The Good, the Bad, and the Ugly

In this segment the Lifeline Express is focusing on orthopedic, plastic, reconstructive, and ENT surgeries. These can be especially painful, tense, and chaotic as we rarely put patients “under” with general anesthesia and instead give them simple shots of lidocaine. While legal and humane, the results are brutal but due to the sheer demand for surgery we change the lives of more people by performing the operations this way. June 17, Friday              Medic, we need a medic over here! Today I woke up and hopped into the LLE car to find two women already waiting. Surprised, I soon learned that they were two medical students from Mumbai and were here for just three days to assist and observe surgeries with the orthopedic surgeon. After arriving at the train I stepped inside and began to chat  with the new batch of doctors as best I could. Some spoke English and I soon had fond opinions of the two plastic surgeons and their anesthesiologists. The orthopedic surgeon was a different story. As we scrubbed in and began operations it was clear that this part of my experience would be different. Instead of speaking calmly and leading the rural nurses through procedures they had never dreamed of assisting in, the physician seemed tense and hurried. Truly, we all were stressed out. The staff that had already been working with me for almost two weeks gave each other reassuring smiles and patted each other on the back as we did a dangerous tango with this man’s ego. In the meantime, the two operating theatres were more different than night and day. I enjoyed my time in the reconstructive plastic surgery unit (as I am leaning towards this medical focus) and was fascinated for several hours. With soft music playing in the background the physicians carefully repaired cleft lips and treated severe burns. Although this was painful, only the infants were put under general anesthesia to keep them from squirming. While the soft moans that patients had were sad, the smiles on their faces when they saw how their faces, arms, and skin had been repaired was priceless. No matter the salary, the satisfaction I got from being a part of these operations was priceless. Once again, I will not talk about any specifics of my involvement but I would like to clarify that I had patient permission throughout my service aboard the lifeline express. (Note: This section is graphic) The orthopedic operating theatre was closer to a World War 2 battlefield hospital. moans came from patients as physicians hacked off tumors, cut tendons, shredded muscle, shattered bone, performed amputations, and snipped arteries. These people gritted their teeth as doctors cut their Achilles and femoral tendons so that nurses could straighten their legs. After putting them in casts, the tendons could regrow properly over a period of three to four weeks. Finding one boy with growths on his feet, the operation sliced and cracked through his body to find a cancerous bone in his foot. The grainy, gritty, and brittle structure splintered as I looked at it and a nicked artery squirted at the four people huddled around the pulled back flaps of skin. After also severing the boy’s planter tendon while he writhed in discomfort physicians massaged his bones and feet into place before applying enough plaster of Paris to entertain an entire 3rd grade arts and crafts class. After a few operations I stepped back to change my gown and gloves again. Blood covered the tables, moans echoed in my ears, and yet I felt cool, calm, and collected. The only time I actually felt nervous was when of the unconscious infants had their heart rate spike and then plummet. An AED was attached as the anesthesiologist worked to get the child breathing. The power went out at the worst possible time but stopped the alarms from bothering us as the child coughed and gurgled back from unconsciousness. Had that baby died I would have been crushed. Truly, a few of the operations were excruciating. The patients were administered xylocaine and lidocaine (a topical or injectable anesthetic). Basically, doctors used acetaminophen and topical anesthetics on IV sedated patients for surgeries that were brutally painful. We did this because the demand for these surgeries is so high that if we were to put each patient to sleep we would only accomplish a fraction of the operations needed. I am not saying this is right or wrong. After consulting the doctors, I was confidant what we were doing was completely legal. However, the screams of true pain do not leave your ears the first time you hear them. My catharsis came from seeing children who had never walked before examine their straightened and working legs for the first time. I almost wanted to extend my stay so I could see their joy when they ran or played cricket. These people are tough. They are strong. They are fierce. As I comforted a young man who must have been my age he gritted his teeth to get through the discomfort and smiled at me as I gave him a thumbs up. After work we ran a screening immediately outside the train. While we encountered a variety of diseases and conditions birth