Home!

The trip is over, but that's okay. Thanks to everyone who has read my blog! I also want to thank other people again. First, my family for supporting me and sending me to Kolkata. Second, Turja and his family for keeping all of us alive and making the program happen. Third, everyone involved in Pratit, especially those who were in Kolkata with me!

"My Third Eyes Sees" by the Pratit members in Kolkata

My third eye sees my fourth eye.
My third eye sees sex, drugs, and violence tonight.
My third eye sees Turja getting sick tonight.
My third eye sees one hand clapping.
My third eye sees a mango in an apple tree.
My third eye sees the spices that make my eyes water.
My third eye sees roots with leaves.
My third eye sees seas of my I’s.
My third eye sees the bottom of the sea.

My translator friend

In our second medical camp, one of our local translators named Chandann Raiputt laughed when I asked him to tell a female patient that we needed to palpate her stomach. “Go find a girl to do it,” he said. “This is India.” I promptly asked Turja to do the exam, which he of course did successfully. I tell this story because it’s the only time I can remember Chandann being wrong during the past two weeks. I also know that Chandann was receptive to what he learned about medicine in this situation, just as he has been receptive during the rest of his life.

Chandann has told me snippets from his life and promises to write to me with many more details and anecdotes. His parents died during his early years (Chandann has no idea when they died nor does he know how old he is now), leaving him with nowhere to go. He told me that in the state of Bihar, it’s typical for violent land-grabbing locals to force orphans to run for their lives. Chandann made it on the streets for some time, living off scraps from trains. One day, he fell asleep on a train and ended up in Kolkata. When he disembarked alone in India’s third largest city, a pair of street children grabbed him and took him to their leader. Chandann was told that his job was to continue scouring the trains for products and money that he could take back and share with the pack. He lived around the station for a long time (again, he doesn't know how long), forced to become part of the blackmailing and battles between children fighting to survive. But he knew he was quickly dying. When the founder of Future Hope woke him up at the station one morning, Chandann decided to go with him, aware that he could be another victim of legendary organ harvests.

Chandann is still thriving at Future Hope and now has the opportunity to study layout design for automobiles in the UK. Pratit is extremely fortunate that he’s studying in Kolkata for the time being. First, he has been by far our most reliable translator, volunteering at least 25 hours of taxing translation work during our medical and education camps. Without him, we would have had to scramble and probably pay for translators. Second, he has been an intelligent guide and liaison to the city. Turja does a wonderful job at this, but we needed someone else to help us get around. Chandann knows the back roads. Third, Chandann has become a friend to all of us. He's been out to dinner with us and come over to hang out at our flat four nights in a row. It’s clearly been eye-opening for him to experience our lifestyles, but I don’t think this adjustment has been much of a challenge for him. Finally, we know that Chandann is receptive to any type of discussions, including those involving Pratit's relationship with locals. He always provides thoughtful responses.

I’ve debated a lot in my head how we can overcome the language barrier here. In my opinion, securing reliable translators, whether that involves payment or not, seems to be the essential first step. However, I don’t expect to find other translators with Chandann’s unique and truly inspiring character. Maybe Chandann will help us find others with similar qualities. I want to meet more people here that can become my friend like Chandann, people that can make me feel like I’m connecting with the city and its people, not just trying to help the city and its people.

“My Third Eye Sees” by our students

My third eye sees myself meeting Dev.
My third eye sees myself playing cricket.
My third eye sees myself dancing in front of the Taj Mahal.
My third eye sees myself meeting Koyel.
My third eye sees chow mein.
My third eye sees myself playing badminton.
My third eye sees myself playing football.
My third eye sees myself meeting Salman Khan.
My third eye sees myself playing cricket with Shahrukh Khan.
My third eye sees myself chewing Nimki.
My third eye sees myself reading Bengali books.
My third eye sees myself eating fruits.
My third eye sees myself eating chili chicken on top of a mountain.
My third eye sees myself riding an elevator in a tall building.
My third eye sees the Penn students visiting my house.
My third eye sees myself standing at the top of the Taj Mahal.
My third eye sees myself riding in a flying car.
My third eye sees myself riding a horse.
My third eye sees myself as a flying bird.
My third eye sees myself walking on the moon.
My third eye sees myself riding a ferry.

