John and I always talked about a medical mission trip, but never found the right fit. I envisioned one that would take us to remote corners of the world, climbing through mountains on donkeys. So when he said "Save these dates for a trip to India," my first reaction was, "Can we talk about this?"
The trip was timed poorly, I was worried about my mother's illness, being half a country away and unavailable, and didn't like the fact that it was in a crowded, dirty city. I envisioned a relaxing, beautiful trip to commemorate our 20th anniversary. So I wrote up my list of pros and cons, the cons won out, and we agreed not to go.
But I could see the disappointment in John's eyes and couldn't let go of it. I couldn't think of anything else we could do now, any trip we could take,
that wouldn't seem selfish and small.
I vowed to go with an open mind and get as much out of the trip as I could. Now that the decision was made, there must be some reason for my changed heart. I read "City of Joy" and a few other books that helped me prepare since I knew nothing about India. I got out CDs on Hindi, but grew disenchanted after 30 minutes of learning how to say "I speak a little Hindi" and "My, you speak Hindi well!" No-- I needed to know how to say "Do you speak English?" “I don’t speak Hindi!”, but the CD never got to that. I did, at least, learn the greeting, "Namaste" that I could use for both hello and goodbye.
As the plane tips down, my seat mate, a Canadian Indian, tells me not to bother looking out of the window. It is night time, but there is no skyline in Delhi. Inside, the airport has wisely designed a wall for greeters to stand behind so the incoming are not trampled to death. We feel like we are walking a crowded, slightly worn "red carpet," reading welcoming signs. Our hosts find us and tell us to hang tight to our bags.
John makes the mistake of letting his luggage get into the hands of a "helper"-- we are swarmed by help at our bus and don't know who is officially there to load our bags and who are airport opportunists-- he is urged to pay cash with an outstretched hand.
I watch every last piece to make sure it all gets into the bus.We drive to the guest house... it is not where we were told we were staying because like most things in India, prices are subject to change at last minute. Our hosts found another place that would honor the original quoted price.
Along the way we see people, literally everywhere. Almost all are men, which fits what I have read about Delhi. That it is not safe for a woman to walk the streets, especially at night, especially alone. Men are walking arm in arm, as they do here, some are sleeping on their bicycle rickshaws, others sleep on sidewalks, under highways, and any open space. I have already seen more people on the streets than I have probably seen all year en route to Careywood.
John and I are going to The Last Chance drug rehab on our first day where I have been asked to help "teach the community leaders." I am anxious because I don't know who the audience is, don't know what they need to know, don't speak Hindi, and have nothing prepared. At least I am slightly more comfortable with public speaking after a year of practice in a new job and a few
Toastmaster's meetings. But this is still way out of my comfort zone.Doreen, our fearless team leader, says not to worry, we will play it by ear, and she will support me in any way they can. Me? Am I in charge? I thought I was just there to support the others.
Oh well. I'll wing it. Allyson brought some visual aids about TB since we heard that there is a problem in the community with getting treatment. John is there as our "token male" since we are told that we will be better-received and with more respect if accompanied by a man. Rick and Clarke from My Global Family are there to offer support and fill us in on our setting.
We learn that Hindi time is like Native American time in our country, meaning there is little respect for the clock. We wait in a small air conditioned room (thank God), watch a few bugs crawl on the wall, and John is warned to remove his backpack from the floor unless he wants to bring home a few extra passengers.
We learn that most in the drug rehab are addicted to heroin and they are India's fortunate addicts. Most are there because their family could afford the monthly fee and there are thousands of others who will never have this opportunity to get clean. The pastor in charge of the rehab was addicted himself and started the rehab out of his own home with the help of his saintly wife. They have helped many and have about a 75% success rate--higher than any other in India they claim. They are seeking funds to open a rehab for women as well.
We eventually go to the basement, which is still holding in the moisture from the monsoon season. It is about as hot and humid, dank and dark as a basement can be. It is filled with 20 or more people, including a few women and children. A stage is set on the pulpit, and a microphone awaits the speakers. I thought we were just going to chat informally at a table, but apparently not.
Fortunately, an interpreter comes with the deal, and he takes my short five word sentences and stretches them into 5 minutes. So I have no idea what the audience is being taught, but at least we are killing good time. I sing the ABC's demonstrating timed hand washing and get a few laughs out of that. I ask for questions about their health concerns, and a few raise their hands.
