Wednesday, July 31, 2013

Another Week in the Garden City

At first time seemed to be moving so slowly here, but everyday it goes by faster and faster and somehow just over two weeks of my five week journey have whiz zed  past. My second week in Bangalore was again spent in the lab, this time extracting DNA from dung samples collected in the field. This sounds like a simple process, just picking through some poo and placing it in vials. However, it's a very tedious and expensive process that takes almost an entire day of work! In addition to purifying DNA to be used in later analysis, I also helped Dr. sukumar's lab begin compiling a database of the flora found inn the Kodagu district where many of his students do their elephant research. The project is long term, it's intention being to better understand what plants elephants eat specifically. Chloroplast DNA sequences for hundreds of plants must be catalogue s to compare against sequences found in collected dung. Before coming here, I never could have imagined how much time and work goes into providing data on something that seems so simple as an elephants diet. A fact  you would read on Wikipedia and think 'hmm, that's interesting' and read on without honking further of how that statistic was researched and proven, not thinking about the months spent tracking and collecting and analyzing by ecologists. I've truly realized how unaware I and so many others are of the environment that is all around us' and the passion and effort that ecologists put forth in studying such particular yet vast aspects of wildlife. 

My appreciation  and admiration for the CES faculty and students grew even more when they held a farewell celebration for one of the women who founded the department nearly 30 years ago. Even though I have only met these people in the past week, I couldn't help but get choked up as they shared stories of the years passed together and the birth and growth of CES' amazing research community. I am so lucky to have been able to  work  and speak with so many intelligent and driven individuals who so passionately pursue their ecological work. 

After a long week in lab, the weekend was again spent strolling through Bangalore, visiting beautiful temples, markets and land marks. Even though the city is noisy, crowded, dusty and chaotic, there are so many little parks and gardens and temples where peace and quiet can be found and savored. Some of my new friends at IISc treated me to a traditional North Karnataka meal, eaten off a banana leaf with endless refills on any dish. It was so delicious, and I've become an expert at scooping up rice in my hands. Not being able to dig into every mescal only using my hands and bread to eat will be quite an adjustment when I return to the states! 

Tuesday, July 30, 2013

Yesterday was tough, Today was better

Yesterday I went a government-funded hospital for the first time. After seeing how loud, dirty, and crowded it was, I came back to the nursing school feeling like I needed to lock myself in somewhere and cry. I couldn’t articulate the huge wave of emotions I felt, but luckily I had some time to sit and think about it.

What I felt was guilt. I wish that all of these people could receive the same hospital experience I would if I were sick. Going further into that, I cannot understand why I am the one on this end of the spectrum - healthy, educated, financially stable – while others live on the complete opposite of the spectrum. I did not choose the family I was born into, nor did I choose to be without congenital diseases. There are so many factors that interfere with our lives before we have the privilege of making a choice.

I believe that the United States does its best to eliminate these pre-determined factors (though I do acknowledge we have flaws). Our President is our finest example. However, with India’s system, those who are born at the bottom stay at the bottom. Thus, my guilt comes into play. I was lucky enough to be born in a land of opportunity and high expectations.

I could go on and on about the shocking sights and sounds of the hospital, but I do not believe that is fair. Going back today proved to me even more that even though this hospital is dirty, it is a step in the right direction. It manifests a system that even the United States (a first world country, I might add) does not have – free health care. In India, the poorest of the poor are given some safety net by being able to walk into a hospital if they are sick.

As I look back on it, the hospital system is extremely well-organized, and strives for similar standards of care that the US requires. This hospital is not perfect, but for being a free health care facility, it comes fairly close. Another problem I had at first was the lack of privacy from having so many patients in one room. However, the people of India are very family-based and do not feel the same lack of privacy as Americans would feel. The hospital staff does reinforce patient confidentiality, but all in all crowded is normal for them. Again, I am lucky enough to grow up with different expectations (private or two-person hospital rooms, clean floors, quiet surroundings).

