Volunteering in Mizoram, an isolated Northeastern state in India, was a blessing of God's design. When we were first given our destination we were excited to be in an area that has restricted access to foreigners, but were not too sure what sort of impact as Christians we would have on an already Christian state. By the time we arrived in Mizoram God knew that we would need a breath of fresh air from our congested lives on the road. In the end the very fact that we were again among Christian people is what endeared us to the region and the people.

Five months of traveling, and a tiring three weeks of travel through mainland India left us desperate to settle down and get away from the hassle of being tourists. The hassle of being a tourist takes many forms. The daily banter of beggars and touts wears quickly on the nerves and often left us raw and rude towards them and each other. The discrepancy between men & women in our past few countries has been quite a trial as well. Lastly the scheming and scamming that is expected as a tourist, at times would make us cynical about even the most honest approach for conversation. It was from these things that we sought escape during our six weeks at the Presbyterian Mission Hospital in Aizwal, Mizoram's state capital.

The first striking feature about Mizoram is that it is at the tail end of the Himalayas, and the name Mizoram, land of hill/mountain people, aptly describes the land features. Somewhere between the English definition a small mountains and large hills, the entire landscape is wave after wave of foliage covered swells. Imagine the Smoky Mountains in a slightly more tropical climate. The land is sparsely populated and the comparison has been made that there are more beggars in Kolkata than the population of Aizwal. These 2 components made it possible for us to step off the plane and comment about the ability to take deep breaths of fresh air for the first time in weeks.

The next striking thing is the Mizo people themselves. Hugely passionate and protective of their land, Mizo's are a tight knit tribe. There is very, very little diversity in Mizoram and the restriction of foreigners (including mainland Indians) is intentional to keep it this way. The idea is to preserve their culture. The Mizos themselves have almost nothing in common with their national country, India. They look more like a combo of Thai/Chinese, religion is and always has been different than the Hindu or Muslim majority, spicy curries have not migrated this far east with the foods here being mostly boiled, and the iconic saris & nose rings of the mainland Indian women are just as exotic here as in the USA.

It is due to this isolation and the juxtaposition of our travels in mainland India, that we were shocked to find out how influenced by the West Mizos are. Here (in Aizwal) EVERYONE wears jeans and the clothing trends resemble a big city in the States. Everyone watches American idol, can sing popular American songs, watches the newest American movies (my patient has watched Transformers before I have), and the church buildings and services could easily be in the States vs. in a land across the world. People here are more likely to speak English than Hindi as a second language after their primary language of Mizo.

The next astonishing thing is the influence of Christianity on their life and current culture. Due to the influence of missionaries at the end of the 19th century, literacy in Mizoram is higher than almost any other state in India (a rough guess is that literacy is around 80 to 90%). Women enjoy the freedom of equality, which allows them equal access to education & the opportunity to excel through university degrees and the resulting benefits of a good job. This equality also means a relaxed attitude towards gender differences. Men & women hold conversations, develop friendships, and marry for love, all polar opposites to the rest of India. Christianity has also affected how the poor are looked after. Everyone has his or her basic needs of food and shelter met, which means there are no visible beggars. Also, the church holds nightly services and is the main source of entertainment & gathering. People border with being legalistic about attending 2-3 church services every Sunday. We were quoted that 98% of Mizos are Christians (although due to the number of young men in the addictions unit & with the prevalence of HIV clearly not everyone is living a life accordingly). Interesting as well, is that the Mizos have a huge heart for overseas missions and we met many either aspiring to go abroad or who were home for the holidays from living abroad as a missionary. Lastly, people here on the basic level are HONEST! Even the taxi drivers (the most notorious of dishonest professions around the world for a tourist) quoted us normal fares for the ENTIRE 6 weeks.

The basic goodness of the Mizo people is further exemplified in the Mizo doctors, physiotherapist, and nurses that choose to work at the Mission hospital. They work 6 days a week with meager reimbursement for their labors compared to their fellow workers at the Government or private hospitals. Also, many of the staff is not able to enjoy respite from their work. One doctor has worked for the last 30 years without a holiday since he is the only surgeon. This is a huge responsibility since the hospital is over 300 beds.

Our time in the hospital was not quite as demanding when compared to the regular staff, however we faced other challenges. For Mike being at the Mission hospital was testing. Having work experience in some of the top hospitals in the USA, he was astonished to discover that doctor's here work without some of the basic diagnostic tools or facilities (i.e. blood cultures and no ICU since the hospital doesn't have a ventilator). The lack of current medical practice in regards to prescribing medicines was also particularly eye opening. However, the pharmacy was such a different world (no known organization of medicines and pharmacists gave NO drug information to the patients when dispensing – not even when/how to take the drug) that Mike found it easier instead to work along side the doctors (which is more similar to the practice in the States anyway and the Mizo doctors spoke English while the pharmacy staff only spoke a little). As far as therapy was concern it was limited to one trained Physiotherapist in the ENTIRE state and the mission hospital was VERY blessed to have her working there. This means NO speech therapists OR occupational therapists in the region. Although well trained, a single physiotherpaist can only make a very small ripple compared to the hundreds that could really have been benefiting from the services and knowledge that therapies provide to improving basic quality of life and independence despite disability.

