I clearly remember the day they found my breast cancer. It was a perfectly routine annual mammogram. I could see the concern in the eyes of my radiology colleague even as she tried to cover it. I am a physician myself and looking at that shadowy mass, my gut reaction was a jolt “Oh , oh! Now I am in trouble”.

 

   Why is it so? Why does the word ‘cancer’ trigger such immediate reaction of doom and dread? I am a pathologist. I daily deal with cancers and other diseases. I know the prognosis, the five and ten year survival figures. I know that, with the latest treatments, many cancers have remarkably good prognosis and many non-cancer diseases have dismal figures. Yet the cancer phobia lingers.

 

   No other disease generates such primordial reaction. Hear disease, diabetes, stroke and kidney failures are far more common than breast cancer and kill many more men and women every year. But, somehow, we have grown familiar to them and expect to live with them for a long period of time. We are not terrified of the severe morbidities, or the slow, painful deaths or the high cost of medical care of these diseases. But the diagnosis of cancer, of any body part, even if small, in early stage or of very low grade, can severely affect our sense of wellbeing.

 

   Perhaps it is a historic fear. After all, it is only recently, in last 2-3 decades, that the treatments and survival figures of some common cancers have shown some improvements. Up till the ‘70s, the prognosis of most cancers was uniformly bleak, and the treatment modalities expensive and painful to the extreme.

 

   I think we fear the treatment more than the cancer itself. The surgery, chemo and radiotherapy for most cancers have serious, painful and permanent side effects. The surgical removal of a breast is severely traumatic to one’s feminine psyche. It is an overt, visible disfigurement, unlike loss of vital internal organs. The loss of hair—another visible -- albeit temporary—disfigurement only adds to the surgical trauma. All this, added to the systemic illness due to the cancer killing medications and radiations make one thoroughly miserable. It feels like an extra punishment added to the trauma of cancer diagnosis. Often these effects may linger for years or be permanent reminder of the disease. It is a cruel irony that the treatment appears harsher than the cancer itself.

 

   Yet it does not have to be this way. It isn’t your mother’s breast cancer anymore! Unlike palpable lump, the breast cancers detected now a days are extremely small, non palpable and almost invisible to the naked eye. Consequently, the surgeries, too, are much smaller, less traumatic, entailing removal of only a small part of the breast, rather than the entire organ, thus making cosmetic reconstruction possible. Even removal of the lymph nodes from the armpit has changed. It is now far less traumatic, involving only one or two nodes instead of all, thus minimizing the risk of debilitating swelling of the arm.

 

   Yes, the chemotherapy and radiation still make the hair fall out. But easy availability of wigs and other prostheses make the changes more bearable. Even the side effects of vomiting, anemia and weakness are far less severe with the newer medications. Newer, less toxic and more effective anticancer drugs are daily being introduced.

 

   All these changes have improved the prognosis of breast cancer significantly. Now it is just another chronic disease one has to live with. Not unlike diabetes or high blood pressure. In other words, nothing special. No big deal.

 

   In the long run, I am convinced, it is far healthier to think of cancer as another chronic disease. Perhaps only then we will be able to get over fear and stigma of this all too common malady.      ---11/06 

 I cringe with fear when I think of our childhood days. What a dangerous time we lived in! Compared to the current safety conscious environment, we literally lived in death traps. It is a wonder that most of us survived unscathed. By all probabilities, we should have been dead, many times over.

 

To start at the very beginning, our mothers never had the ‘proper’ antenatal care by today’s standards. No ultrasounds, no blood tests, not even checking blood pressures. Many of us were probably born at home, in dark, stuffy small rooms filled with germs and women relatives. No forceps or C-sections, no certified nurses, obstetricians or pediatricians for our mothers and us. I guess only the strong survived.

 

But most of us lived through it all. We grew up on mothers’ breasts or unfortified formula from unsterilized bottles. We slept in cots without any regulation size railings, and in beds without getting smothered in our pillows. We crawled on dirt floors and caught every germ that came by including some very dangerous ones like mumps, measles and chicken pox. We played bare feet in the dirt, made mud pies and ate them, harbored a few parasites in our guts and a few million germs in our noses and throats. No one took our tonsils out, or put in ear tubes. No one purged us of the parasites or skin tested us for allergies to peanuts and dust mites. How did we all survive?

 

But we did grow up, somehow. At home the elders often ‘physically abused’ us whenever we acted up. In the play yards, we were regularly tormented by bigger playmates, little girls were always ‘sexually harassed’ by little boys. In schools, our teachers paid no attention whatsoever to our ‘self esteem’ and had no respect for ‘objectivity’ or ‘fairness’. There were no Parent-Teacher meetings and in any student-teacher conflict, the teacher was always the winner, with no court of appeals. We still somehow managed to master the three ‘R’s and even have some fond memories of those days.