What I really liked about the hospital, was that it was separated into male and female wards. Female wards are not allowed to have male attendings during the night shift. Most hospitals in India are like this. I think this is a really interesting idea in terms of patient comfort. It is an idea I have never even considered.

In terms of HIV/AIDS management, the hospital goes out of its way to ensure that the virus does not spread more than it has to. They treat their waste in a similar fashion to US hospitals, and have specific protocols for accidental needle stick injuries. The hospital also has two centers for HIV/AIDS patients, a unit for medications/patient information/counseling and a clinic. All paperwork is done by hand, and is systematically organized in a way that works for them.

In the end, government hospitals are a beautiful thing. They provide help to those who would not normally be able to receive it, and open up jobs for many educated people. What I am experiencing now is largely a cultural gap, but I hope with more experiences like these, I can understand Indian life much better. 

Saturday, July 27, 2013

First Hospital Visit!

Today I visited my first hospital in India, the Rajiv Gandhi Cancer Institute and Research Center (RGCI & RC). This is solely a hospital dedicated to the treatment or prevention of cancer.  Although I originally came here with a focus on HIV/AIDS, Jayaa believes that it is important that I see this hospital.

One of the teachers from the Salokaya College accompanied me on this trip. She introduced me to many nurses that work in the hospital, and explained to me what a hospital experience here is like. Throughout the day she and the other hospital staff members emphasized the importance of preventative measures, or prophylactic treatment. For example, oral cancer is extremely common among both men and women. This is usually from chewing tobacco. Patients do not usually go to the doctor immediately after experiencing symptoms, therefore in this example, patients come in to the hospital once their oral ulcers have become cancerous. Unfortunately, women have a tendency to be more a culprit of disregarding prophylactic treatment. I learned that women discount their own health, until it is usually too late. Women either do not know about or opt out of receiving the HPV vaccine, making cervical cancer a popular problem among women in India.

First off, RGCI & RC is one of the top hospitals in Delhi. In addition, it is a privately funded hospital, rather than government-funded. This detail is key, due to the fact that today I learned that privately funded hospital require out-of-pocket expenses (insurance companies can reimburse the patient after the payment, however). Government hospitals are free to the public. The hospital I visited today was fairly similar to an American hospital – it is highly focused on patient-centered care. I would say that the largest difference between an American hospital and the RGCI & RI is that the latter is far more crowded. I felt like there were so many people around at all times, coming in and out of small rooms and doctors offices’.

Within a population of one billion, India cannot afford to have so many patients in the hospital with diseases that could be prevented. Like the United States, two major lifestyle diseases are hypertension and diabetes mellitus (both diseases that can lead to cancer or other complications). The RCGI & RC has a unit in the hospital that checks for an early detection of cancer. It costs them only 200 rupees (approximately four dollars) for a check up, complete blood count, and specific exams for each gender. Nursing students are also a great resource for spreading awareness. Nursing students go back home to their families, and teach them about what they are learning. They can make conscious decisions for their families in terms of what they eat, and how to take care of family members and friends when they are sick.

I came back from the hospital with so much on my mind. I feel that a great portion of India holds the necessary research for a healthier population, however implementing these research ideas proves to be a problem, due to unwillingness or lack of education.  I talked to Jayaa about this, and for her, none of it is a simple or lone issue. On a more positive note, though, she said small advancements do make a large difference. After seeing what this nursing school has achieved, I fully agree.

Wednesday, July 24, 2013

The Kuznia Family's First Adventure Abroad

We came out of the airport in Delhi and immediately felt the air, feeling like a creamy tomato soup wrapped around every crevice of our American bodies. We met up with Jayaa's driver and headed towards our first night in the hotel. Driving in India is an experience within itself. We quickly realized that all the detail that goes into making a road is immediately disregarded as decoration. On top of this, India does a wonderful job coexisting with camels, elephants, dogs, and monkeys on the streets. My family and I feel extremely grateful to have a driver during our stay that is able to artistically maneuver through the chaos of the roads.