defects were by far the most common. A child with a large intestine outside its rib cage, multiple leg and foot conditions, cancerous growths emanating from the spinal cord, we saw it all. This only reaffirmed my faith in what we were doing as people excitedly gazed upon their admission papers. Since they kept the operating theatres hot to keep the children away from getting cold and shivering we returned to the hotel sweaty, hot, and covered in a multitude of bodily fluids. The girls left to make rounds at the hospital while I tried to connect my new “dongle” to the internet. I’ll give you one guess to figure out what happened. Yep, India happened. So, without internet once again I socialized with one of the doctors about family, politics, economics, and our two countries as we fought off sleep for a few more hours. When the girls returned we began a Bollywood movie entitled “Gangs of Wasseypur” for a respectable thirty minutes before we decided to call it a night. With noise, blood, and no morphine, MG   June 18, Saturday                                Road Trip Today I started my day in the OT without a gown and with my trusty Nikon D3300 camera. I hoped to catch some of the crazy action of the day before and capture the feel of the Lifeline Express at work. Within twenty minutes I was fully sanitized and holding a screaming child down with 3 other men so that we could operate on the inside of his mouth safely. It’s probably for the best. I honestly think that the biggest danger in the OT is when I am not working. Mainly because the doctors and nurses, like many Indians who see a lanky white boy, all want to take pictures with me. I am not exaggerating when I say people turn around while driving the other way to stare at me in public. While I have started to get used to it, it isn’t pleasant to be constantly observed. I’ve made a game of it by attempting to count how long I can stare a person directly in the eyes without a facial expression until they turn away. Unfortunately, once I turn my back they often stare at me again. But back to the medical stuff. I feel compassion for these brave patients yet the staff here seems to give little coddling. Only a handful of the doctors and nurses will take more than a few moments to comfort the worried individuals who are heroically putting themselves under the knife. So I have made it my goal to comfort as many of the patients as possible. Since many of the young children are easily distracted for a moment by my white skin and green eyes this has actually been a great help to the doctors. One emotional moment found an infant holding on to my index finger with one hand as I caressed its head and smiled to keep the IV sedated child from watching his own operation. When complete, I carried the child back to its mother and glowed with pride as I handed the woman her baby. Later on in the day, while I worked in the plastic surgery OT, I witnessed a beautiful young girl of 14 years seat herself on the operating table. Turning her head sideways she showed the doctors a silver-dollar sized scar that radiated across her upper cheek. A hideous mark on the face of a wonderful child. During the hour long procedure to remove the tissue and sew her face up we traded smiles as I gave her thumbs up and ok signs from above her cheek. As the final sutures were put in place my smile faded and I felt my heart swell. This amazing, perfect, innocent child had her cheek back. She could feel pretty again, leave her face uncovered, be confidant, maybe even get married someday. The only reminder of her misfortune would be a long thin scar. While not invisible, this scar was a tribute to her resilience, her strength, and all that she had been through. As the girl smiled and sat up I felt my eyes water. There, right there in the middle of the operating theatre surrounded by professionals I felt a powerful urge to cry. I was so proud to witness this transformation, to be a part of the gift that this beautiful child was receiving. I gave her one last smile and then turned away to fan myself with my face mask so I wouldn’t sob all over the instruments. What this train does isn’t just good. It’s beautiful. Returning to the orthopedic OT I arrived just in time to be present for the amputation of a child with six fingers on each hand. I think I was the only one in the room who actually pondered if there was an evolutionary advantage to having two opposing, opposable thumbs as we cut them from the surprisingly calm infant. (hear me out, you could grab like twice as many thins with each hand!) After the disembodied fingers lay neatly in a line I asked the nurses what would happen to the used equipment and leftover body parts. I wanted to know if the incinerator was in a part of the train I hadn’t seen or at the local hospital. The answer disgusted me. The nurses didn’t understand the concept of incineration and told me that the body parts and waste would simply be thrown “in the garbage”. Great. Around lunch time the two students and I made a last minute trip to the town of Gwalior about 2-3 hours away. This town is more like an actual city and our first stop