We wake to the dawn of an ironically cool, perfectly clear day. We eat breakfast and are told to pack and have our suitcases outside our tents soon, as camp is already being broken around us. Wet mattresses and bedding are piled on top of wet cots. The kitchen and staff tents are down. Trucks are being loaded.
We jeep into Sukhvasi, where the local school (again, empty rooms of cinderblock) has been set up for the medical camp.
A large, patterned fabric covering has been strung up over the courtyard formed by the elbow of the L-shaped building, casting a red glow on the waiting area. We unload and are given job assignments. “Intake” sits with a translator to get patients’ name, age, and complaint, which are recorded in a log book as well as on a routing slip piece of paper the patient will carry with them and present at the appropriate doctor’s station. Most will see more than one doctor. “Dispensary” workers from our group fill small dosage bottles of syrups and lotions from giant jugs as well as count out pills for distribution—the prescribe-able medicines list given to the doctors has probably 20 medicines on it that we supply. The “Bananas and Oranges” team hands these out to a community whose diet comprises mainly onions and millet. “Triage” helps direct and control traffic, and there is a “Door” person assigned to each doctor. There are pediatricians, a GP, eye specialist, Ear/Nose/Throat specialist, and a dentist. All but the dentist are local volunteers from the medical community—the dentist, Dr. Vivek, has volunteered with Alexander at each camp and travels to meet the rides wherever they are.We had been told earlier that the assistants to the dentist would have to have a strong stomach since there can be blood as he occasionally has to do extractions on the spot. I’ve previously expressed interest in this so I can feel as “immersed” as possible—little did I know that about half a dozen others were of the same mind. As Alexander asks for volunteers for other posts, people head off to their stations, and the six of us steadfastly wait for him to call for volunteers for the dentist—seems we’re a bloodthirsty lot. Two of us are eventually chosen, Rebecca and I, but Rebecca is called back and replaced with Barry. Once we get to the room and meet with Dr. Vivek, Barry too is sent away as the doctor only requires one assistant.
Dr. Vivek has a periodontal and implant surgery specialty practice in Jaipur, and has been doing the camps with Alexander since the beginning of RRI. He is great and very no-nonsense. Our “office” is an electricity-free empty classroom with swirls of blown dust in the corners of the cement floor and birds flying in and out of the glassless windows. A small table is set up with a model mouth and oversize toothbrush; an illustrated standing flip chart explaining cavities; several boxes of antibiotics and topical oral pain relievers; a few bottles of xylocaine and other injectibles; a dental hand mirror; the doctor’s bag. He sits in one mud-stained molded plastic patio chair and we have a second chair for the patient.
I run out to the jeep to fish out my LED headlamp for the doctor since he has no light source anywhere in the room but the murky, indirect light bleeding through the windows (around the cooing pigeons).As people start to arrive at our door (everyone wants to see the dentist), I check the routing slip of each patient and try, in a culture without a firm grasp of the concept of queuing up, to get them to stand in some semblance of a line. I’m startled by how young some of the papers say a person is, as the person standing there invariably looks much older. If I had to guess, I’d place 30-year-olds at 50 or more. Most women keep their heads and faces covered beneath red and pink veils (red is the color of this region). They remain covered until they sit in the chair opposite the doctor. One older woman refuses to lift her veil—wanting the doctor to somehow, perhaps by magic, examine her teeth through the fabric. She finally relents after much agitated talking and Doctor Vivek’s threat to turn her away untreated.
90% of the cases are gum disease and general decay due to lack of oral hygiene. There are not toothbrushes here—there is a particular kind of branch or root they chew for tooth care. Since the average male starts chewing tobacco and/or beetelnut at a very early age, chewing a root doesn’t help. A few have painful cavities. There is lots of fluorosis since there is far too much fluoride in the desert’s water supply—it causes brown mottling of the enamel even in healthy mouths.
While my usual vantage point is looking over the shoulder of the patients, facing the doctor, he calls me over to look at or observe a few cases. A pre-cancerous leukoplakia from beetelnut…serious decay…a tooth that needs to come out…
We do five extractions total. Perhaps since we are a horseback trip, communication with the Red Cross, who sent the supplies, got confused. The only hypodermic needles they sent were equine, and I’m here to tell you, a horse needle is a good bit larger (and scarier, especially if you are in a village that never really has any medical attention) than a human needle. The numbing xylocaine injections are, therefore, pretty excruciating—this is rough country medicine. He gives an injection, waits a few brief minutes for numbness, then goes in and pulls. They are all simple extractions—anything more would be beyond the scope of this camp. The first is pulled with simple forceps and much twisting of both the doctor’s hand and wrist, and the patient’s writhing body. Another is pried out with a scraping tool. For a later case, he breaks out the big guns—two heavy-handled prying blades, one for each hand, meant to use as sharp-bladed fulcrums to get under the roots and cut away gums. It is bloody and harsh-seeming to my sensibilities, but Doctor Vivek is incredibly deft and suffers no foolishness. He finishes one, gives them a chunk of gauze to bite down on as he writes an antibiotic prescription, and they are done and I send them on their way. The only sterilization is a metal cup of antibacterial rinse into which the instruments are dropped between each use.