Our tour was a six day trip around Delhi, Agra, Jaipur, and Mandawa. Each day was absolutely incredible, and I am so grateful that my family decided to make this trip out here before I begin working with the Salokaya College of Nursing. Here are some highlights of the tour:

DELHI - We weren't expecting to make such a purchase, but after learning about how families in Kashmir spend their entire lives devoted to hand-knotting rugs, we couldn't resist. We learned about the different kinds of tools they use, and how they learn to make the design so intricate. They also gave us special green tea from Kashmir.

AGRA - The Taj Mahal is the greatest love story there is. This was probably my favorite sight to see in India. Although most may know the story of the Taj Mahal, I needed a little refresher. The Taj Mahal was built by Shah Jahan (a Mughal emperor) for the love of his life that he met at age 14. He already had another arranged marriage, and therefore could not marry his love, Mumtaz Mahal. However, his first wife died after their marriage of one year, leaving him the opportunity to remarry Mumtaz Mahal. Together, they had (I believe) four sons and two daughters. Later she became ill, and on her deathbed Shah Jahan promised to build her something magnificent to show their love for each other. Twenty two years after she passed, the Taj Mahal stands. She is buried right in the center. Within those twenty two years, there was a race between the sons on who will be the successor. One of the sons killed all his brothers, and locked his father away. When Shah Jahan died, his daughter snuck him out of the prison, and buried him right next to his wife.

From this story, a masterpiece arrived. The Taj Mahal is a beautiful combination of Hindu and Muslim architecture. From the Muslim side, everything in there is symmetrical, except for Shah Jahan's grave. The Hindu architecture decorated the Taj with tiny flower inlets, all made by hand. I am blown away by how much work went into making this. Every detail is absolutely perfect.

One thing I want to mention with Agra, is how poor the city is around the Taj Mahal. So much money comes into the city from all the tourists, but outside of our hotel and the Taj itself, is basically a slum. I do not understand why this is, but when I pictured Agra and the Taj Mahal, I thought the whole city would be as grand as one of the seven wonders of the world. Keep in mind also that I am here during the tourist off season, and that even though it was pouring rain, the attraction was still packed.

JAIPUR - Jaipur is packed with energy. Unlike Agra, it is a planned city. My family and I agreed that Jaipur is our favorite city. We had an awesome tour guide that day named Vijay Singh (no relation to Jayaa, or the golfer). Our day spent in Jaipur was packed, but the best part was with the elephants. we started off the day riding an elephant up the to Amber, just as the queen did back in the day!Lucky for us, Vijay has a friend who owns ten elephants and took us to go play with baby elephant, Gury, after. What a gentle giant she is!

The end of the day consisted of walking around through the city. Vijay wanted us to get a feel for what walking around the city was like, outside the tour bus. He wanted us to smell the Indian spices and flowers being sold on the side of the road. It was a beautiful experience, walking around with all the locals. Although we did stick out, it was really cool to feel like one of them. (For the record, my dad, pictured below, was proudly wearing his Michigan cap the entire elephant ride)

Vijay also taught us about the caste system in India. My understanding of it, is that there are three castes on top - the teachers/priests, the warriors, and the businessmen. The fourth class is below the three, called the "untouchables", or the servant caste. One is only allowed to marry within each caste, even though the top three are equals. Vijay also told us that not too long ago, only eleven percent of women are educated (as in reading and writing). Now, sixty-four percent of women are educated. According to Vijay, he believes that India learned how much more valuable it is to have women educated in terms of arranged marriage. An educated woman is far more attractive within a household rather than an uneducated one.

MANDAWA - This was the last stop of our tour. It was really interesting to see the rural parts of India, mostly because the city is fairly Americanized. Where we were, we saw more people taking a more traditional route, rather than using any sort of technology. Driving by the fields, we saw women digging with their hands and carrying bricks on their head. It was a whole new way of life.

