We were taken straight to Malalikara School where we after a quick introduction to one of the project's key drivers, Leena, were led to a hall with a group of about 100 very attentive students in the age of 10-12. The students were in the middle of a session on healthy lifestyle given by the project team. Diet and exercise were the key points in the presentation and afterwards Henrik joined in on the stage, which was a great thrill for the students, quizzing them on what they had just learned.
Afterwards, we observed a session on yoga, where the children were introduced to pranayamas (breathing exercises) and asanas (stretching exercises). The children started off shy, but soon absorbed themselves in the exercises.
Practising yoga is a great way to keep diabetes at a distance as it balances body and mind and encourages a healthy diet. If one follows the yoga principles for 2-3 month it has been proven to reduce the blood glucose and cholesterol levels according to a small (non-scientific) study by Dr. Vijay Kumar's team.
Lunch time arrived, so we went back to the car. The drive from the school took us through rural settlements. We turned our heads an extra time when we passed our first elephant in the roadside ridden by an old grey-haired man dressed in the colours of a Swami (orange clothes), reckoned it must have been a temple elephant and then we turned our heads once more as we passed a holy white cow standing in the side of the road with one horn painted green and another painted red. Why, is yet a mystery to us.
We were taken to a restaurant in Kulanada for a thali-resembling meal and under the watch of our four new friends, we dug into the meal using our fingers to mix the rice with the different side dishes like sambar (thin lentil curry with cubed vegetables), thoran (vegetable dish), dahi (buttermilk) and coconut chutney. (We of cause used the right hand since the left hand is reserved for 'impure' tasks). Our good intentions but somehow failing intent to get the slippery rice to the mouth using our fingers was to great amusement of our hosts and without much understanding to our struggle: "Eating with five sticks is surely easier than eating with just two sticks as you are used to in Japan!" they said laughing. 'Practise makes perfect', so we struggled on for a while until a glance at the other's empty plates told us we better start to speed up by using a spoon, thinking we have another two month to learn the skill of eating with the senses. One of the benefits of eating with your fingers is that you get to feel the delicate textures, which is healthy (?) according to the traditional Indian natural doctors – the ayuvedics.
The temperature here in Kerala calls out for siesta, so after lunch we continued to our accommodation which Dr. Kumar had insisted on taking care of.
A left turn down a dirt road led us along cocoa plants and coconut trees until we parked in front of a beautiful gate, with a sign above citing a famous poet in the Keralean language, Malayalam. This turned out to be the hospital's lifestyle reformation centre and our home for the next two nights. As the photo witnesses we were excited!
Entering the gates, a beautiful, lush garden greeted us. Red palm trees, banana trees, jack fruits and coconut palms were amongst the varied vegetation and the butterflies made the place perfect.
Practising yoga is a great way to keep diabetes at a distance as it balances body and mind and encourages a healthy diet. If one follows the yoga principles for 2-3 month it has been proven to reduce the blood glucose and cholesterol levels according to a small (non-scientific) study by Dr. Vijay Kumar's team.Lunch time arrived, so we went back to the car. The drive from the school took us through rural settlements. We turned our heads an extra time when we passed our first elephant in the roadside ridden by an old grey-haired man dressed in the colours of a Swami (orange clothes), reckoned it must have been a temple elephant and then we turned our heads once more as we passed a holy white cow standing in the side of the road with one horn painted green and another painted red. Why, is yet a mystery to us.
We were taken to a restaurant in Kulanada for a thali-resembling meal and under the watch of our four new friends, we dug into the meal using our fingers to mix the rice with the different side dishes like sambar (thin lentil curry with cubed vegetables), thoran (vegetable dish), dahi (buttermilk) and coconut chutney. (We of cause used the right hand since the left hand is reserved for 'impure' tasks). Our good intentions but somehow failing intent to get the slippery rice to the mouth using our fingers was to great amusement of our hosts and without much understanding to our struggle: "Eating with five sticks is surely easier than eating with just two sticks as you are used to in Japan!" they said laughing. 'Practise makes perfect', so we struggled on for a while until a glance at the other's empty plates told us we better start to speed up by using a spoon, thinking we have another two month to learn the skill of eating with the senses. One of the benefits of eating with your fingers is that you get to feel the delicate textures, which is healthy (?) according to the traditional Indian natural doctors – the ayuvedics.
