The Dispensary

After working at the orphanage in the morning from 8:00am until 12:00noon, I headed over to the Sealdah Train station for 3:00pm to work at the Dispensary medical clinic. The job there was to do wound care for the street people that lived in and around the Sealdah Train Station. If I thought that my training in Emergency Medicine was going to help me I was wrong. This was nothing like anything that I had to deal with before. The wounds that I've had to deal with in the past at work all occurred at some point that day. The job was to clean the wound and get the person to a doctor as quickly as possible so they could receive stitches, medicine, etc.
The wounds at the clinic were all massively infected. Some to the point of having gangrene. Most having rotten dead flesh on them and many with maggots feeding on and inside the wound. My first reaction was to get these people to the hospital because many of them needed a skin graft or even an amputation. After a few days of being there, I came to realize that these people were not going to the hospital because they either could not afford it or they did not want to go. We were all they had. And strangely enough, when I first started, I was the only one with any medical training. I was amazed at the other volunteers who, with no prior medical training, were in there cleaning and bandaging these wounds. I really had to learn to harden myself to this and just do it. Which after a couple of days of doing this, you do. On my third day I had to clean the maggots from deep inside a wound on the foot of a guy with elephantaisis. Rightfully so, this guy should be at a hospital getting his foot amputated. But that's not going to happen. I got down into it and started cutting and scrubbing and cleaning. The smell is horrendous. You never forget the smell. While I was working on him, I heard someone say right behind me, "Oh my Jesus!" I turned around and it was one of the Sisters. She had just transfered to the clinic after 9 years of working with the orphans. She was shocked at what she saw (the Sisters have no medical training, which is a bit of an issue, especially since they are the only ones that are consistently there).
Most of the wounds here start off as just small cuts that in the US would be tended to that day and heal up in a week. Even if they weren't tended to that week, they would not get as infected as they would here. The streets in Kolkata are absolutely filthy and the street people walk around them barefoot. Within a week a simple cut will become this massively infected wound. Add a couple of fly larvae and a week more of not cleaning and you've got gangrene setting in.
It is really, really rewarding work, though I must say at times it can feel so futile. A drop in a sea of poverty. You really have to focus on the comfort you bring one individual person because if you start thinking about the reasoning behind these conditions, the poverty, the corruption, the bigger issues and how things need to change on a global level, you'll lose your mind. Or at the very least, you'll become so disheartened that you'll give up and leave.
One day, a woman came in who had gangrene pretty bad on the bottom of her foot. The inside arch of her foot was rotting away. The volunteer, a woman from Spain name Paula, with no medical training was cleaning the wound and cutting away the rotten tissue. Needless to say, this was excruciatingly painful for the woman. After an hour long session of this where Paula worked and myself and another guy held the woman down, Paula finished for the day and patched her up. She would have to come back in for follow up treatments. The next time she came in, I was already working on another patient. While one of the other volunteers was working on her, the woman was again crying out in pain. I finished with my patients and sent him on his way. I then reentered the room where the woman started yelling at me and waving her hand. We all thought she wanted me to leave the room because I was a man. We then realized she wanted me to come over to her and when I did she immediately clung to me and started crying. She just needed someone to hold onto her while she was going through this painful ordeal.
When you finish working on a patient, they are so thankful. Some of them start to bless you feet. Some of them cry. It's these moments you have to balance against the problems of feeling futile.
Eventually, I would work at the Sealdah Train Station clinic three days a week and then at the Orphanage's clinic two days a week. I would fill in that time with 3 days of doing laundry at the orphanage.
We would finally get some medically trained people in and that was great. At both clinic, the majority of the volunteers are from Spanish speaking countries so it has been a good exercise in dusty off my rusty high school Spanish. We now have a Doctor from Spain, a nurse from Chile and a nurse from Australia.
The biggest issues we've been having lately at the clinics is which ointment, medicines to use and when. There are these jars of white cream at both clinics that the volunteers put on all the wounds. When I asked what it was, I got several different answers from several different people. One was that it was an antibiotic. The other was that it was a skin softener used to soften the hardened skin around the wounds. And the last was from Mickey, a hilarious Irish guy who can go a day without telling a joke that includes the word, "willie". Mickey said that it was glue to help hold the patients together.
After a little research I found out that it was Silver Sulfadiazine. And ointment that is used solely for burn victims who are waiting for surgery. Everything I read on line tells me not to use it. I confirmed this with my buddy Tod Levesh, a paramedic with King County outside of Seattle. After discussing this with the two nurses at the clinics, we agreed that we shouldn't be using this stuff. The question is, how do we keep the people who come after us from using it? The Sisters and the guys that work at these clinics permanently love this stuff.
Today I had a guy come in who had sliced his finger almost right through and should have gotten about 30 stitches to fix it. Instead he waited a week and then came to the clinic. The meat was hanging off of his finger. I had to clean underneath it. Under normal circumstances, this guy would have received at least a local anesthetic to numb his finger and maybe a general dose of pain killers. Instead, he got me, a piece of gauze and some betadine. One of the other volunteers had to hold the guy down while I worked on him. His screams were only broken by the sound of him convulsively gagging while dry heaving from the pain. When I was done patching him up, he thanked me and blessed me, still with tears in his eyes. I followed him outside. After he had walked off I looked up and noticed that two little street kids were flying a kite over the train station.