 

In the playgrounds, things were downright dangerous. Toys had no safety inspections, no gender or age specific designations and by definition were void of any proven educational value. The playground equipments came in one size only, and were never inspected for safety. There were no safety barriers, no handicap access, no first-aid facilities and no adult supervisions. Getting beaten up or hurt was routine. Only the ‘sissies’ complained and nobody dreamt of legal actions.

 

We tottered on our non-regulation bikes without helmets or safety reflectors. We climbed trees and fell from them. We learned to swim in ponds and rivers without any instructors or lifeguards. We rode in cars without any childproof doors, car seats or even seat belts! We   rode scooters and motorcycles, clinging to our parents, without any helmets. Our prams had no safety bars, locks or padding, Kitchen cabinets and power outlets at home had no safety covers. Medicine bottles had no child proof caps. We still managed to avoid being run over, drowned, poisoned or electrocuted.

 

None of us got any allowances, nor did we dream of demanding payments for our chores. We were routinely recruited for clean ups around the house, running errands, kitchen duties, even babysitting our younger siblings. We worked without any minimum wage, in eternal servitude, in blatant disregard of any child labor laws.

 

We played with pets that were never vaccinated, flea protected or dewormed. We never flossed our teeth and never visited any orthodontist. Our holidays and vacation times were utterly devoid of any pre planned, supervised educational activities to broaden our mind. We still managed to have straight teeth and a lot of fun. 

 

Just imagine. We set off fireworks in our backyards, wearing clothes that were not fire retardant, wearing no gloves or eye protections, still avoided burning down our houses or ourselves.

 

We ate unwashed fruits and drank unbottled water. The meat we ate was never ‘inspected’, the home remedies we took for our ailments were never ‘FDA approved’. Our public buildings had no tornado shelters, no fire escapes, no smoke detectors, no sprinkler systems and no safety drills. By today’s standards, they would surely be condemned.

 

To be sure, some of us did die or suffer from serious mishaps, but the vast majority of us managed to grow up hale and hearty with good educations and happy memories of our childhood days. They say what does not kill us only makes us stronger. Does that mean our current generation is growing weaker? I wonder.

 

 india abroad/2004

 I have been told that the most memorable first impression in America for visitors from the Third World countries is the local grocery store with tiers of fresh vegetables, meat and all kinds of boxed and canned goodies. For a person used to perhaps one cut of meat and one brand of cereals, this abundance of choices can be positively dizzying.

 

We have choices in this country. Choices are all around us and permeate every aspect of our culture. We have choices of bread, soups, paper towels and razor blades. We have choices in education, health care, job and housing. On the whole, choices are desirable. We can select the item that specifically suits our taste and budget. We ca change the wallpaper in our living room, if we get bored of the cereal we can try a high bran or low sugar. We can choose the latest model of car to show off to our neighbors. We can send our kids to the best school across town if needed. All this sounds very wonderful, very American. Having the options to choose should make us feel more satisfied, more in control, right? Surprisingly, the answer is not that simple.

 

Various studies have shown that having varieties and choices does not necessarily make one more satisfied. As a matter of fact, often the opposite is true. Having to select from 12 different patterns of bone china may be exciting for some bride-to-be, but it would be a chore for most of us. Making a choice needs time and energy, two commodities in short supply in today’s high speed world. So we often stick to one or two tried and true varieties and ignore the rest. Of course, this fact persuades the advertisers to try even harder to catch our attention. Adding to the already high noise level of our life style.

 

Do we really need so many choices? Complete lack of varieties will not suit any of us, but I wonder if there is an optimum number beyond which one’s mind will wonder and eyes glaze over. I presume choices in luxury items like perfumes and lipsticks or varieties of food items may be essential to cater to different tastes. But is it really necessary to have 150 types of door knobs and dead bolts, toilet bowl cleaners and bottled waters, coffee makers and detergents?

 

Choices in expensive items too can cause significant anxiety and stress. Just ask any man trying to buy an engagement ring for his fiancée. For most high budget purchases, the buyer will have to surf the internet for hours, read up volumes of Consumer Reports, solicit opinions from friends and neighbors and comparison shop for days and weeks all over town before deciding on say a particular brand of color TV. Even then he may not be completely sure if hegot the best deal for his money or the very cutting edge in technology that he desired. And there is no guarantee that his brother in-law would not show up bragging about his own latest acquisition, and the ‘rat race’ will start all over again. All that is enough to give a man (or a woman) a severe case of heartburn! But, wait! What can you take for relief? Prilosec or Prevacid? Maalox or Xantac? Should you go for the best prescription drug or opt for the cheaper generic? Should you take them just in case you need it or wait and see? And what about the side effects? And the costs, the co-payments. The ‘choices’ go on and on. For every choice one makes there is a possibility that the right choice

 was missed. The probability of error increases with number of choices available.

 

The easy availability and societal acceptance of certain lifestyle choices have significantly altered our culture. We routinely change our jobs. The old image of loyal long term employee now rouses derision and suspicion of laziness and lack of ambition. we change our spouses for the slightest of reasons, with no social stigma attached. If we could we would probably change our kids and parents for ‘better models’ too.