The temperature here in Kerala calls out for siesta, so after lunch we continued to our accommodation which Dr. Kumar had insisted on taking care of.
A left turn down a dirt road led us along cocoa plants and coconut trees until we parked in front of a beautiful gate, with a sign above citing a famous poet in the Keralean language, Malayalam. This turned out to be the hospital's lifestyle reformation centre and our home for the next two nights. As the photo witnesses we were excited!
Entering the gates, a beautiful, lush garden greeted us. Red palm trees, banana trees, jack fruits and coconut palms were amongst the varied vegetation and the butterflies made the place perfect.
Besides the small pond near the entrance, the secluded paradise included a yoga/meditation hall, a conversation platform, a small cafeteria and living quarters. Every morning at 7 am there were given yoga classes for whomever (locals) who wanted to join. The yoga master only spoke a little English though, so we didn't have the chance to join, so we just watched quietly from the sideline:
Our room had a balcony facing the river floating next to the premises.
From nearby temples, calming music drifted into our room. Waking up at this place to the peaceful music (chanting) of the Hindu temples completed the feeling of having ended up at a magical place.
We would later discover that Leena's auntie would prepare all our meals during the stay, giving us an authentic experience with the South Indian kitchen. With a lavish use of curry leaves and coconut, we were practically sent to heaven.
This was breakfast one morning: Rice noodles buns with sambar and coconut chutney. Yummy!
The first night after dinner we had our first meeting with Dr. Vijay Kumar who had been busy at his hospital during the day in the yoga hall where we also watched an informative video about diabetes.
From nearby temples, calming music drifted into our room. Waking up at this place to the peaceful music (chanting) of the Hindu temples completed the feeling of having ended up at a magical place.We would later discover that Leena's auntie would prepare all our meals during the stay, giving us an authentic experience with the South Indian kitchen. With a lavish use of curry leaves and coconut, we were practically sent to heaven.
This was breakfast one morning: Rice noodles buns with sambar and coconut chutney. Yummy!
The first night after dinner we had our first meeting with Dr. Vijay Kumar who had been busy at his hospital during the day in the yoga hall where we also watched an informative video about diabetes. The second day started off with a visit to the Kunalada Diabetes Care Centre founded and owned by Dr. Vijay Kumar.
Twice a week the diabetes wing of the hospital called The Kulanada Diabetes Care Centre is open for its approximately 7000 registered patients and the between 20 and 40 new patients that make their way to the clinic every week, - often patients from other hospitals that have heard about the hospital's good results and fair prices.
Fair health care prices are not something to be taken for granted in India where some clinics demand prices that makes counselling and treatment unreachable for poorer diabetics, where tax paid 'free' health care system is non-existing and where healthcare insurance is a luxury for the few.
We received a grand tour of the centre and learned much from the visit to the different areas.
It seems to be the emphasis on a holistic consultation and an individual treatment that gives the good results.
On arrival new patients go through the same thorough procedures, securing a holistic view on the patient's condition and lifestyle including:
- Tests made of blood glucose level, cholesterol level, blood pressure, liver function etc.
- Consultation with a diabetologist
- Examinations done by various specialists to determine the progress for various complications related to feet, eyes and the nerve system.
- Consultations with a dietician and a physician
The patient is also offered lectures on relevant subjects such as nutrition, physical exercise (yoga asanas), breathing exercises (pranayama), insulin management, foot care, symptoms, smoke-stop etc.
There is a great emphasis on individual treatment plans designed to match not only the development of the disorder, but also by taking the patients financial means, education level and degree of 'rural' lifestyle (meaning eg. no access to refrigerator for storage of insulin) into consideration.
India is the country in the world with the highest number of people living amid poverty. The otherwise obvious insulin treatment can be unrealistic for some patients due lack of means, and as it can inflict great damage on the health to suddenly stop an insulin treatment after first begun, it is essential to make sure a prescribed insulin treatment can and will be followed properly by the patient. In some cases the solution is to postpone insulin treatment and instead regulate the disorder through diet, exercise and non-insulin medications as long as possible.
Individual advice is also given about nutrition and exercise. Nutrition and exercise are the most important means to control diabetes in the early (pre-insulin) stages. Right nutrition and proper exercise can postpone or even prevent severe complications.
