May 2018

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BRINGING YOU HANCOCK HEALTH INFORMATION AND NEWS ABOUT OUR ASSOCIATES!

A special issue commemorating Hancock Health's Caring Community Partners 2018 mission trip to India. CCP's team departure: Bound for India

RUSSEL JARVIS overnight flight will take them to beautiful strips and other over-the-counter remedies. Chaplain, Pastoral Care Team Leader Frankfurt, Germany where they will wait The host physician, Dr. Rajesh Paul, will Hancock Regional Hospital 2.5 hours for their flight to Chennai, India. oversee the local purchase of necessary January 31, 2018 – Hancock Health Caring 9.5 hours later, they will arrive in the prescription medications using funds the Community Partners all started with a ancient land of India around noon on team has raised. medical mission trip in October 2005. Over Sunday. They will be 10.5 time zones away. The team will also deliver care at the new thirteen years later, a team of Hancock The team will lodge at the Blue Diamond Christian Medical Center, made possible Health professionals and community Hotel in Chennai for twelve hours before partially through funds donated by residents return for the sixth time to taking an overnight train ride (400 miles), Hancock Health. They will spend several Machilipatnam, India. They have obtained followed by a two-hour bus ride to their days instructing nursing students on their visas, taken preventative medications destination in the state of Andhra Pradesh. practical subjects such as triage, body against Malaria and Typhoid, and reassured It is the eighth largest state in India and 49.4 mechanics, I.V. placement, first aid, and loved ones who will be separated from them million people live there. CPR. Other team members will meet with for two weeks. community leaders and educate them about The team will perform a variety of services. It infection control, diarrhea prevention and These Hancock Associates are on this year’s will conduct village health clinics where up treatment, food safety, caring for the team: Gretchen Pike (Admin), Marc Petrey to 500 people will arrive daily. This consists depressed/anxious, and other life-changing (Building Services), Steve Long (CEO), and of converting a concrete block, one-room health practices. Dr. Kristin Bagley (Hancock Family church building into a place where patients Medicine, New Palestine). They will be will be triaged and screened. The team will If this trip is like previous ones, the team joined by Bill Pike (Gretchen’s husband), identify and treat such things as high blood will have time to explore downtown Carol Gunn (retired HRH RN), Linda pressure, infected wounds, orthopedic pain, Chennai, eat the food of the region, ride in Myers (former HRH RN and nurse diabetes, scabies, diarrhea and more. motorized rickshaws, shop in a bazaar, and practitioner w/Eskenazi Medical Group), walk a black-sand Indian Ocean beach. Through the generosity of many donors and and Julia Grubbs. They will arrive back in Indianapolis the the collaboration of the Hancock Regional evening of Feb. 24. They will depart Indianapolis International Hospital Pharmacy, the team will distribute Airport on Friday afternoon, Feb. 9. Their over 350 pounds of vitamins, pain relievers, For more information about the host first stop will be Washington, D.C. An wound care supplies, glucose meters, test organization in India, see naceamission.org. 2 My thoughts on India in six parts

STEVE LONG to Machilipatnam. Not sure how many streets of Chennai yesterday, it seems clear President and CEO Hancock Health hours total that is given that we stayed a day that water is their enemy and would make in Chennai and the time difference to home them deteriorate quickly. Thus, the reason Part one is 10½ hours. I still haven’t learned where for so many stucco covered exteriors I guess. the ½ hour comes into the mix but have Just now a few homes sped by that look like February 2018 – I am in India. The very been told the easy way to figure out the time something straight out of a Florida realty thought is striking to me as it is so far in Indiana is to take the current number on guide, but they quickly pass to be replaced outside the realm of my daily life. Gone the clock here, minus 1½, and then change by houses with years of patches marking are the meetings, the email messages, the the AM to PM (or vice versa). clear blemishes on their distressed facades. office with easy access to our executive As I peer out the windows of the train there team, my assistant Sharon, and all the tools Though our train is a non-stop edition, it are times when I could imagine we are that make my work life hum. Gone are my slows through every town and I am able to traveling somewhere near the gulf coast in beautiful wife and daughters and the clearly see the people sleeping on the train America. Sandy soil, palm trees, flat plains comfort and cleanliness of our home. In platform’s granite benches, finding shelter with a few hills, ponds and small lakes their place is an environment of stark from the sun. As we enter a small city, the dotting the landscape. And then, suddenly contrasts and unique realities. condition of the homes quickly declines and often, the random village built close to with an associated, though odd, increase Alcohol hand gel has become my friend, as the train tracks pops into view. Concrete has the ever-present bottle of water. I block and mud brick houses, rectangular in the number of brahma cows and mangy approach foods with a mixture of interest features, usually sporting a faded pallet of tan dogs wandering the streets. The dogs and apprehension, having heard the stories exotic colors. Occasionally a newly painted are exceeded in number only by the massive of traveler’s diarrhea and the associated home sweeps by, providing a punch of count of yellow, three-wheeled, taxi-cabs dehydration. The latter is a real concern. vibrant color. called auto rickshaws (think bicycle Although this is the cool season, daily highs rickshaw with a motor), and a truly Though corrugated tin and cement appears are still near 90°, and the humidity is extraordinary number of small motorcycles. to be the dominant choice of roof, there is stifling, though bearable. Considering the the occasional home with clay tile, and even Marc noted to me on the plane that I would temperature back home is 27° with snow, I a thatched roof here and there, though I am be impressed with the driving ability really can’t complain. led to believe that rural areas away from exhibited on the roads, and once I got over We left Indiana early afternoon on a Friday. main transportation corridors tend toward my shock at the apparent lack of traffic rules, It is now 11:00 AM on a Monday and we this end of the spectrum. Block walls, often I became equally impressed. When I still have not arrived at our destination. colorful, surround many pieces of property comment to our Indian friend that there One flight across the US, a second to and serve to strike the boundary line. Many seem to be many close calls, but no wrecks, Frankfurt, a third to Chennai, a train trip homes seem poorly constructed, and based he informed me that, unlike in America to Vijayawada, and an upcoming bus trip on the bricks we saw for sale along the where things are orderly and we do not expect rash behavior from other drivers, in India rash behavior is always expected. Given this, everyone is keenly aware of their surroundings and pleasantly surprised when the motorcycle to your left does not actually pull out in front of you! This, and the constant sounding of horns, creates a vehicular maelstrom that seems random yet purposeful. The horns are not sounded in anger (usually), but rather appear to be convenient, almost cheerful, notices of close spaces. These toots are incredibly important when the bus you are traveling in is suddenly surrounded by a swarm of motorcycles (often with three or more riders) and three wheeled cabs! 3 Most of the India that I have seen so far we bacteria swimming their way to my stomach of the occasional annoying rooster crow, is in America would describe as “abject clearly in mind. The travel doctor that I saw comforting and allows me the opportunity poverty.” Our four-star hotel, though in preparation for the trip was right, putting to reflect on the last few days. staffed by exceptionally polite people, would the bottle of water in the sink is a great way Was it yesterday, or the day before, when not satisfy the requirements of a $30 a night to remember not to put my toothbrush we arrived? Another quick bit of math tells motel and the majority of the houses would under the faucet as years of daily repetition me this is Wednesday morning, which be immediately condemned in most have programmed me to do. means we arrived on Monday afternoon…I American towns. Garbage is absolutely think. I do remember arriving at the train everywhere, dirt is endemic, open sewers What now? Breakfast is not until 8:00 AM station at Vijayawada and being greeted abound. The underground sewage systems so I have a few hours to kill. Fortunately, by luggage handlers wearing scarves. that do exist, empty their untreated email is ever-present and offers a distraction, “Odd,” I thought at the time, “it is 90 contents directly into the rivers, where men at least until the 6:00 AM rolling blackout degrees out here, why do they have scarves are fishing and women are washing clothing. arrives. I glance at the battery indicator on around their neck?” Conveniences like sit-down toilets, flowing my laptop, relieved that it has sufficient sewers, clean water, and power that lasts charge to weather an hour without Darkness suddenly blankets the room as throughout the day are simply dreams in electricity. The solitude, with the exception the blackout arrives. At the same moment, many parts of this country of nearly 1.5 billion people.

