Ayurveda - The Science of Life

You know it's saying something when within the 1st 5 minutes of checking into a guesthouse the owner says, "shandi shandi," or "relax" "chill out." Hmm... I guess I was a little worked up after surviving a 15-hour train ride as a single white female in India going from Vellore (Tamil Nadu) to Varkala (Kerala), a beautiful place which is known for its spectacular cliffs and nice beaches:

Well, what other way to do that than do a 21-day Ayurvedic treatment? Yup! Welcome to the"Science of Life" or Ayurveda that seeks to protect life and longevity. The idea is that we have an intrinsic order and balance, 3 doshas in our bodies: Vata (wind or air), pitta (fire) and kapha (water/earth). Supposedly, if either of those are severely out of balance, that leads to disease. So almost until the last day, I thought the whole purpose was to have them even out, but the ayurvedic doctor says that they will never even out.... it's basically just trying to restore them. So after looking at how many times I blink, how I talk, the way I walk, my mannerisms, my blood pressure, body type, the ayurvedic doctor determined I was mainly kapha, then pitta, and less vata. Based on those things, and also that I am relatively healthy without ailments, we did more or less a "Rejuvenation" package. People really seek this treatment anywhere from helping with arthritic pains to slimming, and I think that you have a specific ailment, they really do cater towards with treatment programs via medicines and/or oils. Fortunately, I don't have any of that.... yet.

Here is the resort, Krisnthatheeram, where I did my treatments and where I ate:

What most people think of Ayurvedic treatments, they think oil, oil, and more oils. And yes, they sure use a lot of oils. The last time I was in India I did 2 single Ayurvedic treatments. The 1st time it was super oily, awkward, and uncomfortable. I didn't like it at all. I decided to do another one because I figured it was probably just that treatment center which happened to be in a gym. Nope, the 2nd one was equally as oily, awkward, and uncomfortable. Why did I decide to do 21 days of it? Basically, they say, and I see it is now true, that the only time you will really benefit from it is if you do at least 2-3 weeks. Being that I had nothing really else to do these 3 weeks before xmas and I actually had some friends here that I met on the Arctic Circle trip that were also doing it, I thought it would be a nice way to treat myself.... from all the hard work of this sabbatical travel life :-)

I started with "external" cleansing... the body is prepared for 5ish days before the "internal" cleansing begins with an ayurvedic diet, oil massages and herbal steam baths.

Then comes the "internal" cleansing or "panchakarma" - internal purification. This can be done through a variety of ways, "vaman" or vomiting (really. And no, I didn't do that), "virechan" or purgation (drinking medicated butter. Yes, not the most pleasant of them all),

"vasti" or enemas (purgation through the rear-end), "nasya" or elimination of toxins through the nose, and finally "raktamoksa" which is detox of blood (leeches and other things which I DID NOT need or DID NOT do!). I had that to do that drinking purgation of "ghee," medicated liquid butter for 3 days. I survived. Then one day I took this little black pill to encourage "loose motions" and have lentils and literally rice with water all day,

then to top that off (I guess I have a dry colon, not to give too much information!) I had that "ghee" "vasti" cleansing. Ew, I know. But hey, when you do something, you got to do it all the way, huh? I have to say, I do feel "lighter" and detoxed!

So yes, between the 3 ayurvedic meals a day and 2 hour treatments, time passed quickly! Treatments was everything from them hanging on a rope and massaging me with their feet,

(Above is my therapist Biji, who literally hung onto that rope to massage me with her feet, ha ha).

to "shirodhara" or medicated oil dripped onto the forehead...

to that medicated "ghee" in my eyes, ears, and nose. And when I say I think I've had every aspect of my body, I'm not lying, from my ears to my cheeks to toes to..... yes, everything. Again, something to get used to.

Also, an important component of Ayurveda is diet, and for 3 weeks I ONLY ate vegetarian foods, no-spice, no eggs, lots of fruits and salads, and lots of curries:

Besides that, I spent the remaining time on the beach reading (I think I ended up reading 6 books!),

taking walks, doing window shopping or real shopping (hehe, things are too cheap here!),

hanging with friends I've met, lounging on the hammock,

having afternoon fruit shakes or tea, and going swimming. Tough life, I know. The 1st week I didn't feel much difference, but now I do feel my skin is clear, soft, and shiny, my hair is softer, and I think I even lost a few well-needed extra pounds (3.5 kg's!) I gained from all the meat eating in Serbia.... and carb eating in Ghana, etc.

