August 30th- September 2nd: Visiting ICTPH Clinics

Rachael, Marjorie, Alison, Andrea and Sarah at the clinic on Wednesday

The rest of the week we have been visiting the three clinics that are currently open and functioning in three different villages. The clinics are small and the patient flow is sometimes minimal at this point. Most clinics only see about 5-25 patients a day. In one of the villages the clinic is the only access to health care for the entire village. It was nice to have such an amazing introduction to the theory behind the program and then to see the theory in practice at the clinics.

Clinic equipment: scale and blood centrifuge

The clinics are sustainable and small. ICTPH typically buys out a shop and turns it into a clinic, using nice floor tiles and translucent doors that can be used to create privacy when needed (like it can be pulled out to cover the bed, but is tucked away when not in use). The materials are all locally produced. The one we saw had a large room with dividers and two examination rooms. Each clinic has an autoclave (to sterilize instruments) and lab diagnostics. Currently, two clinics send their blood to the third clinic which serves as a diagnostic hub. Samples are sent by way of a motorbike, then the blood is tested at the hub, and information is uploaded on the computer and the original clinic can view the results. The patient waiting area is on the covered terrace. All of the health records are electronic and are audited in real time.  

The vegetable garden behind the clinic

Prices are listed on the walls and payment is made at a separate shop. If patients can not pay the full price, then they can pay any amount that works for them. There are also Community Health Workers (CHW) who are from the village and work 20 hours a week, going into houses to tell community members about heath promotion (they do not say to just come to the clinic, but to seek care in general). Villagers can go to the CHW's house for questions or to ask for their blood pressure to be taken.

The nurse's work area in the PHC

On Wednesday we went to a clinic. It was very modern and clean. Unfortunately, there were only a few patients- it was Eid (a Muslim holiday to celebrate the end of Ramadan) and there was a big wedding in the village, so that might have affected the attendance. We went to a primary health center (PHC) afterwards which was further away from the center of village it served. The clinics were different in a number of aspects, including types of services offered (for example, the PHC also cares for pregnant women including labor and delivery).

                                             

An example of one of the delivery beds at the PHC

In the afternoon on Wednesday, we drove by a rice field and decided to stop and watch the women as they work and take pictures with their permission. They were chatting a lot as they worked and there was a lot of laughter, which was nice to see.

Women working in the rice fields

Peruvudaiyaar Temple

Wednesday evening we went to the huge Peruvudaiyaar Temple (also known as Brihadeeswarar temple) and wandered around. It was a large holiday that day, Ganesh's birthday, and there were many at the temple to celebrate. We went inside the holy of holies and were all blessed by the priest and then he asked us where we were from. At the next altar, the priest welcomed us again and gave our blessing in English and told us about the gods. It was very nice and welcoming. A lot of people approached us- to practice English, to learn about us, to see if we liked India, and to take pictures with us. It was very nice to be a part of the ceremonies and feel like we could observe and not be a complete outsider.

The ICTPH clinic from Thursday

On Thursday we went to a community health worker's house to hear her story. With her new education, she helps meet some of the health care needs of her community. She feels that her status in the village has risen with the training she has been given.  She said she wanted to be a CHW to learn more about health and at first her husband resisted but she persisted and now he is glad she is a CHW. Other villagers come to her house to get their blood pressure taken and many are on medication now because of that awareness. She refers villagers to seek care when needed.

One of the children in the village showing off his reading skills
in english and tamil

The village we visited on Thursday while
spending time with the CHW

Over a cup of chai, we learned more about her family and played with the many children running in and out of the house. All of the children (4+) speak English (as do the mothers) and they receive workbooks in English and Tamil at school. We played outside with the children, one boy was very energetic and running around then when we went inside, he wanted to show us his school work and he sat right down and practiced his letters and numbers. He was almost four years old and writing in both English and Tamil. It's amazing how most people are bilingual! One four year old girl sang a song in English for us. We had so much fun spending time with the CHW and her family. The women had all married into the same family, three brothers, and were very close-knit. We have noticed that in India the family is very important, if not the most important part of life.