And yet. And yet... The people seem happy and content. Certainly, they toil endlessly at back breaking jobs to earn a few cents an hour. Clearly, their living conditions are harsh. Health status is terrible, malnourishment is pervasive, infectious disease rife, and chronic disease on the rise. But there is genuine love between people as they walk arm in arm down the street smiling and laughing together. I am troubled by the comparison to the disgruntled, self-absorbed people in our own country who live in constant fear that the Jones, the Smiths, or the Browns next door have a better yard, a better car, a better job…

I do not know what the next ten days will bring, but if the last 36 hours are any indication, it will be a life changing experience indeed. Part two

February 2018 – “I wonder if it is legal to murder a rooster in India?” Such is the first thought as I roll over to look at the time on my phone, which for technical reasons unknown to me still reflects the Greenfield time zone. Requiring math to decipher the time (only 5:00 AM in India) is a wonderful way to ensure a return to sleep will not occur, especially when my body believes it to be 6:30 PM. A quick shower with cold water and mosquito repellent soap, being careful not to open my mouth, the vision of 4 Hindu chants begin sounding via the men walk the length of the train station chanting of the ongoing morning prayers. loudspeakers in the distance. Strangely to our waiting bus, dodging running A loud voice sounds as a man wakes the melodic, the sound seems to float across the children and passengers awaiting the arrival boys sleeping in the orphanage on the floor morning mist, adding intensity to the of their own train, fast asleep on the ground. above my room. Breakfast is coming soon, already surreal experience. Though I am and as I am learning, “egg toast” or what The bus trip through Vijayawada reminds beginning to feel accustomed to this land, we would call “French toast” is the meal du me of Chennai the day before - surrounded the initial experiences remain jarring. jour. I am so thankful for the small packets by motorcycles and three wheeled cabs, Those scarves, for example, were actually of syrup that Ty made available to the team dodging out of the way of the larger cargo wraps used to create a wider base and a before we left! cushion for the luggage our porters carried trucks, attempting not to run over the While we have already had our share of on their heads. Our suitcases, averaging 50 people walking haphazardly down the edge pounds each, are piled two high on each of the street. Clang! My reverie is Indian meals, the occasional bit of western head, a carry-on is tucked under an arm, interrupted by the sound of a metal pipe cuisine is comforting as I recall the pizza pinned in place by the weight of the fourth dropped on concrete somewhere next door, (Pizza Hut and Dominoes) and burgers piece of luggage dangling from that arm. causing the dogs to bark and whine, (Burger King) we were treated to during a The other arm supporting the load above, momentarily drowning out the melodic quick stop at a modern shopping area on the main road. What a contrast to the bottles of green chili water buffalo milk from earlier in the day on the train…

We munch on the pizza and marvel at the contrast of the high-end retail stores passing by noticing mostly how they adjoined to the all too common 10’x10’ store front stall where you can find seemingly anything you might want. No big box stores here, no grocery stores either, just stall after stall of fresh fruit, toiletries, apparel, medications, building supplies, interspersed between Benetton and Jockey.

The road from Vijayawada to Machilipatnam is under construction, all 60 miles of it. Many buildings along the road seem to have had the entire front wall mysteriously clawed away. One apartment even had a bookcase lining the edge of a wall-less room facing the highway. I ask Rajesh what happened and he notes that the government is transforming the road to highway size and if the needed width impinges on your house or building, they draw a red line on the side and tell you to reduce the size to that spot. If you refuse, or are too slow, they will do it for you using the crude means of a back hoe or excavator, thus the lonely book case full of books. The result has the look of a sci-fi movie where large robots fight and wipe away the side of a building in the process…

As we leave the city, we begin to see huge piles of brick in shapes resembling the stepped pyramids in Mexico, though, of course, much smaller. Smoke is emanating 5 from some of the piles and I learn they are actually kilns for curing bricks. These are not the type of bricks we have in America. Dozens of people toil among huge piles of sand and ash, mixing the correct proportions with water, filling molds, then laying the brick on the ground to dry in the sun. After a few days, the resulting bricks are built into these small ziggurats with straw and wood placed within. When the pile is complete, the fire is lit, and a week later, the bricks are ready to sell.

Venturing further into the countryside we notice heavily loaded trucks beginning to appear. They are not just loaded, nor even over-loaded, but MASSIVELY over-loaded with straw. Though the trucks themselves are no larger than a dump truck, the loads they carry stretch nearly the entire width of the road, the straw flowing over the front windshield, and out the back of the track by many feet. The top reaching nearly 20 feet high, the trucks appear to be lumbering creatures from Star Wars, slowly ambling along the road.

In the country, huge fields of green with well-marked borders reach to the horizon with the occasional large stack of straw dotting the landscape. When questioned, our Indian friends indicate these piles of straw are from the rice fields, but the current crop is a small bean that is grown in rotation with the rice in the off years. Though we did not understand the Indian name of the bean, a bit of quick research via Google reveals it to be…soybeans. In an ironic twist, the next field contains corn. I joke that “all we need now are some hogs, and it will feel like home,” and suddenly a wandering pig appears in the ditch.

It is like Indiana! Part three

February 2018 – Well, the rooster is not going anywhere. Turns out he is a pet and is tied to a chair on the porch of the house next door. Drat…this 5:00 AM (6:30 PM at home) start to my day will be the norm. I guess I shouldn’t be surprised at a rooster on a leash. After all, I have heard stories of the duck herders here. No kidding, I have 6 seen goat herders and water buffalo herders The churches themselves are one room and a pump in between. The very privileged (usually trekking down the middle of the structures about 20’ wide and 30’ long with may also have a small on-demand electric street), so why not herds of ducks as well  stucco covered concrete walls, hand hewn water heater for the occasional hot shower. timber roof supports, and a corrugated roof. For others (almost everyone else), there is On Tuesday, the team prepared the There is minimal electricity, no water, no often a community well (good) or central medications we brought, separating bottles sewer (ergo, no bathroom), and no windows. pond (bad). The latter are actually man- of ibuprofen, acetaminophen, digestive aids, Clarification – there are window-like made retention reservoirs intended to store vitamins, blood pressure meds, antibiotics, openings to the outside, but they are water from the infrequent rains. In this etc., into sandwich bags of smaller quantities decorative blocks that are part of the wall pond, people draw their drinking water, to be distributed to patients at the sites. Since and allow fresh air (and bugs and dirt) to take a bath, wash their clothes, water their I am a bit of a fifth-wheel on the medical side enter the building. The floors are typically animals (usually cows, goats and water (I will be doing lectures on leadership and large slate tiles set directly over a sand floor, buffalo), and give their animals (usually the visiting local hospitals to learn more about with the seams covered by mortar. If this cows) a bath as well. Imagine the following Indian healthcare), I have the opportunity structure sounds very basic, it is. But please sequence: these ponds are made to gather to visit several of our clinic sites for the know, it is usually one of the best-built water from the surrounding land, thus, coming days. Most of these are located in buildings in town. when it rains, the water flows over the one-room churches in the villages ground and into the pond. There are no The villages usually average 500–700 surrounding Machilipatnam. Churches are sewers, thus human and animal waste are families (around 3,000 individuals). 90%+ ideal locations here as they are located on deposited on the ground. When it rains, of the jobs are seasonal and associated with paved roads, have large open rooms, and are this human and animal waste is washed the agriculture industry. The only real viewed in many ways as community centers. into the pond. Transmission of parasites, manufacturing companies are the brick among other diseases, from animals to I should comment that “paved roads” in factories. Some individuals are involved in humans via the water supply make parasitic the rural areas of India are about the width making candles (needed because electricity infections absolutely rampant in the villages. of a bike path in the states. Imagine two is spotty) or garments for sale to other lane traffic on the Pennsy trail with locals. Other jobs are limited to small retail We visited 14 churches yesterday, scouting motorcycles making a third lane between stores, repair shops (mostly bicycles and locations for the medical clinics. The pastor or around the traffic! Non-paved roads motorcycles), and food shops. Since there of each church met us, usually with their literally look and feel like paths that farm is essentially no central water system, there wife and children in tow. None of them equipment take through the fields back are also companies that bring water to your speak English, thus everything except house in barrels for a fee, though most home. There is no apparent rhyme or gestures must be translated. I soon learn families are too poor for this and hand that a quick smile, a hand shake, and the reason to the layout of roads in the villages carry or load it on the family motorbike. holding of both hands flat against each and the overall configuration feels very other as if in prayer, accompanied by a much like a go kart track complete with The wealthy will have a well with one water slight bow of the head are the very best ways chicanes and blind corners. tank at ground level, another on the roof, to break the ice.

The pastors here are incredibly poor, receiving support from their parishioners in the form of small bags of rice, eggs, and other food items. Their meager income is enhanced by a tiny stipend from a central mission that also provides them a motorcycle, schooling for their children, and healthcare from the mission clinic. In most of the churches, we are greeted enthusiastically, offered chairs to sit in, and beverages ranging from water, to freshly poured (in front of us) coconut milk, to small glass bottles of Thums Up cola. While we had never head of “Thums Up” before, we have found it to be ubiquitous here.

In addition to offering us their hospitality, these pastors showed genuine joy that we 7 had chosen to visit their church. They Pastor Barnabas also has polio, and is I know this pastor spent his own money (of quickly called parishioners to visit with us entering his 3rd decade with the disease. which he has so little) to give us refreshment. and at each stop we were warmly greeted Pastor Barnabas greeted us at his church, As we drink the beverage, children begin by throngs of people, mostly children as the smiling broadly up to me from his place in filing into the building and taking seats on day grew later and they had returned home the dirt. He has no use of his legs at all and the floor. from school. In these visits, I had the moves from place to place by leveraging his I speak with our guides regarding Pastor opportunity to meet two individuals in two useless knees in such a way that he crawls Barnabas only to learn that he has been different villages who suffered from polio. with reasonable speed across the ground. crippled most of his life and struggled As he motions us into the church, he makes Polio is a disease last seen in America in mightily to survive. There were times when a statement in Telugu and smiles even more the 1970’s. Last year there were only 30 he blamed the world, blamed God, for his reported cases of polio in the world, all in broadly. I ask what he is saying and learn condition, then one day just a few years ago, India. Polio is a communicable disease that that he wants us to know how blessed he is he experienced a life changing spiritual is spread via water and food contaminated to have us visit. event and from that day on was a changed by fecal material. It is treatable, but not A few helpers swiftly set up chairs in the man. I gaze into the eyes of Pastor Barnabas curable, and is a muscle-wasting disease church and Barnabas motions me to take a and see that his smile is genuine and reaches that disproportionately affects the young. seat at the head of the group in a chair to the depths of his soul. This man who has Polio was an epidemic in America in the obviously designed to support his disability. suffered so much, and has so little to give, early part of the 20th century and there are I offer it to him but he vigorously declines has welcomed me and given me without still Americans living with the life-long insisting I take the seat of honor. He then hesitation from what little he has. Tears impact of the disease. Given this, the only slides up next to me on the floor, takes my come to my eyes and I asked if I might have polio victims I had ever met prior to visiting hand and again indicates how proud he is a picture with him. As I lowered myself to India were very old. of this moment. We spend the next few the floor to sit with him and place my arm around him I finally understand…This is Not so with Nina, a young boy aged 11, who moments chatting via our Indian team why I came to India… contracted the disease in early childhood. leader when suddenly a young boy walks Nina is able to walk, with significant in with freshly sliced watermelon, a delicacy Part four assistance from an old pair of worn crutches. that is new to India. While the melon slices Nina arrived with a group of children who look wonderful, we cannot risk the February 2018 – “Is that a body?” I ask with excitedly came to the church to see “the possibility of infection as we don’t know if surprise upon entering the emergency room Americans” who were in town. I ask Marc the knife used to slice it was clean of at the regional government hospital. My if he knows why so many come and he pathogens unique to the Indian Indian friend answered “yes” as he nodded responds: “the circus has come to town, and environment. Barnabas graciously toward the shrouded figure prostrate on it is us…”. While all the children appeared understands and a few moments later, a sturdy, but unattractive, metal cart, the happy, Nina’s smile was especially bright, young boy appears with small bottles of kind you would find in morgues in the US in spite of his condition. “Thums Up” for us to drink. I am aghast as in years past. “Shrouded” is likely not the right descriptor here. The body is wrapped in non-hospital blankets, presumably brought from home by family members who have gone to make arrangements for the body, leaving it alone, here in the emergency room corridor.

