Taste and See

Due to limited wi-fi access these next three posts will be very long and will comprise an entire week aboard the Lifeline Express. Each week will focus on the theme of the operations that are currently being performed. So grab some caffeine and tackle this beast of a blog post.

A word, let me state that I love this country. The students and I that blog on this site are merely travelers and the crazy, exciting, and awkward stories we have may not be indicative of real Indian culture and often may be a disservice to it. Indians are disciplined, brilliant, and a truly vibrant people. While our cultural differences may separate us, I hope that no one reading my blog is offended by any of the stories or content I present. I wish only to convey my respect and fascination for a culture very different from my own.

 Day 1 – Wednesday, June 8     Sight to the blind

It’s hot. It’s hot, it’s hot it’s hot. So hot, in fact, that even Indian people are surprised by the 115-degree heat. I know there is one of you reading this who sees 115 degrees and thinks “yeah but it’s a DRY heat, he’s a wimp”. To you I say, “Get off your couch and sit in a Sauna with your clothes on, tell me 12 hours later whether you care if the heat is dry or wet.”

To make things worse, today I was doing screening all day. To prepare for cataract surgery patients who have been informed about the program several weeks ahead of time are brought to a District hospital that unites all of the 6 regional hospitals within Bhind. Then, one by one, they walked in front of a physician and myself as they were evaluated for surgery. If deemed operable, they would be given a full blood panel, pathology, and physical before operations began the next morning.

As we pulled up to the hospital I realized that it was a single story compound of buildings, this surprised me as American hospitals are traditionally massive structures. I was even more surprised to see pigs feeding, a boy peeing, and a man defecating amidst buildings that performed surgery 7 days a week.

If you’ve read some of the posts from anyone in this fellowship you might think that we talk about bowel movements and gastric distress more than a third grader who just discovered the word, “poop”. But as one of my fellow travelers put it, “I’ve never been more worried and aware of where I might suddenly soil myself than while in India.” Honestly, she’s right. The food, heat, and travel make for a deadly combo. Being so accustomed to this, public defecation shouldn’t bother me. Yet somehow, every time I see two men talking about cricket while crop dusting their own sugar cane fields I can’t help but lose my grasp for words. This awkwardness is even more distinct when the metaphoric sugar cane field is a very concrete hospital.

Anyways, I stepped out of the car and was greeted by stares from, no exaggeration, over a two hundred people. In India, people stare. They just do, and when you’re white they stare a lot. Some will look away if you lock eyes with them but many just engage in some nice, creepy prolonged eye contact that I assume is merely curiosity. As I walked amidst the eyes and silence trying not to smile from embarrassment I entered our examination room. 6X6 tile block with a barred window and an AC unit that probably carbon dated to the Jurassic period.

Through the next 8 hours the Doctor and I sweat in the trenches together as we saw patient after patient. Many claiming illness that didn’t exist (huh, like America) but curiously, none wanted painkillers (again, America, up your game). Believe it or not, not even a single one asked their Doctor about drinking lemon tea with pepper to clean out the bacteria in their gut, and nobody decided they were allergic to gluten, vegetables, dairy, or meat-but-not-fish by simply saying they “felt better” after not eating it for a day. (Seriously guys, can we at least act like we aren’t pansies?)

To those who suffer from real allergies and documented Celiac disease, Lactose intolerance, or any other documented disorder I mean no offense. But honestly, people walked in this door completely blind and would simply tell the Doctor their vision was bad. (The Doctor is the one man who speaks broken English as of now)

Suddenly, three men burst into the tiny room with two carrying cameras. Everyone immediately rose to their feet and I sat in an awkward stupor as a small man uttered barely two sentences and then nodded. He exited the room and things went back to normal. Remember this guy when we get to day 4, he’s dangerous and very important. Hours later I found out that the men with cameras had been photographers for the press, which I made the cover of! The mysterious leader who they were photographing us with was known as the District Collector, and became an important part of my life two days later.

The patients ticked by about every 3-4 minutes which is rapid for a diagnosis but seemed to work just fine. As the day grew hotter I grew more interested in the documentation each patient was carrying. Since it’s rural India, digitized health records are non-existent so people would bring in pieces of paper decades old that describe conditions and prescriptions. In certain parts of Indian culture, like Medicine, English is used for the names of procedures, diseases, and drugs. Finally, something I could understand! I began pouring over the health records of patients and noticed something: HIV, HIV, HPV, HIV + HPV, HIV. The number of people we might be operating on with debilitating blood borne infections began to worry me, how were we going to keep ourselves safe?

My train of thought derailed momentarily as a child threw up all over the Doctor, narrowly missing me, which signified that it was time for lunch. Upon beginning the process again I realized that even if patients were turned away or un-eligible for surgery the received free treatment for some of their conditions at the local hospital free of charge. You go Lifeline, that’s awesome. But as the day began to sizzle to an end I grew sad. A man with horrible Neurofibromatosis sat down and put my life into perspective. His entire body looked as if large marbles sat under his skin and I could only imagine the pain that he endured in public each and every day. A while later a young boy with a lazy eye was brought in by his mother, sadly we could do nothing for him. As his mother picked him up to leave he looked up at her hopefully and asked a question. She left without a word. I was too frightened to ask, but I could only imagine him asking, “Mom, will I get the surgery to make it better now”.

My heart broke. Suddenly, there in the midst of a few hundred sick people, with puke on the floor, sweat in my hair, and pain on my face, I wanted to cry. Why was I healthy? Why did I get health care? How unfathomably painful were the lives of some of these people? Then it hit me. I couldn’t save them all. No matter how hard I tried, how much I sacrificed, how hard I worked there would always be people I couldn’t help.

But I’ll be damned if I don’t do my best. Mother Teresa was once asked during her service in Calcutta why she did what she did. Her reply was something to the effect of, “I can’t help everyone. I just know that God wishes me to help anyone who comes into my life.”

Obviously I am paraphrasing (no internet) but you get the idea. Sitting in that hot little cell I began to feel like Oscar Schindler from the film Schindler’s List. In one of the final scenes of the film, Schindler has sacrificed his fortune, fame, and future to save the lives over 1,000 Jews. As he flees for being ironically branded a war criminal, due to his expert job at covering his tracks, he stands amidst those he has saved with his last two belongings in the world: A ring and a car. He begins to weep uncontrollably as realizes that these items could have saved 11 maybe 12 other people. He cries, “I could have saved more!”