A few short comments:

This is an exercise I learned from Michelle Taransky while coordinating Write-On! last semester. The major similarity I see between West Philly middle school students and these students is their adoration of celebrities. This also highlights their focus on their technically possible dreams.

We told them from the beginning to focus on fantastic ideas, not things that they can do in this reality. We decided to thoroughly reemphasize that after they produced a chain of dreams about meeting celebrities and playing sports. The very next statement: “My third eye sees myself reading Bengali books.” With the way these kids have shown that they can learn, I have no doubt that many or most of them will be able to read Bengali books if they continue with school. Only about 50% will enter the government school system when their time at this schoolhouse ends.

I’m quite excited to ride elevators and eat fruit when I get home.

I’ll be posting a “My third eye sees…” by Pratit members in the near future.

1.8.09

We held our most recent medical camp in a social club attached to a temple. The temple’s two human-size female goddesses faced a cow pattie-covered wall across the narrow street. The wall guarded the jute mill of famed violence. Here is a sequence of events from the camp:

For only the second time since arriving, we were all told to stop working at once in order to examine a particular patient. It was a ten month-old girl with encephalocele. Her brain was squeezing out of a gap in her skull, forming a bulge the size of a golf ball just above her forehead. This is the case we were prepared for; we’re funding the child’s surgery and recovery costs. Minutes after we sat back at our stations, puja began just feet behind me. Attuned to the bells and unintelligible chants, I questioned and examined a diabetic and hypertensive woman that had stopped taking her medication without explanation. She just wanted her blood pressure checked. After the prayer stopped, I examined an 88 year-old man with extreme protein-calorie malnutrition. He weighed 60 lbs. with no meat on his arms, legs, or chest. Marasmus, especially on his arms, made me want to vomit and/or cry more than any other bodily sign I’ve seen. (I’ve learned that I can control those reactions by getting back into my healthy body and pulling its parts together.) He also was in severe respiratory distress, had no front teeth, was blind in one eye, and had glasses so dirty that I don’t believe he could see out of the other.

I saw another malnourished man later. He was more capable of communicating with us and repeatedly asked me if he was going to be okay. (He was, except for that whole weighing only 75 lbs. part.) When I got on my knees and touched his feet for the PMS exam, he became quite emotional and repeatedly bowed to me. I love forming a doctor-patient relationship, even if it’s unintentional and I’m not a doctor.

Edit: The scans on the child revealed that it was not encephalocele but rather meningocele. That's good news.

1.7.09

We visited the school for the third time to talk about germ theory, hand hygiene, and first aid. I’m extremely surprised by how quickly these students remember what we tell them. Our translators also are doing an excellent job, seemingly taking the teaching into their own hands.

Between the schoolhouse and the park where we play, there is a strip of twenty or so chest-high, tarp-covered homes on the sidewalk. The strip is divided in the middle by a gated display of Ramakrishna’s first British disciple standing above a polluted pool. A student that acted as a bacteria cell in one of our demonstrations led us into his home on this strip. A young girl cooked on a kerosene stove as I scooted in on my butt. Turja and I sat alone inside for a moment, cross-legged with our heads just below the tarp. The father of the family quickly came to greet us. He is a former rickshaw-driver that now works in the mineral water factory a few kilometers away. He said four people live and sleep on the 25 sq. ft. cement tile floor. When I asked through Turja if the city hassles them about their overt squatting, he said people only get paranoid when a government doctor visits the settlement to treat them.

The US consulate, a young Penn alum, dropped by our education camp in a full business suit. When a Pratit member picked him up, he immediately said, “I didn’t bring a checkbook with me.” Aww, shucks. One-by-one, we talked his head off. He kept the conversation light and uncontroversial while we discussed our organization, slums, and Kolkata in general.

We took the consulate on a tour of the squatter settlement, the likes of which I doubt he had seen before. The houses are made of bamboo, most with tarp covers, and usually reach three or four stories high. The alleys between them are no wider than four feet. We visited at 3 pm but most first floor rooms on the shadowed interior of the settlement were completely dark. We were invited into the home of Payal, possibly the brightest student that we’re teaching. Her mother left her family when she was about one and her father is an abusive alcoholic that lives with her grandmother and her. They had a two-story home with only two rooms. The three of them slept on the second bamboo floor, a 50 sq. ft. room. They also had a battery-powered TV in their bedroom. When we walked out, we saw the floss we gave Payal on the first day hanging by the door.