In the Indian healthcare system, the family provides much of the required care for their hospitalized loved ones. Nurses (arrayed in white uniforms and hats) provide medical care, while families (often two or three at the bedside much of the day) take care of feeding, bathing, toileting, and transporting the patient. With so many people in such tight quarters, personal privacy and confidential discussions are non-existent. Doctors spend very little time with each patient as the volume of people arriving is 8 simply overwhelming. In this teaching bare bulbs dark while the room is lit by the Hand hygiene would not appear to be a hospital, most care is provided by interns, morning sun pouring in through large priority here. medical students and nursing students, windows. There is no air conditioning, so There is no EMR, no lab results reporting, especially after the faculty physicians leave ceiling fans and open windows are required no PACS system, no pagers. But every to maintain a tolerable temperature. I am in the afternoon. physician has a cell phone that appears to visiting during mid-winter when the ring incessantly as others in the hospital The building itself is large, split into three temperature outside hovers around 85 attempt to reach them with questions or sections, and houses 500+ inpatients and degrees. The ward is on the warm side of information. The hospital has a robust more than 1,000 outpatient visits daily. The comfortable today so I can only imagine laboratory, but imaging is limited to x-ray, upper floors of each section contain the what it must be like in the summer… ultrasound, and one 16 slice CT scanner inpatient wards. No private rooms here, nor Besides lights, ceiling fans, electrical outlets, through which they process 100 patients even double occupancy. All are open wards and beds there are no other devices to be daily. The hospital does have some areas housing 25 – 30 beds each. The beds in the seen. No head walls, no med gases, no IV with access to advanced equipment. The general medicine and surgical wards appear pumps, no monitors, no nurse call, no respiratory ward had a few patients on to be 1950’s vintage and the few that elevate alarms, no bedside table, no over-bed table. modern ventilators. The kidney unit had do so at the bidding of manual cranks. The Nothing. On closer inspection, I do see very nice dialysis machines. The anesthesia rooms are outfitted with fluorescent lights, paper medical charts placed on the end of unit had physiologic monitors as well. some of the beds, ragged pages spilling out. I have the chance to speak with the head I also see unattended specimen tubes filled internal medicine physician, an associate with blood on a few beds, some placed professor and a few of the residents as they alongside drug vials and syringes, also round. I decide not to ask about infection unattended. The floors are dusty, though control, or the lack thereof, and instead piles of sandals are staged at the entrance inquire as to how they keep track of so to each ward where patients and visitors many patients. The head physician is remove them as is the custom when entering cheerful and she willingly answers my a home. This means all individuals in the question stating simply that one “gets used ward, except for the doctors, are barefoot. to it over time.” The group then moves on I shudder just a bit at the infection control to the next ward down the corridor, this issues associated with dozens of barefoot one with patients lying on gurneys in the people. Then I realize I have not seen hall because the beds are full. While these anyone wearing gloves. I also have not physicians practice without many of the seen any alcohol-based hand cleansers. I supporting systems we have in America, pay specific attention now and notice no the range, acuity, and volume of conditions sinks are present in this ward either. they see in the government hospital gives

9 them familiarity with a broad spectrum of room is open, the windows are open, and Following our adventure at the government diseases. That said, the sheer number of only the caretaker is present. 12 – 15 metal hospital we take time to explore the private patients under their care, the lack of support tables are visible as we enter, arranged in side of healthcare. As I learn, private system, and essentially no investment in two rows down the length of the room. healthcare has two main branches. The first infection control, patient safety, and privacy About 1/3 of the tables are occupied with is comprised of private hospitals operated lead to many poor outcomes. No wonder bodies in various stages of investigation. A by large for-profit companies or religiously- the physicians say they are happy the laws few of the bodies have clear signs of trauma affiliated institution. The second are smaller in India do not allow lawsuits against or disease that is fascinating to the two independent hospitals owned by physicians. physicians who practice in the government doctors accompanying me on this walk so While we can view some of the institutions hospital setting… we take advantage of the opportunity to get in the former category from the outside up close and personal...I tolerate the I am interested in costs in the hospital and (they seemed several notches better than experience better than one might think! ask about the CT tech about his the government hospital), we are able to compensation. The answer? 230,000 rupees The room next door is labeled “medical per year, which sounds like a lot until you museum” but I find that it actually contains figure in the exchange rate to dollars in a great many glass containers filled with which case it becomes…$3,600 per year. formaldehyde and encompassing a variety Drugs costs are lower here by a factor of 10 of internal organs, extremities, deformed in many cases. Labor rates for construction fetuses, and one shelf even holds cross- average around $2.00 per day per person, sections of various parts of a human body so capital costs must be low. Overall, the including the head and torso – reminiscent cost of healthcare in India is much lower. of the stairwell at the Museum of Science In America, we spend approximately $9,500 and Industry in Chicago. per person per year for healthcare. In India, As we complete our tour of the government they spend $75 per person per year… hospital campus I am convinced of a few We walk across the road to the medical things: 1) there is no attention paid to college next door, one of the largest in South infection control, patient safety, or privacy, India. As we stroll along the sidewalk 2) the doctors here are very good, but do connecting the college to the hospital, we not possess the resources or time to deliver notice families camped out on the dirt lawn, quality care, and 3) If something ever cooking fires burning, laundry hanging happens to one of our team members that from the few lonely trees, people sleeping requires medical attention, we will handle on the ground. The college itself is it ourselves and medivac back to Europe or undergoing significant renovation and America quickly! really needs it. The lecture halls and labs are reminiscent of my undergraduate days in the old chemistry-botany building at the University of Iowa. That building in Iowa is long gone now, but appears to have been transported here! Everything is, of course, made of concrete and there is no air conditioning. The building is laid out as a huge hexagon with an enormous courtyard housing a basketball court, a cricket pitch, and a variety of walkways and landscaping.

It takes 40 minutes to walk the circumference of the building including a stop at the gross anatomy lab. In most med schools, these labs are hidden in the bowels of the building and access is restricted. Not so here. We recognize we are getting close when we enter the wall of formaldehyde vapors wafting down the corridor. The 10 peek inside one of the hospitals in the latter in America…early in the last century. The entrepreneurial spirit is alive and well category and found it to be a…house. in many sectors of Indian healthcare. What We then go to the most amazing site of all is missing is attention to infection control, India is in a state of flux in terms of – the hospital district in Vijayawada. patient safety, and privacy – the regulation for the private healthcare system. Imagine a ten-block section of a city the foundational elements that are required in There is no CMS, no HFAP, no Joint size of Indianapolis populated almost America. Our partners in India are opening Commission that are in place to provide entirely by healthcare-related businesses. a new small hospital in Machilipatnam, and oversight. Indeed, I am told all that is Narrow streets, unimaginable traffic, dirt, their leader and I spend a few hours talking required to open a private hospital is for a garbage, air pollution, neon signs. A large about their vision as we return home privately licensed provider (a physician) to billboard pasted to the side of an emergency following our hospital tours in Vijayawada. send a letter to the government noting they generator announces the “Heart and I am relieved to learn that he sees precisely are starting a hospital. That’s it. So, when Vascular institute”. Located nearby is the the same issues as me and that their new we visit a new hospital that is built in an old “Liver and Gastro Hospital” and just down hospital is being built to the highest of house, I am not surprised. Bedrooms are the street are one of many “Eye Hospital” standards. In fact, the piped-in oxygen is converted into inpatient wards. The kitchen being installed the tomorrow! is now the delivery room for babies. The and “Dental Hospital” organizations. In large closet in the back of the kitchen is between are literally hundreds of small Part five being outfitted as a C-section procedure druggists, medical stores, and food shops. suite… No fire alarms or fire suppression, Walkers, wheel chairs, bed pans, crutches February 2018 – “Yet another surreal no med gases, no…anything, except the are placed in shining piles on the sidewalks experience”, the thought flashes through large sign noting it is a hospital and a long in front of the stores and open-air my mind as a small herd of goats meanders line of patients out front waiting to be seen pharmacies provide access to almost any past the leadership class I am teaching. We by the doctor holding clinic in the front prescription drug, though in India sit under the large shamiyana (canopy) room. This would have been a typical scene prescriptions are not required. erected on the road adjacent to the church