 

Receiving healthcare has lately become a matter of personal choice. To avoid any hint of Marcus Welby style paternalism, the physicians (read health care providers) now expects the patients (read health care consumers) to be full and equal partners in the quest for health and to be aware of  the pros and cons of all the different treatment strategies for his ailment. The physician is there merely tp provide the information and make helpful explanation. I often wonder if this is always desirable. Would a lay person in chronic pain or some incurable disease be in a position to wade through all the information and make the best choice (not unlike ordering from a Chinese take out menu)? Or would he rather rely and trust his doctors to make the best choice for him while maintaining a veto power if and when needed.

 

Consider the issue of career choices. Our mothers and grandmothers were raised to get married, produce children and run a household. Yes, some of them might have chafed at the restrictions, but by and large the vast majority were satisfied ith their choices or lack thereof. In contrast, today’s woman is raised to be anything and everything, from the President of the United States to Mommy at Home.

 

She has received expensive education and the societal expectation that she ‘better do something more than just have a family’. Consequently she suffers from an ‘overdose of choices’. To satisfy all, she tries to do all and  invariably ends up exhausted and guilty.

 

I am all for equality of genders, but we need to have true freedom of choices. These high achieving women are not any happier than their grandmothers were. Perhaps I our enthusiasm to offer them allthe choices, we forgot to tell them that can not have it all, that Superwoman is a myth, that in life, the important ‘C’ word is not ‘Choice’ but ‘Compromise’. In life, one has to make choices and compromises. The key to contentment is making the compromises one can live with and not second-guessing the choices one did not make.

 

INDIA ABROAD/7/9/2004.

 Human beings have always been concerned about personal health. Historically, this concern has ranged from mere consciousness amongst the young to overt obsession as we approach old age and senility. At the core of our national quest for ‘happiness’, we would like to see ourselves physically strong, attractive and youthful. After all, what is ‘happiness’ without health?

 

    I have been in the medical profession since the early 60s. I have watched this ‘healthy’ consciousness blossom into a full-fledged obsession in the late 80s and 90s when a number of socio-cultural factors confluenced to fundamentally alter the way we perceive our physical and mental health. Besides the national anxiety over rising health care costs and diminishing health care accesses, besides the periodic mourning about managed care and malpractice, we are now bombarded with a veritable deluge of medical information about everything from Botox to Viagra, cancer to osteoporosis. One specific factor has been the direct advertisement of prescription medications in television and other public media. Aside from directly responsible for the astronomical price increase of these medications, this daily bombardment of Lipitor, Prilosec,Vioxx, Zyrtec and Allegra in our living rooms have made the ordinary folks suddenly acutely aware of the availability of these wonder drugs and how they can cure all ills from falling hair to diminishing libidos. We are suddenly drug savvy and demanding of the latest and best that medicine can offer regardless of the cost, side effects or restrictive third party payments.

 

    The second important development to shape our collective health consciousness has been the electronic media. Like everything else in our lives, the Internet has fundamentally changed how we obtain and process our information regarding health. Hundreds upon thousands of websites have sprung up like mushrooms after a rain, touting everything from legitimate treatment options to snake oils. In the true cyber democratic tradition, all are given equal status in the electronic world. Thus ordinary public has no dependable way to sort the wheat from the chaff. In the not so distant past, medical information was limited to professional people only. But that era of ‘paternalism’ is over.  While the easy access and open discussion are certainly desirable for the education of the patient, incomplete or incorrect information without proper perspectives can cause unwarranted anxiety and hypochondria.

 

    The third factor –closely associated with above two—is the increased—indeed incessant –reporting of the latest medical studies. Most news services now have a full time medical reporter, not unlike a sports reporter or a foreign news reporter.  Every newscast devotes significant time not only on breaking important news like SARS epidemic but also on the latest half baked study reports, not yet published or even peer reviewed data on something like the effect of eating cabbage on incidence of gallstones! Most of these reports are over simplified and made to fit a 60 seconds sound bite without any explanation of methodology, statistical limitations or context. Even reputable medical journals are regularly ‘scooped’ days or weeks before the journal even reaches the physician’s desk. Inevitably incomplete findings are reported, only to be retracted or radically changed next week. Thus, one week we hear that fish is good for our diet and next week we learn that it is loaded with deadly mercury.  One week we learn that hormones are good for bone building after menopause, next week we hear that they also can cause cancers. One report says mammograms save lives; other reports they may not make any difference. Understandably, the lay public is confused and frustrated. A person without scientific background does not understand that this apparent confusion is the normal process of science, that these seemingly random baby steps of progress precede major breakthroughs. The frustration may cause some to tune out completely and others to become overly vigilant in following each new information as the gospel truth.