John's reward for bringing me here is to get some time on the microphone. I ask him to talk to the people about the signs and symptoms of TB. We probably forgot a few key items, but it's all right. We spend some time helping men create posters showing signs of coughing, fevers, weight loss, and the need to take medicine. We hope they will share this with their respective communities, whatever and wherever they may be.
Meanwhile, Doreen instructs the others on clean water and vegetables, and time passes. Slowly, despite the fan.
We go back to the air conditioner and drink cold coca-cola, which will become my favorite beverage of the trip. John forgets we are not supposed to accept ice cubes from unknown sources, and we hope he will not live to regret his icy cold drink.
We wait, again in India-time, for the rest of our group. They are attending church and traffic, even on a Sunday, is bad. After awhile we switch to a plan B since we have promised a medical clinic and it will be midnight at this rate getting done. John and I set up shop in the basement, and give brief assessments and advice through interpreters. Most of the men seem fairly healthy. I learn the British word for hemorrhoids is "piles" and a few complain of that. Knowing this will come in handy for the rest of the trip.
Our group arrives, and together we eat what will soon become a very familiar sight-- rice, and "non-veg" with yellow curry sauce. "Non-veg" in India equals “chicken,” since beef is sacred and pork second best. We learned this on the plane where the steward asks each person "Veg or Non-veg" when passing trays. We looked so pathetically naiive and American, he made an exception for John and I and asked "Veg or Chicken?"
Back at the hotel, we are beat, but spend time counting and bagging up medicines for the next day.
The Burmese
Monday and Tuesday our clinic serves at one site, for the suburban areas of Vikas puri and Janak puri in Delhi. This proves to be one of the more heart-wrenching days of the trip. The Burmese have fled violence in their own country only to find an unwelcoming response in India. Indians will not hire them or cheat them out of pay— they see the Burmese as unneeded competition since so many Indians are starving themselves.
The Burmese live in a slum community that has sprung up next to a garbage dump. It smells, there are flies and rodents everywhere, and their basic sustenance is what they can scavenge from the dump. They know this is not normal, many had decent lives in their home country, and a few even can joke about the absurdity that is their new life.
You get the feeling from these bright and lovely people, if they were plopped down anywhere else in the world, they would lead productive, admirable lives.
The view from the clinic door is all rubbish. A clothesline hangs above. Pepsi cups have been cut into pieces and separated from the trash into a neat pile. We learn that logos are sold to an organization to create accessories. Pigs lay in a filthy trench, cows chew on the garbage, and a few stray chickens hide under a truck. We have a decent lunch with the church pastor who has invited us to hold this clinic (“non-veg”, rice and beans, plus coke and ice crème –yes!) We invite our interpreters who have to be cajoled into joining us; they are shy, modest people and eat in the kitchen together, seemingly intimidated by us. They are
impressive as translators because they have to make their way around several Burmese dialects.
My interpreter tells me her oldest child, 11, can’t go to school because they need her work to survive. She does some sewing and housecleaning, at rock bottom wages, no doubt. Younger children go to the church school and get rice and banana—the Global Family workers note how much the kids have changed since adding this one daily meal.
Many of the complaints from the 150 or more patients we see each day are of “stomach problems.” Inquire more and you find it is often heartburn, no appetite, and constipation. Ask what they eat, and it is rice, rice, and more rice. Very good treatment for loose bowels, not so good for regularity. Many of the adults weight 70-80 pounds. Children are gorgeous and round-faced, but many are sunken-eyed and thin. I counsel them to eat vegetables and beans when they can, and wonder if I should retrieve that perfectly good carrot from the pig I saw edging near it at the garbage pile.
We find several people who say they have been treated for TB, but still have symptoms. We learn from Dr. Mark, who has made many of these trips over the last 20 years and has a special interest in TB, that India does not follow recommended guidelines for TB, only providing one drug instead of the combination needed to prevent resistant strains. They also have red tape that makes it hard for people to get “free” treatment. They must come to DOT centers with a confirmed diagnosis, such as X-ray, and who can afford that?
Read more about the refugees here or here.
In the evening we walk to a mall, which in Delhi is an act of courage and faith. There are no pedestrian walkways, and to cross a busy 4-lane highway, you must be aware of bicycles, rickshaws, and motorized vehicles that will not stop for anything in their path. We watch and try to walk across with the locals, using them as our safety shield.
Zsolt has traveled India before so leads us home at break-neck speed through a crowd celebrating one of the Hindi holidays. We weave through cars, bikes and humans while a 7-foot-high God is mounted on a post and set afire. Fireworks are cracking, smoke burns the eyes and throat, and it is exhilarating, only once safely home.
