went to a stuffy establishment for lunch, of the kind that is mostly frequented by rich tourists and rich people from Colombo. An oppressive silence hung in the air, as thick as a velvet curtain and just as old-fashioned (to use a Dire Assassin-ism). Our (whispered) conversation went a little like this:

Me: Are we allowed to talk in here?
Iresha: I have no idea!! It's so quiet!
Me: I'm too scared to use my voice.
Iresha: Maybe we should whisper?
Random tourists on the other table giggle

Some woman also asked my relatives if I was Indian. Then we stole some cacti. The trip to Nuwara Eliya, one way, was 3.5 hours or so, despite it being only 80km from Kandy. As a result, we were exhausted by the time we returned home.

I've been alternately hot, tired and ridiculously hungry since getting here. I keep going to bed at 10pm, exhausted. I'm clearly not used to 8-hour sleep times.

I'm going to buy myself a calling card today.

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A Life Less Ordinary

Dec. 23rd, 2005 | 01:18 pm
mood: amusedamused
music: The Killers - All the Things that I've Done

How do I explain how Sri Lanka is alive in a way that Australia is not? Perhaps it's just the crowding, the heat, the chaos. Whatever it is, there is life everywhere, the streets are packed and busy, there is culture all around you, all the time. Cobblers on the pavement, fixing shoes, street vendors selling guavas and mangos at the top of their voices, three-wheelers (tuk-tuks) winding in and out of traffic, rickety buses squashed with people. The heat. Random goats, cows, dogs, cats and chickens. Blue kingfishers and other tropical birds. Hordes of crows picking at piles of decaying rubbish. Bus conductors calling out their bus destinations: "Akurana akurana! Katugastota! Akurana!".

We saw a water purification plant and came up with many ways to dispose of people. There were the "rapids of death waterfall manhole", the "mustard gas chamber", the "skirt-eating fan of doom" and the "sludge bucket". We hope to return some day to commit many a murder, some of which may be featured on such British shows as "Saturday night murders", "A murder too far", "Murder, a drink with jam and bread" and "the sound of murder". I can't believe this, but due to my unoriginality that entire paragraph will be reproduced on Snipergirl. Anyway, what was I saying? Sri Lankan plants are dangerous!

I am no longer sleeping in the same room as my grandmother who sleep-shouts. This is very good, as now I can actually get some decent uninterrupted sleep. In fact last night I was very happy to receive all of a sound 9 hours or so. While I had some odd dream featuring pretty Malaysian girls kissing each other and woke up feeling groggy as usual, the effects of my increased sleep is profound. I can string sentences together again!

We have also determined that the worst thing that could ever happen is going through Labour Colour Oedema Anaesthesia Theatre at the Centre for Paediatrics (OK, so maybe I went overboard with the Brytysh speeling, but really what I meant was labour, as in the pregnancy, not as in the work or the politics. Isn't it a shame that you didn't end up at the Women's Hospital, you ended up at the CHILDREN'S?!?!?!), while you're passing a kidney stone. Then, suddenly, you get a 3rd degree perineal tear. Then you get pyelonephritis (kidney infection). Then you have an asthma attack. So your obstetrician decides you're better off if you have a caesarian, making all that pain and suffering a bit, well, redundant. Then they shatter your kidney stone with ultrasound at the same time (this is the only happy part of this story). After all of that, you manage to get an amniotic fluid embolism, which manages to give you disseminated intravascular coagulation (DIC or basically having so many tiny little clots EVERYWHERE that you can just bleed to death). Then you die of strokes. The end.

"Thilini just said that it is ok to make fun of dead people ie if this actually happened to someone...she is going straight to hell in a handbasket!!!!!!!!!!!"

Clearly I have been having too much fun. Till next time!

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Dec. 21st, 2005 | 03:41 pm
mood: frustratedfrustrated
music: Jill Sobule - I Kissed a Girl

I passed med!! In fact I got an H3!! A middling H3, not just a scrape-through H3!! And I got depressed, had bad stuff happen to me and took 5 weeks off class no less!!


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The Girl and the Small Umbrella

Dec. 20th, 2005 | 02:56 pm
mood: contemplativecontemplative
music: The Killers - All the Things that I've Done

Kandy, the old capital during the days of the last Sri Lankan Kings, is a small city in the High Country (it is inland and at a higher altitude- as a result it is also much cooler, temperature-wise). It has old, narrow streets and buildings dating from colonial and pre-colonial times. The roads are thick with chaotic traffic. The slightly worn buildings are faced with busy, narrow shopfronts that sell all manner of goods- jewellery, watches, clothing, electronics, toys, food. It almost seems to be from another decade- the busy streets, the men in short-sleeved shirts and black trousers, the women in long flowing skirts and short fitted blouses.

Today it rained, fat raindrops pounding the city and turning me (dressed, once more, in my overcoat as it is rather cold these days) sodden. Pedestrians streamed past one another on the pavements, determined, carrying an assortment of umbrellas, and occasionally straying out onto the road in order to cross. I made my way hurriedly, bent over in the rain, to the umbrella shop. It was congested with customers, unsurprisingly. I pushed my way to the counter and perused the merchandise. There were no small, conservative, black umbrellas of the sort I was seeking; no. The plain ones were large men's umbrellas, and the small ones were ornamental and feminine.

One of the small umbrellas caught my eye- it was silky black with a red centre and patterned with small flowers. Opened up, it was bright, bold. Though perhaps a little garish, it seemed almost like it should be mine. I thought I would peruse the other umbrellas further. I came back empty handed. By this point another woman had "my" umbrella in hand and was deciding between it and a more drab greenish and somewhat old-fashioned one. To her, I feel, disadvantage, she ended up choosing the other umbrella, and handed me "my" umbrella with a smile. I bought it, and walked out, with this odd umbrella, quite happy.

I'm not sure what drew me to this umbrella. Its colouring perhaps? I have always been a fan of black and red. Or perhaps the ring of flowers that somehow reminded me of cherry blossoms, or maybe it was the small ornamental handle, in a delicate shade of blue-green. Whatever it is, it was an umbrella that stood out, even among the many designs and patterns of Kandy City. It was, oddly enough, very me. Even though it was this delicate, flowery piece. It was me.

What else? Some guy who seemed either sleazy or dodgy directed me to a cobbler and did not leave while my shoe was being mended. Wanker. I caught yet another packed bus from the chaotic bus-stop near the clocktower to the University. The crowding makes the bus smell intensely of stale sweat. Even on a cool, rainy day such as this one.

At the university, I discovered a building that was almost exactly the building from one of my dreams. It even overlooked rooves in the same way. The only thing it lacked were the abandoned dormitory rooms and cracked, mouldy bathrooms. The ELTU building (English Language Tuition Unit I think?) of the Medical Faculty. It was this very intense feeling of recognition- though I have never been to that part of the University. A similar thing happened to me when I went to the Flinders Street/Wellington Parade end of the Fitzroy Gardens. Odd.

Need to go and pick up my white coat from the tailor.

Till next time!

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