 

    I am completely in favor of educating the patient (lately known as ‘healthcare consumer’) and sharing all facts with him and his family. However, sometimes too much information may be as harmful as too little, causing undue anxiety and unreasonable expectations. The constant bombardment of health information makes us believe that drugs are panacea for all that ails humankind. Currently the so-called ‘life style’ drugs are the best sellers of all. There is drug to cure baldness (Minoxydil), a drug to take away your blues (Prozac), a drug to make you feel sexy (Viagra), a drug to make you slim down (Dexatrim), and a drug to cure hot flashes (estrogen), to mention a few.

 

     One area where American health consciousness has been markedly affected is in the area of preventive screening for diseases like cancers and their pre-diseases. True, early detection by mass screening can make a life or death difference in individual patient’s life, as well as marked decrease in certain common cancers like cervical cancer. However, this has been achieved at a great cost of over diagnosing many benign and insignificant diseases.  In addition to diagnosing true diseases, common cancer screening tests like mammography for breast cancers and serum PSA tests for prostate cancers routinely over diagnose numerous benign, non-lethal conditions that need to be examined further at the cost of high personal anxiety and health care costs.

 

    Probably the most successful test for early detection and prevention of cancer is the Pap test for uterine cervix cancer. Introduced some 50 years ago, this test has been hugely successful in reducing the rate of cervix cancer, which is still the number one killer of women in those countries where this test is not available. It is inexpensive, easily done and relatively painless, ideal for a mass-screening test. A few cases still seen in this country are mostly due to lack of proper follow up of an abnormal test rather than any deficiency in the test itself. But, thanks to our colleagues in the legal profession, we had to spend enormous resources to update this test. The ‘new and improved’ Pap test costs three times more and delivers only slight overall increase in accuracy. Ironically, the increased cost makes this test unavailable to the uninsured, indigent women who are at a great risk of this cancer and need the test the most.

 

    At the risk of sounding fatalistic, we need to understand and accept that all these tests may work well in a population, but in individual cases, nothing is guaranteed. Disease may strike in spite of repeated normal checkups.

 

    We the ‘baby boomers’ are not the first generation facing old age and death. We could learn a thing or two from our parents’ generation. They did not consider any of the above to be a ‘disease’, let alone spending good money for the ‘treatment’. Even now, in many traditional cultures, grey hair, baldness, a paunch, menopause and lack of libido are all considered normal physiologic processes of aging. In many cultures menopause is not mourned as loss of youth but welcomed with relief as freedom from the hassles of monthly bleeding and risk of pregnancy. Lack of sexual desire too is seen as a freedom from earthly desires and ties, indicating purity of the soul, not something to be treated with Viagra!  I remember my mother in India, proudly showing off her very first grey hair, eagerly anticipating that venerable age of wisdom, respect and authority. Old age is to be revered not feared. Wrinkles and grey hair are to be proudly shown off as badges of honor, signatures of maturity and wisdom, worthy of respect, not to be ashamed of. But somehow we have lost that perspective. We not only actively try to postpone the inevitable but also actually look down on others who refuse to do so as being negligent of their own health! Somehow we have come to expect all 70 year olds to be physically and sexually active. Anyone not being so is viewed as ‘abnormal’.

 

    I wonder why this desire to prolong youth has such a strong hold in our psyche. Our predecessors did not waste their energy trying to postpone death as we do, (or is it that they had no choice in such matters or had other more important problems on their minds?). Perhaps they were strengthened by their faith and spirituality, something that seems to be in short supply nowadays. I remember my grandmother praying the Lord to ‘take her’. It was not because she was suffering physically, was depressed or suicidal, but she just felt that her job was done and she was mentally ready to go. In America, any healthy octogenarian acting this way will be definitely treated for depression if nothing else.

 

    In this country we go to any extreme to stay alive and look youthful. In spite of the awareness of living wills, and DNRs, 90% of the health care dollars is spent in the last year of one’s life. We will consume expensive medications, undergo costly procedures, and spend weeks and months in hospitals for terminally incurable diseases like cancer, stroke or Alzheimer’s. An entire specialty of Geriatrics has arisen to treat these diseases. We spend much of our research monies looking for cure of these diseases, forgetting that ultimately, one has to die of something. In old days, people died of pneumonia, usually at home, surrounded by relatives and friends. In fact, pneumonia was called the ‘old man’s friend’. Now we admit them in ICUs and treat them with antibiotics. So, now we die of other things like cancers. We can treat cancers too, but then we will die of say Alzheimer’s disease, perhaps in near future we shall have cure for Alzheimer’s too, only to die of some other yet undiscovered malady. Perhaps we have bought a few years at the end of our lives, but at a tremendous cost to society at large. For every bypass surgery on an 80+ year old, we are probably costing hundreds of childhood immunizations or prenatal care for pregnant women.