Dinner in a nice restaurant one of the first nights is colored by overhearing from our host who has ordered the food that one item, presented as “chicken” or “non-veg” is actually dog. Another is monkey brains. I know she may be joking, but can’t eat anymore—the bones don’t look right for chicken, and stray dogs are all over the city, unneutered. One has to wonder also, why you see nary a cat. Outside the restaurant a family is living/sleeping on the sidewalk. Hopefully they get good dumpster diving after our meals. Tiny beggars run up to us, hip-height, and little hands slip into purses, quicker than you can blink. We’ve all managed to hold on, but it leaves some of us shaken, thinking about the desperate lives after our big meal. I’m sure they wouldn’t care if it was dog, cat, or orangutan meat.
Sangam Vihar Clinic- “The Day of the Rickshaw” 
Wednesday we are prepared for a difficult day. Pastor Koshy visited us the night before over Papa John’s pizza (Yes!) to tell us about the school he leads along with his lovely wife. She has a PhD in economics, he has a Masters in theology from Oxford, and they decided to move into one of the worst slums in the city. It is a “ragpicker” society where most make their living from whatever can be gotten from the garbage piles. He has a school of 400 or so children from the poorest of the poor, and they consider the school like the “The Taj Mahal.” They get two meals a day, often this is the only reason parents allow young ones to attend, otherwise they are needed to help pick through garbage piles.
We leave extra early, told we will try to avoid traffic, but this is not possible in Delhi. Traffic is everywhere all the time. We get off the bus, which is like a daily movie show as we drive past the hundreds of people, living by the road, bathing with pitchers of water and picking lice out of their children’s hair. We are assigned three to a ri
ckshaw because to get to the school there is one way in and a bus can’t travel. You must see it to believe it, and even then, you wonder if you imagined it. The road is bumpy, dusty and mobbed. Lanes of five or six go in every direction, with no order. Our three-wheeled rickshaw rides the bumper of the rickshaw in front of him – otherwise you lose your place and will be traveling at a constant, bumpy 1 mph rather than 2 mph. I am squeezed in the middle holding a clear Rubbermaid bin of medicines. Bicycles, pedestrians, small cars and the occasional SUV pass by. It is noisy, Indian drivers beep horns constantly for no apparent reason, and it reeks of fuel fumes. My eyes are burning, nose is filled with dust and smoke, and I am feeling claustrophobic.
At one point the driver hits a bike, then another rickshaw, and jumps out -- to see if he’s gotten a dent or maybe killed someone? No worries, but he decides after seeing the pace of the traffic it is a good time to stop for some chew. He leaves the motor to idle and walks up an alley, leaving us parked in the middle of this sea of grim-faced humanity. Take a ride here.
I start to think of the stories we were told the night before, how some in the neighborhood are against the Christian school we are visiting, that there have been death threats and bombings at other churches, and I wonder, “What am I doing here?!” Men stare constantly, I am feeling uncomfortable from hostile gazes, then I look to the right. My question is answered. There is a rickshaw coming the opposite direction, with a young boy, his sister and their mother. The boy sees me and his face 
lights up with a smile. He nudges his sister and I wave. He waves back excitedly, smile growing bigger. I imagine he is about as excited as if he has just seen Julia Roberts (who by the way is in Delhi while we are, filming “Eat, Love, Pray.”)
Such a simple thing, to bring his day some light.
In just a few more minutes we turn off of the crazy mobbed road and onto a quiet lane. We arrive at the clinic site—a newly renovated building which will be used to house rescued children in deepest need. It is a block from the school so the students will walk, amongst cows and discarded garbage, to see us.
I have been given the privilege of the basement assignment with our one Hindi-speaking physician. The other two doctors and nurses will see community members upstairs, while we see the school children. The children line up with some direction, more orderly than Samantha, our basement gate-keeper, has feared, and there are lots of smiles. 
The children tell Dr. Mahdu they want to be doctors, teachers, and pilots when they grow up and she tells them to study. She tells the girls they must sit up straight and walk with pride if they want to reach their goals. She is a wonderful, warm role model and I can’t help but wonder how many lives she changed that day.
With me—they just stare and giggle and seem tongue-tied. I can barely get a “Namaste” back—but they take their wormer medicine and one does reply to my questions of how he is today with a “Fine, mamm” -- in perfect English.
I am struck by how different they appear in health than the Burmese children yesterday. They are full and smiling, no obesity mind you, but appear well. About 90 percent get a “well child” comment on the doctor’s report. A few have runny noses, wounds that won’t heal, or coughs. I surmise their good health is due to the simple addition of beans.