was the Scindia palace: home of the royal family of India. While the Scindia family still lives in part of this sprawling mansion much of it has been converted into a museum. Curiously, the building is dimly lit, and most of the rooms on display are cluttered with tacky pictures of the royal family and pointless artifacts than any actually interesting information. Childhood cricket trophies, pens, and neckties make the exhibits feel more like a child’s bedroom wall than a lavish and exquisite palace. But what a lavish and exquisite palace it is. Hundreds of rooms, crystal furniture, ebony dining rooms, great halls painted in gold with massive hundred foot ceilings make this a Disney castle come true. The architecture includes baroque, chinoisie (a British imitation of Chinese), classical, modern, and a variety of Indian and middle eastern styles. Weapons, pianos, armoires, vehicles, and gorgeous furniture fill the breathtaking rooms as immense, awe inspiring chandeliers look down on visitors with impunity. By the time we left I was walking with perfect posture, trying out my most regal accent, and was actually considering reading a Jane Austin novel. (I know, crazy right? Seriously people, lengthy social traditions can only be interesting for so many pages. As Mark Twain said about Jane Austin “I should like to take out her femur and beat her with it.” ) Our next stop was a luxurious hotel. The nicest place I have stayed in India for only 40$ a night. Not bad, not bad. Or maybe I’ve just stayed in really horrible places. Next we drove to the fort I the middle of town. As the sun set we drove up the massive hill in the center of the city that is crested with a majestic fort. Created by ancient dynasties the road to the stop is populated by elaborate carvings made into the stone of the hill that almost distract travelers from the haunting drop-offs on the sides of the road. Reaching the peak my jaw dropped as we gazed out some several thousand feet above the city. Favelas, buildings, slums, monuments, all of these stretched before our eyes as the sky burned red. Taking plenty of photographs of the intricate red-stone fort that was veneered in jewels we sat down to a light and sound show that occurs in the fort three days a week. I think this town puts more of an emphasis on sound. Loud speakers hidden throughout the fort blasted an hour long story of love, loss, mass suicide, siege, and revenge that I couldn’t understand a word of. All the while I expected to be amazed by spectacular lights but was disappointed by what seemed to be single, incandescent bulbs with colored film over them. While most of the show was an expensive disappointment I did enjoy the illuminated and colored bats that circled overhead. The one redeeming moment came when the external wall and guard towers of the fort were illuminated as they kept watch over the city below. Tired, we ate a non-veg meal (thank you thank you thank you) as I explained the merits of general meat consumption. After polite argumentation on the matter had subsided we retired to our hotels for some much needed sleep. I had wanted to be an action photographer and I wound up in the heart of the action. Today was a success. Proud of the surgeries we did and full of tasty meat, MG   June 19, Sunday          Guess who’s back, back again, Dr. Matt is back, tell a friend. – Eminem Today we woke up and immediately resumed our conquest of Gwalior with India’s most redeeming breakfast food; Dosa. Think of like a thin pancake-tortilla with cream and a bit of spice. That’s Dosa. After polishing off my large breakfast my friends informed me that in India most hotels include a complimentary breakfast. Since I had been sleeping in apartments thanks to airBNB and the luxurious hotel Mahduvahn in Bhind, (ps. The mouse is officially named Wilson) I hadn’t gotten to experience this wonder. So, after wasting $2.55 US dollars on room service breakfast (sorry dad, looks like I can’t afford college now) I ate my second meal in two hours with the ladies as we demolished the handsome Indian breakfast buffet. Our next point of conquest was the famed Gwalior Sun Temple. This beautiful and intricate temple is carved out of red stone and literally radiates with the sun’s light. Incredible patterns cover the inside and outside of this symmetric marvel of ancient architecture. Even the beautiful surrounding gardens seemed to reflect light at us as we walked around the exterior of the religious building a customary two times. The inside of the temple was the only detraction from the immense beauty this location held. The marble walls had been carved into in order to place electrical sockets for fans and air conditioners. In the same manner as the Scindia mansion, I couldn’t help but feel like the people who ran this temple were destroying its beauty by attempting to make it modern or more comfortable. Maybe I’m just an American. It’s true, we Americans simply don’t have the depth of history and architecture that this country has. I won’t judge, but I get the embarrassing thought in my head that some of these historical sights are being tarnished instead of