 

    No, I’m not advocating pushing all old people off a cliff, or stranding them on a drifting ice floe in the North Pole. But we can perhaps adapt some common sense approach and restrict certain costly procedures and medications for say people over 70 years of age, if that would mean providing better healthcare to younger people. Yes, many card carrying AARP members will be horrified at this suggestion, but some may actually endorse the idea. I personally know of healthy, sane, productive people who absolutely do not want to live a day beyond age 65! Contrary to the popular opinion, most people do not fear death, but dread the pain, suffering, loss of autonomy and personal dignity that usually precede death. A universal terminal palliative care may be achieved at a fraction of the cost we now pay. This must be every old person’s right. But beyond this ‘creature comfort’, we old people should try to be less selfish in giving up our hold on this earth and allow our children more access to the finite resources. Our time is past; we should make room for the next in line and exit gracefull.

 

    The fairy tale ends with “…and they lived happily ever after”. Perhaps because ours is still a relatively new country with abundant resources, we still have naïve optimism that we can cure anything and all can live happily forever. The two requisites for ‘happiness are health and wealth. We try our best to accumulate as much wealth and want very much to control and hang on to our health by preventing as many illnesses as possible and delaying death as long as possible. The current health obsession is a reflection of this ‘can do’ attitude that has been the source of strength in our society. But, in the matters of health and happiness, more is not always better.  We need to realize that there is no ‘ever after’. We need to bring down our ideas about health and happiness to a more realistic level and realize that it is possible to achieve both without mortgaging the future of the next generation.

 

AIIMSONIAN/2006

 There is no getting around the fact that we all are getting old. Those of us who emigrated to this country in the 1960s and 1970s are now on the wrong side of 50. Our 20-something children are now swelling the ranks of the ABCDs.

 

Understandably, upon arriving here, our first concern was to secure a job, a green card , the citizenship, a car, a house, not necessarily in that order. Many of us were already married. So we settled down to raise our children.

 

This proved a much harder task than we had assumed. We struggled with our carriers, dual full-time jobs, the lack of traditional family support system of mothers, grandparents aunts and maids.

 

For the first time in our lives, we learnt the facts of American teenage culture. We were worried, concerned. Even scared. We spent all our time and energy protecting our children from the ‘evils’ of this ‘promiscuous’ society. I remember so many discussions on this topics in reunions and get togethers. We wrote many letters to the editor in India Abroad and local papers.

 

Along with our children, we too learnt about sex education. We became savvy about driver’s licenses, summer camps, pajama parties, dating, drinking, and proms. And then the complicated process of college admission tests and interviews. We were inundated with cultural demands from all sides.

 

Somehow we managed to provide a steady guidance for our kids. It truly seems a miracle to me that in spite of all our uncertainties and doubts ignorance and bunglings, our kids, for the most part, grew up pretty decent human beings after all.

 

Now they are young adults, phew! What a relif! The worries are over. Right? Not quite. Not yet. We begin to worry about their marriage, career,,,

 

Why do we not worry about ourselves? Getting old in this country? As parents we are so wrapped up in our children’s lives that we often neglect our own physical, spiritual and financial concerns.

 

How have we aged? How do we want to age? We are alone in this, without the tradition and continuity that would have been available to us in India. How should we spend our golden years? Fortunately, our cultural background provides us with some spiritual guidance. I see many of my contemporaries flocking to the local temples and gurdwaras. Some find satisfaction in charity work and volunteer services. However I sense many of us, including myself, are uncertain and ambivalent about religion. We seek alternatives for our spiritual fulfillment.

 

We have questions about how to keep ourselves busy after retirement. Where should we live out the last years? Near our children? In an old people’s home? Or some place new, preferably sunny? In this country or back home in India? What are the logistics involved? Old age often makes one nostalgic about the past, but we know that the India of our youth is no more. How practical is it to move back again? We need information on these topics as well as shared first hand accounts of trials and tribulations by those who have paved the path.

 

Of course, the  most important issue is the availability oif adequate health care. We do not want to dwell on the toughts of death and diseases. But we do need to give serious thoughtto how we would like to die and what resources are available in our communities to ensure that desirable death. How many of us have ‘Advanced Directives’? or living wills? These are the decisions we need to make while we are still healthy. We have successfully arrived at Vanaprastha, the third stage of our lives. We need to figure out how to navigate the last stage of Sanyasa.

 

We Indian women are particularly vulnerable. It is a fact that on an average, women in this country outlive men by at least a decade. Widowhood in the late years is a distinct possibility. At the risk of sounding alarmist, we need to be advised about it. Many of us have ‘sacrificed’ ourselves for the good of the family, parents, husbands or children. We seem to forget to take notice of ourselves. In our perimenopausal age, just when we ourselves need physical and emotional care, we often find ourselves saddled with a double load of troublesome teens at home and aging parents halfway across the world.