The lack of applying current medical knowledge (on some fronts but not all), the lack of accountability for medical decisions (a patient would not/could not question a doctors decisions) , but most notably the lack of money were all detriments to people attaining a higher level of medical care. This resulted in Mike witnessing numerous deaths, often among those in the prime of their lives (20s-40s), with diseases that would have easily been treated in a Western hospital.

The life and death struggles that Mike had to grapple with were far tougher realities than I had to deal with. My initial challenge lay in the fact that for the first 2 weeks of our volunteer experience the Mizo PT was on medical leave due to a broken arm. Of course I learned of this the day before starting, and so my start day was nerve wreaking in what sort of duties would be expected of me. Thankfully, there was a wonderful therapy aide who had been managing the therapy patients, as best he could, and so was my tutor on how to act as a PT. Thankfully, I have always worked closely with PT's, and seceretly wished I was one, so was happy about the opportunity to apply the knowledge that I gleaned over the past couple years. This also forced me to learn a few, very few, mizo words to guide my hands on treatment with patients (thankfully most patients basically understood my sloppy attempts at their language and were appreciative if not outright amused). To augment the rest of translating during my first 2 weeks of treating patients, were the some of the best English speakers in the hospital – patients (young men) from the addictions ward.

With the return of the Physiotherapist my role significantly switched to more observation, asking questioning, and at the end of the 6 weeks giving presentations to the staff and student nurses about topics that traditionally concern both the nursing and therapy worlds.

It would be impossible to sum up all our experiences from this 6 week experience, so I won't try. Here is just a smattering that sort of frames our lives while there. A definite highlight was a trip to a remote village with the mission hospitals mobile medical clinic. The village was 3.5 hours by a main road and 1.5 hours by dirt road. We found out that in the past 25 years (or possibly longer) no white person had visited the village. We witnessed the treatment of 100s of villagers from a combined 3 villages, ranging diagnosis were from the beign (and bizarre – a girl with an extra tear duct that couldn't control her "crying") to the serious (stroke). Treatment was mainly medicine (from the limited pharmacy that was brought as part of the supplies with us) to the spontaneous basic surgeries (performed in a shack with a few windows broken, poor lighting, and even more questionable surgical equipment – since only minimal was brought with us).

Mike spent the time taking blood pressures, while a line quickly developed around me for massages once it was discovered that I was a willing set of hands (SO much tendinitis since these people were farmers). Although we anticipated being a rarity amongst the villagers our shock came when attending a wedding back in the state capital, Aizawl. At the reception a young man in his early 20s came up to us, and in perfect English and sincerity told us, "You are the first white people I have seen and met." Another eye opening experience resulted from visiting the drug addictions ward where the mode of choice is IV. As a result many of these young men have completely occluded their veins (some so much so that the only available vein to use for IVs in the hospital is one in their forehead!). As a consequence of the blocked veins almost every patient has some sort of physical aliment - amputations, complete skin grafting of ENTIRE legs as a result of gangrenous skin from infected sores, strokes from blocked arteries in the neck, and HUGE groin ulcers. They were living examples for a DON'T do drugs campaign.

Nature highlights was the side trips up a river and a mountain that is a local favorite picnic spot. And eating highlights include the times that we were invited to peoples houses - yummm! New Years will be a one of a kind experience for us - seeing the fireworks from our mountain top position and eating the local festival food (prepared with help from numerous hospital staff the holiday feast is held at one persons house and will serve over 200 people. For us it was an interesting experience to discover that they eat ALL parts of the animal - on my plate I got the heart/lungs/gall bladder of the chicken in a curry dish, had some clotted blood sausage, and was served pig brain soup broth with veggies). Even our basic day to day living during this time, although similar to our travel experiences, is much different than life in the USA. Bucket bathing is the norm for EVERYONE (rich and poor), NO central heating in ANY building (at times we could see our breath in our apartment, just imagine the patients in the hospital), power cuts are common (more in the city than where we were at the mission hospital - but 2 times in 6 weeks the hospital had no power for ~1/2-1 hour), all laundry by hand, a basic lack of value applied to time, and animals wander everywhere (in the hospital cats are frequent, while a dog interrupted one of the church services).

Our six weeks were a great time of introspection as to what we really need vs want in life and the pros/cons of Western culture/modernization. This time also served to create valuable friendships. A young Swiss nurse married to a local young mizo (Karin and RD) brightened many nights that would otherwise have been lonely (playing board games, watching American idol, and making spaghetti dinner were highlights). And the almost constant companionship of Silo, an intelligent young doc, allowed Mike especially to feel a sense of purpose during his time of volunteering as well as filling many long nights with cards and he was the energy behind our side trips to see Mizoram (instead of just the hospital). Of course there was others who will always be remembered fondly and of who we hope to get hospital updates from (such as the many junior doctors, the young ortho MD and the physiotherapist).

December 1st - 2nd
Mumbai

December 10th - 11th
Udaipur / The White City

December 12th
A Side trip to Kumbalgarh fort and Ranakpur Jain Temple

December 13th
Jodhpur / The Blue City

December 14th - 15th
Jaisalmer / The Golden City

December 16th
Random Stop : Bikaner and the close by Karni Mata Temple

December 17th - 20th
Pushkar / Important Hindu Pilgrimage Center

December 20th - 22nd
Bundi

December 23rdth - 24th
Agra

December 25th - 28th
New Delhi

Nuances of India

Volunteering in Mizoram