Today is my family's last day in India. Last night I met Jayaa and her family for the first time. The Singh Family is very warm and hospitable, and got along very well with my family. Starting tonight I will live with them, and tomorrow morning we will venture to the Salokaya College of Nursing. Jayaa explained to me that while I will be here I will be visiting different NGO's and hospitals that focus on HIV/AIDS research and reporting back to the school. As sad as I am to leave my family, I am so excited to live with the Singhs and to start an adventure on my own.

Tuesday, July 23, 2013

First 2 Weeks in Tamil Nadu, India

Flooded Street in New Delhi

How to sum up everything I have done in the past two weeks? Has it really been that long? How time flies. I’ve never flown before, nor have I really left the Midwestern United States, so flying to India by myself was an adventure all its own. My first day in India, spent in New Delhi, was anything but pleasant thanks to the terrible airport services and staff. Fortunately, I made some friends during my 17 hour layover, so I had the opportunity to walk around Delhi and learn some conversational Hindi. Some of the streets were flooded due to heavy rains, and some small children tried robbing me. It was adorable!

One flight with a brief layover in Mumbai later and I was in Coimbatore, about an hour away from the ashram in Anaikatti where I am primarily residing. My driver was there waiting for me to take me on the four hour journey to the small (not even on Google maps) rural village of Mangala Puram, on the outskirts of Mangalamkombu Village in Tamil Nadu, where I would spend the next 10 days learning Taittiriya Upanishad Chapter II and Bhagavad Gita Chapter IX. I am grateful for this journey, as it allowed me to see parts of southern India I may otherwise have missed, although I was so exhausted from my flights that I ended up sleeping through the latter half of the drive. 
Tranquil Nests: My Daily View

I should probably mention for the record that this class was an optional expense paid for with my own money; fellowship funds were not used. I felt it was important to experience a traditional style of Vedic teaching, opposed to just relying on my own self study, before beginning my formal research. I am so glad that I opted to do this, as the teacher taught with great clarity and I learned and experienced far more than I had bargained for. 

Tranquil Nests: Dining Area at Night
The classes were initially to be held at the ashram in Anaikatti, but due to limited space, they were relocated one week before my departure to a beautiful inn called Tranquil Nests, tucked away in the mountains of Palani Hills on a small coffee plantation. No internet or cell phone connectivity made it difficult to keep in touch with family back home, but at the same time provided the perfect atmosphere for study and focus. The view of the misty mountains, the abundant variety of insects, animals, fruit trees and plant life, and the sounds of the jungle and the nearby village made this place the closest thing to “paradise” I have ever seen.
Tranquil Nests: Activity Area

The class size was small (about a dozen students) and I will never forget the people I met there. Each person brought an invaluable contribution to the group dynamic. I was sick and jetlagged my first few days, but everyone was extremely helpful and understanding during this time, even interrupting scheduled classes to make a visit to the local pharmacy with me, where we got to see Mangala Puram’s colorful atmosphere and visit a small roadside temple for prayer. 

Mangala Puram: Anti-Plastic Demonstration by Local School Children
Our days were divided between 3 delicious vegetarian meals, yoga, meditation, pranayama, tai chi, tea time, nature hikes, and of course, 2 intense lectures on Taittiriya, 1 on Bhagavad Gita, and a nightly satsang (a Q&A session). I was also given the opportunity to write and deliver 4 brief lectures during this time – one on special relativity, two on quantum mechanics, and a fourth describing how I plan to incorporate Vedanta into my research in the sciences, as well as discussions on various topics related to the relationship between these ideas. Each lecture was permeated and followed by Q&A. With no internet connection or other resources at my disposal, this was a good opportunity for me to discover how much I really know, and to practice lecturing/teaching/public speaking. 