The large and welcoming family we enjoyed spending time with at the village on Thursday

An example of the equipment used during
 eye exams at the vision clinic on Friday

On Friday, in the village of Alakuddi, we visited the last clinic and then walked through town. We were being shown the village by one of the ICTPH health workers who lives in the village. She showed us her house which was next door to a house where a feast was taking place for a woman who was 32 weeks pregnant. It is village tradition to hold such a feast at 32 weeks for the woman's first child, in the father-in-law's home. There were many people from the village and we were asked to join. The pregnant woman was wearing gold jewelry around her head, neck and even tied into her braid. Her clothing was a beautiful sari of maroon and gold. She looked so proud! We took pictures with her and then sat on the floor where banana leaves were placed and seven different types of rice were set out. We felt so honored to be a part of such a special day.

The ICTPH vision clinic we visited on Friday

We then had dinner at our hotel restaurant and as we have been enjoying most of our meals here, the waiters knew us and our music tastes. Sarah enjoyed a particular song and asked our waiter friend about it. He was kind enough to go to the market and gave the CD/DVD of the singer to her as a gift.

Our favorite waiter from Temple Tower in Thanjavur!

Friday night we all piled into an overnight train back to Chennai for our last weekend.Once there, Sarah decided she wanted a new hairstyle and cut off around 6 inches from her hair! We can not believe the three weeks are already finished. Time has flown by and we've enjoyed ourselves immensely.

Alison, Rachael, Sarah, and Andrea enjoying
a game of Quiddler on the train

Getting ready to board the Thanjavur train

Thank you to all who have followed our adventures. We look forward to sharing more pictures and stories when we return with our family and friends. Our biggest thank you is to all of the Indian villages/ communities, CMC, and ICTPH for hosting us and making us feel welcome!
Sincerely,
Sarah Chipps, Alison Ercole, Andrea Leverkus, and Rachael Starnes

Sarah getting 6 inches chopped off

August 28th and 29th: IKP Center for Technologies in Public Health (ICTPH)

Sarah, Andrea, Rachael and Alison in the lobby of our new hotel

                                  
On Monday morning, we all woke up bright and early at 6 am  on the train to start our first day at IKP Center for Technologies in Public Health  (ICTPH). We were able to easily find our driver once we arrived at the Thanjavur train station and made our way over to our new hotel. The hotel is comfortable with very kind and helpful staff. A few of us were finally able to turn our clothes over to be washed, which we have needed to do for a few days now. After settling in, we were off to meet Dr. Zeena Johar at the ICTPH headquarters. Upon arriving at ICTPH, Dr. Johar took us out to a wonderful breakfast at an authentic Indian restaurant. The menu was in Tamil and Zeena had to translate for us to tell us what was available. After breakfast we walked back to ICTPH with Dr. Johar and sat in on a meeting with different members of the staff and learned the details of how ICTPH is involved in the community healthcare of 3 nearby clinics. We were lucky enough to be observing in Thanjavur at the same time as Dr. Nachiket Mor, who is  a member of the Board of Directors at ICTPH.

An example of the household ID cards used
to identify patients and track their visits through
 computerized documentation at the ICTPH clinics

ICTPH  has three community clinics and plans to continue expanding. There are 200,000 people in a targeted area that do not have nearby access to a primary health clinic (PHC) which is the institution for government care. In this way, ICTPH is setting up an alternative (for some, the only) option for healthcare. Each clinic has a physician, a health extension worker (HEW) and community guides and services approximately 1,500- 2,000 community members.
There were several topics presented throughout Monday and Tuesday to help design protocols and other systematic aspects of the organization. The protocols are followed by the ICTPH physicians who  have a bachelor's degree in medicine or another health science field with additional training provided by ICTPH. Currently the training is about three months, but they hope to expand that to one year in the future. The topics included women's health, cardiovascular disease, nutrition and micronutrient supplementation, defining the roles of the different medical care workers, design and placement of new clinics including the furniture, computerized documentation (they are designing an entire new system for use in the clinics). The discussion was intellectually stimulating. Issues are thoroughly discussed and debated with everyone sharing their opinion, experience, and knowledge. The staff frequently cites relevant literature and identifies areas where more information is needed. We contributed to a few of the topics discussed, sharing our experiences with electronic medical records, women's health, and other areas of health care. The staff is impressive - they are passionate about the mission of the organization, intelligent, and experienced (even the many young staff members).