preserved. After the temple we drove through town and gazed at landmarks from the car as we drove the girls to the airport. As we sat in the sun (haHA, didn’t make the mistake of going inside the airport this time!) the girls tried to get my Wi-Fi modem working with little results. Saying goodbye, I left the ladies for a two hour ride in a car known as a TATA Nano. I will not exaggerate in saying that I am taller than this car is long. It has no airbags, no trunk, a flap that poses as a hood, and a lawnmower engine that tops out at 40 kilometers per hour. For you Americans who refuse to learn the metric system, that’s really slow. As I drove back to the elegant hotel Mahduvhan in Bhind my phone magically began to start receiving data for the first time in the entire trip. Much to my dismay the network was too slow to even work, figures. Back in Bhind I had an emotional reunion with Wilson who had attempted to consume some of my hidden food but had been thwarted by man’s cruel invention of the elevated shelf system. Knowing the day was fading I popped up and decided to go for a walk which yielded water, buckets of sweat, and sweet boondi. After polishing off season 3 of Game of Thrones (don’t spoil it for me) my boredom hit new heights but was quickly subdued as I simultaneously called my parents and determined I had bedbugs from the new and fascinating array of red bumps on my exposed skin. Following another confusing and emotional argument with the hotel staff I ate a measly dinner and decide to call it a night as Wilson defended his territory from an array of lizards. It’s not great to be back. MG   June 20,  Monday                                                   To sweat or not to sweat (as if I have a choice) Today I resumed my usual duties and found myself with the new reconstructive surgery team. We journeyed to the hospital and began screening patients in the only two story building within the hospital compound. As we sat together and let our bodies act as swear factories my mind wandered. The examinations today focused on eardrums and other auditory issues so apart from the half a dozen times I was allowed to peer inside a patient’s pumpkin I sat in the heat and asked questions about the medical conditions. Why was there blood, did drainage mean a puncture, could we release the pressure with an incision? (The answer to all three was yes) These questions got me through my day. As it got closer to lunch time, 3 pm in this small town, the young girl who I had recently seen on the operating table came into the room with a scarf on. As she unraveled the shroud I immediately recognized her and the thin, bandage covered, scar that traced her cheek. I wanted to acknowledge her but I had been cautioned by many people before my trip not to smile, wave, or stare too long at young women as it could come off as flirtatious. As I pondered my options I locked eyes with the young woman and decided to be bold: I smiled and waved. I swear people in that exam room gasped. But what the heck, I’ve flown under the radar for my entire trip so far and he girl’s smile back at me was more than enough of a reward for being considered a silly American. After breaking for lunch I opted to stay aboard the Lifeline Express and attempt to use their internet USB modem to book more of my trip. After ensuring my safe passage out of Bhind and contacting my family I stepped outside to find the staff playing a one sided game of cricket. Surprisingly, I was not offered to try and play which suited me fine as I enjoyed the sunset view of the surrounding attempts at farming. Arriving back at my hotel I was informed that I was to be moved to a different hotel due to several important physicians arriving the next day. Great. I packed up and forked over some rupees as the consistently drunk hotel manager smiled, knowing he had successfully ripped off another traveler with his disgusting establishment. As I left I couldn’t seem to find Wilson but somehow I knew he would fare just fine without me. “WIIIIILLLLLSSSOOOOOOONNNN” – Tom Hanks My new hotel held the promise of being nicer with its more expensive nightly price tag. Alas, it seems I am paying for proximity to the hospital. I walked through a nauseating back alley and up a flight of unfinished stairs to a room covered in insects and dirt. The staff spread a single, horrifically stained sheet over the mattress and walked out. Thankfully the AC worked otherwise I might have left for New Delhi right then and there. As my uncontrollable urge to explore ignited again I ventured out into the back alleys of Bhind for an exciting and rewarding walk that culminated in dinner. Retiring to my new room I locked the door and chose the side of the bed with the least insects and stains. I might miss Bhind when I have to leave, but certainly not its living arrangements. It’s still hot. MG   June 21, Tuesday                                  Adapted Today I woke fighting the remnants of a street-food meal from the night before. Deciding not to grace the LLE express with my energetic bowls I spent the day in my new hotel room. At first I was ecstatic. I had a TV