Dr. Mahdu and I walk to the school with the medicines prescribed to some of the children and I listen to her talk to inspire the teachers. Though I don’t speak Hindi (yet) she throws in just enough English so I know she is telling them about the children’s dreams and how they are the ones who can encourage these dreams to fruition. Like most Indian women,
even the poorest of poor, the teachers are impeccably dressed in saris and shalwar kameeze.
The school truly is a “Taj Mahal” by any standards. It is three-stories high, marble floors, and a roof top terrace where I can imagine a garden one day. We eat what the children eat, rice, beans, non-veg (chicken!) and it is good. We see a class learning to sew, a computer lab and we sit at the brightly painted desks. I see hope for India's future in these children. If the Koshy's continue their work and enrollment can grow, perhaps there will be a new generation who can improve the dismal conditions.
Outside, across the street, we can see cows grazing on garbage and the peanut shells from an operation going on next to the school. A rustic piece of machinery is shelling peanuts. Like most machinery we’ve seen in India, it looks old and crude. Most jobs are manned by twice as many people as the US would use, and little sophisticated equipment. This is what happens when you have an abundance of manpower, and little else. At least two men drive every bus—one to drive, one to load-- and road gravel is made by bashing rocks together with one’s hands.
Papan Kilan Clinic 
Thursday we are told this is an area of widows and children. Widows are ostracized in Indian culture and have difficulty finding help. John and I have the best interpreters at our triage table this day, who work fast enough for me to spend time asking about their lives. One has a Masters degree in history, but can’t find a job. We tell her is would probably be no different in America. The other has a high school education and works as a domestic for a Spanish family. Her husband works in a call center, so they are fortunate. She complains of shoulder pain, probably from her manual labor. I ask if anyone in India exercises or does yoga, she laughs and says she wouldn’t have time for that. She has two small children and pays someone to care for them while she’s away. In India, all but the lowest classes usually have help in the home, beca
use labor is so available and cheap. She has come to help today, forfeiting her day’s wages, because she saw the group last year when they held the clinic and felt inspired to help.
This is what I come to feel is one of the real values of our visit. Not that we can change India, but that we can model for others in the country, especially the children, how to lend a helping hand. Also, we are lending credibility to the pastors so they can gain respect in their community, and hopefully, reduce some of the animosity. They are all doing noble, important work.
Our table sits under a broken fan, no doubt a victim of "Indian wiring," so we have flies collecting on our chairs and arms all day. Note 
to self-- next time, bring more bug spray. The memorable patients this day include a young boy who has injured his fingers on a firecracker. Probably from the holiday celebrations a few days ago. He was lucky he did not blow off his hand. His torn skin is covered by a dusty old rag. We give antibiotics, treat with clean bandaids and send home instructions. He will likely be fine. His older sister, maybe 12?, takes the bandaids and guards them safely in her pocket.
Another man has cracked his patella after a fall. He brings X-rays and reports from the hospital, but doesn’t feel he is getting better. He asks to be well in a week so he can return to work. Dr.Sai-ling re-wraps and advises, it will take more than a week. He likely needed surgery and did not receive the proper care.
Evenings and meals run together, but there was time to don hair-nets and take an impromptu tour of the KFC 
(manager wanted to impress us with their technology and the separate veg, non- veg sections of the restaurant), and an evening of shopping for handmade wares. It was too stressful and time-consuming to bargain. We were advised to never pay first price-- next time, I will just pay and forget about it. Mornings come early, up at about 4 am, and spent reading newspapers and laughing at the ads for Mcdonald’s Maharaji burger (the non-veg equivalent to Big Mac), available with delivery—via rickshaw no doubt.
Final clinic day- Yamuna Vihar Clinic
We are told that this church is located in one of the worst parts of the city for crime. The pastor followed his heart and arrived from northern India, knowing no one. He has built up his congregation to about 100, but his meeting space is so small he must run three services each Sunday. This is our first outdoor clinic and we sit partially shaded under a tent.
En route we see people who I come to view as the “water people.” 
They seem slightly more fortunate to me than those in Delhi center because there are several water bodies twisting and turning and at least they have whatever can be provided from waters. There are again lots of large rubbish piles with adults and small children picking through them. The sidewalk is sectioned off in perhaps 8-by-8 foot sections of “homes” where we see mothers washing children; some have rooftops, others open to the air. Along the highway we pass a loaded up elephant. First time we’ve seen that mode of transportation, and it seems to fit in with all the other absurdities. 