This is the feeling I experienced as I sat with my pen and notebook and attempted to contemplate the sacrifices I could have made that would have benefitted the people in front of me. For me, this issue isn’t resolved. But the rest of my thought process is personal and that I will keep for myself.

We gave treatment to 250 people that day, 157 of which will receive cataract operations aboard the Lifeline Express. These people will get their vision back. These people will regain sunsets, the faces of grand children, heck, even the humor of watching some dude poop on a hospital back into their lives.

It’s not enough. But it’s a start.

Day 2 Thursday, June 9    – I see skies of grey and clouds of grey, and I think to myself, “I probably have a cataract.”

Today I decided to shove my nose into the doctor’s business a bit and hey, it paid off. No, I did not get to go into the Operating Theatre but I did spend 8 hours giving pre and post operative care to the 80 patients that the solitary doctor preformed surgery on today. My day started with a jolt as the hot water and iodine was poured on me in order to sterilize my hands. Curiously, after scrubbing into the medical unit each person donned sandals….. hmm. India. I then released a gasp of joy as the first patient I saw was injected by shoving a needle through their eyelid and into the muscle behind their eyeball (YASSSSSSSS). It only go cooler from there. I soon forcefully integrated myself into the process by listening to the lens sizes that each patient had been measured for and handing them to the doctor. I engaged in a bit more than this, but for reasons explained in Day 3 below I won’t go into detail. Basically, today was great.

However, it wasn’t safe. The room I was in was crowded with medical equipment and filled to the brim with people. Injections were administered by simply having a patient lean back where they sat. Coming from an American system where even hospital hallways have to be regulation size this type of health care seemed much more practical, if less structured.

Oh, remember all the AIDS patients I talked about? Yeah, they received injections without gloves. Then, instead of disposing of used needles in a sharps box that could be disposed of, we piled all of the potentially infecting needles into a waste basket that sat at our feet. Our feet that were clad only in sanitized flip flops. At one point, an assistant actually tossed a needle across the room and missed the trashcan causing the plastic cover to fly off and expose the used needle itself. My knuckles whitened and I chose where I stepped very carefully for the rest of the day.

Since I don’t have to much to right about I’ll focus on part 2 of this post’s title, seeing. Sight is something we take for granted and being here has already helped me appreciate it even more. However, there are some things I see to much of. You’ll get some statistics at the end of this trip but here is a running commentary on a few peculiar views in India.

  1. Defecating publicly, yep, still weird.
  1. Men aggressively touching me and it meaning nothing. This one is interesting, there is a de-sexualized nature to touching people of the same gender that I think is a positive lesson Americans could learn about friendship. The downside is that if I look at a woman too long I’m hitting on her. Not kidding.
  1. Have you ever walked through the supermarket and wondered where all the food goes once it passes its expiration date? I swear it gets sent directly to India. Seriously, I have hardly consumed any packaged food that falls even remotely within its expiration date. I’m sure there is a valid reason behind this that has to do with supply, demand, and turnover but it stills smells fishy and I suspect that United Airlines is probably behind it.
  1. Cows Cows Cows Cows. We all know that certain religious sects of Hinduism don’t believe in harming cattle, but they are EVERYWHERE! Every street, every field, eating everything. Apparently, an independent group operated on some of the stomachs of these cows and found them to be lined with trash. Is this a good time to mention that these cows aren’t wandering animals but are indeed used for milk each day?
  1. The milk here is all curdled and that is the way it is consumed. Sometimes with varying amounts of sugar. It’s different, and I still can’t picture myself filling a cereal bowl with chunky white stuff but I won’t go so far as to call it bad.

(More to come I guarantee)

Day 3 – Friday, June 10                      Giving sight to the blind

Today I woke up with a smile on my face that even an early morning battle with the Geckos who had invaded my room couldn’t erase. Today I was going to walk into the Operating theatre and assert myself. Getting to the Lifeline Express early, after dropping a Doctor off at the regional hospital, I realized that this was still India and my plans were always going to be invalid.

In India, you get up early, even if you have nothing to do. I’m not opposed to getting up at 7 each morning and I’m sure this blog has shown I am indeed a morning person. But sitting around until 12 before doing any work is something I hadn’t experienced until today. When we finally did start, after a breakfast of spicy food and curdled milk that I am gradually getting used to, I scrubbed up and cemented myself in front of the Operating Theatre/ (or as it is strictly called here) OT door. Behold, I was allowed entry into the promised land. The Doctor had taken a liking to me and I looked over his shoulder happier than a 10 year old girl watching the movie Frozen as he laid the first patient down. Thankful that my mask covered my stupid grin for the entirety of the day I literally rocked back and forth with glee as the Doctor performed 75 surgeries directly in front of me. I even got covered in juices, JUICES!! (More on the OT sanitation later)

Cataract surgery is a procedure that can take a long time, however this Doctor churned out one every 5 minutes and was considered and expert in the field. I encourage you to google this procedure if you are like me and aren’t squeamish as it is totally engrossing.

Since we don’t have general anesthesia (again, it’s India people) the patients get the lovely experience of being conscious during the procedure. First, in pre-operation, we inject the muscle behind the eye with a local anesthetic mixed with adrenaline bitrate by inserting a three-inch needle through the lower eyelid and into the muscle behind the eye. This paralyzes the eye for surgery and numbs the eye ball. Next, when on the table, we thread a thin line via a hook through the base of the muscle attached to the eyeball that the Doctor can use to pull and rotate the eye like a Christmas ornament. Then the fun begins. The Doctor makes two incisions, one larger at the top of the eye and one smaller incision on the side. After inserting a blue dye, the lens of the eyeball and it’s filmy covering are stained permanently blue. The Doctor then carefully tears away the lens covering (we’re inside the iris, the colored part of the eye now) and removes it with a syringe. After rotating it he then pops out the cataract filled lens and the eye immediately loses its round shape. After filling the eye with liquid the new, proper lens is inserted and cleaned after the remaining bits of lens film have been removed from the sides of the iris. After that it’s just eye drops, iodine, a towel for the blood and some Ciprofloxacin and the patient hits the road. Boom, snap 5 minutes.