View from the Bus en Route to Kodaikanal
View from Coaker's Villa
We took one day off from our usual schedule on 15-JUL-13 to visit Kodaikanal and a nearby temple in Poombarai. We traveled by bus through the mountains, seeing spectacular views along the way. One of our students made special arrangements for us to be guests of honor at Coaker’s Villa in Kodaikanal for the day, and I saw firsthand the immense difference between American and Indian hospitality. We were greeted with fresh flower malas, tea, and a drum and dance performance. A five-star chef prepared a custom-made meal of our favorite dishes (even some Italian food!) for us to enjoy on the edge of a cliff overlooking the scenic mountains and valley all around.

Poombarai, Tamil Nadu, India
As if this surprise weren’t enough, another of our students made special arrangements for us to visit the Kuzhanthai Velappar Temple, a small, discrete 3,000 year old Hindu temple nested at the center of the valley town of Poombarai. We were told that no cameras, technology, etc. had ever been allowed inside, and that unless you were destined to be there, you would never come. I believe it too, considering the fact that on the way there our bus avoided being crushed by a fallen tree by just less than 1 minute. (We were not held up by this obstruction for long, as local villagers quickly obtained an axe to chop through and move the tree, which was too large for the 20+ men at the scene to even budge.) We were given a special puja in which the priest of the temple prayed for us and our close family members by name, and then allowed us to chant in the temple for a solid 45 minutes – another miraculous thing, considering many people were said to be incapable of even speaking in this ancient place, let alone entering. The deity, Lord Murugan, was created over 3,000 years ago purely out of herbs, known as navabashanam (nine herbs), and still remains preserved to this day.
Tree in the Road

On the last day of our classes, the remaining students and I visited the Balamurugan Temple in nearby Thandikudi, again being given a puja and chanting for a while. It was situated on the top of a hill overlooking the village and the surrounding mountains. The shape of a peacock, which is known as the vehicle of Murugan, naturally formed on one of the nearby rocks on the hill.

Palani Hills Murugan Temple - Inside View
Palani Hills Temple (Source:
The following day, 19-JUL-13, we left to return to the ashram in Anaikatti, but made a stop at the Hill Temple of Palani, one of India’s oldest and largest temples. A puja had been arranged for us here as well, and I was graced with additional vibhuti (ashes from the deity which are symbolic of the basis of life – carbon) from the head priest. We stopped for lunch and were served a full course South Indian meal on banana leaves. This easily would be a $20 meal in the US, but it cost only 100 rupees – less than $2 in US currency. Amazing! We dropped off the last remaining student besides me at the airport in Coimbatore, picked up some food and supplies, and made it to the ashram in Anaikatti, Arsha Vidya Gurukulam (which means the place where one lives with the family of the guru to learn the knowledge passed down by the Rishis) late that night.

You will see by the date of this post that I have been at the ashram for a few days now. It is truly a remarkable place, but I will save my descriptions and stories for the next post. I will however mention that I am off to a great start in terms of research leads – I have 2 pages full of topics to research, people to interview and talk to, places to visit, books to read, etc. Needless to say I will be very busy in the next month. I owe a HUGE thank you to Surya and Neema for going above and beyond in terms of teaching me Vedanta, helping me navigate India, arranging my accommodations at the ashram, and providing a great abundance of resources for my research project.

Saylorsburg Ashram

Hello everyone. I’ve been in India since 08-Jul-13, but have had virtually no internet access until now.  I have kept very busy, and have truly had the experience of a lifetime. I would like to briefly thank the donor and UM staff for making such an amazing opportunity possible, as well as everyone in India and the U.S. who has helped along the way. I’ve taken hundreds of pictures, but my connection speed will prevent me from uploading many of them until I return home to Michigan. I will only be able to upload a few low-resolution photos here, so I will create a public photo album when I return. 

I’m going to double up on my blog posts because before describing my Indian activities, I would like to share about the unique opportunity I had in May which is related to my academic endeavors here in India. One of my mentors for the trip, an Indian physicist and Vedanta scholar who lives in New Jersey but frequents India’s ashrams, informed me that the Arsha Vidya Gurukulam in Saylorsburg PA, an ashram associated with the one in Anaikatti, was having a Memorial Day weekend event with Swami Viditatmananda Saraswati hosting as the guest speaker. We arranged to meet there to discuss my project and so I could gain a sense of what ashram life might be like in India. Although this experience would be an additional expense for me (as I had to travel there from Michigan), there was no way I could pass up such an opportunity. So I made a road trip out of it and stayed there for 3 nights. It was an incredibly worthwhile experience.