11 building where the team is staffing another My musings are interrupted by commotion Marc is especially good as the guardian of medical camp. The building is located at just down the street as we see a farm tractor the front door. His size, long mustache, and the crossroads of a rural highway and a and trailer hauling a large load of straw flowing white locks hidden under the paved farm road. The canopy has been from the rice fields. We quickly vacate the “do-rag” cause many to think he is Hulk erected over the part of the side road that street and watch as the load barely makes Hogan (who knew Hulk Hogan was famous sits just six feet from the church, a large pile it under our canopy and on toward the in India…!). Given this, we have of sand in between. Our medical camps main road. This is the first meeting I have affectionately renamed him “Hank” Hogan.  have been strategically located in areas ever had to move because of a tractor . In settings where crowd control is not an where they can serve multiple villages, and The medical camps are organized very issue, Marc also staffs the triage table as this one sits midway between four of them. similarly every time, as all of the churches well. For most of the camps we are including At most of our camps, I have been asked to are built from a common design. A small students from the nursing school since this teach a short class on leadership to the triage table is set up at the front door, two is a prime educational opportunity and they pastors in that area. The class is based on provider stations are set up farther in and assist at the triage table. Gretchen is the John Maxwell’s, “Five Levels of Leadership”, to the right, a third is set on the opposite master of this station, checking vitals while and appears to be well received. Since I am side of the room to the left, the wound care/ building instant rapport with the patients. “PowerPoint-dependent”, I typically use the procedure table is set up at the back of the That said, if any patients attempt to cut the laptop and portable projector we have church on the left, and the pharmacy is set line (this is common), she quickly gives brought with us, but today there is no up at the back on the right, near the exit them the “mom stare” and they cease and door. The flow through the clinic can be indoor place for us to go, so we are meeting desist immediately! under the canopy on the road. I hold the very smooth, or very chaotic, depending on Our three providers are Dr. Kristin, Dr. laptop on my lap (ironic, don’t you think?!) how well controlled the crowd is. To ensure and the pastors sit very close so they can we tend toward control, we are blessed to Minnie (a mission physician), and Linda see the screen – they love the pictures I have have Marc and Bill on the team – both are (an NP). Kristin and Linda are assisted by included from back home. During the tall and imposing and have the ability to interpreters and all three providers are course of our talk, distractions have regulate the flow with precision. presented with a wide variety of ailments and injuries ranging from exceptionally abounded. Many people have trotted, single Bill is guardian of the back door. file, behind our group on their way to the Exceptionally important we have found, as high blood pressure, to small wounds, to front door of the church to enter the there are so many people seeking care that parasitic infections, to uncontrolled medical camp, a few small motorcycles have they will enter through any unattended diabetes, to orthopedic issues causing pain. traversed the narrow gap behind us as well, portal. Bill has the inauspicious recognition You name it, they have likely seen it, and the aforementioned herd of goats! of being proposed to by a young Indian lady including a very pleasant middle aged at the clinic whose hopes were dashed when woman just today with a 20+ year history Since I do not speak Telugu, there is he introduced her to Gretchen, his wife! of a goiter (now the size of an orange). significant downtime while TB, the leader of the mission, translates for me. I have learned there are two ways to translate: 1) verbatim, which flows quickly, or 2) ensuring the concept is understood. The latter method requires significant additional time to build the foundation for each thought, and is the one he uses. As I gaze across the small roadway toward the straw- roofed hut on the other side, I notice a small goat attempting escape through a corner of the connected stable. I hear, not for the last time, the snorting and bellowing of the water buffalo tied to the front of the church building, and I notice, for the first time, the satellite dish attached to a pole at the rear of the hut. I later have the opportunity to peek inside the hut and see that the dish is attached to a TV set…in a grass hut…it really is surreal… 12 Diabetes is of particular interest to the team By the end of the day on Monday, we The facilities at the school are sparse, but as it is a fast growing issue in India. Diet is calculate that between all of the medical adequate, and include classrooms, a very largely limited to rice, fruit, and camps, plus the day spent at the school, we small science lab, and a computer room carbohydrate-laden foods. Obesity rates are have seen nearly 800 patients. I joke with (with only 7 working computers for all increasing, plus Indians have a specific Dr. Kristin that I had no idea productivity 600 students – we are going to help with genetic predisposition to insulin-resistance could be so high and we may need to that). The entire compound is about the that makes them more prone to diabetes. readjust physician contracts back home – same size as a single floor of our parking Given this, many of our patients require a she quickly retorts that we aren’t using ramp and the courtyards contain no grass, visit to the “sugarist.” This is their term for Meditech here and document everything only sand and dirt. Transportation is the person, or clinic, that takes blood sugar on a single sheet of paper… Touché  provided by four buses owned and readings and provides treatment. In our operated by the school and strategically Speaking of the school – the mission we case, Carol is that person and she does a placed each night in surrounding villages work with not only oversees the operation wonderful job at keeping up with the to make the conveyance of children as volume of finger sticks while still caring for of nearly 40 churches in the rural village, efficient as possible. all of the wounds. but a few years ago started a school that now has more than 600 students ranging The school employs 17 teachers, 17 support The last stop in the clinic is the pharmacy, from the equivalent of our pre-K through staff, the principal and a nurse. The latter which is well-stocked with the common 10th grade. They are in the process of two individuals, are members of the family drugs the providers typically prescribe. It preparing for certification of the last grade that started the mission. The total budget is staffed by Rajesh, one of the leaders in level (equivalent to 11th and 12th in the for the school is less than $100,000 per year. the mission and a local dentist/oral surgeon, state) and this will increase their enrollment 34 people, four buses, three buildings, for though his background and education allow to 750! It is an amazing experience to stand less than $9,000 per month. I ask Rakesh, him far more insight medically. He speaks the principal, how they can do this and he English fluently as well and the combination on the stage while the students attend responds that it is through much prayer, of all these gifts make him indispensable morning assembly and see 600 smiling, to the mission here. fidgeting figures all standing in an area no the support of sponsors in America, larger than the main lobby of our hospital. running buses in two shifts, and routinely The final member of the team from the returning the salary of $50 per month that Though the school is still young, it has states is Julia, our documenter and he and his wife, Rose, receive to ensure participated the last few years in photographer in chief. She has been that the teachers and other staff can be standardized testing and ranks 1st, 2nd, affiliated with the mission for many years paid on time… and her father-in-law, Charles, was a and 3rd, for the three highest grade levels founder of the ministry back in the ‘80’s. respectively, as compared to other private The Paul family (TB, Rani, Rajesh, Minnie, Her insights and memory are incredibly schools in the state of Andhra Pradesh. Rakesh, Rose, and Richie) have devoted important during those moments when This would place it, comparatively, on the their entire life to reaching out to the people we are trying to place context around the same level as the very best private schools in the villages in the state of Andhra work here. in Indianapolis. Pradesh. TB was born in a grass hut in one of these villages and was blessed to be able to attend college. He moved to Chennai and became the professor in a seminary and began raising a family there. Nearly 20 years later, following the death of his father, TB returned to Machilipatnam at the request of his mother and created the vision that has resulted in 40 churches, a school with 600 students, a hospital, and a school of nursing. To say that this family is completely sold out to this vision is an understatement – they have given everything and are making a difference daily in the life of many thousands pf people on the east coast of India.

They also are blessed to work in a place (in India) where they love people for a living… 13 Part six touched. Some have been here since the “Travels home…” What a wonderful beginning when the trip was about tsunami thought! While I have grown to love this February 2018 – “Did you hear we ate the recovery, all have been engaged long enough land, its people, and its culture, and will rooster?” asks Marc as we pack for the train to have seen real change. Each and every certainly return, I cannot wait to get home trip back to Chennai. Apparently, the one exhibits kindness, love, generosity, to my wife, my family, and my own home. dedication, patience and the true heart of annoyingly loud rooster tied up outside our But that is still a bus ride, a train trip, and a servant, and each are so deserving of the window during the first week was not a pet, three airline flights away. but was being fattened up for a chicken title: “Caring Community Partner.” I am penning the closing of this last article curry recipe our hosts treated us to a few We leave the celebration, held in a large days ago! I wondered where he had gone… second story classroom in the main church somewhere over Canada. We are racing dusk in a battle we cannot hope to win as It is hard to believe we are already nearing building, and descend to the sanctuary the sun is a much faster steed than our the end of our time in India. The where arrangements have been made for us surroundings have now become familiar, to provide food to more than 100 of the plane. We float above a silky blanket of the nameless faces from the first day are neediest people, mostly elderly, from the clouds, as unaware of the events below us, now friends, and our bodies well adapted villages we had visited. as the people down there are unaware that we travel above. How similar this was to my to a time zone half a world away. As we hand out the food items: 5 kilos of rice, life just a few weeks ago. Peripherally aware We ended our work here with two days of 1 kilo of Dal (grain), 1 kilo of sugar, and 1 of life-circumstances in India. Exposed, in training for the nursing students, school liter of oil for each person, I gaze at the such a limited way, to the extraordinary teachers, and church pastors. Sessions scrawny, wizened figures passing before us. ranged from basic first aid, to CPR, to They hold out all manner of bags to accept impact a small team from America could wound care, to HIV prevention and the rice we pour. Some do not even have a have on a huge number of people. Now my treatment, to a second leadership class, and bag, so we provide them the used canvas ignorance has been replaced by awareness, many more. With topics tailored to specific bags the rice arrived in and they smile and apathy by empathy. The team has audiences, everyone had insights to share. gratefully. I am told we are providing enough already begun planning for the next trip in food for a week, but I imagine that for many, The men on the team were even given the early 2020. Resources are being identified, it will need to serve for several times longer honor of standing in as CPR mannequins! ideas generated, communication beginning. than this…. In spite of their obvious need, All that is missing now is…You. Our last evening in Machilipatnam was spent they smile, they laugh, they hold our hands at a departure celebration where the pastors and thank us with words and gestures and Our desire is that you seriously consider were awarded their continuing education again exhibit the capacity of the Indian whether you are at a point in your life where certificates in front of a large audience. people to experience, and to share, joy. you can offer your time, your talents, and Amazingly, in such a short time, I feel a Our final work complete, we return to the your treasure to bless people on the other kinship has developed with some of these compound, finish packing and begin our side of the world, and be blessed far more men, despite the barrier of speech. I have travels home. in return by doing so. Will you join us? been privileged to glimpse into their world, if only for a moment and have come away changed. I was especially happy to see Pastor Barnabas again and remain in awe as he pulls himself quickly across the floor, up onto the stage, and accepts his certificate. As I grasp his hand, the smile on his face and in his eyes remind me again of why I am here.

