The Work Commences

12/29
Finally, our work was to begin after a full day of rest. But first we had to get to the slum, situated in the far reaches of North Kolkata. Our journey was not without characteristic delays of Kolkata. We were halted in traffic in the middle of a highway for at least 30 minutes because of a protest. I don’t know what it was about, but I’m sure Mamata Banerjee, railway queen and controversial leader of the opposition to West Bengal’s ruling communist government, played some role in it. From the back of our ambulance as we were stopped, we could see drivers stepping out of their car, chatting, stretching, and cleaning their dashboards (as if that would do anything to prevent the dust particles from returning immediately from the polluted air). We saw no signs of exasperation on their faces, as if they knew all of this was coming and they were perfectly fine with this kind of delay. What would happen if a group of protestors went on I-95 (or insert local highway) and exercised their First Amendment rights to a degree that would halt traffic in such a prolonged manner?
After guiding through the roads of Kolkata with the help of our ambulance siren, and stopping briefly at Turja’s paternal house for some refreshments, we finally arrived at Rajabagan Basti (slum). Situated near the sacred Dakshineswar Kali Temple and Ganges River, this is one of North Kolkata’s most diverse and dense slums.
When we stepped off the ambulance, the tension was palpable. Some of us were snapping photos immediately, others (including myself) were taking the environment in through simple observation; on the other side, the slum residents were looking at us quizzically even though you could tell they were expecting us for some time. At the same time, neither of us knew the other party’s next move. We were finally here to do what we came for, but frankly, I’m not sure we were in the state of mind to get to work right at that moment. Thankfully, the initial confusion was settled promptly as community leaders gave us a much needed tour that would acclimate us to our new environment nicely. As we walked through what was the main thoroughfare of the slum, most of the residents paused their activity, whether it was a simple game of dice or daily collection of water from the local pipe, to stare at us. The community leaders made it a point for us to enter the mosque, and seemed to have no problem with us interrupting the lesson of the children that was going on in the madrassa (but no shoes allowed, Mike Karp!). About 100 meters from the site of the mosque stood a Hindu temple! If you know me, this sort of juxtaposition gets me going. My hesitancy with both my mothertongue languages went out the window and I scampered over to the community leaders and fired away my questions in whatever broken Hindi and Bengali I could manage. I learned that the slum had a very mixed population of Biharis (from the state of Bihar) and Bengalis, and a Hindu-Muslim ratio of about 1:1. They lived together, however, and were not as segregated as I had anticipated. Behind the temple stood what was the public bathroom and latrine, which looked like a pond of green muck.
After our tour, it was time to work. We set up shop in what’s known as the slum “clubhouse” which was actually a dark room 15x15 with a small photo of Netaji at the back of the wall. We gave tickets to the first 80 patients who showed up seeking medical attention, telling them to come back at 5 pm. We recorded their name, sex, age, and reason for visit on our fancy Mac computers. After the tables and chairs and the doctors arrived, we set everything up and got going. We had three tables inside equipped with 2 medical assistants (us), a translator, and a doctor each. Outside we had two Pratit members giving out medications that the doctors were prescribing and another member with the laptop checking off each patient and making sure they had the registration slip we gave out earlier (surprisingly they all kept their slips!). At the medication table, we also had a supply of food packets, consisting of bananas, cake, and an egg, which we gave to the patients at the end of their visit. I was with Kalyan and Dr. Banerjee for most of the evening, who is the doctor out of the three with an expertise in clinical research. At first, I thought he was being too lax, prescribing whatever medicines matched the symptoms the patients were reporting, but I quickly realized that this was a function of his experience working in such high density settings and not of a lack of expertise in diagnosis. As medical assistants, our job was two-fold: doing clinical questioning and conducting a thorough physical examination based on chief complaints. The physical examination was a challenge for me mainly because I was not sure whether doing a thorough exam was even necessary given our time crunch. Doing the clinical questioning while Kal was doing the physical exam gave me more power and opportunity to learn from Dr. Banerjee regarding what he was prescribing for the patients’ ailments. We saw a lot of patients with nutritional deficiencies, which Banerjee gauged from the BMI using the height and weight of the patient we measured initially. Many of the elder patients had cataracts and skin disease such as scalp psoriasis and fungal and bacterial infections due to lack of clean water, while many of the children were malnourished. One girl came in with a retinal disorder that resulted in partial blindness and converging of the pupils. All Dr. Banerjee could prescribe was vitamins to help her wiry frame, but we could do nothing for her main problem. Towards the end of the day, an old man came in with a cataract and also high blood pressure (around 170/110). Given the eye problem and high blood pressure, here was someone who could have been a diabetic. We administered the blood glucose test but his reading was 89mg/dL which is within normal. Turns out the cataract was just due to senility. This was my first chance to experience the diagnostic process to its fullest. Our three hours were up, and it was already dark outside. The doctors had to leave and we proceeded shortly. We said our goodbyes and said would be there next week. As we were leaving, an old woman with a deformed foot was pleading that I help her now, but we simply did not have the means or the time, so I hope my promise that we would come back next week sufficed. Next time, I think we should make sure that the patients of most need are seen first.