I truly wish I could write about how exactly I was involved in this process as it is likely both more and less than you might think, but, while I am not indicating that I have violated any ethics, patient rights, or American Medical Association laws (whether or not these apply here) for the safety and privacy of the patient’s and myself I will not write exact details in this blog. Feel free to email, message me, or better yet call me and I would be happy to go into detail.

But today I gave people sight. I helped 75 people get one of their sense back. For some, they will finally be able to see flowers again, to see loved ones again, to view their lives through their own eyes and not the description of another person. Today was a good day.

Truly, today was one of the best days I have had on the trip. For my medically enthused personality it was a dream come true and a needed break from my current situation in this town. I was able to help literally give sight to the blind and for that I am thankful, as well as happy.

Back to sanitation. The OT is much safer than the pre/post operation room for patients as well as staff. So naturally, the OT is where I cut myself. It was so dumb, using a scalpel to open a package that held a new lens for someone’s eye, I didn’t even notice the cut until a Physician’s assistant spotted a small trickle of blood. Looking less professional than ever I wrapped up my finger and carried on with the work after re-sterilizing every inch of my arm.

In between my duties I was able to chat with a couple of the nurses who speak broken English. Over the past two days we have grown as close as people who only share words like, “Food?”, “Thank you.”, and “Scalpel please!” can be. Close enough, it seems, that today the women asked me about my religion and marital situation. Two topics I have been told by many Indians to never discuss due to many regional and ethnic tensions. Answering, I then asked them the same questions in return, “God, husband?”

I was floored. These women ranged in age from about 25 to 30. They were married when they were between 8 and 10 years old.                                   Yeah.

Upon hearing 8 I asked the woman to repeat herself but sure enough, photos of the wedding and the other nurses corroborated. Not 18, but an 8 year old bride. I couldn’t bring myself to ask how old her husband was at the time and instead just pondered this new information.

At 8 years old I didn’t even know that Birds and Bees flew together frequently. I mean, I had just discovered that Darth Vader was indeed Luke’s father! My biggest life problem was whether to spend the 5$ from Mom and Dad on candy all at once or buy a piece here and there for the next few weeks! (I maintain the answer is and forever will be, ALL AT ONCE)

Struggling to level with my emotions I distracted myself by examining all of the different fluids and textures that can explode over someone when cutting into the human eye. Many. The body can shoot many different things at people.

As we headed back to the “hotel” (notice I’m using quotes for it now) for the night the physician next to me began crushing small red particles and mixing them with a white, Vaseline like substance. I honestly thought it was homemade lip balm as the man placed it around the lining of his lip. He smiled, handing me some, and encouraged me to do the same. I placed the substance on and around my mouth while asking what it was. Watching the other men in the car smile as they placed it on their tongues I instantly knew I had done something wrong. Upon hearing the name I debated spitting the tobacco on the outside of the moving car but decided, what the heck, it can’t be that bad, maybe Karma owes me one for giving site to the blind and stuff. Wrong. While I am of legal age to consume tobacco in both the US and India I will firmly insist that no one ever try this substance ever again. Not only for the variety of horrible health risks it has, but because of the film “The Sandlot”. Watch it, laugh, never go near the stuff again. I’m telling you, tobacco had me paralyzed in fear as I struggled not to let any of it slip away from touching my lips while the classic movie scene played again and again in my head.

Back at the hotel feeling incredibly alert and a bit queezy I zoned out to what has become my favorite TV show and the only Indian TV programming I have seen, COLORS. I understand none of it, but the dramatic stares, poor acting, and instances where characters are turned into flies by a witch make this soap opera a must for anyone looking to waste their life half an hour at a time.

 Day 4 – Saturday, June 11 –                                         Tastes like Chicken

Today I woke up with low expectations as I thought I had experienced the peak of excitement aboard the lifeline express. While I did not usurp my time in the the operating theatre with any other exhilarating moments I did have the pleasant surprise of meeting the Dental Staff. All female, the dentists are a talkative, fashionable, westernized, and English speaking bunch that absolutely made my day. Mistaking me for a surgeon (as everybody here seems to) they invited me to watch their work. Fascinated, I looked on as teeth were pulled, scraped, and chiseled to perfection.

One of the highlights was peering over a shoulder at a man who was having a tooth excised. He had chewed tobacco for several years and his cheeks had tightened up which prevented instruments from getting inside. This resulted in the dentist having to break apart his tooth one piece at a time as the man whimpered. The molar had completely bonded into the bone and when it finally crumbled out there was a gaping hole in the man’s jaw line. Unhindered, the talented dentist set to work stitching him up and he was on the road in no time.

Kids remember, tobacco kills.

In between cases I had chances to talk with the ladies about dentistry, medicine, and relationships. Unlike the OT nurses who hailed from the town of Bhind we were in, these ladies came from Mumbai. None of them were married, all had focused on their careers, and one of them was in the process of applying to the UofM dental school! As we discussed the Lifeline Express the women mentioned that the chief difference between India and the United states, in terms of medicine and dentistry, was that in India they “mas practiced” and in America people would “class practice”. What they meant is that in America, much more attention and care is given to each patient while in India the health care focuses on how many patients you can see in a day.

This is a direction that the Affordable Care Act (in part) has forced medicine to move towards as it requires physicians to see more patients in less time. Let me say, after watching how these physicians operate, this is not a good trend for American medicine. The doctors and dentists treat the patients with little, well, patience. There is very little respect, explanation, or comfort given to these people as they undergo intense procedures. Even the dentists admitted that health care treats people with higher quality when it works more like an American system. But, it doesn’t reach as many people. In terms of quality, accessibility, and affordability we get to chose two. After being here for a few days, I think quality is pretty important.

Thanks to their broken but strong English, the ladies seemed to be very aware of social and economic differences between themselves, their patients, and their assistants and frequently complemented the latter on their hard and dedicated work. Even if these women didn’t show it, they admitted to me later that they respected their patients for going through so much hardship to receive care.

Fascinated by the cultural differences I had uncovered I made my way back to the front of the train where a worried-looking administrator rushed me away saying “Matthew, come now, I will introduce you to the District Collector”. Yep, here’s where it gets good. The short man who had entered our screening room was back and was already inside the OT watching the doctor work. After he exited I met him and noted the social queues around me. Everyone was standing and even the good natured Mr. Gupta who spoke the best English and had a great sense of humor was silent and straight faced. After exchanging pleasantries with the DC (District Collector) I noticed the tension leave the room as he exited the train car. One of the dentists came forward and told me, “You don’t have to be scared!”

