Namesake

Namesakes are fun.  A recent google search came up with an Andy Eicher who is a photographer. Gorgeous shots like the one above and more can be seen: here.

Judging by the subject matter on his site (no other info seems to be put up so far) this Andy wields his camera somewhere in the US - most likely a rural part of the midwest or in one of the western states.

Here is a shot the Andi Eicher who lives in Thane, India took this evening as we celebrated Nikita's upcoming 13th birthday:

We just had to thank the Lord for his goodness to our families - 12 years of knowing John and Nalini and their amazing daughters Nikita and Jasper!

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small side note - the trusty rusty counter tells me that this is our 1300th posting on Chai Chats with the Eichers... thanks for still sticking with us gentle readers!  blessings to all you out there!

Tina

Medicine seems to be able to do so much.  And yet we often see the hard edges of what can be done.

We have a lady who we will call Tina.  Tina has a grown daughter and lost her husband a few years ago to AIDS.  Today Tina is sick.  Very sick.  Because of her HIV she has suffered from a stroke. The root cause is a viral brain atrophy condition called PML where only 1 in 10 come out recovered.  It seems that no real treatment is available for PML.

Add to this, Tina has HIV 2 – a version usually found in W. Africa and which does not respond to the basic meds we use.   She has been getting treatment from the main govt. hospital in Mumbai – but it doesn’t seem to be working.

Her immunity is very low.  She has the mouth sores that we used to see commonly before the Anti-Retroviral medications were widely used.

And on top of all of this she has a large ulcerous sore.

It’s this sore that brought Tina to us.  One of our Home-Based Care teams was diligently caring for Tina at her home.  But things just got too bad.  Though our nurses were pressed into home-visits to help dress the sore, it just would not heal.

Tina’s daughter goes to work early every morning.  Leaving Tina at home all day.  Someone has to earn if they are going to eat and continue to pay the rent.  But Tina’s wound just has not been healing.

So to give mother and daughter some respite, we brought Tina to the JSK centre.  Her daughter comes in the evening and sleeps with her - then leaves early the next morning for work.

To our dismay, Tina developed 2 more sores yesterday.  These are not 'bed sores.'  They point to an on-going infection in Tina.  One that is clearly not under control.  The basic antibiotics that we have been giving orally to Tina do not seem to have worked.  A pus culture done on the original sore shows a serious bacterial infection.  If it spreads further it could well be the end of Tina span of life on this blue ball.  Sheba had asked for a sensitivity test to be done – the good news is that the bacterial shows that it may still respond to most higher level antibiotics.

This morning we started on a high-dose regime, given intravenously.  Will Tina be able to pull through?

We just don’t know. 

Sheba spent some time with her today.  Talked about forgiving others.  Talked about the hope that we have in Jesus.

Tina responded.  She cried and prayed.  Prayed to set herself right with God.  To accept His great love for her.  And then she prayed for those have hurt her so much over the years.  She expressed a deep happiness that she was able to do this. 

Here is a woman who has lost everything.  Who is at the very edge of her life.  But yet has something that so many do not have.  A real sense of peace.  It’s a peace that has precious little to do with her circumstances.  Others would rage and curse, but Tina is working through what may be the end – or maybe another beginning – with something nothing short of remarkable.

It is humbling to serve folks like Tina.

Looking back on the 11 years that we have now been at this – I can say again how grateful I am for each person who has worked alongside us at JSK.

Our partings have not always been the most cordial. But each single person has touched so many of the quiet unknowns like Tina.   The current batch who are part of the JSK team are so precious, so vital to see the small steps forward in love like we see happening in Tina’s life.

Agnes, Anil, Annie, Carmella, Chinnamma, Daniel, Dipali, Dipika, Giri, Kamal, Marise, Peter, Sandhya, Sangeeta, Santosh, Sheba, Sunita and Vikas are all such a blessing.   Their ongoing love in action has made many who are poor to be rich in love.

Walking with Oma - A photo essay

For three glorious weeks Oma was with us here in Thane - pampering us in hundreds of ways - as Sheba went about recovering from her surgery.

Each morning, when it was time for the kids to go to school - Oma would be up.  At 6.30 they would leave the door and walk the 500 m to school.  Then at 1 PM she would pick them up from outside the school and walk back with them.

Each day Oma saw new things.  Here are some of her pictures from her walks with Asha and Enoch!

We will start with a shot of the lady in question with her two adoring grand-kids!

Enoch looks a bit pained at the thought of a day of school - but this too shall pass!

