It Rained

For four days straight it rained. Normally this time of year in Kolkata is the dry season, the monsoons don't start until the summer. So it's unusual to have this much rain, if any, coming down. The news kept saying that this part of the country was caught in the grip of a severe cold wave. Which is true, relatively speaking. It just seems funny to think of 50 degrees F and rainy as a severe cold wave, especially when much of the northern hemisphere is in snow. That being said, I do realize that if you are not use to these temperatures and are stuck living on the street, this is indeed a cold wave for you.
On the first day of the rain I went to the orphanage to do laundry. Its was an unusual day with all the rain. Normally we'd be hanging sheets in the sun by 9:30am but here it was almost 11:00am and we were waiting.
There were only a handful of us now, the Aussies had all gone home and it was just a few Japanese guys and me. We all went downstairs to help feed the kids while we waited. I got to feed this little physically disabled girl who was strapped into her chair. She was maybe 2 and had this chubby little baby cheeks. It appeared to me that she did not have any motor abilities from the shoulders down. We fed the children a mash of rice, some sort of vegetable and curry sauce. This is pretty much what the kids eat for lunch every day and I can attest to that from hanging up the curry stained diapers to dry on the roof.
How much do you feed a 2 year old? I hadn't fed a child since my nephew Jack was a baby and he wouldn't eat anything unless it was sweet. But this little girl just kept eating and eating. I asked the volunteer next to me how to know when she's had enough. The volunteer said, "I don't know, I guess when she stops opening her mouth?" So with those words of child care wisdom I fed this little girl a giant plate of the mush and she ate the whole thing.
After that we went back onto the roof. It was still raining steadily but Massie had us hang the sheets anyways. There was no way these things were going to dry today and actually they were getting wetter and heavier hanging out there in the rain. We did what we were told and laughed about it the whole time saying out loud to each other, "No drrry, no drrry!" instead of the usual "No drrry, no pull." It makes me wonder what they do when the monsoons are here.
We finished up at the orphanage for the morning and after lunch I headed over to the Sealdah medical clinic for my afternoon of wound care. On the bus ride over I started thinking that with the rain it would either be empty all day or jammed packed. It was packed. And most of the volunteers were late, so it was just Anita, the Chilean nurse and I for the first half hour.
Sometimes when it slows down at the clinic, you can take a patient and start doing some really good, detailed wound care on that person. Fixing up problems like pre-scarification and conditioning the wound for better blood circulation so it will heal quicker. This is usually done by the removal of skin by either scrubbing or scalpel. But on days when it is packed, you switch into triage mode and just try to clean, patch and bandage as quickly as you can because there is a crowd of people waiting to get in. This was one of those days.
The bandages of the patients from their previous visits are usually dirty by the time they return the next day or two. Mainly because they walk around barefoot. But now the bandages were filthy and soaked or just plain gone. Wounds that were doing well had become infected again after being exposed to the dirty water that inundated the streets.
When the day was done, I walked back to my guest house under a thick canopy of dark clouds and pouring rain. I couldn't help but think about how there are many dark sides to all this volunteering, especially the medical treatment portion.
On one dark side, you have the patients. Many of them are addicted to and strung out on drugs while you are working on them. Some of the patients drink a high alcohol content drink called, "Banglu". It is actually made by gathering the fermented run off from a heap of rotting garbage. Needless to say, it's readily available in Kolkata. The rest smoke heroin, which I'm told is easy to get as well.
Another dark side is the bureaucracy and lack of public health care in India. If you can't pay for your health care up front, you're not getting into a hospital. Naturally, the street people can't afford any health care, even the ones who are not on drugs or sipping Banglu. And most of the patients that we see are not on drugs, they are just poor people trying to live through the day. When they get a cut or burn that we would call simple in our clean environment, they now have a serious health issue.
It takes a special letter from Mother Teresa's to get the most severe patients into the hospital and it is paid for by the Missionaries of Charity. But just getting a stamp on a piece of paper that allows you to try and present that letter to the hospital to be considered for admission can be an all day event. The paperwork involved in doing anything here is beyond comical. It's tragic. One of my coworkers, Mickey from Ireland, brought a man to the hospital who was actively having a heart attack. The doctors told Mickey they couldn't do anything to the man until he had the proper stamp on his piece of paper. Even threats of physical violence got Mickey nowhere with the doctors and the man died there in the waiting room.