As you see, life has slowed down a lot for me, so I was majorly entertained by the fisherman action. I never realized how much work it is, and it was really interesting to see them... and hear them. I have some cool videos of them shouting at each other but for now hopefully the pictures will do:

I also went to a famous Keralan traditional temple dance drama called "Karthakali." Back in the day, these performances would last at least 5-7 hours. Of course now that it is a tourist thing and there is no way people would sit for that long, it is condensed to 3 hours... 1/2 of which is the make-up and preparation. That was super interesting to see and I can't believe that every night they spend at least 2 hours of make-up and prep. The show was actually very short and had, umm... let's just say interesting plots:

"Nakrathundi and Jayantha: Nakrathundi was a servant of an Asura King Narakasura. She is a demoness. She went of Devaloka the abode of Devas to capture maidens to give the king Narakasura. On the way she saw Jayantha the son of Indra. She fell in love with Jayantha and wanted to marry him. To fulfill her desire she assumed the form of a beautiful girl and asked him to marry her. He drove her away. She got angry and assumed her real form. There was a fight between them. In the flight Jayantha cuts off her nose, ears and part of her body...." and some other stuff added to that that made somewhat sense. Here are some pics from the performance:

So yes, the drama was actually done without speaking and using facial and hand gestures which were... fairly easy to understand. I really liked it, something different and again, I was just flabbergasted on the make-up and costume dressing that goes into it!

(The above is them putting this ointment in the eyes that literally make the eyes turn red. It actually looked like it hurt, although he claimed it didn't. They also made a joke that often Indian students will get this to put in their eyes and claim they have red eye to get out of class. Those Indians, always up to something!!).

Now.... it is almost Xmas time, and I probably wouldn't have known it if I wasn't getting emails asking me where I will be for Xmas. Here there is no xmas music, no gawdy green and red ornaments, no trees, nothing. There is a part of me that enjoys being away from it all, BUT I have to admit I do kinda miss catchy xmas tunes. I will be spending the next month in Sri Lanka... mostly in Tangalle to meet some friends I met the last time I was here and then may do some mini travels from there. Now beings the R&R phase of my travels... beach, beach, and more beach!!! And sunsets, sunsets and more sunsets (I'm obsessed, I know!)

Sooo... I'm sending off 2010 happy, relaxed, rejuvenated and energized, a few pounds lighter,

and want to wish you all MERRY XMAS AND HAPPY NEW YEAR!!!!! I welcome 2011 with open arms!

A+ for HVO!!

Well, I did it!!! I just finished one of the main things that was the main reason I went on this big trip in the first place... "official" volunteering! All this volunteering I did beforehand were independent, but for this, I went through an organization, Health Volunteers Oversees (HVO or hvousa.org).

I liked them because you didn't have to pay to volunteer (hmph), as many organizations make you do, and I liked the mission of improving health care by education. HVO had several locations specific to Physical Therapy: Peru, Vietnam, India. I chose India because from travelling here a couple of years ago I was familiar with it and also liked it and didn't mind coming back. I also was impressed with the location being at the Christian Medical College, CMC, in Vellore because this is actually one of the best hospitals in ALL over India. People literally come from all over to get care here, so impressive!

The Outpatient Department (OPD).

The "assignment" was 3 weeks. In those 3-weeks I was to teach and give lectures daily from 1-1.5 hours, and then also spend time in the clinic. So my day began at 7:30 am and I would typically get home around 7 or 8pm. My lectures were from 5-6:30, but often I stayed later for questions, and as they are in the clinic from 8:30am-5:00pm. But first, always starting with a morning prayer:

Most of my time during the day was in the clinic or spent preparing for that days lecture. LOOOOOOOOOOOOONG days, I tell ya! I was often exhausted at the end of the day and I never realized how hard teaching is! It wasn't just the prep work, which was a lot, but it was the details, concentrating on speaking slowly, trying to understand if they understand, adapting to the different knowledge/levels.

My class consisted of approximately 40 students, and when we had our "lab" time (practical), it was pretty hard with just me to go around and try to teach, demonstrate, or answer questions. I actually became a dictator a couple of times in that I used a whistle I got for travelling (safety and it has a compass on it!) to either get their attention (they are ALL under 28 y/o, hence distracted) or to move onto a different demonstration. But yes, this was very very challenging. Where are TA's when you need them? :-)

I found the staff here very very very very smart! They are excellently trained in "theory," i.e. very "book smart." A little out-of-date with evidence-based stuff, i.e. they have a whole "electrotherapy" department whereas we are trying to ween away from modalities in the States...