Our waiter beginning to make our paan

We concluded the day by getting together with the members of ICTPH for dinner and tasted a variety of delicious food including both north and south Indian and Chinese cuisines. We  continued an informal discussion of community health and learned more about India in general. Some of us had never used finger bowls and were introduced to the idea - warm water with a lemon slice used after a meal to clean the fingers and emulsify grease. We also tried paan - an extremely sweet after dinner digestive which is made by wrapping betel nuts, rose water and other seeds and spices in an areca leaf. Some of us enjoyed this as a one time experience, while others (mainly Alison) said they wouldn't mind making this a part of their daily after dinner ritual. This was a great opportunity to get to know the ICTPH staff on a more personal level. We had a wonderful time!

Alison, Rachael, Andrea and Sarah very excited to try paan

Alison and Andrea dove right in, while Rachael and Sarah
were a little more apprehensive

    

Rachael and Sarah reluctantly watching each other eat the paan

Dr. Mor said he was very impressed we swallowed it all,
 but even more impressed when Alison asked for seconds!

    

August 27th and 28th: Taj Mahal and more

Taj Mahal

Saturday, August 27th

The beautiful view from our rooftop during breakfast

We woke up today tired from our late night, but very excited to finally see the Taj Mahal. The morning started with breakfast on the roof of our hotel, which had an amazing view of the Taj Mahal. The location of our hotel turned out to be perfect with the view and being only 600 meters from the Taj Mahal East Gate. Our tour guide, Issi, picked us up at 9:30, grabbed our tickets and then led us in the Taj Mahal. We were all so excited and the Taj Mahal was even more amazing than we expected. As soon as we had the Taj in view, we started taking pictures and didn't stop until we left two hours later.
As we walked down along the empty reflection pool, our tour guide began to share with us the history of the Taj Mahal. The Taj Mahal was built by the Mughal Emperor Shah Jahan in honor of his wife, Mumtaz Mahal, who died during the birth of their fourteenth child. He was so heart broken he decided to build the Taj Mahal as a memorial and resting place for her. It took twenty two years to build, along with an estimated 22,000 laborers and 1,000 elephants.  Walking up to the beautiful mausoleum, one of the seven wonders of the world, was surreal. Once inside we got a closer look at the marble, which was extremely intricate and decorated with an array of colorful stones. Our tour guide took out a flashlight and held it against the colorful stones in the marble. Because it was so dark inside the Taj Mahal, the flashlight lit up the marble causing the stones to glow. From behind the Taj Mahal we could see a cleared area where Emperor Shah Jahan had started to build the Black Taj Mahal, but was arrested by his son for his extreme spending used to build the Taj Mahal before he could start it.

Rachael and Alison with one of the people
who asked to take a picture with them

One of the experiences we found entertaining while at the Taj Mahal were all the Indian men, women and children who asked to take pictures with us. This seems to be a common occurrence when foreigners visit the Taj Mahal, but we liked to think we were special :)

Alsion, Rachael, Sarah and Andrea in front of the beautiful Taj Mahal

Our salesman at the marble factory with some of the workers

After reluctantly leaving the Taj Mahal, our tour guide took us to a marble shop. We got to see the marble workers in action working on various pieces. After watching the workers and seeing some of beautifully finished pieces, we each purchased something special as a memory of the Taj Mahal and Agra. 

Agra Fort

We then went to Agra Fort. When Emperor Shah Jahan was imprisoned by his own son, Aurangzeb, he was sent to the fort and looked on from afar to the Taj Mahal, where his beautiful wife was buried. The Agra Fort was large and had a two tiered moat- one dry, one wet. The dry one held tigers and predators, while the wet one held crocodiles to fend off intruders. There is still an army presence at the fort and we could only explore what India has sectioned off as a historical society site. Then we went to Itimad Du  Daulah or "Baby Taj." The "Baby Taj"  looks over the River Ganges, a holy river. It was very warm in the afternoon and we looked out over the large river to see two figures waving at us,  enjoying an afternoon swim.   

Rachael, Andrea, Sarah and Alison relaxing in a doorway
at Agra Fort

Rachael, Andrea and Alison relaxing at the "Baby Taj"

Itimad Du Daulah, or "Baby Taj"

Andrea and Alison enjoying the view of the River Ganges

    













We finished up our exploration of Agra and ate on our hotel rooftop restaurant with a beautiful view of the Taj.