 

Sometimes, when I look back, it seems ironic that our generationgot our timing wrong twice! We came to this country in our 20s, after spending all our childhood and teen years in India under strict parental control abnd societal supervision. Most of us did not get to enjoy the freedom routinely granted the American teenagers by this permissive society. It seems as if we missed out on so much fun, like choices in make up, hairstyle, dress, sports, clothing, driving, friends, even the freedom to argue with one’s parents and throw occasional tantrums. I remember helping my teenage daughter into her first strapless dress for her prom.  Among the feelings of joy and pride was a twinge of regret at never experiencing any such occasions in my teenage years.

 

Now at the opposite end of life, we have again messed it up by opting to grow old in this country. A very harsh country to grow old indeed! Unlike India, this culture does not pay homage to old age. There are no respect for wisdom and experience, nor admiration for the serenity and spirituality that come with aging. Here the pressure is on acting as young as one possibly can, for as long as one can get away with it.

 

Getting old in America means falling out of step with the rest of the society; not trying to act young may actually suggest being lazy and unproductive! So the rush is on to seek that illusive youth in gyms and spas, in lotions and hair dyes, Botox and cosmetic surgeries. What a sad, pitiful way to spend our ‘golden’ years!

 

I remember my mother being so proud of her first gray hair in her forties. When I plucked it off she was visibly upset! I wanted her to remain young a little longer, and she wanted to reach that ‘respectable’ age as soon as possible what a polar difference in attitude towards a perfectly normal process in our lives.

 

Attitudes notwithstanding,  this is the time to plan for a secure and serene old age. As we shared our wisdom and experience in childrearing, so can we do on issues of aging, discuss various choices and outcomes, share our sorrows and fears as well as the serenity and the spirituality that we all seek as we age. Come, let us celebrate getting old. Let us age and be happy.

 

 

India abroad/8.23/2002

 

 

 

 

 

 

 

 

 

 I bet you are! You are skipping through these pages impatiently as you rewind your answering machine, mentally inventory the refrigerator for today’s dinner, and make a grocery list,  all at the same time. We have become so used to speed, doing things fast, getting instant response, instant replay, fax, phone, instant check out, bank deposit, fast food, airline reservation, news, weather, traffic report, you name it.

 

Thanks to dissemination of computers, lap tops, and PCs, we take instant response for granted. Has all this speed made our lives better? Granted, instant dispatch of a rescue team to a disaster can mean the difference between life and death. And yes, live telecast of an event is almost as good as being on the scene, but what price do we pay for all this instant gratifications? Are we becoming a nation of impatient, gadget-happy bundles of nerves with maximum attention span of five minutes?

 

It seems like we are losing patience with anything that takes time to do, projects or ventures that need time plan, train, execute, measure and wait for, seem to be losing out. In this era of instant cameras and instant meals, disposable watches and razor blades, nothing seems worth holding on to. Is this the reason we expect instant love, loyalty, gratitude, instant wealth, knowledge and competence? When they don’t happen fast enough for us, are we too impatient to persist? Is it the quest of instant marital bliss that makes a couple so quick to divorce and remarry, or leave a family to start a new life somewhere else?  Is it the lure of instant wealth that makes so many gamble away their fortunes on horses and lottery tickets? Or is it the promise of instant happiness, the ultimate goal for all. , that makes drugs and alcohol so irresistible?

 

What if we took time out of this fast paced life and decided to invest in building a lasting relationship, gain an in-depth knowledge, or just sit back and smell the roses (after all, roses need smelling too)? If we did, would the frenzied global economics, politics, technology and industry really halt and come to a stand still? Somehow, I don’t think so. I have a snaking suspicion that a few die hard workoholics may suffer some nervous breakdowns, but the rest of us will be decidedly better off with longer (and uninterrupted) meal times, shorter (and more productive) work hours, time off for long vacations, time see our families, etcetera, etcetera.

 

After all, if you look at nature, you find that it keeps its own rhythm. Plants and animals keep in tune with the seasons, human babies still take nine months to grow in mother’s womb, the day stays stubbornly 24 hours long. We can not make it any longer or shorter, hard as we try. I suggest we call ‘time out’. Halt the train and get off to stretch our legs a little. Will we miss the train? May be, but no sweat, there is another one rushing in to take us away in a hurry, always in a hurry.

 

SANDESH/AUG/1994 

 Bharatpur (aka Keoladeo-Ghana National Park) in central north India  is a tiny park about 12 square miles. It was started in 1890 by a local Maharaja who dug lakes and ponds to attract migrating winter birds for his shooting pleasure. The shooting long since stopped but the waterways remain, attracting thousands of birds from Siberia, central Asia, Mediterranean and eastern Europe to India’s balmy winter.

 

Bharatpur currently happens to be one of the top ten birding hotspots in the world. It is easily reached by car, train or bus , about a day’s drive from the capital, New Delhi. The park allows no motor vehicle inside, but excellent knowledgeable guides with row boats and cycle rickshaws are available for a ridiculous 50 cents per hour rate, to show you all the nooks and crannies in the park and help you identify all the birds you see.