The optimal diet is the same for all patients, however a sudden huge lifestyle change can be difficult for a patient to manage, why emphasis is on adjusting the patients current lifestyle with small changes step-wise until optimal lifestyle goal is reached. The centre has a long and successful experience with this approach.
The optimal diet according to the hospital's dietician for a diabetic (and the rest of the world's population) is equally parts vegetables, salad, protein source and stables (in Kerala; 1½ cup rice).
Oil intake should be kept at a minimum with no more than 2-4 teaspoons per day which is one of the greatest challenges as the Indian kitchen traditionally use a lot of oil, - even the bread is fried in oil.
Another cultural challenge is the use of (or the lack of) footwear. In some rural areas of India, there is a culture of not wearing shoes, which increases the risk of cuts on feet that can develop into infections. For many diabetics the cut or wound will not heal properly. For an undiagnosed diabetic an infection can be the first symptom of diabetes which results in the diagnosis.
If it is discovered in time, the development of an infection can be stopped, meaning the patient will avoid ulcers that can lead to amputations. Untreated or late treatment resulting in amputations often has catastrophic consequences for the poorer patients and their families because of lost income.
In one case the centre found more than 100 maggots coming out of an untreated infection in a foot of a diabetic. Fortunately, this is an extreme case.
Besides detailed instructions on good foot hygiene and daily routine check of the feet, the patient receives recommendations to wear footwear. The centre offers handmade shoes to less than half of what commercially shoes cost. The shoes are designed in such way, that blisters etc. caused by normal shoes are avoided. The centre consequently has a very low prevalence of amputations among its patients.
A Trust Fund has been established to supplement and extend the centre’s activities in order to aid the people who need it the most. This aid sometimes makes the difference between life and death. At present 8-9 children are given free insulin treatment as their families have no means to pay for the treatment. The sad story of a family where one child died of diabetes because the parents could not afford treatment and who had yet another child diagnosed with diabetes Type I has inspired Dr. Kumar to take this measure to ensure a future for those – in every sense – poor children.
Its also a heartbreaking fact that the suicide rate in India is high among type I diabetics who cannot afford the proper treatment and thus eventually are left with unbearable complications in their late teens or early twenties. The burden on their family is too great and the future perspective is simply too depressing. One of Dr. Kumar's patients came back to the centre, as late as 9 years after he was diagnosed by Dr. Kumar. He had not followed the medical advices he was given and thus developed severe (and irreversible) complications, leaving no hope for the future. He committed suicide.
Complications caused by diabetes are amongst others; amputation of feet/leg due to nerve damages, blindness, kidney failure, cardiovascular disorders.
After the visit at the centre, we continued on to St Marys Jupi School, where approximately 400 children in the age of 8 to 12 were taught about diabetes. Parents and teachers were invited too and offered a free blood glucose level test, cholesterol test and a BMI calculation. Unfortunately only few parents had shown up.
We were received kindly by the headmaster and led to the stage to hysterical amusement of the kids. After having given a short presentation about Denmark and after explaining the importance of following a healthy diet and doing regular exercise, an innocent question to the children “Any questions?” forced us into performing the Danish children's song ”Lille Peter Edderkop” for the around 400 children. H did the singing, B did the hand gestures. It was all very... well... embarrassing, but the children sure looked like they had fun as they tried to keep up with the gestures.
When they asked us to dance, we drew the line though.
The kids were too excited by our presence on stage so we went back stage, so the project team could continue their presentation about diabetes. When lunch break arrived we ended up at the headmaster's office trying to avoid causing turbulence at the school with the eager kids wanting autographs and handshakes. The kids just followed us though. Eventually we were driven back home to give the project team the possibility to do their important job.
Later, in one of the informal conversations with Dr. Vijay Kumar, Dileep Kumar and Leena, we were explained some of the reasons for the high prevalence of diabetes in Kerala. Since the mid-eighties there has been a dramatic change of lifestyle because of a high growth in the average income. The general growth in India's economy is of cause a contributor, however the biggest change in Kerala is found in the steady flow of money from the Gulf. On average, every family has at least one member working in one of the oil-rich countries in the Gulf for 4-6 years where they are able to earn much more than in India, making it possible for them to send money home to the family. The consequences are seen in the change of lifestyle towards what we see in "westernised" countries. It includes a tendency of people doing much less exercise (maybe the main contributor to the increase in lifestyle deceases such as diabetes), people eating more unhealthy food with excessive use of oil and a family structure which is becoming more nuclear, resulting in a more stressful life, since problems and issues are no longer solved with the support from other family members.