Our team is welcomed to the stage and Pastor TB relates the work we have accomplished in so many places, in such a short time. He is clearly touched by the fact that all of our team, with the single exception of myself, have been here before and chosen to return, some of them time and time again. As I look at this incredible group of people – Bill, Gretchen, Carol, Linda, Julia, Marc, and Kristin, I also am 14 Reflecting back on my fifth India trip

GRETCHEN PIKE illness, and polio. Through interpreters, our I asked God for patience and compassion. Provider and Payer Relations Hancock Regional Hospital medical providers were able to obtain He sent me to India. information that helped them to provide The support that our team received in As my fifth Mission trip to education and medications that they can preparation for this mission was incredible. Machilipatnam, Andhra Pradesh, India continue to receive at the CMC Hospital. comes to a close, I find myself reflecting We were able to provide medicines that were on all the changes I’ve seen. We also provided education sessions to not only used in camps, but were left behind village preachers, nursing students and for the providers at the clinics to distribute The Christian Medical Center (CMC) is school teachers. One of the most popular, at no cost. We were able to provide rice, dal, open, the NACEA school—which now and most needed, was education about sugar and cooking oil to over 100 senior teaches over 600 students in grades 1-9— dehydration, heat exhaustion and heat stroke. women from rural villages. We left behind and the Hancock Regional School of There is a superstition in India that it’s bad blood pressure monitors, cuffs, Nursing have all been moved from dream to try to cool a person that is overheated. In stethoscopes, wound care supplies, and status to reality. The children’s home, which a place where temperatures and humidity small toys for the children…sometimes a cared for seven children in 2005, now run high year-round, death from these provides a loving home and an education bottle of bubbles can help soothe an ouchie. conditions is high. Needlessly high. to over 50. Not all these children are I cannot close without a word or two about orphans. Some come from families that Another thing that hasn’t changed are the my husband, Bill Pike. Bill is 74 years old. either can’t—or don’t want to—care for people. The dear people of India. I work a He has had three knee replacements (two them. The home also provides a living to triage station at the camps. My personal plus one reconstruction), shoulder surgery, the women who care for the children. goal is to touch—really touch—everyone hiatal hernia surgery, and carpal tunnel that comes to my station. (Yes, we use a lot Unchanged is the poverty, lack of sanitation, repair twice. He has been with the team on of hand sanitizer). Masks? Not unless we overall lack of medical care, and the four of these mission trips, and always with suspect that someone is truly infectious. A presence of diseases that were long ago mask hides a smile and creates a barrier. a heart to do whatever he is able to do, eradicated in the United States. Since many of these people are of the lowest which often includes making sure that we Many of the former thatched huts have been caste, known as “untouchables,” we take have water and a cool headband when replaced by brick buildings, although I great care to show them the highest level of needed. He is my hero. doubt that they provide any real kindness and compassion. If I should Thank you, Hancock Health and improvement in the living conditions for “catch” something, I have the best medical community members for all that you do to the residents. The former open sewers lined care in the world at my fingertips. Not so if make these mission trips a possibility. We with dirt are still open, but the waste runs you live in a third-world country. are grateful beyond words. in cement troughs. There are more western toilet facilities and "squatty potties" for And about the people: It’s the smile. public use, but urinating and defecating in Smile at any person on the street or while public are still all too common occurrences. riding a bus and they will always smile Trash is everywhere except in trash back. Not a canned smile, but a genuine containers. Cows, oxen, goats, and pigs smile that will light up a dark day. Add roam the streets freely. a wave, and you’ll get a wave in return. These are generally happy people just Our team of eight—along side our trying to survive. colleagues from NACEA—conducted several medical camps during this trip. One, To say that I have been blessed by at the school for third and fourth grades, participating in these missions is a gross one at the hospital for villagers that traveled understatement. I have come to appreciate there, and two in distant rural villages. things that I always took for granted. A Diabetes and high blood pressure were the flip of a switch does not always mean that words-of-the-day at most of the camps. The lights will come on. Faucets will most common complaints that I heard were frequently not provide water. There is a headache, backache, chest pain, gas, and local “911” system, but it is currently out- open diabetic ulcers. We also saw patients of-order. And beds—even in real with treated/cured leprosy, goiter, mental houses—may be made of plywood. 15 Perspectives of a family physician

KRISTIN BAGLEY, MD that a smile, a touch, a kind word and a listening ear to symptoms Hancock Family Medicine New Palestine are just as important medicine as the pills and the expensive testing we are often inclined to order. I believe that the time I spend here When I tell family, friends makes me a better physician at home. and patients that I am going on a mission trip to From what I have learned, we were not able to provide much India, I get varied medication on our first few trips here. However, since the mission responses. “Aren’t you has completed building of the Christian Medical Center and the scared”; “Why would you Hancock School of Nursing, patients now have a place for follow want to travel so far away up care. We could diagnose people with high blood pressure, when there are people here diabetes and thyroid disease. We could then educate, initiate that need you too”; “What medication and refer for continuing medical care. I saw many good can you do there if patients that I first met two years ago and they recognized and you just leave again”; “What a wonderful thing.” It is hard to convey appreciated that I came back. We consistently encourage the villages all the reasons and answers for why I came here in 2016 and again that medical help is available and that disease can be treated and in 2018 and why I plan to return in the future. To answer the first prevented. We also are able to provide education to the local question, yes I was quite nervous to get out of my comfort zone and teachers, nurses, ministers and community leaders. Medical travel further than I had before on that first trip. I was even dreading education topics this time included First Aid, CPR, IV starts, the length of travel for the second trip. However, I was never “scared” treatment of dehydration and heat exhaustion, and recognition and for my safety here. The Paul family is very protective of their respect of special needs children. We will build on these topics and Hancock family and would never put us in harm’s way. We have a add more at further visits. safe place to stay and visit villages where the mission has established It is not possible for me to describe all the ways that my experiences churches and community ties and are welcomed with open arms. here have changed me. I have a stronger faith in God and humanity. Medicine in rural India is different than medicine in Indiana but I have a greater desire to help both my community at home and more importantly patients are different. I love my practice in New here in Machilipatnam, India. I have a greater appreciation of my Pal and each of my patients. When I come to such a distant place home comforts and the advances of medicine in the US. I look and provide that same love and respect, I share the joy that medicine forward to years of collaboration and watching those same advances and my New Pal practice brings me. That kindness from a physician reach rural villages. I have never felt stronger in my calling as a is something many of them have not experienced. It helps them to physician, and I would encourage all physicians to serve on a mission know they are not alone in their lives. It also brings me the reminder at least once.

16 17 18 Blogging our journey to India

Editor's note: the following is the entirety of Linda Myers' blog We had a chance to meet with Rajesh and Minnie on last Friday. recounting her experiences leading up to, and including, her visit to They had a meeting with our team earlier in the day that I could India with Caring Community Partners. Due to space limitations not attend but sounds like we have a plan now for when we get there. only a portion of her photographs have been used. I encourage visiting We will be training the nursing students in some basic skills like her blog for the full visual experience. Please visit online to read her CPR and wound care as well as triage. We will provide some story at worldwanderer718.wordpress.com. education for the ministers on basic health topics such as hand washing, clean water, malaria prevention. We will be going to some India villages for medical camps. So it sounds like we won’t be doing much patient care in the hospital, but who knows. We are open to anything, ready for anything. Rajesh says the train ride will be better, we will travel at night so we can sleep, then get there during the morning. I think our team is going to work well together, we are all seasoned travelers except for one, it will be fun seeing how he reacts, it’s always fun to watch the newbies!

This week: My trip to the travel doctor! We are almost there!

