Working in India

A few words about what we’re actually doing here other than setting up food and shelter (…stay tuned for “clothing”). The primary reason for our temporary move is my research project as part of Gastroenterology fellowship. I’m studying treatment for dehydration from diarrhea. Specifically, I’m conducting a clinical trial to establish the efficacy of a variant of the standard (World Health Organization’s) oral rehydration therapy for acute diarrhea in infants and young children.

It’s business for me, very cut and dry, but I have developed the awareness of all gastroenterologists that we’re filed by the masses somewhere between doctor and leper terrain. Leper to our peers -- “ha ha ha colonoscopy” – but champion to the older folk, who look at me with knowing smiles and probing glances when they learn what I do.

The setting is Christian Medical College (CMC) Hospital, founded by an American missionary 100 years ago. They adore her like a deity; her stern face floats in the sky in weird photoshopped pictures of the hospital campus. It is one of the most reputable hospitals in the country for its research and tertiary-level care, offering advanced procedures such as organ transplantation. You would never know it from its physical plant. It is a maze of concrete block buildings without any pretense or fancy finishes –often no finishes whatsoever! The nurses wear white saris and antebellum white paper nurse hats, the open wards with concret floors and iron beds have a retro feel as well. The city has emerged because of the hospital’s existence, and it is situated otherwise in a rural, agricultural area dotted with small villages (thatch-roof, clay huts, no electricity) that provides much of the patient base. However, given its excellent reputation and charitable care, patients flood in from as far as Kolkatta and West Bengal. After traveling sometimes days to get here and often selling their livestock (cliché but common) for cash, they line the floors of the open corridors – sleeping, eating off of banana leaves -- waiting to be seen.

My trial is about to kick off; I hope then things will settle down and I can focus more on clinical work. It’s hard to describe what I’ve been doing on a daily basis, but so far it’s been less intellectual and more sweat equity going into the project. Let me give you an idea. Perhaps I should have known, but I didn’t, that the hospital does not supply diapers for infants. They’re not used here, due to the expense and/or the heat; babies are carried around bottomless and do their business wherever. Even infants with diarrhea – no diapers of any kind provided or used by the hospital. I need them for the study, so I ran around to the purchasing department, the main pharmacy with no leads – they have never bought diapers and knew of no suppliers. I was dumbfounded. No one knew where and how to buy diapers. So I ended up visiting the city pharmacies, where diapers are held in glass cases, to study the options and perhaps purchase through them.

Other misadventures include looking for an infantometer, a simple device used to measure infant length, that I again assumed was a matter of fact item. After visiting countless doctors and nurses in different departments looking for one, asking where I can obtain one, and taking pictures of a Galileo-era prototype, I finally settled on having one made. The options were a group of lepers who are enabled by the hospital to make and sell crafts, or a local carpenter. Purely due to logistics (would have loved to have custom leper-made infantometers) I had a man in a moped from the carpenter’s shop meet me halfway so that he could lead my auto-rickshaw driver through a maze of back-alleys and shacks to the carpenter’s shed, where I haggled for the right price to have infantometers made.

Last scenario – printing and Xeroxing. A heroic feat here, and I urge you all after reading this to take your printers and copiers aside and tell them tenderly how much they mean to you. First step, find a computer that has a USB port that will read your flash drive AND is hooked up to a printer (usually one per department), guarded by the department secretary. Make one copy only; if you need multiple copies, even one more, get it Xeroxed, as it is cheaper for the ink. If the department’s Xerox machine operator is on coffee break, which is a certainty, and despite the copier being in front of you and possessing the skills to use it, go to the hospital library and its Xerox man, have him copy one page at a time (collating? Bah!), wait for him to write a bill in his ledger, take the bill to the cashier to pay in cash and have him write the bill number in his ledger, receive a receipt from him, bring back receipt to Xerox man and have him write the receipt number in his ledger. And voila! You now have 2 sheets of paper!

So at the end of the day, having worked tirelessly, I have to stop myself from thinking in U.S. terms what I’ve accomplished. It is too demoralizing to think that the fruits of my day’s haggling, insisting, pleading, hunting, improvising, could have been accomplished in our Garden of Eden in an hour’s time with a phone call, a few clicks of a mouse, and definitely less sweating.

Alex speaks…

Before our departure, I was given some vague inkling of what help I could offer to the Christian Medical College Hospital. There was talk of expanding to a new campus, but the e-mails I received from the director were so politely circuitous that I thought that maybe he just wanted me to feel like there was a place for me in Vellore. Honestly, I wasn’t expecting much, and the thought of helping Jeeyung with her study excited me. Who wouldn’t be excited about weighing dirty diapers?

The reality here is that they are in dire need of expansion. As a private hospital they not only service the local clientele, but even folks from West Bengal (northern province by Bangladesh) will hop on a train to get surgery. Indeed, this is medical tourism Indian style, but unfortunately CMC struggles daily to absorb these patients financially as well as spatially. International medical tourism is also a hot topic at the moment. For months now a CMC committee has been exploring the possibilities for growth, and I have landed somewhere in the middle of this inquiry. Although I possess some general knowledge about hospitals, Jeeyung has been instrumental in imparting details about western medicine. My hope is to execute a comprehensive study of their present and future needs as well as help them work with an Indian planner and architect to realize their project. Weekly, we have presentation meetings before the doctors to outline how the process is developing. Unfortunately, these don’t always go down as smoothly as the local gulab jamon. The doctors are passionate about their work and the history of this missionary hospital. The thought of even relocating some of the specialties to another campus met with vehement cries of, “Man, how will our teams be able to cover multiple campuses?” Inserting “Man” sometimes means “You’re full of shit!” Fortunately, I have not been on the receiving end of these remarks, but I am not sure what they think of the pale white guy in the corner with a sketchbook. Hopefully after several presentations, we can have a more productive dialogue.

On the practical side, they have given me a temporary work station in the department of Engineering. At first, I was really excited imagining this technical panacea with high speed internet and flat screen monitors. After having read The World is Flat, I was conditioned to think that although the physical infrastructure was still developing the IT world was flourishing in India. Well, here’s the reality. Engineering Department get’s dial-up, and out of 25 or so computers only the boss-man gets internet connection. Even when I tried to check my e-mail for business purposes the connection failed, so I walked to the other side of campus just to access the internet. Despite these failings, it is nice to have a place to belong. I am excessively polite because I am a pathetic engineer, and I want them to like me. Perhaps we can learn from each other. They will teach me about forces and I will show them how not to swing a door into a toilet. Design mishaps like this happen all over CMC.