Talking with Dr. Kumar:
That evening we went to the local Festival for Nandi (the bull, Shiva's vehicle) and the next morning we were driven by Leena to Alappuzha, where Kumar had arranged for a houseboat for us (see the next couple of blogs).
It was with a sense of regret that we said our goodbyes (or rather the Malayalam “see you later”) to Dr. Kumar, Dileep Kumar, Leena and their team. Being total strangers they had received us at their place like family, devoting time to us, making sure we had a wonderful stay and an inspiring program. With the expectations to learn a lot about Diabetes in India we also learned a lot about the life and culture of India and the incredible hospitality known as "Atithi Devo Bhava".
We were very impressed with the knowledge presented to us in a fine balance of professionalism and 'big hearts'.
Twice a week the diabetes wing of the hospital called The Kulanada Diabetes Care Centre is open for its approximately 7000 registered patients and the between 20 and 40 new patients that make their way to the clinic every week, - often patients from other hospitals that have heard about the hospital's good results and fair prices.
Fair health care prices are not something to be taken for granted in India where some clinics demand prices that makes counselling and treatment unreachable for poorer diabetics, where tax paid 'free' health care system is non-existing and where healthcare insurance is a luxury for the few.
We received a grand tour of the centre and learned much from the visit to the different areas.
It seems to be the emphasis on a holistic consultation and an individual treatment that gives the good results.On arrival new patients go through the same thorough procedures, securing a holistic view on the patient's condition and lifestyle including:
- Tests made of blood glucose level, cholesterol level, blood pressure, liver function etc.
- Consultation with a diabetologist
- Examinations done by various specialists to determine the progress for various complications related to feet, eyes and the nerve system.
- Consultations with a dietician and a physician
The patient is also offered lectures on relevant subjects such as nutrition, physical exercise (yoga asanas), breathing exercises (pranayama), insulin management, foot care, symptoms, smoke-stop etc.
There is a great emphasis on individual treatment plans designed to match not only the development of the disorder, but also by taking the patients financial means, education level and degree of 'rural' lifestyle (meaning eg. no access to refrigerator for storage of insulin) into consideration.
India is the country in the world with the highest number of people living amid poverty. The otherwise obvious insulin treatment can be unrealistic for some patients due lack of means, and as it can inflict great damage on the health to suddenly stop an insulin treatment after first begun, it is essential to make sure a prescribed insulin treatment can and will be followed properly by the patient. In some cases the solution is to postpone insulin treatment and instead regulate the disorder through diet, exercise and non-insulin medications as long as possible.
Individual advice is also given about nutrition and exercise. Nutrition and exercise are the most important means to control diabetes in the early (pre-insulin) stages. Right nutrition and proper exercise can postpone or even prevent severe complications.
The optimal diet is the same for all patients, however a sudden huge lifestyle change can be difficult for a patient to manage, why emphasis is on adjusting the patients current lifestyle with small changes step-wise until optimal lifestyle goal is reached. The centre has a long and successful experience with this approach.
The optimal diet according to the hospital's dietician for a diabetic (and the rest of the world's population) is equally parts vegetables, salad, protein source and stables (in Kerala; 1½ cup rice).
Oil intake should be kept at a minimum with no more than 2-4 teaspoons per day which is one of the greatest challenges as the Indian kitchen traditionally use a lot of oil, - even the bread is fried in oil.
Another cultural challenge is the use of (or the lack of) footwear. In some rural areas of India, there is a culture of not wearing shoes, which increases the risk of cuts on feet that can develop into infections. For many diabetics the cut or wound will not heal properly. For an undiagnosed diabetic an infection can be the first symptom of diabetes which results in the diagnosis.
If it is discovered in time, the development of an infection can be stopped, meaning the patient will avoid ulcers that can lead to amputations. Untreated or late treatment resulting in amputations often has catastrophic consequences for the poorer patients and their families because of lost income.