1.6.09

We held our third medical camp in a dirty, poorly lit 10x10 ft. social club. We had to put two tables outside under a tent because of limited space. A border patrol campus was directly behind us. One guard stared at us from his tower on the other side of the wall.

I worked with a new doctor and thoroughly enjoyed his help. He maintained a sense of humor, gave me the opportunity to perform as complete of an exam as I wanted, and explained what he was diagnosing and why he prescribed what he did. Our first few patients were particularly interesting. The first woman had been diagnosed with scabies the day before but couldn’t afford her medication. It’s absolutely satisfying to pay for medications for a patient that you believe will follow through with the treatment. Unfortunately, we can’t apply treatment to her bed, so the scabies will probably come right back. The second patient was a very young child with protein calorie malnutrition, represented by severe edema in his stomach and feet. The third patient had a tumor in her neck and a tumor in her cheek. A past blood test on a tumor in her arm supposedly revealed that it was benign, but the other tumors had not been checked. The doctor I was working with recommended to the camp administrators that we pay for biopsies. She was told to come back in thirty minutes, but apparently she never returned. That was my first ever patient with tumors, and I have no idea what happened to her. Another man probably still had TB after he quit his medication eight months early. He said that everyone in his family died of TB a few years earlier.

Photos

A cow pattie-covered wall that guards the jute mill
Inside the temple where we held our most recent medical camp
Outside a home by one of our medical camps
Inside a social club where we performed clinical work
Waiting outside the clinic
The schoolhouse, its students, and its brick floor
A row of squatter tents by the school

my first beggar in Kolkata

My first beggar
Approaches the window asking
Me like I’m a guru of materiality, “Please,
Just a Rupee for your groupie.”

I can’t understand his words
Directed at the window, his eyes
Squinted, but I perceive,
“My arm tapers to a toothpick—
I’ll even pluck holy beef from your teeth.”
Trust me, I’ve heard this deformity schtick.
“I shoulder this glob of skin that flaps
In the same God’s breath that you breathe.”
Now we’re talking.
“Fill my mouth with notes, for I have nothing
To grasp with, nothing, but shalln’t food
Make the rest of me?”
Cotton currency fed the colonizer. You and I,
We should exchange equally within material reality.

I ask fellow passengers to provide for him, for me.
Oh, and translate please!
“He said he needs a shirt.”

Ramblings from Week One

I’m learning Bengali words to help me perform physical exams, but I’ve resorted to body language to demonstrate to the patients what I need them to do. This system of one body imitating another is an incredible relief from my every day experience of trying to express myself in words. Wait, why am I writing this blog again?

The doctor-patient relationship flies out our tiny clinic windows. Doctors oftentimes are prescribing medication within twenty seconds of looking over our patient charts. Maybe we the medical assistants are supposed to be creating that relationship, even with our language constraints.

I think that I correctly anticipated finding in India a stereotypically Western obsession with medication. It is inappropriate for me to doubt the doctors’ knowledge of disease trends and treatment needs in the area, but as I said, they seemed eager to prescribe as quickly as possible. Nearly all patients received a prescription, and certainly the strong majority needed it. However, we undoubtedly medicated a number of curious people who probably didn’t need a syrup or pills, including my interviewee Ajay Sankar. Sankar clearly was more interested in talking and experiencing the clinic than in being diagnosed and treated. I also understand that most of these people would benefit greatly from vitamin B supplements. Maybe the nourishment can have long-term benefits for both parents and children. And maybe medications given to the elderly women coughing up worms will be able to exhale without life forms falling from her mouth. We used potent ibuprofen to treat the worm woman’s major complaint: back pain hunched her over every winter. (This Kolkata winter is no less than 50° F, but countless people wear black and camouflage earmuffs in the highs of 80° F.)