But overall, I was impressed by their knowledge and some even caught me off guard when they started talking about super technical things like force vectors and momentum arm. Uhh..... I haven't even thought about that since grad school. Having said that, they often had challenges with comprehensive and didactic thinking. I learned when I got here that they were definitely more interested in the hands-on stuff, like mobilizations, manual therapy.

Class before a 'theory' lecture. There was a screen for power points behind me...

...And class for the practical sessions. There are 9 PT departments so this was an opportunity for them to learn, but more importantly, see their friends :-) ha ha. For the lab sessions, I would be placed at a plinth in front and either have an actual patient or a staff member demonstrate.

So I really had to work hard to revamp a lot of things I prepared to make it more practical as well as to stress more practical exercise interventions for their patient population (a LOT of chronic issues).

Teaching was okay, I did find that the more interactive classes were both more interesting (and fun!) for myself and the staff. But I especially LOOOOOOOOOOVED the time I spent in the clinic. It was a good chance to get to know the staff, to apply and teach them some of the things I taught in class, to show them (hopefully) new or different things, so nice. AND, towards the end I even had my own patients which I primarily saw (an AVN patient,

an osteosarcoma patient). These 2 patients in particular touched me because they were so young and so sweet. They were both from Bangladesh, and the boy, Season, was so motivated about his walking, and it was soo nice when we got him up walking. And the girl below was going through radiation treatment and was super sensitive and apprehensive when I first started working with her... had absolutely no active movement and because after her last shoulder surgery she didn't move much, not only was her shoulder joint stiff, but also the soft tissues and skin around it. BUT by the end we were goofing around (as much as we could with the language barrier) and she loosened up. Better yet by the end of my stay she was able to lift up her arm and eat as well as reach behind her head. Ahhh.... sniff sniff. I know it sounds like a little, but those 'little things' mean sooo much to a patient when they can't do it.

So yes, their patients are definitely different than what I would normally see in the US as here even in outpatient ortho we saw neurological cases, cardiopulmonary cases, even pediatrics as young as 6 weeks! etc. So yes, learning experience for me as well!!

(Above: not the 6 week year old!)

I think the biggest observation of the Indian culture is that they are EXTREMELY reserved. In the class setting they would NEVER ask a question nevertheless answer it. Not to say I was a big fan of teachers calling on me, BUT I almost was feeling down that there was absolutely NO interaction during the lectures. Then the director told me, and actually previous volunteers through a Volunteer Trip Report, that that is how the Indian culture it. It is actually seen as rude to answer a question or even speak up because it is almost as if you were putting the teacher on the spot... and of course you actually DON'T want to be seen as a "superior" amongst your friends. Soo... I just tried to make my lab sessions more interactive and also that I can be easily approached. Funny thing was just being there for 3 weeks I went from being called "ma'am" and "madam" to Ellen... it did take at least 2 weeks for both of us to get familiar and comfortable with each other. Ahh... the good 'ol teacher/student relationship.

They were very respectful to me and as with any class, some were very inquisitive and eager to ask questions and others almost avoided me. So again, that dynamic was always interesting. And I have to admit I had my favorites as well that I tended to hang around more.

The thing that was the most interesting is how their system works in the first place. They get referrals for 1-day, 3-days, or say 1 week + (more serious conditions). Also a lot of flexibility with that and it is fairly easily for a therapist to ask for more. Being that they just have 20-40 minutes with a patient (usually 20, supposedly 40 their 1st visit), hence 16-20 patients/day, they often don't fully examine or evaluate, and just jump into these already-written home exercise program hand-outs. Soo... critical thinking not the best. Of course doesn't apply to all. So I tried to be proactive with teaching them even quick functional assessments and... more importantly, thinking "outside the box" (or in this case, outside of the already written hand-outs). I had to be very very polite and cautious with my constructive criticism, i.e. when a staff member asked me why I was concentrating on a hip (with a particular knee patient) than the knee. A big part of me (in my head) was to jump and be like "WHAT?!?!? That is soo basic! You ALWAYS assess the joint proximal and distal to the affected joint!! Helloooo??" (I would never really say that). But I instead I answered politely and non-confrontational.