 

Bharatpur is a year round sanctuary with peak season in winter. It harbors about 130 resident species of birds and 270 additional ones during winter migration. On a good day, one can see up to 100 different species of birds in this tiny watery park. I managed to spend only 3 hours (a visit cut short by family emergencies) last winter. It was a wintry foggy day with poor visibility, but I managed to count 60 species and 42 of them were new life birds for me.! The place is literally crawling with birds!

 

The most noticeable bird in the park is the painted stork. They are huge birds with pink and white plumage and a raucous cry. They roost and nest in bare branches along with egrets, ibises, herons, cormorants and spoonbills. The trees literally droop under their combined weights. Some one counted 117 nests with eight different species in one tree alone!

 

The ibises are aplenty, although they are nearly extinct in their native Mediterranean countries. The glossy ibis for example is the sacred bird of Egypt, but now is almost never seen there. One strange bird I saw was the open billed stork. With a large gap between its beaks when closed. I never found out why the small fishes didn’t slip through the gap. The elite bird in Bharatpur is the Siberian crane. It is endangered and every years its number is decreasing due to habitat loss in Siberia. This year I saw only one pair in Bharatpur. Art this rate they will soon be extinct.

There are many types of ducks and geese in Bharatpur. The most numerous are greyling geese. The bar headed geese are associated with Saraswati,  of wisdom and arts in ancient Hindu mythology. Also seen are comb ducks, spotted bill ducks, and more familiar teals, pintails, shovelers etc. Scattered among them are anhingas, and cormorants standing still in the weak sun, drying their spread out wings between dives.

 

Other more unusual waterbirds included moorhens. Lapwigs and waterhens. Indian waterhen is a fearless little thing that struts around tourists and rickshaws. Waterways always attract kingfishers. I saw pied lack and white kingfishers  and brightly colored red-blue-green ones. I think they are the most beautiful birds in Bharatpur.

 

Indian sky is full of raptors; kites, hawks, vultures etc. In Bharatpur the most exciting raptor I saw was a crested serpent eagle, majestically surveying his domain from a lonely treetop.

 

On the ground, the trees were crowded with chattering parrots and under the trees were clusters of chattering babblers and mynas. It was common to see the beautiful black and white magpie robins fleet from bush to bush, pitch black drongos and blue green flycatchers dangle their long tails from the telegraph wires.

 

Bharatpur was the place where I saw my first Indian jay or roller. It is the same size as our blue jay abut has no crest and the plumage is bright red-orange to blue-green. A most colorful bird and prettier than the ones here in my backyard.

 

Besides birds, bharatpur also has deer, monkeys and snakes of many kinds. I n winter most snakes were in hibernation. But we were lucky to come across a huge, sluggish python right next to our picnic table. It had crawled out to get some sun. it made feeble attempt to crawl up a tree, perhaps in search of eggs in a nest, but gave up and flopped back on the ground. All the while the babblers and mynas were chattering in panic around the snake. Soon tourists started to crowd around it too and reluctantly it slithered back in its hole.

 

That, in brief was my visit to Bharatpur, a birder’s paradise. Wish I had stayed longer. Perhaps next time.

 

Previously published in BIRD DROPPINGS APRIL/1999

 

 

...So the tiny plane landed in the dusty little town called Timbuctu... Nope. that does not sound romantic at all. Timbuctu is a place where one should make long and hard treks, over dangerous terrains, not a quick airplane trip. Though, to be truthful, the plane ride was quite difficult to arrange, expensive, on again off again, unpredictable and long and bumpy. So, in a way, I did pay my dues...

 

... I had been volunteering in Ghana this summer and on my way home I decided to detour via Mali and Timbuctu and sahara...places i had always been dreaming about. unlike Ghana, mali is all muslim. When I arrived it was the first day of ramadan. Their month long fasting. I really felt bad for my guides, walking around with me in all that desert heat, watching me eat and drink...

 

...Mali is half desert. Entire north half is in the western sahara. Timbuctu is right at the edge of sahara. You leave the city and take two steps north and you are in tractless sand that stretches all the way to the Mediterranean sea. And it is hot, hot in the desert. Timbuctu was going to have a new weather station, I don't know why they would even bother. It is always hot, dusty. When I asked the guide how hot it was that day, he casually said, 'not much, must be 45-46C in the shade.' when I realized that was in centigrade and translated to around 113F, I decided to return to my cool cave like hotel right away and not emerge till 4 pm when a cool desert breeze was starting.