Puzzled by her remark I made my way to the dining car to pour myself a cup of chai. This was where I began to realize my situation. In front of the car sat a man in a paramilitary uniform I could not identify. He carried with him only a knife and a large, matte black, Galil automatic assault rifle. It wasn’t the weapon that bothered me. All of the policemen here carry AK-47’s and even the police in Paris wield deadly FAMAS rifles. I was raised in a home where hunting and sporting weapons are treated with the utmost respect and when not in active use, are cleaned, unloaded, and locked in a secure location. (C’mon America, just be responsible and we’ll have less issues)  No, what worried me is that this man’s uniform didn’t match any I had seen before and his gaze, as well as his weapon, were focused on the train car I was entering. Sitting down with my tea I was immediately joined by the DC, his protégé, Mr. Gupta, and another administrator. Mr. Gupta and his associate proudly showed me off as the only American in a town of 115,000 people. It seems the DC had remembered me from the hospital and wanted to meet me. I cringed as he, along with everyone else I have met here, couldn’t understand the concept of undergraduate education when I explained it and thought my status as a rising sophomore meant I would be in my second year of medical school. To change the topic, I kindly asked him what a DC was, as this is not a position we have in America. I asked if it was similar to a mayor.

His explanation made it clear why everyone was afraid of him.

You see, in an earlier blog post I referred to India s being socialist. Technically, this isn’t true. But it is true in the sense that any success in this country is tied to the government via rampant corruption. So while disguises may be in place, the government effectively controls production, utilities, military, business, etc. A result of this is that while the Lifeline Express is legal and wanted by many people, in order to operate in a town the program must “wine and dine” the military police, government officials, and anyone else who has power in these towns by providing free meals and socialization each day. I understood this and was used to eating lunch beside five or six young men with improperly cleaned AK-47’s. What I hadn’t expected was to meet the Jabba the Hut of Bhind.

Like Jabba, this short and slightly rotund man explained to me that a DC was a remnant of the British Empire. As such, it was an appointed position and not an elected one. Yet, a DC had relative power over government, police, events, and business inside his or her district. Essentially, this man controlled anything and everything that happened in this town.

You may have begun to realize what the town of Bhind is like from my description of hotels, child marriages, and general disorder, but let me make it crystal clear. Bhind used to be a town where bandits and criminals hid from the government. It also had some of the highest rates of robbery and burglary in the country. It was very dangerous and eventually the government solved the problem by stepping in and giving many of these men paying jobs in the military. (Facepalm. Thank you again government) The man who runs all of this with a powerful, and I am assuming corrupt, fist was sitting in front of me and in clear language telling me he controlled everything around me. One of his final sentences was this, “Everyone wants to be a DC because you don’t have to be elected, you have lots of power, and all of the benefits. Also, some responsibilities. Responsibilities come with great power.”

As my blood pressure rose and I truly understood what was happening in this small train car I immediately switched on my Public Speaking mode and was as cordial as a Jane Austin character falling in love for the first time. This was a mistake. Taking a liking to me, the DC asked me if I would like to explore around the city at all. Nodding my head Indian style (side to side) I asked if he had any recommendations. He answered by telling me about a remote ravine about 30 km away with crocodiles and what he claimed were dolphins. Excited by my polite smile he pronounced, “I will take you next week yes? Yes. We will go together.” Looking at Mr. Gupta for help I was declined as Mr. Gupta answered for me responding with a quick and almost fearful “Yes, yes sir. How far away? Very good. I will arrange a ride for you.”

Help.

I don’t know why the universe hates me but somehow I waddled my way into a city the equivalent of Mos Eisly Cantina and made friends with a man who seems like Al Pacino in Scarface. So next week, if I haven’t fled for Delhi I will be accompanying the DC on a trip to go see crocodiles and dolphins at the bottom of a mystical ravine in the middle of the driest part of the country….. I am definitely getting shot quicker than Old Yeller.

JOKING!! Kind of…   Since I get the impression that you don’t say, “No” to this man or even, “Please, no thank you” I am a bit worried about this. I have suddenly entered a one sided relationship that poses a possible danger to me and to the future of Lifeline Express’s operations here.

After he left, I asked Mr. Gupta if the man was powerful. Mr. Gupta wiped his brow, gave me a fake smile and “Yes, very powerful…” was the only part of his sentence I heard. Feeling like I had just entered the world of the mafia I returned to my hotel and had dinner with the dental staff who gave off emotions of laughter, jealousy, and intrigue at my invitation from the DC.

After they had yelled at the hotel staff for giving me the worst room in the hotel with an AC unit that only ran half the time the ladies and I discussed romance, religion, and race while enjoying some sweet lime juice and Peta. A sugary petrified pumpkin candy. When it came to be my turn to share about my romantic other I used the lie I had employed ever since my interaction with Deeksha. Not wanting to be rude and feeling very “hit on” by these ladies (an unusual gender reversal in India) I told them I did indeed have a girlfriend. While it was a lie, I had been using it to avoid awkward conversations from the LLE staff about why I wasn’t married, why I didn’t have children, and why I didn’t actively flirt with some of the single women on board.

The ladies thought this was adorable but two were unhindered and after our meal asked (I am not kidding) if I would like to stay and “share anything else with us tonight?” I didn’t know how to respond but thankfully the other three women reprimanded the ladies in Hindi for asking such a question and the two apologized much to my relief. Returning to my room I double checked the anti-dentist deadbolt, smiled at the thought of my imaginary girlfriend (who I accurately described as “smarter than me”), and crashed on the bed.

Day 5 – Sunday, June 12 –                 My body is leaking too much water

Today encompassed both highs and lows. Sensing that my presence at the LLE was sometimes distracting for the staff I gave myself the day off and spent the morning in my hotel room compiling some of the research I had done and eating a stomach-calming mix of American peanut butter (by far the most expensive thing I have bought here) and Imodium. With the leaks temporarily plugged I decided to have fun and took a series of Tuk-tuk rides to the train station where I met the dental staff who had invited me to tour the area with them. We drove to a haunted fort in the middle of nowhere which was the highest place for what I estimate was 1 or 2 miles. Even out here in the desert the pollution blocks your view after a certain point. The group took so many selfies that I struggled to hide my impatience as I was constantly pulled away from actually enjoying the view to engage in the photography session.