In one case the centre found more than 100 maggots coming out of an untreated infection in a foot of a diabetic. Fortunately, this is an extreme case.
Besides detailed instructions on good foot hygiene and daily routine check of the feet, the patient receives recommendations to wear footwear. The centre offers handmade shoes to less than half of what commercially shoes cost. The shoes are designed in such way, that blisters etc. caused by normal shoes are avoided. The centre consequently has a very low prevalence of amputations among its patients.
A Trust Fund has been established to supplement and extend the centre’s activities in order to aid the people who need it the most. This aid sometimes makes the difference between life and death. At present 8-9 children are given free insulin treatment as their families have no means to pay for the treatment. The sad story of a family where one child died of diabetes because the parents could not afford treatment and who had yet another child diagnosed with diabetes Type I has inspired Dr. Kumar to take this measure to ensure a future for those – in every sense – poor children.
Its also a heartbreaking fact that the suicide rate in India is high among type I diabetics who cannot afford the proper treatment and thus eventually are left with unbearable complications in their late teens or early twenties. The burden on their family is too great and the future perspective is simply too depressing. One of Dr. Kumar's patients came back to the centre, as late as 9 years after he was diagnosed by Dr. Kumar. He had not followed the medical advices he was given and thus developed severe (and irreversible) complications, leaving no hope for the future. He committed suicide.
Complications caused by diabetes are amongst others; amputation of feet/leg due to nerve damages, blindness, kidney failure, cardiovascular disorders.
After the visit at the centre, we continued on to St Marys Jupi School, where approximately 400 children in the age of 8 to 12 were taught about diabetes. Parents and teachers were invited too and offered a free blood glucose level test, cholesterol test and a BMI calculation. Unfortunately only few parents had shown up.
We were received kindly by the headmaster and led to the stage to hysterical amusement of the kids. After having given a short presentation about Denmark and after explaining the importance of following a healthy diet and doing regular exercise, an innocent question to the children “Any questions?” forced us into performing the Danish children's song ”Lille Peter Edderkop” for the around 400 children. H did the singing, B did the hand gestures. It was all very... well... embarrassing, but the children sure looked like they had fun as they tried to keep up with the gestures.
When they asked us to dance, we drew the line though.
The kids were too excited by our presence on stage so we went back stage, so the project team could continue their presentation about diabetes. When lunch break arrived we ended up at the headmaster's office trying to avoid causing turbulence at the school with the eager kids wanting autographs and handshakes. The kids just followed us though. Eventually we were driven back home to give the project team the possibility to do their important job.
Later, in one of the informal conversations with Dr. Vijay Kumar, Dileep Kumar and Leena, we were explained some of the reasons for the high prevalence of diabetes in Kerala. Since the mid-eighties there has been a dramatic change of lifestyle because of a high growth in the average income. The general growth in India's economy is of cause a contributor, however the biggest change in Kerala is found in the steady flow of money from the Gulf. On average, every family has at least one member working in one of the oil-rich countries in the Gulf for 4-6 years where they are able to earn much more than in India, making it possible for them to send money home to the family. The consequences are seen in the change of lifestyle towards what we see in "westernised" countries. It includes a tendency of people doing much less exercise (maybe the main contributor to the increase in lifestyle deceases such as diabetes), people eating more unhealthy food with excessive use of oil and a family structure which is becoming more nuclear, resulting in a more stressful life, since problems and issues are no longer solved with the support from other family members.
Talking with Dr. Kumar:
That evening we went to the local Festival for Nandi (the bull, Shiva's vehicle) and the next morning we were driven by Leena to Alappuzha, where Kumar had arranged for a houseboat for us (see the next couple of blogs).It was with a sense of regret that we said our goodbyes (or rather the Malayalam “see you later”) to Dr. Kumar, Dileep Kumar, Leena and their team. Being total strangers they had received us at their place like family, devoting time to us, making sure we had a wonderful stay and an inspiring program. With the expectations to learn a lot about Diabetes in India we also learned a lot about the life and culture of India and the incredible hospitality known as "Atithi Devo Bhava".
We were very impressed with the knowledge presented to us in a fine balance of professionalism and 'big hearts'.
No comments:
Post a Comment