Oasis In The Fall

If there had been an award for the most varied transportation in a 48 hour period, I could have been a contender... traveling from Palghar, to Mumbai, Delhi, Rudrapur, and now Nainital has been accomplished on planes, trains, buses, rickshaws, horse carts, and one very rusty bicycle. Below is a map showing my travel route (in red is what i have already done, and the purple shows the route i will be traveling over the next week and a half):



After leaving Mumbai on October 2nd, I traveled (via a variety of creative - and at times heart-pounding) routes to reach Rudrapur, a small city in the northern state of Uttranchal. Impact India's Lifeline Express (LLE) Train - the world's first mobile surgical hospital - is stationed there, and Impact wanted me to spend several days on the train and in the adjacent clinic and write a report from a medical perspective. So, donning teal green scrubs, I hitched a ride on a remarkably sturdy horse cart and made my way to the train.

The facilities on the LLE train are incredible; not the high-tech you'll find at Cornell, but nonetheless, the train is fully equipped with a large operating theatre where 3 surgeries can be (and usually are) performed at once. The anesthesia machines are brand new, and the surgical equipment is meticulously sterilized by the half a dozen techs running around with tea and syringes. The actual process - from screening to surgery - is very organized; people show up with referrals from Impact's clinics, receive a pre-operative evaluation and medications in the makeshift hospital, and are operated on within 48 hours of arrival. After a short rest in the recovery train car, they are transported by an ambulance (ok, ok, 'ambulance' is used loosely here...) to the hospital for several days of recovery and post-operative medications. The LLE has computers, a lounge, kitchen, screening room, equipment hall... all incredibly impressive for a small train on rusty track in the middle of nowhere... i left in awe... until I got to the hospital.

During my afternoon on the surgical train, I met two great medical interns who were volunteering there for a week. After a few drinks I agreed to accompany them on their overnight shift at the hospital ward where these patients are kept prior to and after their surgeries. Arriving at the ward, the first thing I noticed was that it was not, in fact, a real hospital floor; the 'walls' were half-finished brick enclosures, the 'windows', open, vaguely barricaded gaps. The thin foam pads that passed for mattresses lay close together on the cold stone floor, as thousands of flies decorated nearly every available inch of space. No one had thought to put up mosquito nets... no one considered that the incredibly bright bulbs would attract even more flies and keep patients awake and itching... and, even more incredibly, no one had bothered to even attempt fixing the few fans dotting the ceiling.

As much as the structural problems bothered me, the enormity of the medical and logistical issues was much more concerning. First of all, there was absolutely no facility for emergency resuscitation - no crash cart, no intubation equipment, not even an epipen! The two interns were in charge of the entire ward (around 40 patients and their families), without any physician back-up; the closest doctors are the surgeons, sleeping soundly in a hotel about a 15 minute drive away. On an even more basic level, the IVs were terrible; they were single-valve (as opposed to the double-valve we normally use), which means that blood clots formed regularly in the valves and catheter, requiring patiens to be stuck multiple times, or even worse, leaving them without any venous access at all. While I was there, we had one child who had been vomiting and had swollen cheeks and oropharynx; his IV line was clotted and he wasn't able to drink fluids orally. Everyone agreed that there wasn't much to do except keep him head elevated (ha! with the one pillow??) and administer antibiotics intramuscularly... a rather sorry intervention considering in the US, this kid would be in a well-monitored pediatric bed. I know, i know... this is India... and not just India, but poor, rural India... and, yet, that explanation is just insufficient. As in many of the situations i've encountered, the changes needed aren't massive, expensive projects... they're simple interventions, like mosquito nets in the windows, a few fans, and some decent IVs. If Imapct is going to spend so much time and money providing these surgeries, they should also make sure that the post-operative care is adequate; I will write all of this in my report, and hope for at least a little change.

On a side note... as everyone knows, i'm a major softy when it comes to small, cuddly creatures... babies or animals ;). The hallways were filled with kids' crying, and they all just looked so small and sad lying there on the mats with bandages all over their faces... I had to do something. So, I went on a bit of an adventure in Rudrapur's bazaar... after several hours of wading through junk and mud, I haggled my way to three large bags of baby rattles, toy cars, and stuffed animals. I didn't have enough for every child, but the interns promised to buy additional toys before they left... these kinds of things don't make an enormous difference, but at least for a little while, the hallways resonated with rattling and laughter, and I could leave in peace.

I made my way to Nainital via two buses, a taxi, and a rickshaw... then climbed the steep hill to my little stone motel and went exploring. Nainital is incredible... it's like a little oasis in the north... a giant lake surrounded by trees and mountains, with small, intricately decorated Hindu temples nestled in the woods. The leafy streets are lined with small shops selling thick beaded shawls, spices, colorful bangles and impressive wooden and bamboo handicrafts. There's even a Tibetan market selling imported clothing and decorative statues from Nepal and Bhutan... and, yes, there's tons of great food, pastries, and a coffee shop that has quickly become my favorite place for a mid-afternoon break (what a life!). On my first night, I met a Scottish guy who's traveling through India for a few months... we spent the last two days hiking in the surrounding hills, rowing on the lake, and chatting about books and politics. Today, i'm meeting up with the two interns I was with in Rudrapur, and on Thursday i'm heading back to Delhi... and on to Darjeeling!!

It's been a wonderful week, and I promise to post photographs from the hospital and my travels once i'm back in Palghar... until then, I hope everyone is well... the fall colors here definetly remind me of October at home, so I miss you all!