There's also a dark side with the patients who, even with a note from Mother Teresa's won't go to the hospital because they are either afraid or don't want to. One is the woman I mentioned in an earlier blog who wanted me to hold her while we cut into her foot. She won't go because she's afraid. She's afraid of losing her foot, I would be too. More than likely it would be amputated.
Then there's the guy with the elephantiasis foot and calf. He's not afraid, he just doesn't want to have his leg amputated, which it would be, because he knows he can make more money begging with that distorted limb than without it. It's a financial decision of the worst kind. I realize that if we keep cleaning his wounds and making his foot temporarily alright and he doesn't get his leg amputated, the elephantiasis could spread to his torso and eventually kill him. So are we aiding in his death?
Then there's the really, really dark side of the police. Once in a while they will come through the train station and try to clear out all the street people. They do this by severely beating some of them. If this is occurring while we are there and we get word of it, some of us will run out onto the train platforms and stand there and let the police know we are watching. This makes the police stop and move on.
One day, after the police had visited the platforms, we had a man with a broken (not fractured, but broken) arm, a man with 4 broken ribs and a man who had his head split open. The man with the broken arm was in his late 60s. I splinted it but it would require surgery. Because we could not get him into the hospital until the next day, we wheeled him back to his spot on the train platform and left him with his family, all living on the street. The same went for the broken ribs. We wrapped him and wheeled him back to the platform. He wouldn't be going to the hospital, just laying on the cold concrete of the train platform for a few weeks trying to heal. All thanks to the police.
The explanation is that the police don't want the street people hanging out in the train station. But it gets even darker. The police also charge protection money from the street people. You pay, you stay. You don't, you get beaten. As if your day isn't shitty enough living on the street.
It's hard not to get angry at the police. At the government here. At India. Especially since India has wealth and growth coming in. In some areas I'm told quite a bit. They've got a large military and are a nuclear power. But they leave their less fortunate to die in the street and they leave the taking care of their poor to the generosity of foreign organizations, like Mother Teresa's and dozens of others (Missionaries of Charity is an Irish organization). It makes me wonder, are we enabling India?
There's another, almost embarrassing dark side to things. It's the volunteers and the organizations. Before I explain, let me just say that the volunteers I have met on this trip have been some of the most compassionate, self sacrificing and giving people I have ever met. Many of them are here working for months and a few are here for years. They will do anything they can to try and help the less fortunate out. And in a way, that can become a problem in itself.
Many of the volunteers I've worked with in the clinics have no medical training whatsoever. And there is absolutely no oversight or guidance from the Sisters, who also have no medical training. You just show up and try to do what you think is best.
In my time here I've seen volunteers working with the bloody wounds of multiple patients without changing their gloves or at times even using the same instruments from one patient to the next. India had just passed South Africa for the most cases of AIDS in the world, so this is a very real concern. Come in with a cut foot, leave with AIDS. Not what you'd call helping, is it? I mentioned in a previous blog about the Silver Sulfadiazine being used as a catch all medical treatment at the clinics. It wasn't that the volunteers didn't care or were being malicious, they just did not know.
This goes for the Sisters as well. Two weeks ago, an Australian nurse I was working with told me of how she inspected a course of antibiotics one of the Sisters had given a patient and it turned out to be epilepsy medicine, not antibiotic. Ear drops for eye drops. Everyone get antibiotics whether you need them or not. There appears to be no medical oversight. It's really frustrating.
But there's a bright spot up amongst those dark clouds. Recently I've had the pleasure of working with some very talented medical people. A doctor and two nurses from Spain, a nurse from Australia and a nurse from Chile. Some of them have gotten together and are writing up a protocol for work in the clinics covering things from wound care to medicines. I was honored that they asked me to take a look at it and give my input. This protocol will hopefully be passed on to other volunteers after we are all gone.
On the fourth day of the rain, I showed up at the Sealdah train station clinic to find out that I was the only one working that day. The water outside was lapping at the clinic's door and no one else could get to work that day, including Sister. It was just me and Peter, the Indian man who opens up and cleans the place. As expected, the place was packed and I went into triage mode again, working my way through the crowd of patients.
When we finally closed up, I walked outside into the calf deep, murky water of the train station parking lot. The rain had finally stopped and the clouds were breaking up. I noticed that the air was actually fresh and clean. For now.