Our view at dinner of the Taj Mahal from our rooftop

Sunday, August 28th

Today was another one of our big travel days. We woke up early to meet our driver and start our 3-5 hour, depending on traffic, drive from Agra to New Delhi. Along the way we stopped to take a break and accidentally found the India version of Wal-Mart. We were so excited to see familiar brands and snacks, we each bought more snacks than we could fit in our bags. We arrived at the New Delhi airport, which was very large and modern, with enough time to wonder around and grab something to eat.

Within a few minutes of being inside the airport, we spotted the famous golden arches and quickly made our way to McDonald's for lunch. After trying the delicious veggie burgers, which are not available in the US, we made our way to the gate. Our flight was two and a half hours back to Chennai and on arrival we were picked up again by another driver. We met up with Marjorie after being picked up and went out for dinner at a delicious Indian restaurant and celebrated her birthday. After we ate and discussed our wonderful and eventful weekends, we got back in the car and headed for the Chennai train station.

Rachael, Sarah, Alison and Andrea getting settled in the train before bed

After searching for a few minutes, we found our sleeper car and seats. None of us, except for Marjorie, had been on a train in India before, so we were not sure what to expect. We had our own area, which was hidden by a curtain, that had two bunk-beds with sheets, pillows, and blankets supplied through the train. After our long day of traveling, we changed into more comfortable clothes and applying ear plugs and sleep masks, we got settled in and quickly fell asleep for the night.

August 26th: Community Health And Development (CHAD)

View of CHAD from the back

Our group with the St. John's masters students

Today has been a very exciting day. This morning, we took a short walk to the community hospital on the CMC campus. The hospital's name is CHAD, which stands for Community Health And Development. We met with Mrs. Suseela who took us and another group of master's nursing students, from St. John's University in  Bangalore on a tour of the facilities. Although the encounter was brief, it was great to chat with the other students. We wished we had had a little more time to swap perspectives on nursing practice and education.

One of the patient beds at CHAD

The CHAD hospital is significantly smaller than CMC's main hospital, however, it still serves a wide variety of functions for the community. On our tour we were able to see several different wards, including pediatrics, labor and delivery, specialty clinics (e.g. ENT, dental), immunization clinics, and others. At the moment there is a rotavirus vaccine program being offered that is part of a privately funded program that is optional for patients.

Instruments to be sterilized

The CHTC buildings where patient education and
workshops take place

Behind the hospital is a separate set of buildings known as CHTC - Community Health Training Center. Here the community health staff teach classes and workshops on various health topics. One program that has been successful is for newly married couples, where topics such as conception, menstruation, fertility, contraception options, and family planning (i.e. spacing pregnancies) are explained. In addition to the work they do at CHAD and CHTC, the staff also does community health outreach in local villages.

A medicinal plant with properties to help decrease symptoms of asthma.
There were many plants on CHAD's grounds

The large oxygen tanks stored at the back of CHAD

Alison and Rachael  

Sarah and Andrea

We were also able to see the theater (operating room). We ran into our new friend Dr. Anand Manuel the anesthesiologist who we met yesterday at the psychiatric department.  Although we were only scheduled for a tour of the facilities, he invited us to observe a scheduled Cesarean section. For one of us, this was the first opportunity to see a surgery, which made it even more unique. The rest of us were able to compare practices and protocol with those from the US. It was fascinating to watch the events taking place and identify the roles of all of the health professionals in the OR and see how the roles are the same or different. All in all, we have noticed often the role of the nurse is not as comprehensive or encompassing as in the US, including that of the OR scrub nurse.

Rachael, Sarah, Dr. Anand Manuel, Andrea, and Alison

Both yesterday and today, Dr. Anand was so good by taking time to explain things to us and to ask us questions to make us really think about what we were observing, the rationale behind the actions, and the relevant physiological aspects. We learned too that his wife, Jasmin, is one of the amazing nurses we met the other day - a true power couple!

As we write this, we are driving from Vellore to Chennai. We're then scheduled to fly to New Delhi and then drive from Delhi to Agra. We will arrive in Agra around 3:30 in the AM assuming there is no traffic. We have to rest up for our 9:30 tour of the Taj Mahal. It'll be a long day of travelling, but we are looking forward to our visit to Agra.

August 25th: CMC Psychiatric Department and Nambikkai Nilayam

Playground area for the children at the psychiatric department

Today was our last day at the psychiatric department/hospital. We leave for New Delhi tomorrow and are actually working out details to change our travel plans because of a hunger strike and political protests occurring in New Delhi. The hotel we planned to stay at is in the area of the protests. While right now the protests are nonviolent, the government has closed several metro stations in the area and there is a big debate tomorrow in the government. Since the nature of the protests could change at any moment, we thought it best to avoid the area entirely.