Besides the fact that the place was beautiful (nested in a valley surrounded by the Appalachian Mountains - I took pictures but they're on my laptop back in the states) and the Indian meals were delicious, I learned a lot about the culture. I became comfortable with being the minority in a crowd (~98% of the people there were Indian), which was a foreign situation to me thus far. Everyone I spoke to was very kind and helpful in offering advice for my upcoming trip, including my mentor, who provided some technical insight. I experienced religious proceedings, cultural preferences and etiquette, and gained knowledge from the lectures of Swami Viditatmananda Saraswati. All in all, even though it was a far cry from life in India, I found this trip to be an enriching form of preparation.   

Monday, July 22, 2013

Establishing My Roots In Bengaluru

Sunday evening last, my airplane landed in the fading light of Bengaluru, located in the Southeastern corner of the state of Karnataka. Exhausted from traveling and slightly overwhelmed by the exclamations of families greeting one another and the calls cab drivers attempting to snag passengers, I was nevertheless so excited to have finally made it to the country I had always dreamed of visiting. I hopped in a cab and directed him to the Indian Institute of Science, or TATA Institute as they call it here, and sat back to look out the window and take inn the sights and sounds (mostly of horns honking). Vani, one of the PhD studentsI with whom I am working here, greeted me when I arrived, set me up in my one room, one loo living quarters and wished me goodnight. After all the months of communication, preparation and anticipation I was finally here, and I was anxious!

Since hat first day of uncertainty and uneasiness, I have come a long way. The first few days were spent settling into campus; finding my way around the wooded pants (though I still get lost) and getting to know the members of the lab and a sense of the work they do. About half work in the field studying more broad scale projects such as human-elephant conflict in crop raiding, migratory patterns and nerd demographics. The other half works here in the lab at a more molecular level, analyzing dung samples for stress hormone expression and the gene associated with tusk development. As different in focus and magnitude as all this research seems, it really is an intertwined relationship bet ween the fundamental  genetics of the elephant and how this influences it's behavior in its natural environment and human interactions, and consequently how these interactions impact it's biological functions. There is such a wealth of information to take in here form the Centre for Ecological Studies, and I'm trying my best to expose my self to as much as possible. 

The weekend was spent strolling through the neighborhood of Malleswaram, one of the most well known and recommended in the city. Despite the constant threat of monsoon rains, the streets were full of weekend shoppers at the garment stands and the produce and flower markets. And of course a good amount of time and energy went into trying as many types of delicious new dishes of curries and breads and sweets as I could. I don't think that my palette will ever refuse the cuisine here.

The past days have been spent reading up on many articles about every aspect of Asian and African elephants, and working in the lab. Today was an exciting day since the PCR reaction (DNA identification and amplification) that has not been successful for one of the girls I'm working with in the lab turned out perfectly. This success takes us one step further in gathering data to understand crop raiding; when elephants enter farm or plantar property to eat. Ill be working more on this experiment this week before preparing to go out in the field station situated amongst the forest habit and farmland. 

Photos of my travels to come! Love to everyone back at home and big thanks to the SISA program for this fantastic opportunity as well as the generosity and support of every one in Dr. Sukumar's lab here at TATA.

Tuesday, July 16, 2013

India Tomorrow!

Tonight is my last night in San Diego. Leaving home is always bittersweet, but right now I am not sure what to feel -- excited doesn't even begin to cover it, and nervousness definitely plays a role. I have not traveled much in my life thus far, so this is a huge step for me. Luckily, this first week I spend in India my family will be right by my side. My family also doesn't really travel, so when we were setting plans for the summer, they decided that they want to see where I will be working and take the opportunity to visit a place so far beyond of our imaginations.

