Additional Pictures

With the committee of "Doctors for the Third World" in the slums of Calcutta and the surrounding Bengali villages

The many lasting impressions, which arise when recalling my experiences in Calcutta, make it difficult to present a meaningful report. Only by distancing oneself by time is it possible to relate this disheartening, yet joyful experience. The chaos, the exciting contradictions within a dazzling, multicolored backdrop make for a memorable experience. In the Indian metropolis, contrasts shape the everyday life of its inhabitants into a fascinating coexistence.

· Calcutta, on the banks of the Hoogly, a tributary of the Ganges, was the capital of British India. Magnificent edifices dating back to the Victorian era, today in decrepit, ruined conditions haunt back to the eloquent, yet suppressive colonial rule. Faded colonial remnants influence the city’s landscape, witnessed by among other objects, ancient, battered busses and trams, the air-conditioned tearooms, "Men’s Bars" and the parks adorned by elite polo and golf clubs.

· Calcutta with its university is also an intellectual, vibrant, center of learning and has participated in the creation of “software” India. In addition to the classic bank office structures, there are glistening glass palaces constructed as modern day temples dedicated to the new economy. On the periphery of the city are 2 million citizens, living in a satellite town with office towers and luxury dwellings for the new, small family, middle class. Unfortunately, the economic resurgence has enriched only members of upper social strata. Money flows into lucrative, large building projects or are misappropriated by the criminal corruption of politics and economics. A mere pittance remains for two national major concerns: improved educational and health infrastructures. Thus, the chasm between the increasing middle and upper class and the disenfranchised in the country and in the slums of the mega-cities continues to widen. Half of the population of India is illiterate, infant mortality is tragically high and a third of the children are emaciated. There is no functioning health system; girls and women are treated as second-class citizens.

· So is Calcutta, also a city of misery and poverty. Both are firmly entrenched in the Howrah quarter on the other side of the Hoogly. There looms the central station and the deserted, grimy factories of the once flourishing textile industry. Here, as in decades past, farmers from northern India and refugees from Bangladesh gather in impoverished conditions, striving for a better life, barely able to sustain a meager existence. Now 5 to 7 million people, mainly Muslims, live huddled in sheet metal and mud huts or multi leveled concrete skeletons between garbage, foul smelling, clogged sewers and gaunt, emaciated fowl and goats. In the dusty lanes noise, intertwined with repugnant odors, rushes and ebbs, and fluctuates between flurried activity and disconcerting inactivity, a flow between celebration and suffering.

· In the midst of this steamy, disease ridden, far reaching slum is a simple dwelling for the "Doctors of the Third World", which has existed for over 20 years. One of their outpatient clinics and "care” stations - for ill and mal nourished children is in the neighboring house. The accommodation is austere, but there is a much appreciated, functioning shower (probably the only one in the area) and a generator to offset the regular power failures. Six physicians live here, welcomed by their directly adjacent neighbors as their "German Doctors". The neighbors are friendly, as the doctors are constantly surrounded by a swarm of a curious, rag clad children. Every morning, they walk in pairs (or to ride via a bike driven rickshaw) to the other outpatient clinics, which have been established in slum areas within unused factory building or classrooms. Each team is comprised of ten Indians, who speak a semblance of English. For the handsome sum of 50 Euros per month, they are engaged as translators, inoculation specialists, nurses and dispensers of medicine or as registration assistants. As health workers, they have also the important task of giving therapeutic instructions to diabetics and those suffering from mal nourishment and addressing such topics such as hygiene, household maintenance and nutrition and family planning.

· I am assigned to a fourth team, which is active in two outpatient clinics in villages 30 km outside of Calcutta and is accommodated during the week in a dwelling in Baruipur, a lively , dust choked poor rural town. A majority of the citizens are without work and without many worldly possessions. Muslim refugees in poverty stricken, hopeless conditions, lack of nutrition and bad working conditions contribute to the poor health condition of the majority of inhabitants. Physicians and medicine are for many an unaffordable luxury. “The German Doctors” organization offers them limited free assistance.