Jan. 13, 2018 – Less than 30 days and we leave, and there is much to do. I have been gathering up my supplies, bought my suitcase, Dec. 10, 2017 – This blog is going to document my journey back to my scrubs at goodwill, starting to think about what snacks to bring. India. We will be traveling to Machilipatnam in Andrah Pradesh We are getting organized now about who will teach what, what on February 9. It will be here very soon and there is so much to do. supplies do we need to bring. I still need my tetanus shot, need to It’s been 12 years since my first trip, ten years since my second trip. get my malaria medicine and my sleeping pills. Its very hard to It changed my life the first time; India is an amazing place. It sleep on mission trips, there is not much privacy and for someone inspired me to become a nurse practitioner and this is really the who has a hard time anyway it is quite a challenge. I don’t want my first trip since I have been a full fledged NP. I feel ready this time suitcase to be very heavy, but I also want to be able to bring what I to tackle the medical issues that we are presented with. That is why need. I will face time this time instead of use my phone, when I I went to school - I felt very helpless to diagnose patients as a RN, went to Africa it cost me $500 in phone calls. I can text anyone with I was not trained for that. I was a labor and delivery nurse but they an iPhone and my family all have iPhones so that works out fine. told us to function as a doctor! Its hard to fake that part, I had no Trying to eat healthier now, maybe lose a few pounds before I go. idea really what I was doing. Now I do! I will miss everyone. There is a lot of planning that goes into a trip like this so I am starting now to document the journey. We actually started the planning in June. Its not a journey for the faint of heart, it takes a lot of commitment, a lot of planning, a lot of soul searching. I am nervous because its a hard trip, this I know for sure. The people of India are amazing, but some of the living conditions are hard to see. But they are making improvements and I am told things are better than when I was there the last time. India is a beautiful place; the colors, the smells, the sounds are all overwhelming-all of your senses are flooded the minute you step off the plane into the airport. But I am ready, again. Ready to make a difference for the people, ready to find out more about myself …again.

I have been struggling to get my visa done. It’s been really a pain! I spent four hours last week filling in all the online screens—first the stateside forms then the Indian government forms. Then I realized I need to do the online version. I had already paid so then I had to spend several hours undoing everything, ugggh! It will be worth it, I know it will. 19 Almost there! over open fires and there are many food stands. We don’t eat at the food stands as the cleanliness is not safe, we also drink only bottled Feb. 5, 2018 – Leaving in 4 days, can’t believe it! My suitcase is very water, including brushing our teeth with bottled water. Very humid full, plus my medicine bag I will carry is stuffed full of Tylenol, here, its gonna be hot today. Rajesh upgraded us to first class on the ibuprofen, children’s toys, vitamins. I am getting nervous, have lots train so we leave tomorrow morning instead of tonight. We will of lists right now, making sure I don’t forget anything. We get 50 # have a little more privacy that the usual second class. That will be for our checked bag. I will take a back pack as my carry on so I can an adventure for tomorrow, for today we are going out to venture hopefully keep it under my seat-I hate using the overhead bins! We into Chennai, do a little sight seeing before the journey to fly out around 2pm and make it to Chicago, then we go to Dulles Machilipatnam. and on to Frankfort Germany. I am working on my books for the We are staying at the Blue Diamond, a quaint, small hotel. Our flight, I hope I can sleep some on the flight too. Need to plan for a friends are familiar with the hotel and they take good care of us. loss of luggage so have a few extra clothes in my backpack, hope Its not fancy, but we trust them to feed us here, its not too expensive, that I don’t need them. Sounds like we are doing lots of medical and boy the bed felt good after sleeping on two flights. camps, some education, lots of fellowship. It will be a rewarding trip I am sure. I measured the girls, hoping to get them a cute dress. The Internet is better here than I remember, and we got our breakfast brought to us! Delicious omelet, fresh squeezed grape juice, fresh Leaving Indianapolis papaya, toast with a very yummy marmalade, and some very delicious coffee. Its bustling outside now as it is around 9 a.m. We are continuing to pack and re-pack—where’s my toothpaste, which bag is my blue shirt in, where are my snacks—this will be the story of every day because that’s what you do when you travel, its part of the fun!

Off we go on our first adventure! Sightseeing in Chennai

Feb. 9, 2018 – Made it to Dulles, small plane! Next one will be big, flying Lufthansa, they treat you well. We had to check our bags at the door of the plane because no overhead space. Russ came to airport, gave us a nice send off, prayer, blessing. He gave us each our own envelope and prayer, and some gum! We have all re-arranged our bags at least 5 times already, and so it will be that way for two weeks! Feb. 13 – Today we went to a crocodile farm and saw many live The picture taken at Indianapolis airport. Great team! crocs, but that was tame compared to the traffic, its absolutely crazy! Chennai Everyone honking, pulling in front of each other, cutting people off. But no one ever seems to get in an accident, thank goodness! Feb. 11, 2018 – Made it to Chennai last night, got in about midnight, We drove along the coast of Bay of Bengal today and saw the vendors by the time we got here it was 2 am and by the time we got organized selling their freshly caught fish. In the background we could see it was 3:30. After 28 hours traveling it felt good to lay in a bed even the boats and the nets. Unfortunately the people in India think though me and Julia couldn’t figure out how to turn out the light. nothing of throwing trash everywhere. There does not seem to be Feel a lot of feelings rush back as we got to India, stepped off the any regular kind of trash removal here so it makes for some pretty plane and it all came back. Chennai is a city that has some very strong odors. Its a shame because the coastline is very beautiful. modern structures and side by side with extreme poverty. The electrical wires are quite something to behold, jumbled up masses We went to an temple from the 7th and 8th century called of wires that look very menacing but work well! The air is usually Mamallapuram-its a temple carved out of stone, very interesting pungent with smoke, smells of cooking. People do a lot of cooking images carved into the stone itself. We did a good bit of hiking, 20 then we stopped for a delicious Indian dinner at a restaurant. We Machilipatnam shared curry, fried rice, and several had lime soda-made fresh with real limes, carbonated water, sugar and water. It was great! Feb. 13, 2018 – We are here! It finally starts to look familiar but a lot has changed. And some things haven’t. Unfortunately they still Up at 4 a.m. to get the train tomorrow and on to Machilipatnam. have open ditches along the side of the road that drains the sewage. We made it! It makes for a very pungent arrival, but the smell wafts away quickly. They have built some new buildings since we have been here and Feb. 13, 2018 – Have had some Internet issues here! This was we are ushered into our host’s home. Rani is our most gracious host, yesterday. Pictures later due to slow Internet. she has prepared us little cups of coffee and some cookies and little cakes. Its fun to catch up, but we are tired. There will be a reception Today we got up at 3:30 a.m. and left for the train station at 5 a.m., tonite at the church so we go unpack. its just as I remember it, hustling and bustling with people everywhere, laying on the floor, women in their colorful dresses. We have very comfortable sleeping quarters, 3 of us share a dorm style room, Gretchen and Bill have their own room, Steve and Marc Carts are coming and going, spices sitting in stacks ready to be share a room. Julia is staying with Rani and TB. We put our punjabes placed on the trains. Carts going by smelling of fish, a vendor on and off we go to church which conveniently is right across the sleeping in his stand waiting for opening in the morning. We are street. Lots of mosquitoes and we are in malaria area so need to fortunate to be on the first class train. I see the second class train grab some Deet. go by -this is the one without air conditioning and looks very uncomfortable, people kind of hanging out the windows to get a When we walk into the church the children are seated on the floor, breath of air. boys on the left, girls on the right with the ministers in the back. All the girls are dressed in their colorful clothing and the boys in Our cabin is actually very comfortable,we have more room than on shorts and shirts. They all look up at us and when you catch their the airplane, that’s for sure. There is a bottom bunk and a pull down eye they grin from ear to ear. They start singing for us and this goes top bunk. Today we just stay up and talked, on the way back we will on for 30 minutes or so. We clap so long I think my hands are getting sleep. They bring us a very yummy breakfast, omelet, peas, a handful sore. Then TB stops them and walks up to all of us who are sitting of French fries, and a bowl of corn flakes over which they poured in the front of the church on little plastic chairs. He introduces each warm milk (not popular with the group). We each got a little cup of us in his native Telegu language which always sounds like he is of delicious coffee made with warm milk, all this served to us by a saying so much more that it would be in English. After he introduces very polite young Indian boy who I am pretty sure did not speak each of us we get presented with a very large hand made lei of fresh English or know what to make of us. flowers accented with little pieces of silver tinsel. Then we are done and go back to eat a very nice meal of prawns with curry sauce, rice, We arrived to Vijayawada after passing by rice fields, palm trees, a fresh tangerines. We are tired! few villages. The landscape is dotted with everything from concrete structures to tarps strung up between two trees. In the villages there School is an array of shacks with people standing around, usually looking very relaxed but not in any hurry to do anything. There are a few Feb. 15, 2018 – We spent our day at the school today. The school animals roaming around in the villages- goats, cows, and ox carts was started by Rakesh, one of the members of our host family. He is the principal and his wife is the school nurse. In India it is very carrying large stacks of hay and sugar cane. expensive to attend an English school, so the school was started to We are greeted by another member of our host family who has serve the poor families who could not otherwise afford to attend. brought a school bus to transport us on our final leg of the journey In India a person’s lot in life depends heavily on whether or not to Machilipatnam. The host family actually runs a school and they they are able to get an education. I was so impressed with this school! have four school buses, and they need this one to be back by 4 p.m. In two years they have gone from 100 to 600 children from grades So off we go, wasting no time. We witness one of the most amazing K-5. Every morning all the children stand outside in the courtyard things in India-porters carrying luggage on their heads. The four and say morning prayers, then they go their individual classrooms. porters stand in a circle and the head porter puts one bag at a time They all wear uniforms, sit up very straight in their chairs, are very on their heads, all together three bags each. They don’t even flinch. well behaved in the classroom. We saw some of the books and they Then they walk to our bus. Two hours and we will finally be there, are teaching these children as well (or better) than some of our left Friday morning and it would now be Monday in Indiana. We schools. We saw the science projects of the older children, all very well done. are 10 1/2 hours ahead of Indiana. Before we leave Vijyuada Rajesh stops and his wife Minnie gets on the bus carrying steaming hot Around 200 of these kids attend free because their parents are too pizza and hamburgers. He knows we are Americans at heart, and poor to pay. It costs around $20 a month per child, the school we won’t have this again until the journey back. operates on a budget of around $9,000 of expenses a month. We 21 were able to see a medical clinic while we were there-most of the I learned today the people with dengue fever can have a platelet children were very healthy for the most part. There is one child with count go down to 10,000. That is extremely low (normal is 150- muscular dystrophy-no other school would take him. They make 300,000) and they often need platelet transfusions. Dengue is a sure someone carries him around the school because it is too hard hemorrhagic fever and many people can die if they mistakenly take to push his wheelchair around in the sand. Every morning Rakesh ibuprofen as it promotes further bleeding. Dengue is transmitted and Rose pick him up and take him to school. All the kids bring by mosquitoes and its nickname is "breakbone fever" because the their lunch to school, the staff sits out on the sidewalk and eat their pain in the muscles is so intense it feels like your bones are breaking. lunch. They bring their lunch in little silver containers, sit down on Carol and I had an opportunity to teach the nursing students the ground and they eat with their hands. Doesn’t seem to bother today. There are 3 students and HRH is helping to sponsor their them that they are eating on the ground. The picture of the “pink” education. The nursing school is named after the hospital as ox is due to the Hindu festival that just took place, the painted the they provided much of the funding for the program. The students ox pink! will eventually be able to go into the villages and provide care. They spend time in the hospital when Dr Minnie and Dr Rajesh are not able to be there and have to make decisions about patient care. We talked about triaging patients and how to start IVs. If there was an unstable patient they would have to be transported to a larger facility-the ambulances are very unreliable so they call a rickshaw. That would be the equivalent of calling an Uber! Probably not the best situation but Indians have a way of making the best of what they have to deal with.