In the morning we went to the Occupational Therapy department. This department was different than the OT rehabilitative services we went to yesterday because this service is for the inpatients at the hospital. OT is very comprehensive here and seems to be the backbone of the hospital especially in regards to the schedule.

At 8am the patients (divided by gender) meet and perform simple exercises for 15-20 minutes. The exercises are especially helpful for patients taking anti-psychotic medications who experience EPS (extra-pyramidal symptoms) as a side effect and exhibit Parkinson's-like movements followed by breakfast from 8:30-10am. From 10-11am, all of the patients (including outpatients who live locally and participate in day care) meet for discussion time which includes reading a newspaper article and discussing the topic. One patient reads the article aloud, another summarizes it, and then they all discuss. There are three language groups: English, Hindi/Bengali (combined), and Tamil (the local language). Then there is general discussion about hobbies and sports. The OT said that this helps with cognitive ability as well as overcoming social phobias and practicing speaking in groups. All topics are encouraged, but, murders and suicides are not topics that are encouraged.

From 11-12pm, there is activity time and people participate in individual hobbies that are tailored to their abilities. For example, one woman was working on sewing and a man, previously a physician, is working on computers. From 12-2, patients eat lunch and rest (during the hottest time of the day). From 2-3:30, there are individual and group sessions in which stress management is addressed as well as other topics. Games are included, and there are also goal-oriented activities. From 3:30-4 is tea time followed by 4-5pm with outdoor extracurricular activity time (such as playing volleyball or badminton).

Caregivers (i.e. the patient's relatives) are encouraged to participate, especially in the beginning. The OT said that it is helpful for the relatives to observe how the physicians are interacting with the patient and the behavior can be modeled. Also, the caregivers can participate in their own stress management group. In terms of rehabilitation and re-integration into the community, the patients are encouraged to simulate activities they will participate in upon discharge. For example, one teacher with paranoid schizophrenia was unable to teach for a year, but was able to re-integrate into the community and wanted to return to teaching. She was very nervous about speaking in a group, so students were brought in to simulate a classroom setting and she felt much more confident.

Then we went to observe ECT ("shock therapy") in a seizure is therapeutically induced and helps with many types of mental disorders, including depression. One woman we observed felt a lot of guilt from
her past and could not function. Today was her last round and she received 12 rounds total in 6 weeks. She has been improving and her guilt has dissipated. The patients walk into the treatment room and lay down, then a sedative is administered followed by a muscle relaxer. One of the young men we observed today was chanting something to himself to help keep calm before the sedative took effect. The beeping was loud but he kept his chanting up and even though we were listening to the chant, it slowly faded away and his chant became the monitor beeping. One woman had to receive two shocks because the first was sub-therapeutic. The anesthesiologist was great and showed us around and grilled us with questions. Andrea was the best at answering his questions because of her background in cardiac nursing. He knew that we wanted to see, so he allowed us to get up close for observation.

ECT is not like it was many years ago - the patient is sedated and also given a muscle relaxant so the body does not convulse widely. A blood pressure cuff is used on one arm to block the muscle relaxant from going into the patient's lower right arm but the shock goes through and the M.D. can observe how long the seizure lasts (at least 20 seconds is therapeutic). This is like how it is done in the US. We also observed the recovery room. It seems like the nurse's role here is concerned mostly with the biological needs of the patient (medications, sleeping, eating) unlike in the states where nurses would lead group activities like in the OT department.

In the afternoon, we observed the child and adolescent ward. Children with autism, mental retardation, developmental delay, and cerebral palsy come here for support. The family is invited to stay for at least 3 months, and after discharge, the family checks in with CMC every few months (if they lie locally) or annually (if from the north). Parents are taught how to engage with the children as they are the main caregivers and will have to care for the child everyday. At CMC, the parents learn about positive reinforcement and how to administer the rewards (like keeping charts and then giving candy, stickers, or an activity as a reward). Psychologists are the head teachers in each room and take part in the interdisciplinary rounds each week. The patient's progress. Siblings are also brought here to help encourage sibling relationships and sibling rivalry is addressed. The families can leave on outings and are free to explore the city.

