Leah’s Blog

Question and Answer Time

     I apologize. I am officially horrible at blogging; or rather the keeping up part of blogging. All the same, I thought that those of you who diligently planted my blog in your reader deserved more of a finale than a mere blank page. In all honesty, I think I’ve refrained from summing up my stint in New Delhi because that would mean admitting that my time there is up; that I am indeed back at work in the States, where on my first day back I was oriented to the new ipads we have for every patient room and the sizable bonus received in the midst of a national recession. This, while the memory is still warm of my patients in the slums of New Delhi who died, unable to afford an abdominal ultrasound. Welcome back to the U.S., Leah.

My time in Delhi was filled with an array of questions. These questions initially stemmed from seeds of misunderstanding and frustration. Questions, such as, “Don’t they know that pigs are filthy creatures and should not be allowed to poop in front of the grocery store?” and “Is there nothing in this city without dirt embedded into it’s fibers?” and “If they have six faucets in the bathroom, why can’t at least one have running water?” Then, after a couple of weeks, the questions transitioned into ones of intrigue and concern. Questions, such as, “Why can’t the government see far enough ahead to provide better ART?” and “Why exactly does the stigma of AIDS still brood so strongly that hospitals turn patients away simply because they have HIV?” After a few more weeks, the questions transitioned even further to those of proactive fervor. Questions, such as, “What needs to be done within this system so that patients receive adequate care?” and “How can I do what needs to be done?”

Italo Calvino mentions in his book, Invisible Cities, that the beauty of a city lies in the question it asks of you, or the answer it gives to a question you are asking. I asked many questions of Delhi, but my experience gave me a single answer. An answer to a question I have bee asking for some time, “Is there any rhyme or connection to the seemingly random tangents of my life’s interests?” My answer came in a moment on my last day at Shalom Delhi clinic. I was sitting at my computer in a 6′x6′ office with 2 other staff in100 degrees and 60% humidity without A/C or windows; sweat pouring down my back as I drank in the sweet, milky afternoon chai and finished writing a training module; all while listening to the soothing sounds of Bob Dylan streaming from the laptop of the Australian lawyer sitting behind me… and I just had this overwhelming sense that “this feels so right.” In that moment, somehow, all the other questions became inconsequential, and I knew that this is what I wanted to do with my life. All the random tangential streams seemed to merge into one river: international development. Infectious Disease, women’s health, HIV, marginalized populations, trauma, travel, adventure, mercy, encouragement… they all flowed into the same channel… and my question was answered.

I was sad to say goodbye to this place that revealed to me such an epiphany… but I hold tight to the memories it gave me and those I was privileged to meet: Dr. Saira and Dr. Savita, who make an accurate diagnosis using only deduction and intuition, as labs and diagnostics are scarce resources; The beautiful family that walked from the slums, sans shoes, ill and malnourished, but with the warmest smiles of pride when they looked onto their children being screened for dengue; the strength of the widow who cared for her abusive husband until his death at Shalom, never once showing anything but grace and love for him, and daily greeting me with the kindest, “Namaste. Good morning”; the tiny HIV positive boy, 12 years old but appearing much, much younger, who for days wouldn’t look us in the eye, until he began to improve with treatment and suddenly… laughter was heard from his bedside and our eyes were met with his smiling back at us.

In the midst of the beauty, the bittersweetness that is Delhi insisted on showing it’s face as well: The alcoholic patient I previously mentioned passed away. A total of 7 patients passed away in the 5 weeks I spent at Shalom. And, as hard as I tried, I couldn’t help but think of how they might still be with us, had they been treated in the States… or even in India, only with money and without stigma of HIV. But, you rejoice that they are no longer in pain; and that their families are relieved of the responsibility of using their scant finances to feed and care for them. And, you rejoice that there is such a place as Shalom; a place to house and hold these marginalized patients with nowhere else to turn. And while I know that not all of the questions Delhi begs to be asked with be answered quickly; it remains a place of hope and shalom… a place where at least some questions are indeed answered.

