Fires, fires and fires

Yesterday, many women…over 2 million in fact, celebrated the Attukal Pongala festival in Trivandrum, Kerala where I just spent just over 2 months.  I do not fully understand the story of the goddess who is being celebrated.  The largest impact is that huge numbers of women line the streets of Trivandrum, Kerala in a large radius around the Attukal temple. Each woman has set up a cooking fire with a terra cotta pot, with bricks supplied by the temple.

She has brought the raw ingredients for payasam– rice, jaggery (unrefined sugar in blocks), coconut, cardamom powder, cashews, raisins, ghee (and maybe bananas).  Each woman waits for the flame, which is delivered from the  from the temple.

Then the ingredients are added in step-wise fashion, and boiled until a certain consistency.  This is most notable because 2 million other women are doing it at the same time.  And for a week after this festival, Malayali men will offer visitors and work mates their mother’s payasam as the best in the district.


These fires and the sheer quantity of them, and the image of 2 million women bent over these cook fires prompts me to write about other fires that affect the health of Indians.  Women still cook with firewood in India, more in the rural areas than in urban areas.  More concerning is the disposal of household waste (including plastics) and brush from plants and trees with burning.  It would not be unusual to have a brush fire going around the hospital where patients already have difficulty breathing.  Walking the 3 blocks from yoga to the hospital, I notice all the street sanitation workers who are burning the leaves that they have collected in a small pile.

India has a rapidly increasing difficulty with smogRecent recommendations have suggested vitamin D supplementation for India’s population because people cannot get the 10 minutes of sunshine needed to make vitamin D in the skin.  What would happen if households or districts used composting–using either worms  or microbes to accelerate the decomposition of household and yard waste to fertilizer…without burning?  Could this be an employment  project with an district entrepreneur paid by neighbors to take the household non-plastic waste and yard waste and make fertilizer?

Burning as a method of waste disposal is a health issue.  Some day, the Attukal Pongala festival could also be a celebration of the triumph over smog and will be one of the few  times open air  fires are used.

There are people in Kerala who are champions for composting. I did not get a chance to visit with the Kerala compost champions on my recent trip.    Next time!

For now, I will just go back to Iowa and love my pet worms in my composter.

And now for your moment of Zen:


Barrier Free Trivandrum Mural, painted by Pallium patients and staff



Is a razor in your palliative care toolbox?

I was lucky enough to be invited to the beautiful Lakshadweep Islands, off the Kerala coast,


to visit and consult with a palliative care organization, Thanal Charitable Organization.  Travel to these Islands off the coast of India is highly restricted to preserve its ecological balance  and the Muslim way of life.  Permits can take months to get.  My trip was made possible by the dogged determination of the Chairman of Thanal whose name is Moulana.



Moulana is a secondary school history teacher. He has done many other things, including 5 years as a Kathakali performer. He started Thanal Charitable Organization in 2009.
My Malayalam ( zero) and his English mean that I cannot report all the details but he saw a need for care of the house bound elderly patients and responded to it, initially on a bicycle with a shoulder bag in 2005.  Now he has recruited volunteer physicians, nurses and support staff who have committed themselves to DAILY wound dressing changes, and seeing 3-6 patients every afternoon after work. Their current census is 62. Their funding is all local, which means that they are limited on an island where almost everyone works for the government, coconut harvesting, and tuna fishing.

The importance of international palliative care visitors is to validate the importance of this  palliative care program for the island.  This was not lost on Moulana who introduced me  for 4 days to government officials, teachers, students, and community members.  In some cases, I was asked to give motivational speeches to children.

Moulana tells many stories to illustrate his points.  He tells of one man who called and requested palliative care.  Before sending his medical team, Moulana decided to groom his long nails.  He believes that physical appearance reflects the inner sense of being.

I got to see this first hand when Moulana arrived 45 minutes early one morning and said that we had a home visit to do. This was unusual since most home visits are after work. We arrived at a home to meet Nallakoya, a retired government worker from the electricity board. He appeared frail and shuffled to the stairs and Moulana helped him down the stairs into the well swept front yard.

What happened next is not in MY palliative care toolbox. Moulana started cutting his hair!   img_3399

And then he shaved him, changing the blade at least once to get a close shave.
 The result was subtle but real.
Moulana encouraged him to walk about the yard, and water the plants. The shuffling was gone, and he even marched for some steps with a big smile.  Moulana feels that the face, the “visage” as he calls it, is a view of the heart. Before the team of nurses and doctors started their medical assessment of the “patient,”  Moulana wanted the person to feel and look his very best.


On our way out, Moulana said “Madam, palliative care is an art.”

And here is your moment of Zen…