The monsoon means that there is greenery around.  Though you have to look carefully for it sometimes...

Just outside our appartment block is a fairly treacherous intersection.  Even early in the morning there are plenty of vehicles moving here and there... while the politicians and their loyal acolytes beam down...

Near the school is a shopping centre whose courtyard Oma captured...

Wildlife in Thane?  Mainly grey.  Many of them!

Dogs on the other hand, are usually stray... but this chap outside a real estate agent's shop looks decently fed.

The morning is the right time to smell jasmine...

And almost everyday we see this old lady, trying to gather flowers, probably as an offering to the gods.

School is finally reached.  Now to get through this jumble...  Everyone wants to go first of course.




The school is said to have 42 school busses.  Add parents in their cars and scooters and various private bus operators and you have an instant traffic jam almost every day!

And so our two make the final crossing and are swallowed up by the school.



Its a quarter to 7 and the day is just beginning for most.

But early enough for Mum to spy more beauty in small places:

And observe the pigeons being fed liberally by folks who are working at getting merit.  Someone us uncharitably called these creatures 'flying rats'

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At 1 PM the scene is pretty different.

Along the way Oma spots an auto-rickshaw driver catching 40 winks....

While a cat watches from the back of a delivery bicycle for a local restaurant.

The merchants have long since opened their shops - hoping folks will fork out their rupees for their swag... which of course happens.

And at 1 PM the gates of the school open and a flood of students swooshes out.  Hollering, pushing, being the kids that they are...

Where are Asha and Enoch in all the crush.  Oma doesn't need to worry. They have agreed to meet beside a certain tree - and sure enough - they arrive, hot and rumpled and ready to walk home.

The school has probably something like 7000 students, attending the school in two shifts.  Its no wonder that they have so many large school busses.  Note the name of the company that builds these behemoths!

But our Oma, with Asha and Enoch in hand, are very much on foot as they walk home.  The way back takes the threesome past the coconut man and his wares:

 And taxi-cabs, waiting for fares...

 Wandering past some shops Oma saw this mass of electricals:

 As well as this pleasing green pyramid.

The streets are alive with vendours - many hailing from the northern states of Uttar Pradesh and Bihar.  Here to make a living that is more than they would have eked out on their farms or as labourers in the village.

As Oma made the trip twice a day, she began to make friends.  These girls insisted that she take their photo:

Finally, it is time to leave the streets.  The final crossing is over and a small side gate opens into the compound that our apartment building shares with her 9 odd other sisters.

Oma's camera captures some more beauty of course.

The name of our building is rather crudely stuck to the tiles just outside the lift door.  Oma's camera sees all!

But that is more than made up for by the hint of a smile on our watchman.  A gentle new man who replaced a pretty hard-bitten grouchy chap two months ago.

Oma is home with Asha and Enoch.  Another two small pilgrimages looking at every-day beauty are over.  Time for lunch.  What a feast!

Post-Op

Exactly a month ago today Sheba went under the knife.

After spending the night with her in the hospital, it was time.  The nurse came and took us to the operation theatre, and Sheba, wearing her blue-checked hospital gown was put on the trolley.  We had already prayed.  Several times.  And the prayers of so many others were going up as well at 8.30 AM as the doors to the operating theatre at Bethany Hospital closed.

I stayed outside praying.  For an hour.  Then Dr. Stephen Alfred came out on his way to another task and gently told me that I could go back to the room until he called me.  I went up to room 506 - which was going to be our home for the next week - and spent some time with brother Jolly from church, who had come to be with me in the mean-time.  

Then an hour later I was called by Dr. Stephen.  He told me that the operation was successful.  A nurse was called and she brought a kidney bowl which included a large 15 cm long mass of the hydrosalpinx - the fluid filled body which had grown in Sheba's fallopian tubes and which had caused the severe pain episode at the end of July.  There was also a large stone which had been removed along with the gall-bladder.  It was a black brute - the size of a small walnut.  It was sobering to see these items displayed on the tray.  But I was so happy to hear that the two operations had been uneventful - that the gall bladder removal done by Dr. Stephen and the complete hysterectomy by Dr. Kannan had gone smoothly.

Samples from all those tissues that I saw on the kidney dish had been taken and sent for pathlogical tests.  By God's grace all the results came back later as being non-cancerous.  We are so grateful for another swathe of mercy.