There was a separate child and adolescent OT department that we didn't see. Patients with OCD, ADHD, oppositional-defiant disorder and conduct disorder (the disorder that is correlated with antisocial personality disorder) are treated here.There are games, learning how to interact in a social environment and group activities.

August 24th: CMC Psychiatric Department

The walkway to CMC's Psychiatric Department

Today we went to the psychiatric department of CMC Hospital where there the focus is on family-centered care. Alison is a BSN/MSN Psychiatric Mental Health Nurse student and this was one of the main reasons she wanted to participate in this program. The department is actually completely physically separate from the main hospital and on the same quiet, relaxing campus as our dorm. Family centered care in this case means that a patient needs to have one (preferably two) relatives stay with him/her while at the hospital. The family helps support the patient during his stay and when he is rehabilitated back into the community. At CMC, the family helps deliver the care, learns about medication, and even helps inform the staff/physicians about the patient's personal symptoms and level of functioning. For example, if a person were to come to the hospital and was not performing at optimum functioning, but improved and the physicians were discussing discharge, then, the family would give their input and say that it is not the optimum functioning and the person needed continued support.

The Psychiatric Department is located in a picturesque area

On admission, the patient (and family) are informed and commit to generally a minimum of a four week stay at the hospital. Still, no wards in the hospital are locked, the patients discuss being discharged when they feel ready (and physicians and family discuss the possibility of
continued support if necessary) and if the patient feels it is necessary, he may leave the hospital grounds, and the hospital will call the home to check that the patient got home safely.




Apparently, this hospital is one of the only ones in India that follows the family centered model. The family even stays overnight with the patient, and helps with everyday activities. In the morning, there is occupational therapy as well as group therapy and all patients are encouraged to participate. Mid-day is relaxed, and the patients are encouraged to participate in afternoon activities.

This morning, we observed daily rounds in which the medical doctors, nurses and occupational therapists make rounds on the patients. Medical residents also participate and we listened to a very thorough and comprehensive case study of one patient who was diagnosed with bipolar disorder. The  hospital is very interdisciplinary. We were pleased that we knew answers to some of the questions that the lead physician posed to the group.

Unlike the main CMC hospital (where physical ailments are addressed), insurance does not cover mental health. So, people pay out of pocket, even the patient of the lower socioeconomic classes will pay some amount. The nurse said that it is good that the patients pay, even if it is a small fraction, so that patients understand the severity and importance of the care and she corsrelated payment with good
compliance.

Earings made by
patients at the rehababilitative center

In the afternoon, we went to the rehabilitative services, where people do not stay overnight at the hospital and instead participate in day care activities (like making earrings, candles, and paper bags out of newspapers that are then used in the college store) and then sell their products. The clients create relationships and take anger management classes and learn to identify stressors.

Coconut bowls made at the rehab center

There are four phases and by the end of the fourth phase, the client is encouraged to reenter society and hold a job. The therapists work with merchants (like grocery store owners) to help the clients get jobs, and follow
up with the clients. There is even a half way house for the clients to live in while their life is stabilizing. One downside is that a lot of the clients have chronic mental illnesses, and many of the families desert them and discontinue support, so it takes long time to create a relationship and support the client to reach the fourth phase. The program even addresses stigma of mental illness and how to approach the stigma in society in an adaptive manner.

Nurses station at the Acute Care Unit
where patients are monitored for 48hrs

As we may have mentioned before, the nursing faculty have to teach theory courses as well as clinical courses and manage their hospital jobs. Many also conduct research and are pursuing their own advanced degrees. It seems very time consuming and difficult. As students do not stay long at their clinical sites, and psychology is often not a favorite of students, it seems difficult to integrate students, and meet the patients' needs at the psychiatric hospital. Still, it seems like there is one student for a patient (we learned about some government hospitals where there are 10 students per patient) and not every patient has a student. The role for nurses at this hospital seems to be overseeing things and administering medication, not as much counseling as there is in (ideal settings) in the US.

Dinner at Dean Rosaline's House

That night we were graciously invited to Dean Rosaline's house for dinner. She, with the help of her husband, made a delicious meal of gobi (cauliflower), two types of chicken (one dry and one with gravy), chappathi, vegetable rice and the most refreshing ginger lime juice. For dessert we had fresh mangos, bananas and apples. Everything was very delicious! After eating we all gathered together to take pictures. It was a very pleasant evening.