Building up to this moment in time has been quite the process. Getting our visas in order, purchasing flights, choosing a tour, and packing appropriate clothing has been an experience within itself. When my dad's friend from high school told us that short-shorts and tank tops are a "no-go" in India, we realized that we are going to have to make some major adjustments. Nonetheless, it's all for learning purposes and we hope to gain the most out of our trip!

After my family leaves, I am staying with Jayaa Singh. Jayaa is the founder of the Salokaya College of Nursing, and a Michigan alumna. We have been keeping in touch since last October, and I am so excited to finally meet her and work with her!

Me and all my suitcases! The See's Candies are a gift for Jayaa!

Tuesday, July 2, 2013

A dream to making quality healthcare accessible

These past couple weeks have truly felt like the fastest weeks of my life. Earlier I met two PhD students from Germany, Emma and John, who had come to Narayana Healthcare Hospital to work on their own perspective projects. While they were also constantly in touch with the research department, I never did manage to bump into them until the very end of their stay. Emma’s project revolved around the philanthropic model of the hospital while John’s was an investigation about the use of Electronic Medical Records at the hospital. I found their insight helpful despite the fact that our projects had their differences. We talked for a few hours, and I was relieved to hear that I was not the only one who had a few bumps along the way. My time here as taught me that despite the convenience of email, calling people is the preferred method of getting in touch with people. Patience is a must to navigate and extract web of information Narayana has to offer.

My chat with my fellow student researchers inspired me to pay a visit to the Narayana Institute of Cardiac Sciences. There, I met Laxmi Mani, a very well-known philanthropist. I found out that Dr. Devi Shetty, the  founder of the hospital made sure to personally meet each and every philanthropic case that the hospital takes. After meeting with Dr. Shetty, patients that fall below the poverty line and qualify for care are referred to the philanthropic office with a concessional package. This package is the subsidized cost of their treatment. Patients are asked to pay as much of as they can. The remaining amount is covered by the Have a Heart Foundation for up to 30000/- rupees. Any additional remaining costs are covered by individual donors. If patients cannot pay anything, all the costs for treatment are covered by the generous donors. Ms. Mani told me that many of the individual donors have stipulations for their donations. They limit their donations to patients of a certain religious group or age. Typically, they want to donate solely to children. Luckily, Ms. Mani manages to convince them that there is value in donating to older patients. Providing treatment for a young mother or father, for example, means that the breadwinner of a family can go back to work and provide.

The philanthropic office is geared towards helping cardiac patients. The cost of cardiac surgery has been greatly reduced at this institution because treatment is limited to one part of the body. Unlike cancer that can requires multi-specialties because it afflicts many parts of the body and expensive chemotherapy, cardiology patients entail much less complexity in their treatment. Nevertheless, cancer patients and patients of other specialties come to Ms. Mani for help and aren’t away. In fact, no patient has ever been denied treatment because of their socioeconomic background.

One patient that I met traveled for more than one day from West Bengal to seek care at Narayana. With a monthly income of 2500 rupees, he and his family found it difficult to support a family of six. To pay for the concessional package, the family cut down a tree on their property made of valuable wood. They also borrowed from family and the local mosque. Collectively, they had 80000 rupees, but this still wasn’t enough to pay for the 178000 rupee package. In this case, the Have a Heart Foundation and independent donors stepped in to cover the remaining costs of the subsidized surgery. Fortunately for this patient, he will be admitted within one to two days as opposed to the 6 months to 2 years that would likely be the case at a government hospital.

Another case that I saw was a child that had accidentally ingested acid. The family had sought treatment at a local hospital, and ended up spending all they had. Even then, the treatment wasn’t complete, so they came to the Narayana philanthropic office for help that they probably wouldn’t receive elsewhere. These are just a few snapshots of the cases I have gotten to see recently. While every case is different, they all have a similar story: none of these patients would have been able to seek the care they need without an institution like Narayana that cares for the poor.