While we were talking, a young man was brought in and Dr. Stephen advised him on his father's gangrenous leg which was next on the operating list.  Its a 50% chance operation, said Stephen, but we will try our best and pray to God to help us.  I later met the man and found out that the operation was successful too.

And so another hour and a half later I was outside the doors when a conscious Sheba was wheeled on her trolley to the lift and then with me holding her hand while she lay on her guerney we took the lift up to the 5th floor.

A few minutes later Opa came in.  We prayed with Sheba and her first post-operative pain hit her like a hurricane.  It was a hard afternoon for Sheba, but she eventually was given some sedative and managed to sleep off.  The next day was better.  But pain is pain.  As comfortable as the Bethany Hospital is, and as caring as the nurses and other staff are, it was finally Sheba who had to go through the post-op experience.  All I could do was hover alongside.  Humbling stuff.

That was a month ago.  As India celebrated another Independence day.  On the day my brother completed another spin around the sun.

A month has slipped by.

Looking back a month later, I remember the 15th of August 2013 mainly as a blur.  As were the next few days as I shuttled between hospital and home and a bit of Jeevan Sahara too.  Our dear friends John and Nalini and their kids were constant helpers.  As were Jolly and Suma and sister Rachael from church.  And Agnes and, and, and...  Overwhelming to experience the love and care from so many.

Sheba back home from hospital - welcomed by Asha and Oma - our two ladies of the house!

Sheba was discharged early the next week.  We were cared for and spoiled by Mum and Dad who came and camped out with us when they heard that Sheba was posted for surgery.  The kids were jewels.  So many people came and visited and called and prayed.  We have never had so many apples in the home.  Our kids had never had apple pie before.  But their Oma made sure that they were well versed with this till-now-untasted delicacy over the past weeks.

Since Amma and Appa having just left India for 6 months with Daisy and Ramesh and their kids in Arizona, we received their love through long-distance phone calls and fervent prayers on our behalf.

And then - on the 2nd of September - after the staples were removed, and 2 weeks of bed rest completed - Sheba started back at work at Jeevan Sahara Kendra.  She has taken getting back to work slowly, but has already plunged into the challenges of dealing with broken lives.  And with death - as we lost two of our Positive Friends on one day last week.

Sheba is on the mend.  And not allowed bend.  And lift.  And though she wants to do so much, she has to take things slowly.  She has graciously allowed herself to be helped in so many ways.  And continues to press forward.  We appreciate the sheer volume of love that we were blessed with before and after the operation - and cherish your prayers for a full and complete recovery.

Last week Oma and Opa went north - to be with the Delhi Eichers for a few days and yesterday they reached safely back to Shanti Kunj.  These days were golden. We cherish the memories already.

Yesterday Sheba removed the support belt that she has been wearing for the past month when she sits up or walks around.  Today there were some twinges of pain in the main scar.  Its all a mystery, this business of healing.  For a skilled cancer surgeon, the 45 minute procedure to do the hysterectomy was routine.  Something he does repeatedly.  But for my dear Sheba, the massive intentional cut (done to help of course!) just takes so long to heal.

We are aware again of just how good life is.  We want to continue to live each day in joyful anticipation of the next.  We thank God for each other and for our various circles of family and friends who have shown again what a rich heritage we are blessed with.

And so on-wards.  Slowly.  And with the oodles of grace that our feeble frames are washed with.

Two deaths in a day

Tuesday was a hard day.

In the morning - while our morning devotions were going on - ***Tanya died.  We have known Tanya for years.  And have watched her grow from a skinny 13 year old - to a skinny 18 year old - and die.

Tanya's story is almost to sad to tell.  Orphaned along with 3 brothers - she the only one with HIV - looked after the three, keeping house for them as they moved into adolescence and young adulthood.  Our teams met her when an uncle came and asked that she be put in a home of some sort.  Those don't exist anymore.  And with the uncle and other relatives washing their hands of caring for this family it was Tanya who cared even as she went funcionally blind.

In her anger and despair Tanya withdrew from our staff.  They would visit regularly, but her way of coping was to retreat into her shell.  Things did not get easier as she grew weaker and stopped taking her medicines regularly.

The last year saw us admit Tanya a number of times for in-patient care.  She should have died 8 months ago - but for the loving care that our nurses gave her at the JSK centre.  Many people loved Tanya.  She usually did not show much love in return.  Her brothers came and went.  When she became a bit better she would want to go home.  And then our team would meet her in her shack, lying in her filth.  Her brothers dealt with things in their own way - but staying out of the home for most of the day.

