CMC - Day Twelve

Ascending the numerical ladder of departmental divisions I started this morning my one week with Child Health III. This team, headed by the departmental chair, Dr. Prabakhar Moses, focuses on general pediatrics and asthma. Today is their clinic day and so i spent most of the day sitting on a stool next to Dr. Prabakhar as children were paraded before us with this and that typical complaint: fevers, wheezes, and rashes, oh my! For the most part, Dr. Prabakhar, as the senior physician on the team, sees the private patients, i.e., those willing to pay more for the privelage of being seen by the most experienced eyes. I saw for the first time Indian children in western diapers. Most children of diaper-wearing age come to us with a string around the waste, to ward off evil spirits, and a bottom and front liberated from the constraints of western waste management. If they pee or poop, what cannot be contained goes everywhere. So be it. Mother's change clothes, or, perhaps, invert their saris and life goes on. No cloth diapers to wash. No plastic diapers to buy. I'm told that as a consequence of this arrangment, parents become more in tune with when a child is likely to go and children are more quickly potty trained. This makes sense. In fact, before i left i saw a report on TV talking about parents starting to potty train their babies as early as 6 months, or before, simply by learning to understand better the baby's tells, if you will. They learn to know when the baby is bluffing and when he's gonna lay down a straight flush.

I witnessed today that overprotective parents are everywhere, particularly if they have only one child to protect. Little Suraj, 6 years old, came in with a distant history of febrile seizures. In the past week he'd had temperatures faithfully recorded as follows: 98.2, 98.5, 97.9, 98.6, 98.8 and all the way up to 99.5. Of course they gave two teaspoons of triaminic with every recording. I nearly laughed out loud. He read them off as if the child was on a pyrectic path to an early grave. All the while, happy little Suraj sat in his hot pink shirt quietly listening to the proceeding. "Do you have any other concerns?" Dr. Prabakhar asked. "Yes, sir." His teacher says he had difficulty concentrating in school. He's always up out of his desk, being loud, playing with others. He's not studying well at home." I looked at his chart to confirm that the child was still 6 years old. Yep. Other concerns? "Yes, sir. Do you think it's possible he could have TB?" Huh?! Suraj's father was the owner of a guest house for CMC patients and had occasional guests being treated for TB. Suraj liked to play with the guests. "Well, i suppose it's possible..." Anything's possible. "We can do a Mantoux," the very sensitive skin test used to identify TB antibodies. So this child left with the prescription for another bottle of Triaminic, a slip for a trip to room 8 (the procedure room) for placement of the Mantoux, a referal to a child psychiatrist, and my sympathies for being so precious.

As the morning progressed, and the caffiene from my break-time coffee wore off, i started to daydream of the various characters, most of them beggars, that I see on my way to and from the hospital. There's the child who always seems to find me just after lunch and follows me to the hospital gate, tugging at my trousers, his other hand held out in a cup, which he would bring towards his face in a gesture of feeding. He is chatty and smily as he tugs away, sent by his mother who watches from across the street. And yet, as i reach the gate of the hospital, with its baton weilding guard dressed in blues, the boy his gone. There is the man who sits on the Gandhi road near the paper (bike) stand and holds out his half fingers, the tips taken by leprosy. He has a salt and pepper beard, grown wild and long, and a kind face. Occasionally i drop a rupee in the remains of his hand. There seem to be a gang of wrinkled and short old women who hold out their hands and make the same gesture as the child, moaning and gesturing louder and faster when a white face goes by. "Baba, baba," and as i pass, "BABA!!" Baba means father and is a term of respect and endearment. I wonder every day why the color of my skin makes them blind to my youth. That one becomes "father", respected, because of circumstances out of one's control is unsettling. I pass them by. There's a boy i see occasionally who has, in place of legs, a small wooden board with wheels, that he pushes along. His outstretched hand is accompanied by the biggest grin. In contrast to the old women, he doesn't ask for pity, only money. He says with his eyes: "Check this out. Bad luck, eh? Can you help a brother out?" And i do. There are those that do not beg. One women i see every day, her hair matted into brown, dusty discs that hang suspended unevenly aside her ageless face. She dresses in once bright rags now the colour of dust. Her lips are the brightest red, not from lipstick, but from skin condition that i cannot identify. She looks, with her blank look, alternatively, lost and knowing. She take five steps one directions. Stops. Turns around and walks ten in the other direction. Stops. What can she be thinking? A man who could be her brother wanders the streets in a similar manner, asking nothing of anyone, just observing, actively. I wonder how they survive. There are times when there trajectory seems sure to collide with mine, when i expect an outstretched hand, and when i get not even a look, as these ghosts of the street blow by, inches away.

It's difficult to know how to respond to the beggars that are such a feature of daily Indian life. Do you refuse money to all, on the principle that reinforcing their begging only makes them more dependent? Some do. I have my own policy: I'll put aside a few rupees a day to give to those who seem truly in need and ask not just of me, but of everyone, including Indians. Those that single out westerners on account of the color of their skin will remain off my payroll. Each of us has to make our own rules, to find our own balance in a world where abject poverty abuts obvious, if only relative, wealth.

There is an old man who sits at the tea shop of my favorite chai wallah, and the young boy that accompanies him. He sports a trim goatee, a faded green and blue plaid dhoti, a white cast on his leg, and a look of sorrow. The first time i met him i offered to buy him a tea. At first he refused; then he accepted. He didn't thank me at the time and that really didn't matter. I saw him a few days later, sitting on a stone step, and he reached out his hand to me, asking for a cigarette. I indicated that i had none. Then he made a cup of his hand and waved it up and down towards his face. He was asking me for money. I indicated that i had none and continued on. I couldn't help but feel a little disappointed. It seemed so, i don't know...ungrateful...cheeky. A few steps on I chuckled to myself. Their are things about the economics of an Indian street that i will never understand and that this community of urchins and beggars probably wish they didn't have to.

Funny the contrast between the wealthy getting all the care they don't need and the poor getting none of the care that they do. Medicine - its infrastructure and practitioners - needs to reach out into the community, to help people like these. From inside the high walls of CMC, and many other hospitals around the world, you can't even see them.

justin