with an English channel! However, I soon came to realize that the programming was one episode of “Friends” on replay interspersed by terrible action B-movies. I saw 3 separate and equally terrible Nicholas Cage films today. I honestly wonder why people even chose him as an actor. He just isn’t good. I mean, I can see him as a stunt double or maybe Lenny from “Of Mice and Men”. But the man has emotional facial expressions similar to the ones I conjured up while on a toilet during my first day in India. Anyway, back to the important stuff. In the early afternoon I went for a walk to find food and enjoyed journeying through the back alleys of Bhind. I really have started to fit in here. I don’t draw as much attention, I speak a bit of the language, and I feel at home in the dirty and fascinating favelas of this town. My happiness and comfort was interrupted by a short vomit on my return to the hotel but I kept in good spirits as I put faith into another street restaurant. The food was spicy and delicious. I sat in the alley watching the people and cows walk by as night descended on my little town full of banditos. The alley reminded me of Blade Runner with Harrison Ford. The city had a gritty charm that made it feel like it was from another world. People here were tough, they stuck it out, they made do. I liked that. I’m really beginning to truly love this country. Obviously it isn’t “mine” and I don’t share blood with the people here but in my own little way, I feel like India is becoming a part of me. Or at least an important part of my life. I returned to the room only to discover another Nicolas Cage film spreading its Demon-like wings to take flight. I powered off the TV and turned off the light to indulge in beautiful sleep. Nicolas Cage has an amazing agent, MG   June 22, Wednesday BRRRRAAAAAIIIIIINNNNNSSSSS Today I awoke and rode to the train to confront the two men who had kicked me out of my room at hotel Mahduvahn. Trouble was, I really liked them. The two physicians were top ENT (Ear, nose, and throat) surgeons from Delhi and immediately set about making me feel like I was there protégé. The first doctor showed me a more archaic version of a Tympanic replacement. This a procedure done to patients who have a perforation in their tympanic membrane which prevents them from hearing and gives off a painful discharge as well as exposing their middle ear to fungal infections. Warning: this paragraph is graphic In this procedure the patient is given a shot of localized anesthetic behind the ear as well as an IV sedation. The physician then cuts behind the ear in a crescent shape as deep as possible. After cutting several millimeters the physician uses a cautery device to stop the bleeding and cut further. I mentioned that I wouldn’t soon forget screams of true pain, I don’t think I’ll ever forget the smell of burning human flesh. It has a meaty smell, like cooking a steak, but more musty than a grill. Probably because the person is still alive. But we burned on, three patients at a time, down to the base of the skull. Moving upward, the physician uncovers the temporal muscle and carefully fills the space between the muscle and its fascia (gristle in your steak) with water. This allows him to cut away the fascia without damaging the cranial muscle which bleeds excessively when cut. This bit of fascia is scraped with a scalpel until transparent and serves as the skin graft membrane. Looking sideways the physician reaches down into the socket and cuts into the auditory canal. Here, the physician can remove the rest of the damaged tympanic membrane and delicately insert the new graft. After this, the area is packed with an absorbable gel that will hold things in place until the skin graft takes. Covering everything back up and suturing along the way ensures the evidence of the surgery is only a curved scar and a half shaved head. The hair is removed pre-op to ensure antisepsis (which is different from something being sterile, you learn something new every day!). This procedure takes 2-3 hours and completely fascinated me. The focus, precision, and patience these surgeons had made me hugely respectful. They spoke calmly, led everyone through their duties, and gently reprimanded anyone who made a mistake. They honestly made it, fun. The physicians and I began to talk about Bhind and, assuming I had never been told before, the doctors told me about the violent and ugly history that Bhind had. However, they did add some new information. It turns out the reason that Bhind was so notoriously dangerous is because it borders Madhya Pradesh and its neighboring state. Bandits would ride in, kill, steal, and race back across state lines so that police had no jurisdiction to arrest them. The doctor described it as “India’s wild, wild west”. Apparently, just a couple decades ago the Indian government had rewritten jurisdictional law due to this type of violence and the danger had begun to subside. The doctors cautioned that it was still a dangerous area but that, “everybody here carries a gun and learns how to use one to defend themselves”. In fact, the doctor revealed that Bhind was