It would be nice to say that Tanya's last few weeks were ones of joy.  They were not.  Death is cruel and hard.

But we do know that Tanya received a lot of love.  Though she hardly responded, our staff cared for her.  They bathed her.  Massaged her.  Church volunteers came and gave home-cooked food.  On her final day Sheba fed her soup and sang with her.  Tanya received a massage while she sat curled up - a living skeleton - her glassy eyes staring forward.

When she died her brothers came for the body.  They took it away without a word of thanks.

Farewell sweet princess.  Your life here was short and full of sorrow.  But we know we will meet you on the other side.  And then we will have the conversation that never happened here.

Later in the day a church from Mumbai's western suburbs brought one of their members to us.

Munni had been admitted at the government TB hospital in south Mumbai.  It is a hellish place. She was not doing well and so they asked whether she could be admitted at JSK.  We agreed and they brought her in an ambulance to us.

Later that evening Munni developed gasping.  We tried hard, but her life slipped away.  Her husband Bhaskar was numb.  He had never been tested for HIV.  During that day we counselled and tested him - and found out the next morning that Bhaskar too was HIV positive.

But by the next morning his wife Munni was dead.  She died at 10.30 PM on Tuesday.  Sheba went over to sign the death certificate.  One of the church leaders came in the middle of the night to be with Bhaskar.  Now what to do with the body?  We linked the pastor with a senior pastor in Mumbai who was on a cemetery committee.  He agreed to facilitate her burial in a Christian cemetery.

I met with the young pastor the next day.  He himself had been picked off the streets and helped by a group of people who loved God.  After working with them for some years, he has been groomed by his local church and now is helping people with HIV through his church.  He was wearing a crisp white khadi shirt.  He and his fellow leader husbanded Munni's husband.  They arranged for the undertaker.  The body was taken down to the small hearse.  We prayed and off they went.

The church was grateful that Munni had died with us.  She had been loved too.  By the church members and our staff.  She died in peace.  In a clean place, well away from misery of the government hospital.

We are running on a skeleton staff.  Our single trained nurse had terrible pain on Thursday.  A mild appendicitis?  Sheba's major surgery last month means that she is working through weakness - a wounded healer.  We are all stretched.  Is there an end to all of this?  With so few staff to run our place, we are hardly able to admit folks.  And then when they come they die.  We know that it will happen.  We know that our efforts are not in vain.  We know that eternity stretches before us - and that we have the privilege of being with people who are at the very edge of time.

But when we lose two people in a day it is hard.  One - a very long and drawn out saga of care from us and neglect from everyone else.  An end which almost feels like a relief.  The other a person totally new to us - with only a few hours of care before she too breathed her last on the same day.

Are Tanya and Munni talking together?  Exchanging notes about their last hours in this life?  Or lost in a swirl of beauty?

Time will tell.

Two deaths in a day.  Two lives-as-we-know-it ending with us.  Two-lives-as-we-hope-for beginning.

We remain behind.  With the memories. And with the hope.  And tears we have not shed.

Mapping

For the past fortnight I have been looking at our work from a different angle.  Literally from above.  A ‘God’s-eye-view’ as it were.

Courtesy google maps.

Earlier this year we did our survey of all of our active home-based care Positive Friends.  Our home-based care teams worked hard and tried to meet all 142 of them – we finally managed to interview 135 of them.  Then there were the ‘secondary contacts.’  Folks who we have been actively involved with in the past – but who for various reason don’t need (or don’t want) active follow-up these days.   Our teams interviewed 96.  We ended up with 231 priceless surveys done with HIV Positive Friends whom Jeevan Sahara has been working with.

This was the fifth time we did the survey at Jeevan Sahara – a simple questionnaire that asks our HIV Positive Friends to tell us what their health was like in the past month.  And also how rated their adherence to the ART medications that most are on at this point. 

What was different this year was the quality of the interviewing.  We were able to meet almost everyone and make sure that almost every single question was asked and entered.  And in a wonderfully timed move – a new version of Epi Info – the tried and trusted free data analysis programme that the Centres for Disease Control and Prevention (CDC) was released. 

My first joy was to use the EPI Info 7 to run through the survey data.  As we explored the figures we found out so many important things about our Positive Friends that we don’t see in the day to day.  We were reminded of the sobering fact that two-thirds of the men are alcoholics or have a history of alcohol abuse.  We saw the good news that most of our folks are now taking their anti-retroviral therapy (ART) and that too accessing it free from the government sources.  We had the sober realization that even though most people rated their health as ‘good’ or better – that a full 4 out of 5 reported at least one health issue in the previous 30 days.  We saw clear documentation that people who are stable on ART enjoy better health than people who are not on ART or have just started their ART.  The list goes on.