The ride to our next adventure was filled with off key harmonies as the group of dentists sang for me and required me to sing in return. To make things fair, I sang a song in Latin from my senior year in honors choir (and my only year of choir ever) so that they couldn’t understand what I was saying. Pleased by this choice, the group enjoyed the song entitled “Sicut Cervus” and clapped even after my totally intentional voice crack about three quarters of the way through the song.

As the paved road turned into dirt, the sun began to set and our taxi crammed full of eight people crested a hill that put us on the sloping side of a sand dune. We drove down the desert sand and stopped just short of a river that glistened in the twilight. The view was incredible. In a valley of what must have once been a massive river we gazed a small strip of water as the sun began to dip below the horizon. We boarded a makeshift boat and floated out onto the shallow stream. Although crocodiles and dolphins (seriously, everyone says there are dolphins here) can be seen here in the winter, the summer months before the monsoon cause the river to shrink and we were graced with only each others presence. Deciding not to hide my impatience at the frequent selfies I hopped to the front of the boat and sat over the edge. The first cool breeze I have felt during my time here drifted across the water and I watched the sun plunge into the stream as nostalgia set in and I felt I was back at home, sailing on lake Michigan.

My tranquility was broken by my fellow travelers who posed with me for more photos. Interrupting us, the crotchety old taxi driver reminded the ladies in Hindi that this was once the most dangerous place in Madhya Pradesh thanks to the bandits of Bhind and hurried us back to the car. With the light gone I gave one last longing look at the water and stepped into the taxi which slowly made its way back into the desert.

Back at the hotel the ladies and I enjoyed a small dinner as I used their phones to examine the tragedy that had just unfolded at a nightclub in Orlando, Florida. My thoughts and prayers go out to those affected.

Retiring for the night I wasn’t surprised to find my AC unit not working. With the worst room in this cinderblock prison my average air temp when I slept was about 90 degrees Fahrenheit. With the AC unit this became a frigid 74 degrees. I hoped that, as usual, the air would come back on in an hour or two so I lay down to sleep with my customary liter of water. The AC never came on.

I learned a true lesson in dehydration as I sat in a room that was literally hotter than the outdoor temperature. Being placed in an external room over the kitchen and generator my room rose in temperature throughout the night. Since many Indians do not have AC I sucked up my discomfort and tried to do what the people in this town do, sleep on the roof. However, this hotel has no accessible roof and is an incomplete structure (did I mention that this is the nicest hotel in Bhind?) I attempted to sleep in the hallway but the bugs soon made this a futile venture. By midnight I had finished my water which usually lasted me into the next day and by 12:30 I had begun playing quiet music and soaking myself in water to try and cool off and calm down. Of course, the water here is only one temperature; warm. I continued to wipe myself with warm water in the hopes that I could cool off. I don’t want to be too dramatic and I hope to keep things in perspective but I truly struggled to deal with the heat. Yet, it taught me the value of water, temperate climate, and how much I take my life of ease for granted. After hardly sleeping I rose at a customary 7 AM and waited outside the hotel manager’s door so that he could provide me with water when he woke up. Chugging a half liter in about ten seconds I soon ventured to the bathroom. Here’s a tip for if you ever backpack across a country alone: your two types of human waste shouldn’t be the same color. I must admit this worried me and I rushed to drink as much water as I could before I left for work.

So now I begin another day and as the temperature rises I realize that I had chosen today to volunteer in the community, without AC. Of course.

Water is a privilege, food and shelter are too. We should consider that many people have none of this before arguing what are and aren’t our rights as Americans

Is anyone else sweating right now?

Matthew Greydanus

Day 6 – Monday, June 13  –             A TOOTHBRUSH?! Best Christmas ever!!

Today I lacked sleep but was curious about the task I was to perform. Early in the morning I drove with the dental team to one of the small villages that comprise the district of Bhind. It was about 1 or 2 kilometers away but already surrounded by desert and burnt wheat fields. Pulling up to the one-room drywall rectangle that represented the local school the team and I went over our plan.

You see, Bhind is in the same state as New Delhi and Agra. Arguably two of the best known places in all of India. Yet, most people in this district of roughly 115,000 people have never seen a toothbrush. Does the craziness of these blog posts start to make a little more sense now?

That’s like half of Grand Rapids Michigan not having ever seen a toothbrush or learned about oral hygiene in their entire lives. The amazing thing, is that Lifeline Express realizes this disparity and has attempted to combat these issues with programs like the one I was currently taking part in. The dentists gave a presentation (complete with model teeth and a toothbrush) to the small village and talked about the importance of hygiene. Not only comfort, but health, longevity of life, and less money to be spent on pain pills and tooth removal were all benefits named. Next, the team talked about the two biggest enemies of healthy teeth in this area: sugar cane and chewing tobacco. Explaining the risk of using these items frequently, or at all, the team then proceeded to give a short dental checkup to everyone in the tiny village. As I took pictures the dentists gave out a toothbrush and toothpaste to every denizen of this hut odd civilization that almost seemed lost in time. Except of course, that every one of them had a working cell phone.

My pictures captured the young children, eyes painted with black ink to ward off the evil spirits that threaten young souls, opening their very first toothbrushes with shrieks of joy and sometimes fear. My heart swelled.

Lifeline Express succeeds not only because of its incredible free, high level operations but also because of its community outreach and awareness that can shape a community long after the beautifully colored train leaves. This type of multi-pronged approach to poverty is a perfect example of a winning formula, and something more NGO’s should attempt to emulate.

Back at the train I was distressed to hear that the entire town was without power and the train was running on generator, meaning no AC in the operating theatre. As fans were pointed at the dentists and the doctor I kept from boredom by discovering a startling fact.

If you like politics or medicine this will fascinate you.

In India, all opioids are so strictly regulate that they are never used or take at least 6 simultaneous and separate government licenses to prescribe. If even one of these licenses is found to be out of order, there is a mandatory 6 months – 20-year prison sentence with NO BAIL. So no one produces, carries, or prescribes it. No exaggeration, in the entire country it is almost extinct. No oxycodone, no hydrocodone (Vicodin), no codeine. Nothing. Get hit by a bus? Suck it up kid, no morphine for you.

What does this mean?