famous because while guns are difficult but not impossible to obtain in India, the citizens of Bhind had bought large amounts of weapons illegally and had even created an entire industry out of making homemade firearms so that they could defend themselves against corrupt police and bandits. Hi mom and dad, I promise I’m safe here! With Bhind’s mysterious violence now making a little more sense, the doctors began to tell me about some of the notorious weapons made in this small town. Apparently, a common type of homemade rifle that is used in Bhind ix so dangerous that you can’t hold it against your shoulder to fire because it often shoots projectiles both directions. Awesome, I get to dodge twice as many bullets. Thinking my day had hit its high point I realized I was wrong as the doctors excitedly brought me into the remaining OT to watch an exploratory surgery for a woman suffering from a necrotizing tissue disease. If left unchecked this disease causes hearing loss and spreads into the skull causing cranial complications and eventually death. Treatment involves complete elimination of the necrotic tissue which can sometimes have penetrated the skull. That’s right, time to get out the power tools. Warning: this paragraph is graphic. Now, I don’t consider myself a twisted person but there was a certain amount of terrified adrenaline I experienced as we drilled into the middle aged woman’s head with a glorified Philips power drill. (Kidding, it was a standard bone drill used by a trained professional. But still, it was intense) My knuckles whitened as the drill bored into the woman’s skull with the doctor guiding it gently past sinuses, arteries, nerve cells (this procedure carries a very real risk of facial paralysis) and fragile auditory structures to bring us to the surface of the brain. After some probing, drilling, and disease killing the physicians expertly filled the gaping hole in the woman’s head and removed the rest of the dead and infectious tissue from around her eardrum. If this sounds like a hack and slice operation, it wasn’t. Like a perfect symphony of blood, saline solution, and gauze wraps the medical duo eliminated all of the woman’s diseased tissue and had her stitched up in three hours. No complications. In fact, of the average 6,000 patients and 500-700 operations that the LLE does each project, there is almost never a single complication. Hard to believe I know, but this is partly because most of the procedures done on the LLE don’t carry life-threatening consequences. There is no trauma surgery, no heart surgery, limited transplant surgery, and only the occasional open brain. After operations the patients are taken to the local hospital for post operative care. Unfortunately, Bhind is a likely area for complications as very few patients are expected to come in for checkups on their conditions. But so far, so good. (knock on wood) All of this takes 60-70 Lakhs or roughly $ 110,000 US each project. With 10 projects a year, a lot of needy people are getting operations the otherwise couldn’t afford. This is the power of the Lifeline Express. After a long day of work, we headed home when the driver mistakenly stopped at a government hotel to drop me off. Apologizing for the mix up I sat back sheepishly as the Doctors calmed the irritated taxi driver and dropped me off at my Alleyway Ritz (brought to you by Bhind motels). As cows sauntered by and drivers attempted to drum up more patients for the LLE by laying on their horns continuously, I frittered off to sleep. Brains are cool. MG   June 23, Thursday                                Rest As I woke up and walked out into the clamor of the street I knew it was going to be a long day. I was tired, the doctors seemed groggy, and rain the night before had turned the city into a soup of cow poop, delicious spices, and fast motorcycles. Getting to the train I decided I was going to take photos and spent the day getting my camera up close and personal with the holes in peoples’ heads. This proved to be entertaining for several hours but after another drilling procedure to prevent a virus from causing brain damage I slumped against the side of the train and gave in to the sweet, sweet sleep. I was roused a few minutes later when it was discovered that we had treated all of the day’s patients before lunchtime. With an extra couple of hours jingling nicely in my pocket I opted for a rickshaw adventure to the hotel and spent the afternoon walking through the markets. For dinner, I decided to be bold and try one of the things my body was craving. PIZZA. Being a vegetarian while in Bhind was completely doable but, if I’m being honest, left me with a hankering for meat. Spying what looked like chunks of ham atop parmesan, marinara sauce, and toasted bread you can imagine my disappointment when the Indian rendition of pizza turned out to be saffron, capsicum, cummin (spelled with two m’s in India), coriander, curry, hot sauce, cabbage, celery, and chunky cottage cheese. (A lot of “C” related foods) Needless to say, I prefer New York style. I traipsed back to the hotel and settled in for another bout of Nicolas Cage