· On Monday morning from the outpatient clinic Sanka, I drive with my colleague, a dermatologist, a diminutive, but determined woman, with part of our team into the vast suburbs of Calcutta. Slowly the urban hellish din of noise and stench abate. On narrow, dust choked roads we wind our way with the aid of an abused, over worked horn at a slow pace. We pass pedestrians laden with water jugs, wood bundles, and vegetable baskets atop smiling brown faces. We wheel past cyclists and rickshaws straining under the load of enormous straw bundles, heavy building material or schoolchildren. In the villages, the roads are barely traversable. Ambitious, wiry merchants clad in freshly pressed trousers and shirts spread their goods to the roadway’s edge. We drive past rice and vegetable fields, along polluted lakes and rivers until our destination is reached after 1 ½ hours. Our outpatient clinic is in an abandoned country house along a railroad line, to which patients gather in the early morning hours from near and far from sometimes arduous journeys. About 200 patients wait, guarding their place in the queue. Most are patiently enduring the increasing heat, determined to defend their place in line. In addition to the sympathetic patience and friendliness are the signs of the struggle for survival displayed by others. Some are inconsiderate, crowding, pushing and emitting eerie, loud persistent wails, demanding preferential treatment.

· Out initial attention is given to seriously or acute patients. Then, those waiting receive a stamp, so that later arrivals cannot fraudulently receive earlier treatment. Sometimes the demand is so great that we must put off patients for the next day. In the outpatient clinic area, we precariously perch on rickety chairs with our translators at two folding tables. Between the tables is a screen to facilitate a more private setting for those receiving examinations. Medicines, vaccines and dressing material are transported in rickety, wooden crates. The medicine prescribed by us is dispensed not in original packing, but are presented in measured quantities, in bags or bottles to the patient, to prevent resale on the black market.

· Then the consulting period begins. First, the gravely ill people receive our attention. Here often life saving procedures are possible. Such patients include those with critical pneumonia, intestinal infections, deep skin abscess, and complications arising from asthma. Others with serious injuries or surgical emergencies must be transferred to the hospital, whereby neither our medically directed telephone call nor the accompaniment by a health worker can guarantee seriously ill people who are without means will not leave rejected and left to their fate. Then, the chronically seriously ill people are brought in the final stage of their suffering in hope for a miracle. Often a diagnostic review already shows the bitter hopelessness of the situation. Such is small boy with the non operable heart defect, the dying young person at the final stage of cystic fibrosis a, the young woman in the advanced stages of breast cancer, the 40 year old with kidney failure without hope for dialysis , an older man in the initial stages of liver coma.

· Conflicting feelings of vulnerability and eternal hope can be felt in the clinic. A sense of helplessness is moderated by a few comforting words, a brief clasp of the hands or an understanding look. On the other hand, children can emit a sense of hope with their curious rolling eyes and their constant readiness for frivolity, even if they appear in the clinic with sever skin infections or with intestinal complications. Smallpox complications and whooping cough are frequently diagnosed with the weakened children. Incidents of measles are less frequent due to the associated blindness, which led to wide spread inoculation. Polio is also being successfully combated through the consistent inoculation strategy. All children are being inoculated according to the WHO guidelines. The medical conditional of expectant women is just as important to the birth. A complete screening program exists also here, to which I can attest here as being non-gynecological. The national epidemic remains to be tuberculosis: TBC is greatly feared. Behind each persistent cough, back or stomach discomforts is TBC suspect. Almost daily, we must send patients with this diagnosis into the outpatient clinics of the national tuberculosis programs.

· Often the mothers are very young, and their inexperience shapes the treatment of their babies, who becomes through their parents’ lack of education, poorly fed and anemic. The simplest nourishing and care consultation is therefore often necessary. In addition, the poor families receive powder milk for their small offspring’s or a "food pack” for the malnourished mother who is breast feeding. Severely underfed babies can be nourished in our "care" station in Howrah at first, then fed by the parents and cared for through the critical phase.

· The “food packs” and perhaps the vitamin tablets are often the only assistance, we can give to the many prematurely aged and decrepit patients. Their initial appearance is warm and friendly, the women wear their most beautiful Sarongs, proud beards grace the men, but their nutrition deprived bodies with rotting, decayed teeth, arthritic, painful members, worn out musculature, and chronic lung and skin disease give rise to feelings of compassion. In the closed huts, the cooking facilities offer little ventilation and protection against smoke and other toxic emissions. Factories and the agriculture activities, in general, do not adhere to any industrial safety standards. Chronic lung damage and bronchial asthma are therefore quite frequent. In addition, many of the “German Doctors” fall victim to the smog of Calcutta and contact bronchitis. After a weekend of exposing my lungs to the polluted conditions, I always drove coughing, on Mondays, to less air polluted sites of my medical activities in the lush country.