2nd week in Delhi-Land

2nd week in Delhi. Culture shock is beginning to wear off. But, the need to drink in all the sights, smells and sounds that are around me is heightening. I love being in such a hospitable place with such friendly people. The invites for dinner, movies and of course, lots of tea are always extended. Makes the discomfort more comfortable. The clinic has become one my favorite elements of Delhi. The presence of God in that place is undoubted. I’m even beginning to grow used to the thin, emaciated patients. (Is that bad?) Although, the sight still breaks my heart. Seeing more HIV than I ever have at home. And probably more actual AIDS cases than I ever will. 2 patients passed away last week. They said, even now with treatment for HIV, if I’m here long enough you begin to see patients die.

A 1.5 year old boy came in this week. He was HIV positive. His liver and spleen were enlarged, but he was doing okay at this point. His father had died 3 months earlier of AIDS.  His mother also has AIDS and had just been started on ART. He would point to the sky and say his dad was up there. I can’t imagine being that mother or child. Another patient is in the ward, although not doing well. She’s a former alcoholic, has AIDS and with minimal support from family, was found on the streets. She’s emaciated, weak and dehydrated. She was brought to a government hospital and given a quick glance over and released. How they could release her, I can’t grasp as she needs surgery, has an infection and cant even stand due to malnutrition and dehydration. But, she has AIDS and apparently the stigma still stands here to some extent. This is the reason it is so good that such a thing as Shalom clinic exists… to house and hold these patients that society still cant quite accept, even though Shalom lacks so many resources I take for granted at home. (I’m longing daily for gloves, antiseptic soap, caviwipes… and definitely clorox!) But, the beauty of Delhi is unfolding itself to me amid the hot, dirty, loud, garbage filled streets. So, with 2.5 weeks left, I’ll try to take in all I can from it. But only a little at a time, please.

Welcome to Shalom Delhi Clinic

4 days in Delhi so far, and my first go at blogging. Garbage strewn streets littered with cows and kids, both digging through the piles side by side in search of valuables. The endless honking in the streets. The dirt and grime of the city that somehow extends up every wall. (I want to whitewash, clorox and then lysol everything so badly!!!). Welcome to Delhi.The poverty is remarkable, and the normalcy that that poverty holds here is astounding. I had to just come home and cry.

Saw an HIV + man (a drug user) come in to the clinic with his leg wrapped in a cloth. When he unwrapped it, it was gangrenous and necrotic to the bone, extending from upper thigh to ankle. All the tissue was gone. It had been that way for a year and he was just now seeking treatment. We sent him to the hospital for surgical debridement and likely amputation. When a patient like that comes to the hospital in the States, we question so much why they would let it go that long. Here, there was no questioning. Saw a newborn, 3 days old, who hadn’t been fed yet as the mother was HIV + and had decided not to breastfeed. They were just seeking assistance with money for milk 3 days later. The baby was so still, thin and so quiet. It made my heart sink. I had a glimpse of hope though, when Dr Savita prayed over the baby. It made me know then that there are excellent hearts and minds looking out for these people. She gave them money for milk and taught them how to feed the baby.

The state of HIV as well here is amazing to me. In the States, we rarely see a patient with an actual AIDS diagnosis now. Here… the majority of patients seen have AIDS as they don’t begin ART treatment until the AIDS stage. So, the majority of patients are not only impoverished at a level not seen in the States, but they are emaciated with AIDS defining illnesses. Sunken faces abound, skin and bones and vacant eyes for some. From working in homeless clinics in Hollywood to here… the poverty we see in the US doesn’t hold a candle. Here, it is simply the way of being for so many. The local staff simply smile at me and say, “Welcome to India.” Someone told me that the state of things has actually improved. A few years back, before ART was given freely by the gov’t of India, not a day would go by without wrapping up bodies of AIDS victims at the clinic. I thought that I was capable of handling trauma so well after working in critical care and a trauma ICU for years. The gunshot victims and patients run over by trucks at home don’t phase or traumatize me. But this… it’s just a whole other level. I think that’s the hardest part. The trauma of seeing this level of poverty and AIDS, and then having it seem so normal to everyone around me. It’s a bit much.

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