crying while making faces of pain and smiled to myself. Against all odds, and honestly my own wishes, I am falling in love with this small, hot, bandit filled desert town. Short and sweet, like my day. MG   June 24, Friday                     The End Is Nigh This morning I woke up on the right side of the bed because I finally had the last twelve days of my time in India planned. I am going to Leh, Ladakh and its surrounding attractions in the Himalayas! I’ll save the cool info for when I actually get there but basically, getting to Leh requires flying from near sea level to 11,000+ feet and the mountain pass I will be driving over is the highest motorable road in the world clocking in at 18,000+ feet! Awesome. My excitement powered my trip to work and through breakfast. Here at the LLE we have one option for breakfast that rotates every other day. Today was fried bread with garbanzo beans. A favorite of mine. As the physicians and I chatted I was informed that we were also starting a new program today. As it so happens, India has a high incidence of epilepsy. In order to inform people about how to manage epilepsy and protect themselves from some of the side effects the LLE is having a three-day clinic to diagnose, treat, and raise awareness. This is another example of how the Lifeline Express tries to build patterns of sustainable care even in the middle of the desert. As the day came to an early end I rode back home and spent the afternoon doing laundry in my small cramped room. In India, rural laundry is done by soaking clothes in a bucket and scraping them with a detergent bar. Then, you rinse with clean(er) water and smack the clothes against a hard surface. So, with no “laundry clothes” I began washing and smacking my three pairs of clothes against the wall before hanging them up to dry on my mosquito net. With only a few packets of travel detergent to use I had been making the most of laundry days by doing all of my clothes at once, leaving me without a stitch to wear while they dried. This usually wasn’t a big deal since the hot desert sun dries clothes very quickly. However, what I had forgotten was that at hotel Mahduvahn I didn’t have to double check that the curtains were big enough to cover the entire window (Mahduvahn had no windows). Here’s a tip for hotel owners, if you buy curtains for the windows in each room it would be nice if they shielded the entirety of the window from innocent eyes. Mortified, I turned around mid dry-cycle in only my birthday suit to see a child’s head turning in the direction of my room. Suddenly realizing the large gap in window coverage I rushed to the curtain and shifted it over to save a young child’s innocence. Confidant that my Olympic long jump to the window-sill had averted the crisis, I finished my laundry. About two minutes later, thinking I was in the clear, my heart seized again when I realized that my curtain adjustment had resulted in another unholy line of sight. A small slit of light shining through the side of the curtain was visible in the mirror that coincidentally sat on an adjacent wall. Gazing into the mirror I confronted my worst fear, a man turning his face away with what appeared to be a grimace on his face. In horror I hit the deck like a dead fish and army crawled my way to the window faster than James Bond in a shootout. Hiding myself from all mirrors, windows, and every suspicious crack in the wall I nudged the curtain over and made a lunge for the blanket on the bed. Nestled in a fuzzy blanket I attempted to nurse my pride back to health as my clothes dried. Turning on the TV I once again was faced with the burning question, “Why do people hire Nicolas Cage?” It honestly comforts me that someone can be so bad at their job and still somehow be successful. If he can be successful, I’ll be president. MG   June 25, Saturday           All good things… This morning I woke up and quickly sauntered my way down to the alley while I waited for the taxi. It didn’t hit me until I got in the car that this was my last full day in Bhind. As I rode through the town with its crumbling buildings, house consuming swamps, and colorful markets I realized how much I was going to miss Bhind. As one of the physicians said, “This is a trip you will never forget”. Arriving at the train I made myself useful in the epilepsy unit and immediately struck up a relationship with one of the most awarded physicians to be on the lifeline express. This professional, Mamta Singh, is one of the leaders of the AIIMS (All India Institute of Medical Sciences) institute and has done extensive research on epilepsy while volunteering in over 80 free care projects across the country. While not young in years this woman was young in spirit and she was soon joking, debating, and even slapping me when she thought I was funny. As we saw patient after patient she began to answer some of my burning questions. Epilepsy is found at a higher rate in India than the US. While medications are dirt cheap compared to their adjusted price for patients in America there are so few doctors in rural India that people simply don’t get diagnosed. One man believed