It is Mahatma Gandi’s birthday today, a national holiday, so many services are closed. We drive through some beautiful areas of the city, and it’s the first time we’ve seen neat, clean, tree-lined streets. We see the historic wall made of red sandstone and the capital buildings in the distance. It is also the first time we see a “soup kitchen,” which are few and far between in India. Men sit lined up on the curb and are each served one yellow slab of flatbread. 
At the clinic we experience what we are told is more of a “typical” day than the peaceful days we’ve had all week. There is an attempt by some locals to take over the clinic by pushing “important” people to the front of the line. Many demand to see the Hindi-speaking doctor, or the Asian doctor. They are not usually given a choice, but the triage nurses try to steer patients to the doctor we think will be a good fit.
A man in white clothes sneaks through the back entrance and shows up at John’s table showing his identification. It is apparent he is the local “mayor” and he wants his time with the doctor, too. He is politely escorted to the line and assigned a number after several conversations through translators.
Memorable patients include a 101-year-old man who has some arthritic pain, but otherwise looks healthy, well-nourished and strong. I don’t believe the age and ask the interpreter to reconfirm. I check his blood pressure and tell him it is like a young man’s. He bows his head is a modest show of thanks, and stands over me, placing his hands on my head. The interpreter tells me he has blessed me to have a long life, just as his, with health and prosperity.
My interpreter, Hau Pu, is one of the Global Family team and has enjoyed this day with me, instead of the more difficult task he’s had before of crowd control. Firecrackers start to go off as the people push at the closed gate and more young men sit on the wall by our entrance. There is nothing to hold them back except our “registration director,” Nick, who is armored with only one unwavering smile. 
I am reminded of the day’s newspaper and a story about schoolchildren who were trampled to death in a nearby school riot. It is a nervous time when we start to think about ending the day and turning folks away. We are told to discreetly pack up our triage stations and head to the bus. We sneak out the back in teams of three, hop over a fence and wait for the rest of the team.
Many of my patients that day have hypertension and complain of feeling scared and nervous. One man says ever since a cycle accident he can’t relax, and it seems he is suffering from some PTSD. Or perhaps he is just normal, as I would be nervous driving their roads, too. I ask if he has anyone to talk to about his fears and he says no. I admire his courage in admitting this weakness to me, and tell him he must find people he trusts to talk to- perhaps the pastor here. I make a future goal to try to find help for these people from the local medical community –maybe some would visit the church, check blood pressures, counsel, and educate?
On the bus, a crowd of children has formed and are taking delight in waving to us. We get out our cameras and the cheers and crowds grow. They are simply adorable, but Ricky tells us to shut the curtains and not incite a riot. He’s been through this before, and we trust that he knows. 
But I still have my pictures of the faces, the joy, the bright spot in their day, which is all I really hoped to accomplish on this trip. I didn’t expect the bashful smiles and nods from the forgotten elderly, and the new friends made of the mission team.
At home
I didn’t want to go to India, in part, because everyone promised me a “life-changing experience” and I was pretty satisfied with my life. But the movies that keep running through my head, confusing me about whether I am awake or asleep, have certainly enriched my life.
John says he wishes he had done this when he was 20, because his life would have been “much different.” I imagine that everyone should have the privilege of seeing first-hand how a large portion of the world is living, so we are not so caught up in our daily anxieties and frustrations. They seem ridiculous when you have a roof over your head, a bed to sleep in, and food.
Winter is looming with snow on Idaho's mountain tops. We will soon forget the humidity and heat that was India, yet we still have the smell of Delhi lingering on our shoes and in our suitcase. We talk about moving some Burmese refugees into our basement, and finding a way to provide the slum children some beans. Certainly, we will do this sort of trip again, because although it was not relaxing, and despite the heat, smells, dirt, and bugs, it felt like a “vacation” anyway.
“Vacation” comes from the Latin vacatio, meaning freedom or exemption. This trip allowed us to free ourselves from the daily routine, enter another worldview, and experience ourselves in a new setting. The assessments, planning and education that are usual nursing care may be no different, whether in Delhi or Idaho, but the people and their circumstances are surely not the same. 
I leave with no pity for the Indian people, because for all their hardships, they have togetherness, love for their families, and perhaps some blessings we can never know without walking in their sandles. Where there is great need, there is also great opportunity, and maybe that is the purpose of these descendents of our most ancient people, who are believed to have walked the earth tens of thousands of years ago. They can teach us to open our hearts, care for our fellow humans, and reap the rewards of that privilege.
http://www.myglobalfamily.org/