  1. When you break a bone, have a baby, undergo surgery (except for a few major operations), or stub your pinky toe you take either Ibuprofen or Acetaminophen. Yep, the little orange things you take three of when your head hurts after a cold? Those are the highest level pain reliever in India except for one small clinic in the entire country. And no black market exists for high level pain relievers.
  2. Dosage of these two common US pain relievers is a maximum of 3 per day.
  3. There is very little palliative care (end of life care) in this entire country. If you are dying, you’ll feel it all the way until the end. No hospice meds, no sedatives, nothing.
  4. Over 80% of the worlds legal opioid medication is processed in India but it is so strictly regulated that none is available on the black market and none “goes missing” even in this corrupt country.
  5. Some doctors graduate from Indian medical schools without knowing what morphine is.
  6. Cough syrup doesn’t exist here because it contains small levels of codeine. Yeah, no Nyquil or Robitussin for anyone.
  7. Indians take fewer medications and smaller doses than Americans in every single area I can measure. Muscle relaxants, tranquilizers, anesthetics, antibiotics, anti-inflammatories, supplements, vitamins. Everything.
  8. You can buy literally any drug sold in India without a prescription at a “chemist” shop by telling them your symptoms. These are more common than grocery stores. However, you never know where the drug is coming from, how much of the active ingredient is present, if it is actually the drug you want, or if it is safe. There are children who die while on the correct antibiotics because of this.
  9. Americans’ overuse of antibiotics and medications for common colds, headaches, perceived illnesses etc. leads to more addiction and more drug resistant bacteria. How does this happen? In America there is a much bigger business around malpractice lawsuits even though U.S. malpractice is significantly lower than any other country in the world. As a result, if a Doctor sees a patient who insists they need antibiotics (or pain meds, but that’s a bit different) they suddenly enter dangerous territory. Is the person really sick? Are they in pain? Being trained to diagnose symptoms isn’t as helpful when people come in demanding medication after reading about what they “know they have” on WebMD. If you’re wrong, it could possibly mean a lawsuit.
  10. The Indian medical system is relatively cheaper when compared to America and adjusted for inflation and the system also understands the concept that 100% treatment and prevention is not feasible. There are also “government” hospitals that are completely free to the poor in some cities. These differences in systems don’t necessarily make one better than the other, but they provide evidence to the fact that you can’t have universal accessibility, low cost, and perfect care. A lesson many Americans on all sides of the health care debate refuse to see.

Conclusions: Indians have a Navy SEAL level of pain tolerance and Americans are over-medicated whiny babies.

Even more exciting is the political reasons for this policy which dates back to British colonialism and the Chinese Opium wars as well as the presence of drug trafficking from nearby Afghanistan.

Ok ok, I won’t bore you any more. But if this interested you, talk to me soon. There’s way more to be surprised by.

In the afternoon I witnessed a man with 8 impacted teeth all the way into his bone. Ouch. While I was still contemplating the geometric and Tetris-like miracle that occurred in order for this to happen the fans and lights went off on the train. In what was one of the most heartbreaking moments of my time here we were forced to turn away people who had traveled up to 40 and 50 kilometers for this treatment because we had no ability to operate on their teeth or eyes without lights. These people had nothing and many had sacrificed what little they could scavenge for the long trek to our train hoping that we could cure them of chronic pain and vision issues. I still haven’t figured out how to handle the disparity between myself and these people but I am finding solace in the fact that over 80 people received oral operations today and 120 were given some form of care. The ophthalmological surgery unit closed early so the dentists and I took a taxi into the desert which yielded fresh local watermelon and and refreshing breeze as the first rainstorm of the year pulled into Bhind.

For those in Michigan, their rain here is like sneezing. Scientists say there are particles of liquid there, but its so hot and dry that you can’t really see a difference.

Returning to the hotel I marched into a heated argument with the manager over my AC unit and was backed up by my squad of beautiful female dentists who helped me take control of the situation. With the AC working, a mango in my hand, and soft seductive sleep only a few hours away I shut the door on a trying but wonderful day.

Day 7 – Tuesday, June 14         Would they really miss one cow?

Today started off like any other. I went to work, scrubbed into the OT and worked with the medical team for about 8 hours. Feeling tired I drank a large amount of coffee. The coffee here is very weak and served with lots of milk and sugar, curious for a culture that uses strong tastes in almost all of their cuisine.

I hope to talk more about food and clothes in the coming weeks so that those of you back home can get a nice idea of the culture here. So expect tasty stories to come soon.

As the staff turned off any unneeded AC units and lights so that operations could continue I watched a medical duo use their skills and a pair of machines to measure the lens size of each patient’s eye. This was actually a very fascinating task and I was entertained for quite a while.

After lunch I chatted with the doctor as he cut into peoples’ eyeballs and he talked to me about the lack of opioids in India, his favorite types of whiskey, and how in America they no longer use the cataract procedure he was performing. In America, the patient volume would never match this doctor who did a jaw dropping 112 cataract procedures in 8 hours. (That’s 14 an hour or one about every 4 minutes. However, in America we are also a bit more sanitary.

OT’s are often cleaned or fumigated frequently in the United States. But in India, with so many patients to care for on the LLE, this isn’t the case. At one point, I spotted and uncapped, used needle on the ground just inches from the open flip-flop of the physician’s assistant. Asking a nurse to pick it up I was given inquisitive looks as a reward. Seriously, do these people not fear disease or illness at all?

As the day ended I met up with the ladies and one man from the dental unit as we ventured to an orphanage towards the center of town. Arriving, we were greeted by dozens of smiling faces. Two adorable young girls gave me an honorary dance and I smiled as the dentists tried to explain toothbrushes to these tiny little balls of joy. A woman passed around water for us to drink but after a single sip the ladies immediately gave me cues to put the cup down. The water here is just below the surface and the rivers are often black or obscured completely by garbage. However, when I ask where trash goes everyone seems to tell me that it is disposed of just like in America (minus paying for it, I mean c’mon, it’s trash). This is definitely a lie because everyone I see simply deposits their trash on the ground.