One small girl, maybe seven years old, is fearless for her extraction. Braver than I would ever be, tears slip silently down her cheeks. Others have terrified themselves before they ever step into the room. I hand out several tissues from my pocket Kleenex pack to little ones, to staunch the flow.
Most visits are uneventful. The doctor’s kind face and words assure them nothing major is wrong, and he hopes to communicate that a little brushing would go a long way.
As the day wears on, with beautiful weather, of course, now that we are leaving (we learn later after relocating that the terrible rains returned after we left, eventually doing a lot of damage), the camp draws more patients than we predicted, over 550. It becomes a bit of a social carnival. Old friends from neighboring villages are seeing one another and socializing for the first time in a while. Kids yell and play, dogs sleep in the shade, and a cow wanders aimlessly back and forth through our “waiting room.”
A group of adult males, clearly the bigwigs of the village, makes the rounds, inspecting all to be sure they approve. They move in a pack of six or seven, like teenage boys banded together for communal strength and sense of importance. They decide to see the dentist (and I am told later, they had decided to see other doctors as well). I take a bit of perverse pleasure in making them wait their turn, behind, and this is scandalous, women and children who were there first. I am unfazed by their yelling and pushing—if they want to see Doctor Vivek, I am happy to admit them…in their turn, and not before. They are shocked and laugh derisively. Surely I am joking. An imploring, stooped over “handler” straight out of Central Casting (his role would have been played by Peter Lorre) translates for me how very important they are and how men never wait behind women. I good-naturedly assure him they will absolutely be seen…after these patients… I won’t be winning any popularity contests here among the big dudes of Sukwasi. Additionally, and almost as chafing to their sensibilities, I only allow them in one at a time. Separate from the back-slapping machismo of their pack, they are all nice, easy guys, grateful to be seen by Dr. Vivek—they’ll put back on their jester’s faces when they go out into the sunlight, but in here, the fear of pain is the great equalizer. In later conversations, I find many of the others in our group had similar experiences with this group, with a similar insistence that they wait their turn.
In the afternoon, a woman older and more gnarled than the trees is carried into camp on a litter woven of rope over a crude wooden frame. She sits on one hip, her sari tucked around her sunken eyes, peering out. Her bracelet-bangled wrist is surely too thin and delicate to support the weight of her barely-there body. Her bones are so small they seem better suited to a bird. She is, we are told, the oldest woman in the region. Soon after, a young boy is carried in by a neighbor/father/uncle in the middle of an epileptic seizure. Everyone is helpless until it ends and the tremors fade. Everyone is pretty much helpless after that as well…
I hear second-hand that Charlene, our ER doc in our group, said something to the effect of, “If you could see the amount of typhoid and other extreme diseases that we’ve seen here today, you would dip yourself in a vat of Purell and never come out.” She said she saw things today she has only read about in textbooks.
It all strikes me as brilliant. I realize that had my life gone another way I could have found great satisfaction in work like this…Doctors Without Borders or a similar organization. It feels so fulfilling to definitively touch and improve another life, immediate evidence of your efforts in front of you. It is hard, long, and amazing work.
After this marathon day, we jump on an enormous bus much too large for our group, air conditioned, plushly upholstered, weirdly out of place here…and spend the next many hours driving to Dundlod Fort, fleeing Mother Nature.
We have so much time to reflect on this huge day, talk, space out, watch the tiny towns rush by, sleep, listen to iPods in our private little worlds, etc. It is, to me, both a letdown and cathartic at the same time. I’ve been so externally focused for the last many days, that it feels selfish to be inwardly turned. I’m surprised, but not shocked, at how satisfied I feel. I also feel woefully inadequate at not being able to do more.
I stare out the window and find myself jealous of the men clambering on the tops of trucks and buses—dozens on the roof, holding onto…what? A loose screw? Enough of a steel rain channel for calloused fingers to find purchase? Each other? They are bundled in scarves and shawls of beige and cream (so unlike the brightly dressed women), their faces wrapped against the wind and sand. I think it would be fun to ride on top, but of course for me it would be a lark, a choice, not a necessity to get to the day’s difficult work…here I am in air conditioned comfort sipping my bottled water wishing I was in even more in the elements. When we take the jeeps to schools or goats or medical camp, I always sit in the uncovered back section perched on the steel rail. There is sometimes, of necessity, three of us in this tiny roofless bed of the jeep—barely room for our feet as we sit on the rail, our knuckles white from hanging on as it bumps and tumbles across rutted roads and desert floor. One day I take to standing alone in the back, reaching over the cab to a bar on the roof of the driver’s compartment, my head over the roof getting the full brunt of the wind of our velocity, the small Red Cross flag whipping next to my right ear. A big jump will jostle me but I love it—it feels right to have the wind in my face, and some rain too—it feels somehow authentic. There I am again searching for the root experience. It’s actually just me being a kid, wanting to inject more adventure into the adventure, even though the adventure quotient is already bursting at the seams.
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