i've been in india a week now, for those of you who didn't know i was here (sorry). i came to help a nongovernmental organization (ngo) called akanksha (www.akanksha.org) that works with slum children here in bombay. read about them on their website (which is excellent, i'd really encourage you to read some of the kids' quotes under the 'i am here for me' part, they're beautiful) if you're interested, they do incredible work providing educational opportunities for these kids. akanksha runs programs after school at spaces near each of the slums in which the children reside. often they bus them from their slums everyday before or after school to the nearby spaces and then spend ~3 hours on additional educational and extracurricular activities.there are lots of problems, as you might imagine, that come with living in the slums. sanitation, hygiene, clean water, for example. access to health care is also a big one. i'm here to modestly assist on that front, as i'm doing medical checkups on all of the kids in each of as many centers as i can get to in the time i'm here. i'm unfortunately on my own, though, as there is no supervising doctor, and we are very resource poor. i have my stethoscope and a penlight in need of new batteries. i usually take the kids to the corner of the classroom and talk to them a while and then do a basic physical exam. for the girls, i usually take them to a stairwell landing upstairs, and have them lie on a mat on the ground to complete my exam on them -- it's as much of a private space as we have. i'm seeing a lot of dermatological problems like impetigo and pyodermas, malaria, ascariasis (worms), anemia, lice, ringworm, vision problems, diarrheal diseases, the occasional TB, and a host of others. for the diagnoses that i am confident about that are treatable with meds, i'll write the name of the drug, the dose, and duration, and either the teacher, the social worker, or i will go to the chemist (pharmacy) and buy them for the child. it's pretty informal here, if you want mefloquine for malaria, just ask for it and they'll give it to you, no prescription necessary.
i'm hindered, of course, by my inexperience, but i'm doing my best. the kids that absolutely require lab tests (a girl that i think has malaria needed a peripheral blood smear yesterday), and those that are more complicated or serious, i send to the government hospital. but the parents hate taking their kids there and often don't, so i try to do as much as i can, because they trust me. that means i make some presumptive diagnoses that i can't prove with lab tests that would normally be routine at home, but that i have a high clinical suspicion for. i am able to connect to a really powerful medical reference resource called 'up to date,' which i have access to remotely from my medical center's computer network in detroit, and i'm relying on it for a lot of guidance -- it's basically my attending right now.
so that's the means by which i am getting to my end of interacting with these kids. they are inspiring to their very core. they live in the most difficult of circumstances: small, cramped, makeshift homes of concrete floors and corrugated roofs no larger than many of our bathrooms or closets. they are shoehorned into spaces that are chosen based solely on their availability in this teeming, overflowing city -- alongside railroad tracks, on pavements beside main roads, under bridges and overpasses. they are subjected to dirt, pollution, heat, disease, and hunger. they must drink unclean water and defecate by the railroad tracks. they must withstand abuse--verbal, physical, sexual--from society and often their own parents. many fathers have left their homes, having squandered what little money they had on alcohol and gambling, leaving them with only their mothers or as orphans. they are shunned by the government, condescended to by society, and written off by virtually everyone. they are regarded as worthless nuisances, parasitic products of the bottom rung of society. they are looked down upon as poverty's contemptible procreation.
in reality, the slum dwellers make the city run. they are the rickshaw drivers, the vegetable vendors, and the servants. they collect the trash, sweep the floors, and deliver the tiffins at lunch time. without them, the city would be brought to its knees. they deserve a place to live and a certain standard of living, both of which they are mostly denied. many of the adults have given up, they have been defeated by a life of suffering and hopelessness.
yet the children persevere. if only you could meet them, believe me, your heart would be buoyed by their spirit. they are young, and they have known no other life than that of the slums, but with the help of akanksha, they believe in themselves. they desperately want an opportunity, and they dare to dream big, of improving their lives, of achieving and advancing themselves through education. how they personify the audacity of hope.
they are beautiful, they are curious, and there are many that are incredibly gifted. take 14 year old hina, for example, who came up to me the first day and asked me if it was hard to become a doctor. i asked her if that's what she wanted to do, and she smiled with self assurance and said, 'yes, that is my dream.' i watch her sometimes at the center, the way she furrows her brow in concentration when she thinks, when she seeks to understand; the way she explains complex concepts to her peers, and the passion she has for learning. i believe she will be a doctor some day, but more importantly, she does, too. these children will be given an opportunity--thanks to akanksha, especially--small though it may be, and i believe (i hope?) many of them will seize upon it and succeed, despite intimidating odds and a deck stacked squarely against them. this, to me, is a fairer application of the concept of personal responsibility.
i've already grown close to many of them. they accepted and embraced me immediately, and they make my day everyday. they've given me tremendous access into their lives, as well, and i'll share some stories and photos from my time with them in my future writings.
their city, bombay, is full of contradictions, of a stunning juxtaposition of poverty and wealth; there are no protected pockets, no sheltered areas. the staggering dichotomy between the haves and the have nots is evident everywhere you look. it is the legless beggar sitting below the louis vuitton display window, asking for money, at the taj hotel by the gateway of india in colaba in south bombay. it's the barefoot, naked, 5 year old ragpicker boy, scavenging for anything of value in a pile of garbage beside the railway station as a wealthy, 17 year old girl with gucci jeans, driven by her driver in her air conditioned toyota qualis suv, passes by. the poverty is so pervasive, that most mumbaikars (residents of the city) don't even see it. they look right past. it's not a criticism, it's an observation. i don't know how you could do much else, quite honestly, given the scope.
i have been placed in a flat near one of the slums (called dharavi), in a part of bombay called sion. it's centrally located, buried in a crowded, easily disguised maze of lanes. but i've grown accustomed to the area and have carved out in my mind the pockets of recognition that get me home each night, despite often coming from different directions. i ride the local trains to all the slum sites, and i'll be sure to write about riding the central line, for instance, during rush hour here sometime. space, including personal space, is at a premium always. it's been great learning and exploring the city for myself. staying with family, as i normally do when i'm here, shelters me from most of what i've been seeing and doing here this time. but i also get to spend time with my extended family when i'm free, as most of them live right here in bombay, so it's the best of both worlds.so that's my intro. i'll write mostly stories and anecdotes in my future posts, but wanted to start with a frame of reference. i hope you're all doing well, and that life is good.
much love from mumbai,
sachin