The head of the orphanage then asked me for a speech on the spot. I had no idea of what to say. Not knowing if this was customary and remembering our reason for being at the school I launched into a short talk about how important oral hygiene was and how dangerous sweets and tobacco could be without brushing your teeth. I used the dentists’ perfect smiles as example of what the children might have if they took care of their pearly whites. My lecture was greeted with slight confusion but also mild applause: 3-98    (That’s a Forensics joke)

After being given the honor of passing out treats to the children we sipped sweet mango juice and said goodbye as the 8 of us piled into our sub-compact clown car and drove out of the town to a temple. Erected to the monkey God Haneman (with no internet I am spelling purely on what it sounds like) the girls informed me that a festival was just finishing. As some of the ladies prayed, one confided in me that she knew very little about Hinduism even though she had been raised in India. SP, the only male in the tooth-oriented cohort besides myself, confessed that he was looking for a girlfriend but could not find anyone who liked him back. This prompted no comforting from the ladies who found it odd that I told him I felt sorry for him. The idea that I might be sad for SP’s loss was a conundrum that stumped the girls until they were distracted by a chance occurrence. A mahatma was in town.

I have picked up on many of the customs here and have even impressed some with my cultural sensitivity and awareness. But for the first time I grew nervous about doing something wrong or offending people. This man was the most important thing to ever happen to the small village we were in and I didn’t want to cause any problems. Approaching the bearded man who wore only a white sash I knelt and touched his feet as he placed his hand on my head. The women explained who I was as the man’s eyes grew wide as he heard about my ambition to become a physician and his translated response was this: “In Hinduism, I am a doctor of the spirit and soul. Together we are doing the same thing, helping people.”

I thought this was remarkably interesting and as the Mahatma handed out ashes to the ladies (I couldn’t have any for fear I would take the sacred ashes back to America) I pondered this man’s influence in culture. It is no secret that religion and India’s corrupt government are deeply intertwined at many levels but this man was treated like a god. Doctors, were treated as lesser gods. The respect I had been receiving was unearned and yet the people I traveled with had no qualms about referring to people as being from a lower class. This was not disrespectful and held no animosity as Americans might presume, it was merely a fact of life. Some people lived in more important circles than others. Interesting.

With some sweet Boondi in hand (they said it was sweet fennel seed but that might not have translated) we drove back to Bhind looking for dinner. As you may know, a growing number of people in America are diagnosed with serious mental illnesses like Vegetarianism, Pescatarianism and Veganism. These debilitating conditions not only rob people of their ability to consume meat, but often make a person more pretentious and picky in personality. The only known treatment for these conditions is to let these people eat in private, where many of their conditions magically subside as bacon, pork, or chicken suddenly seem less poisonous.

In India, there are only two manifestations of eating habits. Veg and Non-Veg. Calling these Vegetarian or non-vegetarian will get you a sideways look and while I am sure many Indian’s also suffer from Veg food habits, every Indian I have met so far is constantly on the lookout for Non-Veg options. So, our pack of plaque fighting experts drove through the city for about 10 minutes (It’s Bhind, it didn’t take long) scouring the city but we were unable to dig up any meaty options for dinner.

Instead, we retired to the hotel where the group listened to music, sipped Indian whiskey, and tried to teach a white American with a patchy beard how to dance.

It strikes me now that I will greatly miss this group. Half of the team leaves tomorrow while the other half leaves the next day. I however, will stay in Bhind for another two weeks as we begin the plastic surgery component of our project here in the desert. I hope you all have been enjoying this blog and I catch myself missing home for the first time as I write this post. I know I will miss India when I eventually am forced to leave but admittingly, an American cheeseburger sounds really good right now.

Do you think a cow would mind if you took a burger-sized bite out of its haunches?

Matthew Greydanus

Day 8 – Wednesday June 15        Cut in two

Today I slept in and arrived at the LLE after a morning full of rest, writing, and laundry hung from the line of my mosquito net. Almost as soon as I got to the train it began to rain and the number of patients waiting for care dwindled rapidly. Getting off of work early, the dental staff was presented with certificates to commend their work. With 620 dental procedures and close to the same number of cataract surgeries the lifeline express has given medical operations to well over a thousand people and clinical care to hundreds more. Even more impressive is the fact that this is only week one of three.

After saying goodbye to three members of our tooth-oriented troupe the remaining members and I worked on finding me access to wi-fi via a “Dongle” or as I would call it, “mobile hotspot”. My term confused people but humor over the word “Dongle” seems to be a linguistic truth that transcends languages and cultures. Yes, even Indian dentists have the minds of 8 year olds sometimes.

In India, you need a passport and an Indian address in order to buy a SIM card. Having my mobile card bought by Deeksha Yadav, I was in a pickle when my “dongle” required a special type of SIM. None of the dentists had brought passports, the phone store clerk wouldn’t accept my identification, and our cab driver had never gotten a driving license (yep) so I thought I was stuck until a friend came to the rescue. Paras and Shilkha are a dynamic brother and sister duo that work at the orphanage we had visited. They supplied identification and an address in order for me to finally make my purchase. Afterwards, the pair invited us back to the address they had recently provided to see their home. Trekking through a dilapidated alleyway that forced me to hobble over like a cripple, we ventured into the home of our two new friends. Their humble two room apartment was barely above the water table and was nestled among a row of favelas garnered in trash. The quant residence had all remaining shelves covered in cellophane to protect the idols of gods that inhabited each alcove. Taking us outside, the tag team showed us Goli Lake, the pride and joy of Bhind. This small river/lake has the highest concentration of Vishnu temples in the world surrounding it and I was taken to two of these as well as a Shiva temple.

I truly enjoy visiting the temples in India but the ones in Bhind seem especially reverent. As I played solo-twister around the fire ants that had colonized the temple floors I was constantly fascinated at what I saw. Beautiful temples, immense brass bells, colored bindis, walking backwards, and frequently touching the floor were all parts of this informative and beautiful afternoon of exploration. As I walked back from one of the temples with Paras his friend rode up on a motorcycle prompting the two of us to hop on for an exhilarating high speed motorcycle race through the back alleys of Bhind. Stepping onto the ground with renewed reverence for stable footing I was invited by Paras to learn to drive a motorcycle over the coming days. I was so happy I could barely sit still.

Stopping at another friend’s house on the way home our party encountered a family of sixteen living in a two room apartment the size of a super 8 motel room. I was once again floored by the modernization of poverty I was witnessing. The people here wear collared shirts, have cell phones, and buy beautiful religious paraphernalia but can hardly afford food or shelter. Hardly anything is used to splurge on things for hygiene or pleasure.