I have consistently been picking hard, black boogers from my nose. (I’m balancing the internal constitution of my nose.) As Sandeep pointed out, you can look straight at the sun because there is so much pollution in the sky.

The begging in Kolkata is minimal compared to what I have seen in other countries with severely impoverished people. The street-dwellers are everywhere but they simply aren’t begging. I have no idea why this is the case. One case of begging that I experienced overwhelmed me. I was sitting in the front seat of an SUV, traveling to the Ganges for the first time. We were stopped for two minutes at an intersection when a young, shirtless, extremely thin male beggar approached my window. His right shoulder joint had a large flap of skin hanging from it in place of his arm. His left arm tapered to a nub around where his wrist should have been. My window was cracked enough that his eyes could look at me cleanly, but his mumbling was directed at the window. I had nothing to give, so I begged those in the seats behind me to handle my problem.

We are paying $15/day to rent an ambulance and its driver. A member of Pratit’s insurance company had to pay $1060 for an ambulance to take her just one block on Penn’s campus.

I don’t believe that I could do what Turja is doing. Certainly the support provided by his family, especially his parents and Dr. Charkraborty, is essential for the success of this venture. His parents are providing our lodging and much of our food and transportation. The doctor has the connections in each of the slums and controls the clinic like a man that knows where he is and the people he is serving. (Go localized knowledge!) But Turja is the heart of this program. He maintains the system in the background and makes major decisions in the frantic clinic.

I was a New Year’s Eve “celebrity!” I decided to embrace the attention and didn’t turn down a single one of the forty or so boys that asked to shake my hand with the compulsory English-spoken, “Happy New Year!” There were thousands of people on one of Kolkata’s major street and at least 90% were young males. I danced spontaneously with some of them. When one older man came over to jump around with me, he also asked to shake my hand. Then, when a local boy next to me asked to shake the man’s hand, the man begrudgingly complied, then immediately wiped his hand off on his shirt and walked away.

When the mob of males around us on New Year’s Eve grew too large for comfort, we escaped into a restaurant called Marco Polo. I’m consciously avoiding the label of modern-day European/Western explorer, but I can’t help but feel like one sometimes.

Why do people around the world consciously and unconsciously suffer at the hands of time but decide to celebrate it when the whole constructed cycle begins again at New Year’s?

O hey, Krishna! What’s happening, yo? (We road on a cramped coach bus named Krishna to get to the fantastic picnic on the industrial farm. It was the bumpiest ride of my life!)

Picnic on an Industrial Farm

On our day off, we joined Turja’s extended family for a picnic outside the city. Our packed, fifty-person bus slowly passed along the progressively less developed roads and shrinking buildings. As soon as the buildings disappeared and massive clearings of industrial farming land took their place, the bus pulled over. We followed a dirt path back into a farm, eagerly anticipating the bungalow that Turja promised. As we neared our oasis, a four-foot snake bolted between harvested tomato plants on the dry earth. Massive electrical towers dotted the farm everywhere I looked.

The picnic was wonderful. We ate excessive amounts of food and played competitive games by a large pond and diverse flowers. We struggled to decide whether to play cricket or soccer first, but when a Pratit member knocked the cricket ball into the pond with the Americans’ first swing, we settled on soccer. Naturally, our teams were India vs. USA. What a better way to create picnic unity than to battle our nationalities? The USA won when the family’s superstar, a young striker for the Manchester United of India’s football league, joined USA because we paid him more.

The food was delicious but I had a trying experience with a pepper. Eating with my hands, I didn’t pay sufficient attention to what was going in my mouth. I ate an entire hot pepper at once and suffered the consequences. Adults rushed to give me more and more water. They tried to force a new plate of rice on me, which I wouldn’t accept because it was the pepper, not the dahl that made my tongue burn. Basically, my meal became the focus of a mass of adults for at least five minutes.

Turja’s family also encouraged us to dance wildly. It seemed that we were providing entertainment for the adults, who videotaped us, and the youths, who both copied and teased our dance moves. If you know me, you can imagine how I flailed for the camera and the kidzz.

