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?