 

...Unlike Ghana, Mali  (and of course Tombuctou) is a french speaking country, and yes, according to my prediction, does have better food than Ghana. Being a landlocked country, it has wonderful selection of freshwater fish from their great mother river Niger. Like Nile in Egypt, Niger brings life to the desert. From airplane you can see this huge river in the desert with a narrow strip of green on either side. In capital city Bamako, the river is three times the width of Mississipi in New Orleans. It is huge. The fish I liked best is called capitaine. it is one of the tastiest fish I have eaten. I had it everyday, grilled, fried, with different french style sauces. Yum! Their other local food is 'to' (pronounced toe) which is like fu-fu of Ghana, but made of millet instead of casava, so less slimy, but equally tasteless. Fortunately rice is abundant along the river and good french style baguettes are available all over. on street corners in timbuctu, there are community ovens (tandoor style) for baking flat pita like breads. They are pretty good except for the gritty taste due to sand which is everywhere and in everything. Everything is cooked in  peanut oil,  though palm oil is making inroads. I met a palm oil salesman in the airport, he is south indian by birth, brought up in Ethiopia, now works in Dubai for a company called Tunel, based in Singapore and was going from Ghana to Mali to sell palm oil! True global salesman! He lectured me in depth about the virtues of palm oil! It seems to be everywhere on earth!

 

...Timbuctu is apparently named after an oasis where a lady from buctou family found a well (toum). Hence the name. From 8thC AD, it has been a famous fabled city on the caravan route through western sahara. A famous muslim university was founded here, manuscripts from there are still being found and collected in a museum. The mud and stick mosques are the old 13th century buildings, (as old as qutab minar) are the oldest in Africa, after Cairo's mosques.

 

...Timbuctu was nothing like I had expected. The whole city is made up of low mud buildings and the roads are unpaved, sand filled. The famous old mosques as well as the modern official buildings are all mud coated and annually get a replacement coating to keep the buildings cool. The whole place has the mud-sand color with not a single tree or a blade of grass to add any green. In may-july, they have dust storms called harmattan  that lasts days and weeks, when sand is in everything, one cannot take pictures, can not wear contact lens...thank god I did not have to see one. People sleep on the flat roofs of the building and eat, pray and gossip in the evenings. No mosquito, as it is so dry and hot. The whole town looks like a forgotten western style ghost town in some  Arizona desert. I was at a non-tourist time, and except for one french Canadian, didn't see a single white face in the entire town.

 

...Mali has a whole bunch of tribes--Djenne, Dogon, Fulani, Tuareg etc etc. they all live quite peacefully (unlike other African countries). Only the Tuaregs are a bit more 'independant-minded' than the others.They are the nomads of western Sahara and live and roam in many countries from Mali, Chad, Niger etc. they pitch their round tent anywhere in the city for weeks or months and pick up and go whenever the mood moves them. No paying rent or anything. they hate to be restricted to one nationality and are not very tourist friendly. They are the main tribe in and around timbuctu. One can easily recognize them by their haughty looks and signature blue robe and turbans (dyed any shade from dark blackish blue to light sky blue, using indigo dye originally from India. . From time to time they  stage small acts of rebellion - just to show who is the boss- like raid a tourist jeep and leave them stranded in the desert (to die, obviously), acts that have earned mali a tourist advisory from the US govt. but once made friends, they are very trusty. My guide was a tuareg and being a lonely woman, I got a lot of sympathy and kindness from them. Yet, while I was sitting with them drinking tea and watching them sing and dance (they were good friends of my guide), I could tell that unlike other tribes, they hold themselves aloof. I had to do all the gestures of friendship. They are very wary of outsiders.

 

...I rode a camel about 2 miles north of Timbuctu into the desert to see the tuaregs. In case you wonder at my bare feet, no, the sand was cool in the evening and yes, bare feet are the tuareg style camel riding. The tuareg camels do not like shoes against their skin. And I agree. The feel of soft camel hair under my feet is absolutely luxurious. But camel riding is hard. For one thing, you have to lean forward while going downhill and lean back when climbing up-- both are counterintuitive to one's natural body movements and I was always doing the wrong thing, much to the disgust of my haughty tuareg cameleer.

 

... The tuareg kids are the true children of the desert. They sleep, play and roll around in the sand without  any concern for bugs or scorpions. I had taken some candies and a bundle of ballpoint pens for them. They loved them. I was mindful this time to unwrap each candy before giving out. (In past in a masai camp in Kenya, I had made the mistake of giving candies with plastic wrapper. The kids don't know wrappers and eat them whole. I had to sit in the dust and wrestle with terrified kids to open their mouths and take out half chewed plastics! Never again!)

 

... The tuareg women wear deep blue almost black robes, (the only white clad woman in picture is pregnant). They also use African mehendi on their hands and feet in bold geometric designs. It is almost black color,not yellow brown like indian henna. And the designs are not delicate curvy types either. It is very much in fashion and I saw rich malian women with intricate designs on their hands and feet on their way to Paris.

 

...So, it had to happen sometime... while coming back home, a l-ong trek, (Timbuctu-Bamako-Paris-Minneapolis-Omaha) 43 hrs in transit. In Minneapolis, I must have been looking rather ragged and pitiful, a friendly lady asks me 'so where are you coming from dear?'. I said 'Timbuctu'. The lady looked like 'oh, ok, if you don't want to talk, fine...' I suddenly realized how I must have sounded, but was too tired to explain. =)