Arriving back to the hotel I was delighted to find my AC unit broken once again. As laid down a sheet on the floor of the girls’ room and placed plastic bags against the bottom of the door to keep the lizards, mice, and insects from making more friends the girls gave me a startling warning. Since they were leaving in the morning they warned me not to let anyone into my room for lengthy periods of time and to not trust Shilkha and Paras. Surprised, having thought Shilkha was a good friend of the dentists, I asked why. The ladies told me that in this town “you can trust no one.” Young and old, male and female, this town not only has a violent history but apparently has the highest rate of burglary and robbery in Madhya Pradesh.

Awesome.

Considering myself a socially savvy guy I can usually sense when someone is trying to pull strings and manipulate me. In fact, I usually steer the conversation. But in this town I am slowly learning that language barriers coupled with poverty can create incentives for people to target foreigners. At this point though, I have yet to encounter the dangers that Bhind is famous for.

As we drifted into sleep the ladies and I talked about our time together as one of the two transferred several Game of Thrones episodes onto my computer so that I could effectively battle boredom in the coming days.

Day 9 – Thursday, June 16                    And then there was one.

This morning at 6:30 AM the girls woke up and left for their homes in Mumbai. I immediately seized their room and basked in the working AC as I waited for the doctor. The eye surgeon had promised to pick me up at around 8 AM and take me to see the post-operative care at the hospital before he left for Delhi. But yep, you guessed it, welcome to India. The doctor never showed up and after a few hours I made peace with the idea that he would not be coming. In a spur of the moment decision I put my shoes on and walked what must have been a mile of road simply exploring the city. After purchasing some cheap foodstuffs I returned to the hotel and well, laid around all day. I wrote in my journal and ……. Yeah. It was a boring day.

Besides a heated argument with the hotel staff who tried to overcharge me for my food yet again, the day was uneventful. After Pradeep, the manager’s young son, attempted to go through all of my belongings I locked the door and cooled off from my morning stroll. Later, while watching the cliché yet enthralling battle of ideologies that is Game of Thrones I looked up and locked eyes with a small mouse who had been living behind the cabinet where my clothes resided. We both froze and sized each other up from across the room for several minutes. Wanting to document me newfound friend I reached for my camera. I assume the small rodent thought I was reaching for a weapon as he scurried back under my t-shirt drawer. Since then, the mouse and I have an unspoken agreement that acknowledges each others presence but keeps us on opposite sides of the room together. While the mouse seems to have an upper hand and final word when it comes to negotiations I am confidant we can coexist in this room with out conflict. The mouse is honestly a pretty good roommate  It doesn’t make noise and doesn’t use the bed. The only annoying thing is that it doesn’t pay rent. I have yet to think of a name for it but I promise that I am not quite at the Tom Hanks – Wilson level of crazy thus far.

Can you tell I was bored today?

My afternoon was all too telling as Paras called me up and wanted to come to my hotel but couldn’t give me a satisfactory reason as to why he wanted to. Dead bolting my door I picked up the dinner menu before remembering that it was two pieces of paper taped together with writing only in Hindi.  I miss my Indian friends.

As this week comes to a close I assume that many of you with Catholic roots recognized this week’s topic of “Taste and See”. The food here is incredible and I am absolutely loving it but for the first time I am starting to experiment with a variety of dishes. This is not always a wise decision. Being a person who loves spicy food I thought I would be right at home in India. Avoiding the darkest colored foods, I was able to always stay in a comfortable spice range until I arrived in Bhind. I seem to be unable to find any indicator as to how hot a dish will be and have been caught off guard a few times by the throat-closing power of Indian spices.

This is a country of extremes when it comes to food. Hot, sweet, spicy, bitter, and besides the weak coffee, strong. Even though the air is similar in scent to a loaded diaper during the day, the odor gives way to flowers and foods that make walking down a market street a truly amazing sensory experience.

In terms of sight, this town is a mixed bag. Roofless brick and straw huts with satellite dishes on the side, rabid cows that people won’t put down, buildings that have half collapsed and yet are still places of business. It’s truly hard to describe. While the disparity between this city and America is great, my emotions go far beyond the shallow, “It’s so unfair how little they have” trope that is an important if not common result of mission trips and charity work. This place is lost in time and yet a part of the modern world. It’s people are unemployed not for lack of jobs but because they honestly have rarely given a thought to what’s outside of this town. That, or they are criminals with no place to go. It’s an odd dynamic that I didn’t expect. Luckily, I recently entered a stage of my life where I will be having a lot of one on one time with a mouse. Hopefully he/she (mice have very androgynous faces) can help me work through my emotions in the coming weeks.

For now I hope that you all are healthy, enjoying this blog, and mostly un-offended by its (sometimes) brutally honest content.

Tentatively the mouse’s name is Wilson,

Matthew Greydanus

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About Matthew Greydanus

Matthew is a freshman that is pursuing a degree in Political Science and focusing his studies on a pre-medical track. After graduation, he plans to attend medical school and has an interest in reconstructive plastic surgery. Matthew will be interning with IMPACT India, an organization which acts as a catalyst to bring together the Government, the corporate sector and existing NGOs in mass health programs of national priority. He will be spending five weeks interning on one of their chief projects, the Lifeline Express, which is the world’s first hospital on a train and is celebrating 25 years of service. The train has medically served more than 100,000 people in rural India, restoring sight, movement, hearing and correction of cleft lips, and many more types of surgery completely free of cost. Matthew’s final project will explore whether mobile health care is safe, effective and efficient and how this type of care could fill a needed void in rural outreach of health care systems in developed and developing nations alike.

2 thoughts on “Taste and See

  1. I love reading your posts, Matthew! Great memories of you as an outstanding ACS student.
    Enjoy your time in India!
    Dan Day

  2. Hi Matt! I really enjoyed reading this chronicle of your experiences in India! The first blog post from June 8th was really powerful. I think you have the right outlook – to focus on the people Lifeline Express can treat – is the right approach, but it doesn’t make it any less emotionally difficult. I loved reading about your experiences in the operating room, your interactions with the dentists, the DC Godfather, river dolphins (which the internet tells me do exist) and your impromptu speech. And I’m glad you are able to keep up with Game of Thrones! Fingers crossed that you get to start sleeping in your hotel room! I’m thinking about you and cannot wait to hear more!

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