By Lara Vogel
Though meant as a break from the hectic pace of my eight-month trip around the world, it had been an intense few weeks. Leaving Europe and Northern Africa behind, I spent July in Mumbai exploring its hospitals to help decide if I had what it takes to head toward medical school back home.
I went through a program that I had previously interned for, Child Family Health International, which sends pre-medical and medical students to India and Latin America to experience medical care beyond the first world. In this Infectious Disease program during the Indian monsoons, we spent time in public hospitals, private clinics and rural birthing centers.
As my introduction into these rotations, we waited for the rains to let up enough for us to climb down below the highway bridges and into the red light district clinics.
In the words of probably everyone who has visited the city, Mumbai is chaos. I have been to India numerous times before, but am unavoidably shocked by the speed, people, and general bustle of the country, and this city in particular.
For some reason, it is in Mumbai rather than Delhi that the decay feels more omnipresent, as even the large vestiges of the palace formerly known as the Prince of Wales Museum look like the jungle is slowly eating them. Wherever people aren’t, profuse plants and mold are, especially during the monsoons.
With its constant rain creating a new level of white noise and an unrelenting kneading sensation on your my skin, July in Mumbai was such an assault on the senses that I felt myself begin to turn inward. Luckily, we were forced out into the city to make sure we overcame any semblance of order to which this generally type-A group clung.
Broken down into smaller groups, I followed two medical students and a highly necessary guide into the slums on the outskirts of the financial district. After overcoming the flock of children asking for photos, money, and hellos, our guide stopped. We looked at him. He motioned; we blinked.
Having been in cyber-cafés that require you to walk through a cardboard box to get to the terminals that connect me to my family and Jon Stewart, I was used to unassuming storefronts. But it still took a second until we figured out that this door into the darkness was our destination, and walked in.
A small, somewhat clean waiting room greeted us. White and dressed in scrubs, we understood why people began grabbing at us expectantly. In the calloused way of third world travelers, we walked past the pleading faces toward the friendly man who benevolently took in these surroundings from what looked like a ticket window, but turned out to be the reception desk. One more door, this one a bright blue, and we entered the clinic.
Yet again, India surprised me. Packed into a 5x12 room was a doctor, his assistant, all their medications, a clinical bed, and all the gauze, needles and other equipment the doctor planned to use that night. Through a choreography that revealed the years they had spent weaving into each other’s work, Dr. Mehta and his assistant made room for us three students easily, in addition to the patients and their numerous family members.
After two nights of having our visit to this clinic canceled, we had been able to come because the flooding from the rains had finally receded. The clinic, raised a foot or two above the dirt street’s current level, was lucky in this respect. The people who came to see us, all from the slums immediately surrounding the area, were not so fortunate.
The rains are a hard, wet time of year when sickness spreads even more rampantly than normal, and the exotic nature of the diseases peaks. For medical students, it was a wonderful opportunity to see such diseases first-hand; but first-hand was also how we learned how painful they could be.
This area was rumored to be a red-light district, but only a few of its notorious residents visited us that night; mostly it was children and the elderly. We sat and watched the doctor work in this tiny fishbowl of efficiency just inches from the rotting feet that small cuts become when they cannot escape filthy water for days on end, the leprosy that still exists throughout India, and numerous cases of the racking cough of tuberculosis that makes this disease so highly contagious. Dr. Mehta would hold a mask over his face occasionally, but would quickly drop it to smack a kid on the head in a token of Indian affection that shocked us Americans or to lecture grandmothers who refused their medicine. He knew each one’s financial status (inevitably very, very poor), and gave out medicine in small dosage packets for a charge that astonished: an entire visit and the medication it required usually cost less than dollar.
I don’t know how he survived, but in touch with his population and well-versed in the diseases he was finding, this doctor spent few minutes but extensive energy on each patient—the dream of every HMO back home.
This was the first time I had seen so closely what has become the go-to story of the overseas volunteer: a loving caregiver who works efficiently with the limited resources he has. This inevitably leads to a discussion of how doctors in the US have become slaves to some vague machine, and now be saved by the message of this slum prophet.
But there was more than that going on here. I loved the element of humanity Dr. Mehta brought to each visit, and I appreciated how exhausted he was when he slumped over his chai during a break just before midnight. Far more impressive, however, was the thoroughness of his diagnosis and the quality of his extremely limited care—categories that are usually sacrificed in such volunteer stories for the overall message, to care for the whole person and community. We had all learned about malaria, dengue, and TB back home, but this doctor taught us things we had never known before.
In the days we were there, Dr. Mehta sent two people in for confirmation testing for malaria, but diagnosed dozens more. To be fair, anyone can slap a diagnosis on an illness, but the many people coming in for follow-up with a clean bill of health spoke for his techniques.
Informing us of the different ways highly similar diseases can present through emotional, diet-related, and physical cues, this man showed us how very dependent we in the big-bad-West have become on Science rather than Medicine. Had one of the doctors been working that day, testing would have been required of dozens of patients—not for confirmation, but to provide an answer that she did not already know. Back in the States, malaria is an elusive disease, one that testing cannot always confirm. My family remains unsure to this day if my brother has actually had malaria, though he was tested and treated in both Europe and the U.S. It turned out that without conclusive testing, there was just no way for doctors to know.
Obviously, this Mumbai doctor’s skill has been driven by need. People simply cannot afford to get tested at one of the hospitals, and there are serious consequences to such limited circumstances. But over the decades, he seems to have gotten something right.
In a time when medical companies and practitioners are desperate to streamline their practices, while environmentalists point to medicine as one of the greatest wasters of resources, it was inspiring to see the apparently reliable answers born of experience and necessity.
This was true medicine; Dr. Mehta listened to the human body and the human behind it, and intervened minimally by western standards, but as much as he reasonably could in these conditions. In the end, I was impressed with the quality of care this doctor provided; but it was the contrast his practice of hands-on and experiential medicine provided with our own barely humane methods that rekindled my conviction to change this field and its work abroad.