Most patients here cannot afford inhalers for their asthma so many take pills called theophylline instead. It seems many doctors give only about 10 days of pills at a time to patients so its hard to tell how consistent the care is. Patients carry around medical records and so they hand over this package of scribbled notes from 5 years ago, and they hand over foil packs of pills and then we have to figure out what is going on! So many diabetics, and hypertensives! Just diagnosed a new one today, blood sugar 475. Pretty sure I had a lady in atrial fibrillation-we told her to go get an ekg-they have to go somewhere else to get it. Dr Minnie said she probably wouldn’t do it. Many patients with muscle aches and pains due to all the manual labor-many work in the fields all day, picking rice while bent over. Some work in the sugar cane fields where a lurking danger Hospital are cobras. According to Dr Minnie, many aches and pains also could be due to post viral inflammatory issues with their joints Feb. 16, 2018 – About 20 team members stood inside a small church since many patients get viruses. in Machilipatnam on a very hot day in September 2005. Rajesh talked of a vision for a hospital on the property where we were Steve went with Rajesh today back to Vijayawada to see some standing. The government hospitals are too expensive for most government hospitals. I think they are going to stay the night so people and many have literally no health care. SO the vision was they can see how the hospital works in the after hours. Apparently to build a hospital that would serve those that needed health care. there is a huge difference. Today I walked inside the hospital – the culmination of a vision-a We had a delicious dinner of fried prawns and okra tonight when modest but functioning hospital that cares for the sick. we returned from the hospital. Rani works so hard to keep everyone I saw a patient today that complained of her feet hurting-she works fed including the 50 orphans who live here in the compound. They in a shop using a sewing machine and presses the pedals repetitively sit outside on the concrete veranda just outside the house where we are staying and do their homework and eat their meals while sitting all day long. She most likely was suffering from plantar fasciitis due cross legged on the cement. They are the same children who sang the repetitive use of her foot. I asked the translator to explain to for us the first night we were here. Many of their parents were lost her that she could take some Ibuprofen and she needed to wear in the tsunami of 2004. shoes. Her feet were calloused and her heels were cracked with a layer of dust embedded in them. The translator shook his head, she There is a rooster that they keep on a leash right outside the house had no shoes and no chance for getting any. I can’t imagine not where we are staying that crows all night, but we are all very tired having one pair of shoes. so hopefully it won’t keep us up/ The dogs are loud at night too, 22 most dogs look the same here-a tan colored, dingo appearance. I up their own hospitals or clinics. A family member of our host have only seen one very scrawny cat, may scrawny chickens, goats, family who is a doctor actually has a clinic in their back yard-, pigs, cows, and water buffalo that all wonder around wherever they plus the doctor works in government hospitals also. want but always seem to know where to go when its time for dinner! Bay of Bengal Just heard we Steve and Rajesh are on their way back with pizza -too late for everyone so we may be eating it for breakfast. One thing Feb. 20, 2018 – We visited a church that sits directly on the Bay of about these trips is you better be flexible or you won’t survive! Bengal. The setting is beautiful. If you walk up to the roof of the seminary building (still under construction) the vista is ocean views Palem and palm trees. The village itself is quite poor, but I think they are happy. After all, they can walk down to the beach and take a dip whenever they want. We saw an old woman just sitting on a pile of rocks, she was one of the thinnest adults I have ever seen, had to be less than 90 pounds, absolutely no body fat. I don’t know why she looked like that, probably malnourished or possibly she has cancer. But then I saw her walk down to the beach and go swimming in her sari. She just waded into the water, no bathing suit-because women here would never wear anything that was revealing. And she took a swim in this beautiful water. But she lives in a concrete house, concrete walls and floors, not sure but I don’t think they had electricity. The outside is dry dirt, lots of dogs running around because they feed them scraps. But the dogs have it pretty good because they go down to ocean for a swim too.

The beach is black sand here with flecks of gold, I have never seen anything like it. It makes beautiful patterns in the sand flecked with gold. Saw a giant turtle head and lots of little red crabs crawling around. This beach is a lot prettier than the one down the way-the one we visited last time. That was the beach where over 3,000 people Feb. 17, 2018 – Today we visited a village called Palem. Its quite perished in the tsunami of 2004. remote, not very big. People live in concrete structures, windows with slats to let in air. They have fences made with dried palm or It is very overwhelming to see the poverty here, I had forgotten how vegetation stalks. Most people work in the fields. They have minimal much poverty there is. But the people seem content with what they medical care here although many were on medications for chronic have. And they are so eternally grateful for everything we do for issues. Not sure they really take the medicines correctly. They eat them. We went to another village and needed to go find a bathroom. mostly rice, but do have access to chicken although they don’t have Bathrooms in the villages could be a bush, a squatty potty, or a much quantity of chicken in their diet. They drink buffalo milk if western toilet. We ended up at the ministers house and she let us use her western toilet which was housed in a small enclosure outside. their caste allows it. The fruits here are plentiful-bananas, oranges, After we were done she insisted we come in and she wanted us to grapes, papayas. It is obvious the people do not get enough iron in pray for her, which we did. Then she wanted to give us some soda their diet as most are quite anemic. and talked of making us dinner. Of course we could not eat there We are back early today, trying to rest a bit. Today is very hot and as it would not be safe for us. The people here have very little but humid, very dry and dusty. Tomorrow will be church and the beach! they are always willing to share.

Steve had a very interesting experience seeing the government The village we went to yesterday was very far away. We worked very hospitals. These would not be where you would want to find hard, it was very hot and the church we were in was very small. We yourself if you were ill. They do not seem to have much did have fans, our water bottles, and whatever snacks we brought understanding of basic hygiene and sanitation-no gloves, no with us. There is no place to get a snack here so we have to bring place to wash their hands, blood in the bathroom. It’s such simple food with us. We usually eat some fruit, and they bring cookies and fix to so many problems to just use simple hand-washing and bread and jam. I took care of an older lady that came in complaining basic sanitation techniques but they aren’t doing that. I don’t of cough. I reached down to touch her and her skin was on fire-she know whether they just don’t have the knowledge or just won’t had a fever of 102.7! She had pneumonia most likely, was walking change. He even saw a corpse just sitting out in the hallway with around as if she was perfectly fine-in the US she would possibly a blanket over the body. Most care is done by the families. They have to be admitted to the hospital. We had medication with us so have no medical gas, only tanks of oxygen. Many doctors start that was at least something, hopefully it will be enough. I know if 23 I were as sick as she was I would not be walking around in 90 degree On Wednesday evening we were able to distribute rice, dahl (a heat! Its amazing how little people complain here-they are used to vegetable), a packet of oil, and around two pounds of sugar to needy such a hard life that they just take it in stride. families. They bring their own containers for the rice and get 5 scoops ( using a can) of rice-some brought sturdy bags, some brought woven containers, others brought plastic sacks. The line goes slowly because Marc and Steve have to scoop the rice, but the rest of the items are packaged up. They are all very grateful for this much needed supplement to their diets.

We had a very nice dinner on Wednesday evening at Minnie and Rajesh’s home. We had appetizers of fried cheese (paneer), fresh shrimp (the shrimp is very flavorful here as they are fresh and small); the main course was mutton stew and chicken fajitas and dessert was fresh mango ice cream with a fig and honey pizza. All very delicious!