Then I did a little looking back in time.  We compared this year’s data with the data of the first survey that we did in 2005.  Striking changes.  Our folk today are clearly healthier than the people we were working with 8 years ago.  And the good news is that we are still in contact with some of them!  An amazing 17 people have been now interviewed in each of the 5 surveys that we did.  There is data just crying to be analyzed here…

So where does the ‘God’s-eye-perspective’ come in with all of this?

Well, it stems from the fact that Epi Info 7 has a mapping function that seamlessly links in with Bing maps (or whatever your favourite mapping utility is).

When I was in graduate school – taking a GIS course meant accessing satellite data which cost a bomb.  I knew that there was little hope of getting high quality sat data for India so I didn’t bother with the course.  

Today it’s all available on line.  A seamless mosaic of images at different levels courtesy of google maps (and their ilk).

 

And so what Epi Info 7 wanted from me for each of the data points was a geographic location.  I toyed with the idea of getting a GPS and asking our staff to go to each home and get a reading.  Then I thought about using mobile phones.  But to my disappointment none of our staff have mobile phones with those functions.  We are team for whom the terms Blackberry, Galaxy and I-phone are still foreign words.  

But then I realized that I could use google maps.  I sat down with our home-based care teams and showed them the virtual map of Thane.  We identified where a particular person lived – often simulating how the team goes to the particular Positive Friends house.  When we agreed on the location we right-clicked and chose the ‘what’s here?’ function.  Up popped the longitude and latitude for that point in space.  I thus had a geo-tag for the person in question.  I just needed to copy it into the data base – into the newly made columns of ‘latitude’ and ‘longitude’ of course. 

When we had done this for 8 folks to start with, we made our first ‘map.’  The 8 data points showed up on the Thane map.  Showing us where these 8 Positive Friends lived.  I could then have these 8 points show me the spatial distribution of any of the variables that we had asked in the survey.  Who had a fever in previous month?  Bang.  Displayed.   Which are men and which are women?  Add another data layer, change the filter settings – and you have a map showing the distribution by gender.  Which folk are being looked by which of our mini-teams?  A change in the data filter and a new set of info displayed.  Want to zoom in and see who is living close to whom?  The internet enabled map allows me to do so.

 

Thrilled with our first 8 folks, we then worked on the other 223 odd ones.  It was painstaking work – translating our teams’ on-the-ground experiences of getting to the homes of our Positive Friends into a specific data point.  Many, many of our friends live in the shanty-towns that form so much of Thane.  We can never identify exactly where a person lives given the maze of tiny alleys and the uniform image of row after row of flat roof that a slum looks like from above.  But we can get a pretty good shot at the general location. Somewhere within 30-50 meters or so of where they live.  And a surprising number of folks we were able to actually identify what was most likely their shack!

And so a blearly 10 days later we now have an interactive map of the dear folks we are working with.

The next steps?

One is to link the current levels of ART adherence – and display them so that our staff can see which folks are in a ‘danger’ level – and which ones are doing well.

Another would be to make a map that would show folks who have missed an appointment.  We have a small component of our work were we are providing free ART for 6 months to a few folks.  A simple spreadsheet which compares their next appointment date with today’s date can show if a person has missed their scheduled appointment – and this could be displayed on the map as a red dot for example.

But what would really be a bomb would be to have a real time adherence map.  One where our staff would enter adherence data via phone – and which would then update and display the current levels of ART adherence for all our Positive Friends!  One of the benefits would be build in early alerts – say a person has less than 90% adherence – we would want their case-managers to do another visit in a week!   To do this would need some basic android programming – and some time.

At the same time, we have the sobering reminder that maps alone do not change hearts.

What we really have going for us, are our wonderfully dedicated staff – whose love and care have developed relationships that cross time.  The dots on the screen are a small testament to the web of relationships our staff and others from local churches have made with the HIV Positive Friends we work with.

I may have a geo-tag for one of our Positive Friends – but that is not 100% accurate – and that person may leave and head off for somewhere else anytime.  But there is one who knows not only my exact location in real time – but also knows the hairs on my head.  Our knowledge – however sophisticated we may feel it is today - is always a rough tool, a crude instrument compared overwhelming omniscience of Father God.  But how He delights when we discover and explore!