But anyhoo, below are just a couple of many things I caught them practicing that I taught them, YEA!!!

Closed kinetic chain for rhythmic stabilization.

Well, they know this, but this is Level 1 core exercise of marching with abdominal bracing. This gentleman had low back pain and the scene before this, he was working his upper abs for superficial strengthening (NYET), and I quickly jumped on the scene to address core strengthening.

Gasp, they weren't familiar with the sleeper stretch for posterior capsule shoulder stretching! This is the BEST exercise for that and to increase internal rotation ROM. I also taught it in standing. It was SUPER rewarding to see them actually use techniques I taught! Woo hoo!

As this is a Christian hospital, as far as insurance, I think everyone has to pay a very nominal fee, like 50-100 rupees ($2-3 USD) and as I understand it "we overcharge the rich (those with private insurance) and undercharge the poor." There are also many donations that come to CMC so EVERYONE gets treated. They DO NOT turn away patients, which is nice. And I think extra money from these "rich" patients go to patients that can't afford care. So donations come a long way here, as do patients for that exact same reasoning. CMC is known to provide a full comprehensive exam to get a specific diagnosis. Of course there are always infrastructure issues, but where is it not?

Another impression I got, and this is similar to what I saw in Ghana, was that families are 110% involved in the patient's care. There was ALWAYS at least 1-4 family members with each patient.

So yes, the gym got pretty crowded sometimes! And also we had to explain not just to the patient exercises, but also the family member. It was tiring at times, especially with the language barrier. I think I am now a expert at hand signals and demonstration because I am proud to say that I think most of the patients seemed to understand what I was doing ("seemed" is the key word! I tried to have them repeat what to do to confirm, but who knows!). I also picked up on a few lingo tips that I found helpful... they say "loose" for relax, "level" for straight (like "level your knee), and some other little things.

Also similar to Ghana than my other volunteer experiences was that patients typically seek help when their state is chronic... or very debilitating that they finally seek medical help. So we saw a LOT of arthritis and osteoarthritis patients. Again, because of this I had to revamp a lot of not only lectures but also my clinical help because of the fact that I am used to seeing acute patients, so the examination/evaluations were a bit different, as well as the interventions. As I observed in Ghana, and same as in India, the people can take a lot of pain and suffering.

My last day we had a finale party! It was soo nice! They gave me this Indian outfit that I am wearing as a gift as well as a CMC plate. Then the director gave a nice speech, I gave a little speech, and then we passed out certificates to the staff that had 90% attendance or higher. There were actually a lot of participants!! It was really fun!

Samual, me, and Andrew... SUPER SUPER SUPER nice and helpful to me! They are the main people in charge of the PT department.

Andrew giving a speech about me! Sniff sniff.

Again, besides the outfit I am wearing, they gave me this CMC plate. Very sweet and thoughtful!

Me giving my speech! I thanked them for their time and attention, and highlighted some key points of my lectures I wanted to emphasize.

My audience! The 40+ staff that came to my lectures.

And finally (pics above and below) presented certificates to the individual staff.

Soo.... besides the hospital volunteering, which took about 90% of the time, I did a little sightseeing via autorickshaw of course!

I was invited to their graduation, which was nice,

This is a tradition to have a 95 foot jasmine (similar to a garland in the states) chain for a graduation. It smelled beautiful and both aisles had it (luckily I was sitting next to the aisle and could smell it!). I understand it took 80 people 4 full-days to put it together!

Me with Andrew (on my left), the director, and Samuel (on my right), the manager of the PT department.

They have this funny tradition where after the graduation there is a dinner and the newly graduated students serve the staff. Nice!

Me with Sylvia (on my left) and Winrose (on my right) - my fave PT's!

and also ventured to the pool near campus,

and visited some of the bigger sites in Vellore, the Golden Temple (HUGE temple!) and a Roman Catholic Church.

All right! I've been thinking and was a little anxious about this teaching thing since I left the States for my travels, sooooo it feels nice to be all over. Phew! Next stop, Varkala! It is in Kerala, all the way at the bottom of India (literally, the very very end). I am meeting with some friends I met on the Arctic Circle M/S Expedition Trip I was on, so it will be nice to be with people I know while I am maxin' and relaxin' on the beach for the next 3 weeks! So until then!