The village elder came to the church where we were working and watched all the people come to get care. At the end of the day he told TB that he was so impressed with what we were doing that he was going to donate the land behind the church for a clinic. That is a huge deal as we traveled very far to get to this village. For them to have a clinic would make a huge difference for the people in this part of the countryside. It could mean the difference between life and death literally. Many times we get people asking why we come here, why don’t we just donate money instead of traveling. This is a good example of how our presence here will not be a fleeting moment in time, but it will actually make a difference for the people in the long term. Rice Distribution We had a rooster that was tied up right outside our guest house. At first we did not really appreciate his crowing at all hours of the day Feb. 25, 2018 – On Tuesday and Wednesday we had the privilege and night, but then I started to grow fond of him and would wave of providing education for the teachers at the school and the at him when we walked by. Chickens and roosters here are not the ministers of the village churches. The topics were CPR, first aid, fat kind like we have, they are slim. Anyway, I noticed that he was and Children with Disabilities. We presented the material by power quiet and when I went to look for him he was not tied up anymore. point with the help of Steve’s projector and Minnie and Rajesh I figured they moved him. Well, they did move him—they moved translating. Then we took our groups separately and let them him right onto the dinner table. He was our curry for that night. practice CPR and first aid. It was a lot of fun and I was pleasantly We were driving through Machilipatman and I noticed some tarps surprised that they had latched on to the information fairly well. and make-shift shelters over in an open field. We had driven by Who knows-maybe it will save a life someday. Unfortunately they there at night and it was obvious that people were living there do not have AEDs here yet, but hopefully when we come back they because they had open fires and were cooking. There were children will and then we can instruct on that! We were able to see the new running around too. During the day the shelters were under the ambulance also-it is being painted and will be stocked with the blaring sun, which even this time of year was getting very intense. necessary supplies for medical emergencies. The goal is to use the Soon the temperature will get close to 100 degrees with very high ambulance to transport people from the villages to the city for care humidity. I asked Rajesh about these shelters and he said gypsies in the hospital. It should make a big difference for the level of care live there. He said they catch rats and cats to eat. I never saw any and ability to save lives. cats in Machilipatnam. Pictured next is one of the shelters. 24 help from my sleeping pill and my music, along with the lulling of the moving train, I did actually sleep. We traveled for 10 hours in the dark back across the same countryside we had traversed just 2 weeks earlier. The train smelled of urine so I had my hand sanitizer close by. Trips to the bathroom are a little tricky with the hovering over the toilet and lurching of the train!

Journey Home

Feb. 26, 2018 – Hard to believe but our time is almost over here-soon we will be going back in the reverse order that we came. Our last day here is spent with a bit more education, lots of packing, and a final lunch with the family. The family presented all of us with a beautiful shawl, each of us was draped in the shawl by a family member. Women draped the women and men draped the men. Lets just say there were a few tears being shed. We all know this will be good by for at least 2 years or more-the trips are too costly and long for once a year. We have accomplished a lot this trip including getting the donation of land to build the clinic in the outlying We pull in to Chennai at daybreak; there are little men walking up villages. We have treated over 600 people, diagnosed several and down the train cars on the outside with silver containers and diabetics and hypertensives, and seen leprosy, a very large untreated they are calling out ” coffee “or “chai.” I see him pour the steaming goiter, several diabetic wounds, and several cases of pneumonia. liquid into a cup from his silver container -it looks so good but its There is much malnutrition here, especially for women who always not safe for us to drink the water here so I have to look away. I also eat last and we provided vitamins and iron. We made several have to look away from the beggars who point to their mouth in a diagnosis that will require follow up as well. We were able to provide gesture of hunger. We make it back to the Blue Diamond and have Tylenol and ibuprofen, voltaren gel and spray or cream for much some breakfast before we venture out on our last day in India. needed muscle and body aches due to the extremely physical demands placed on these people. Many work in fields bent over all Its a scorcher today, very humid and the bus has no air conditioning, day in the broiling sun. But the biggest thing we did here was show but off we go to see the trail of St Thomas in India. As we travel that we cared about them. We were willing to come to them, care through Chennai I realize I am ready to go home, I need a break for them, touch them. It sends a message. from the incessant honking and never ending traffic ; I need to smell clean air again, not air heavy with smoke and the smell of We did our trip in reverse-bus then train. We said our good byes sewage when we cross a river. But I am sad not knowing when I will to the family who came on the 2 hour bus ride to see us off-only TB be back and feel guilty for being excited about leaving and going and Rajesh would go all the way with us, This time the train was back to my amazingly comfortable life. not first class (darn). The train station at night is more menacing and i make a mental note that I would not ever do this alone. I smell The church we visit is having mass, so we are able to go down to very strong smells of urine and see rats searching for food on the the original burial place of Thomas. They have moved his body in tracks. Its much tighter with 4 bunks to a very small room and then past years, but it is very interesting to see this as I did not know the 2 bunks across the aisle facing the aisle. All the luggage goes under full story of Thomas coming to India. Our second stop was the cave the bunks so it gets kind of hard staying out of the way. My bunk where he lived while in India, and the third was a church atop a hill was facing the aisle, not very comfy but I did have little curtains with a view of the entire city of Chennai (7 million people).At this that I could pull so no one can see in. I decided not to look too close point we were all getting pretty hot, hungry, and ready for our final for crawlers, just shut my eyes and hoped for the best. With a little activity-shopping! 25 we will do different and what I will need to bring “next time”. Because you see there is a connection between me and India. And there is a connection between all those that have committed to this trip. At first it is not obvious to the newcomer-the first thoughts on this trip are usually, “why did I do this?”, “what was I thinking”, and ” when can I go home.” And for those that have been, its usually ” I forgot how hard this is.” It is not the physical hardships -we all knew there would be physical hardships and we were willing to put up with no toilet paper, sharing bathrooms, and brushing our teeth with bottled water. It is the emotional toll it takes on my sense of fairness, my understanding of the distribution of resources that makes this trip hard. I constantly start asking myself,why am I so fortunate to have been born into such comfortable circumstances and why are these people destined to a life of hardship. But honestly, they are happy people. And they are grateful people. I watch them as we drive through all the little towns. I see vendors standing outside selling their food, or I peer in to a small room where a man toils endlessly using a hand held iron that he heats and uses to press the clothes. And I see people laughing, talking, chatting, scolding their children, giving their children a snack, holding their hands, sitting around and visiting while they eat together. All these are the same behaviors that we all have, only a world away in a different setting. We are all human beings and we have many common threads.

I am so proud to know all the members of my team. We range in We ate at a McDonald's at the mall-very modern; saw kids that age from early 40’s to 70’s in age, and between all of us we have been looked just like American teenagers. I had a McChicken that was to India from one to 5 times each. There is a reason for that. We just like home but it you wanted you could get rice, different sauces and spicier sandwiches Indian style. We spent a couple hours buying have a friendship with an amazing family, a family we have known souvenirs here-they sell some handmade items such as real for 13 years, a family that embraces us like we were their family. cashmere, nice jewelry, but also a lot of not so great stuff as any And I am incredibly proud to call all of my team members my mall would have. Gretchen had a fish pedicure at the end-the fish friends because these are people that are willing to sacrifice their eat the dead skin off your feet. Hmmm, not my thing but she didn’t time and treasure to help make someone else’s life a little better. seem to mind it! When I look at this picture taken at an impromptu moment on the Back to the Blue Diamond for one last farewell dinner. I am so beach,I realize that there is a message in that picture. Standing excited to go home, but TB looks at me and says, “So when are you together are people that are a world apart, not only in distance but coming back?” I know there is much work left to be done here and in culture. Yet we are able to be friends and our friendship has stood something tells me I will be back. I say with enthusiasm, “I am sure the test of time. we will be back soon, probably not for a couple years though.” When I look at this picture taken at an impromptu moment on the Especially when TB asks-he is the most humble man I have ever beach ,I realize that there is a message in that picture. Standing met and a true servant to God, the real thing. together are people that are a world apart , not only in distance but Final note to follow. in culture. Yet we are able to be friends and our friendship has stood the test of time. We started this friendship out of a willingness Until Next Time… to lend a helping hand after the tsunami in 2005, and what has developed is truly amazing and a testament to just how similar we Feb. 28, 2018 – Trips to India are amazing. Trips to India are are in this world. It gives me hope in a time when there is far too amazingly hard. Its been 4 days and I am struggling mightily with much division amongst even our own countrymen. jet lag, still waking up and thinking I am there. It happens every time. We started planning 8 months ahead, and the 2 weeks before So I would say if anyone is thinking about a trip such as this, it we left were a whirlwind of activity–working, packing, re-packing, is life changing. If you feel a calling, don’t over think it. You will checklists. Now the hard task of re-integrating back into my be provided for and you will never be the same person afterwards- “normal” life begins again. And I will think and ponder about you will be a better person and you will learn about yourself in whether I am going back, all the while making mental notes of what the process. 26 27 Join our Caring Community Partner ambassadors as they speak about their recent trip to India

The India team will gather together to share experiences during their recent trip to India. Please join them for a short presentation, including time for questions and discussion. Light refreshments will be served. 3-4 p.m., Wednesday, June 6 Robert C. Keen Classroom

Lower Level, Hancock Regional Hospital

Are You a Caring Community Partner? Would you like to help a hospice patient with housekeeping or shopping for groceries? Assist a rehab patient who is housebound? Ever felt there must be something you could do to help those impacted by hurricanes, tsunamis, or other devastating disasters? If these situations have ever tugged at your heartstrings, then you’re a Hancock Health Caring Community Partner. We could use your help to:

• Build or repair a wheelchair ramp or perform minor home repairs for an elderly neighbor • Winterize (caulk, window plastic, etc.) a hospice patient’s home • Clean a home or shop for groceries for a homebound/hospice patient • Read to a homebound patient • Provide temporary pet care for an ill or recovering pet owner • Provide respite care • Participate in short-term mission trips in or outside of the United States

These are just some of the ways Caring Community Partners serve our community. Do you know someone who could use our help?

To volunteer or find out about volunteer opportunities, please contact Board Chairman Marc Petrey at (317) 468-4550 or at [email protected].

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