that his failure to wash his hands before entering a temple five years ago had caused his daughter to develop seizures. In fact, doctors are so scarce in rural India that an estimated 60% of Indians do not have access to health care. Even more distressing is that there is no program in place to help change this statistic outside of groups like the LLE. My sadness was made greater when the brilliant doctor revealed to me that in India, women with epilepsy rarely find a husband, so they lie. When their husband of course finds out, the rural couples often break up when the man and his family declare the woman a lost cause. While only a common occurrence in very rural areas this occurrence proved true as all of the 30 women we saw except for one had had their husbands leave only months before. These emotions of sadness only increased when I visited the local hospital for post operative care. In a crumbling hallway patients were lined up in rows on dilapidated beds. As we inspected them one by one checking sutures and looking for signs of infection we were informed that there were no IV bags left for the 3 most recent patients. Scrambling to find fluids the doctors scoured the entire hospital while I had a photo-shoot with many of the patients. After about an hour I decided to walk home in the dark and casually strutted down the median of the road while taking over-exposed photos with fantastic results. The Doctors were surprised and wanted me to know that it was unsafe to walk outside in Bhind…. Glad I found out after all of my adventuring. As I neared my hotel I ran into one of the administrators wearing sweatpants who seemed startled to see me in anything but scrubs. Nodding, I proceeded onward, treating myself to a bit of ice cream, and beginning to pack for my departure the next day. I can’t believe it, but I’ll actually miss this place. MG   June 26, Sunday                                                      Best laid plans I woke up with a somber smile on my face knowing that I would leave today. After a last breakfast at the train I began working with the women in the epilepsy unit when one of them offered for me to ride with them to Gwalior where I could catch my train. Not envying another jump through a train’s emergency exit window I agreed immediately. So, after photos, a certificate, goodbyes, and a final visit to the OT I gave an emotional but brief goodbye to the LLE and stared back at its beautifully painted walls as we rode off into the desert. Since I was the youngster to these three 50 something female physicians I was given the back seat and the luggage to sit on. Kissing my knees, I squeezed myself into a ball for the entire two hour ride to Gwalior. Upon reaching the town I began un-stretching myself and bending my bones back into place while the ladies decided what to do. At first, the women suggested a coffee shop and reading, which seemed fitting. However, they then decided that a beer was much needed after their week in Bhind. So that is how I came to drink beer in a poorly decorated, British imitating pub with three of the most renowned 50-year-old female epilepsy experts in the country of India. The humor didn’t escape the ladies either. They joked that we should go to a nightclub next so I could “walk in with three elderly dates”. As the jokes continued the attention soon shifted to how much the women hated America. I was soon subjected to a list of every bad thing that these ladies knew about my country. While I didn’t make the mistake of defending the USA and creating an argument, I did ask why the ladies disliked America so much but seemed jovial about Britain. (Considering colonization and the British East India company) This was the wrong move. In one of the most peculiar social interactions I have had while in India, the women began defending the actions of colonialist Britain (actions that sucked the wealth, happiness, and life out of India) while condemning every American decision that they had read about in a newspaper. Realizing that this double standard was ingrained far beyond my capability for debate I decided once again not to push the matter but instead listen and accept my role as an “ignorant American” for the remainder of the meal. A curious perspective indeed. After conversations subsided we grabbed our things and rushed to their train station where both of our trains were delayed by over an hour. With plans that had changed once again I sat down and drifted off to sleep amidst the rats, roaches, and roar of the busy station. MG   As I look forward to the next part of my journey I once again find it important to clarify that neither Bhind, nor my experiences in general are indicative of India. The culture, people, opinions, traditions, and societal norms in India vary as much as they do in any other large country. I hope that through this blog people can gain a window into my experience but are not offended by the situations I encounter or write about. DSC_0822

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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.

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