The highlight came when we ventured off our green island into the arid industrial farm. We followed a path into a rare patch of trees that contained a village of over 200 huts. Most of the huts were made of perfectly smoothed mud that appeared to blend into the dry earth that supported them. After traveling in three Indian cities, I had longed for a glimpse of an Indian village. A village buried in an industrial farm that employed the population was an ideal site for me. Women and men carried enormous hay bales on their heads in and out of the village.

People in the village stared at me less than people in random parts of Kolkata. They said that the white factory owners passed through occasionally. They persistently asked Turja to get them a job in the factory, eventually requesting his phone number. As we left the village at dusk, they sang for us. We danced wildly to 90’s hits again when we returned to our oasis.

12.31.09

Slum locations are oftentimes determined by the location of industries that can employ a slum population. The bustee by the Baranagar jute mill is a wonderful example of how an industry can influence the creation and development of a slum. The British built the mill during colonial rule and a slum spawned to house its labor source. The mill owners exploited the labor for decades until the communist regime took over West Bengal and interfered in the owners’ practices. The mill has a well-known history of violence (http://www.india-today.com/itoday/20010129/states.shtml) with frequent closings and re-openings, no matter the political situation. Thousands of men are currently out of work with the mill being closed, and multiple patients blamed their symptoms on the stresses of this situation. Without an economic reason for the slum to exist, the government may be leaning towards eradicating the slum.

Much of my understanding of this slum came from my extremely rushed interview of Ajay Sankar, an enthusiastic mill worker that was one of the last patients to be seen. On my knees, I spoke with him for about ten minutes through a translator while others packed up the supplies. By the end of the interview, I had six or seven factory workers standing over me, frantically trying to tell me things that the translator couldn’t possibly keep up with. Kalyan and others dragged me out of the schoolhouse and onto the ambulance, which was of course surrounded by a mass of locals.

The jute mill owners recently built the schoolhouse where we held the clinic. The school is only supposed to educate the children of the factory workers. Unfortunately, the building has yet to be used for education. The factory workers I spoke with seemed to see the school as part of the successor system in which sons replace their deceased fathers in the mill. The school appeared brand new, had ample lighting, great ventilation, and was twice the size of the social club from Rajabagan.

The community was well prepared for our visit. A councilor appointed by the government to keep the slum clean and organized informed the public about the clinic. We allowed the community members to hand out numbers to the mob of people that already crowded the entrance of the school before we arrived. I’m not sure how one gives out numbers on a first-come, first-serve basis when people arrive before the clinic begins, but they managed to create somewhat of an order. It is up for debate whether or not we should allow locals not involved in Pratit to handle to registration. In my mind, the argument for letting them be responsible for that is to give them a sense of being part of the initiative. The main arguments against letting them control registration, which I support, are that they may have biases in who is at the top of the list and that we need to systematize as much as possible considering how much we already improvise.

We served ninety-five patients in a bit over three hours! We did fifteen more than expected because we worked quickly and because the mob clearly wasn’t ready to disperse when the first eighty had been served. Women were screaming outside about how the children were not being treated first. Our system of tandems performing clinical questioning and physical exams broke down less than an hour into the clinic, making it even more incredible that we worked as efficiently as we did. This occurred mainly because our translators and their ride were delayed separately in the ridiculous Kolkata traffic. By the end, we were fluidly moving between four stations to work with patients at whatever seat was available.

After our questioning and physical exam, which no longer followed our detailed and well-planned patterns, we grabbed whichever of the three doctors that seemed available. (It’s interesting to note that our doctors arrived before us this time but arrived an hour late at the last clinic. I’m sure I could attribute this to a number of factors, but my cynical side inclines me to believe the $7/hr salary we paid them at the first clinic affected their decision-making. Yes, $7/hr is an excellent salary for an MD in Kolkata.) The doctors are very enthusiastic about our cause, and their emotions during the peak of the chaos demonstrated to me how much they wanted to see as many patients as possible. The doctor that is involved in clinical research and is most aware of our research ambitions actually began grabbing his own patients. He wrote prescriptions without writing down critical info or allowing us to take vital signs, weights, and heights. This leads to my question of the day and maybe my question of the trip. When time, materials and personnel are limited and the patient demand is overwhelming, should long-term research ambitions, which hopefully will contribute to the long-term health of the community, be dismissed in favor of providing as much immediate humanitarian aid as possible?