· Many women complain about “back pain, leg pain, all body pain" as consequences of the hard, arduous, everyday life. In addition, the psychosocial emergency of the women and trauma tables of experiences find their expression in this general feeling of being not well. Careful observation and inquiring reveal depressing views of Indian woman fates. Many fall victim to a violent, alcoholic man. They fear renewed pregnancy, brutal suppression in the family of the in-laws and work, work, work.... The visit to the “German Doctors” is so for some woman also simply a legitimate possibility of escaping the everyday suppression.

· In retrospect, it is almost incomprehensible to conceive how many patients gather daily, desperately seeking medical attention. Burns, which are heavily infected or severely scarred skin, require immediate attention. Stroke victims are treated with medication developed for epilepsy. Many diabetics and those suffering from high blood pressure, according to our standards of medical treatment, are insufficiently attended. Handicapped patients and mentally and physically ill children are treated once a week by two physical therapists. A large sinking abscess, probably TBC, in the groin area. There are, now, in the absence of monsoons, few cases of malaria. Osteomyelitis covered by pus impregnated cloths. Jaundice, edemas with nephritis or heart weaknesses. Cases of uterus infections or complications. Enlarged prostates. On the skin, mycosis infections, leishmaniasis, a fibrosarcom, anemia, children who suffer from thalassemia. In addition, cancer illnesses without hope of therapy in the Indian health system.

· The frustrating limitations of treatment sometimes result in heart-breaking failure. As a result, the evenings’ discussions in our dwelling within our group is essential for mutual support after a day’s arduous, often discouraging work. The good, hearty, vegetarian meals and friendly care extended to us by our cook do us well. Brooding thoughts can he chased away by the multicolored, exotic impressions and merriment, which arise as one tours the city. I borrowed a rickety bike and drove to the surrounding river, forest and field regions. I feel astonished at being transferred to the “Jungle Book”, and still today I see myself content and without care under the graceful, protective branches of a broad, ancient banyan tree.

· On weekends, it’s back to the other colleagues, who in the wretched, rat-infested, dusty hole of Howart , have become much adored, heartily welcomed by a horde of smiling, happy children, acknowledged by a thoughtful, apparently Muslim neighbor with a cautious smile. On Saturday, I visit the St. Thomas Home, a tuberculosis hospital operated by our organization for girls and women, the only one in Calcutta. Female patients with the most serious cases of tuberculosis infections of the lungs, the brain and the spinal column (often with paraplegia, whose only chance of survival is through intensive treatment). Treatment of concurrent cases of AIDS and TB becomes increasingly difficult by the resistance of the tubercle bacteria to common medicines. Causes of this threatening development are errors in therapy regimes and cessation of treatment and the dubious practices by Indian pharmacists in which highly potent tuberculostaticum, e.g. rifampicin are sold as anti-cough mixture.

·

Tuberculosis can only be healed through consistent, effective treatment. Therefore, ambulatory patients are regularly visited on Saturdays by a team of tireless physicians and health workers. Our journeys lead into the most remote reaches, into the darkest, most wretched quarters, into the most desperate areas within the slums. In a six square meter hut, the haggard, mal- nourished disease ridden female patient lives with her large, burdensome family. On the earthen floor, a grandmother sits with a baby in her arm, smiling and friendly, nodding her gaunt head, which partially hidden beneath matted, unkempt, grey hair ; the 6 year old daughter maintains the household and care for two smaller brothers and sisters; two older children are not present (they must work, which is actually forbidden); the father ekes out an existence as a transporter. In addition, there are two people, not members of the family, who would otherwise have no place to live. Despite these abysmal living conditions, we are welcomed. Suddenly, a thin, scarred hand cordially presents me a steaming glass of tea. The children playfully tug at my trousers. An ill elderly woman smiles, as if our presence brings immense joy. We review her medicinal regime, establish the next examination date and travel through the slum area to the next patient, experiencing the paradoxical atmospheres of joy and misery. At the end (and still) I have a feeling of gratitude, feeling as if I had received more than I gave.

· Calcutta is the city of contrasts, whose many forms were possible to explore in our work-free time: The boat trip to the enchanting Hindu temples, the visit of the crematorium on the banks of the Hoogly, the walk to the magnificent Victoria Memorial and St. Paul’s Cathedral, dining on the roof terrace of the Hotel Lindsay, meditating in the administration building of the order of the Mother Theresa. In addition, the never ceasing hustle and bustle of those shopping and otherwise frantically scurrying about within the hectic flow of urban life.

· Calcutta, as the teeming Indian metropolis is often described, is the only city in the world, over which one cries twice: Once when one must travel to the city of chaos and abject poverty and when one reluctantly leaves the city of bright colors and haunting mysteries. The experiences of Calcutta and the work in the Bengali villages do not leave my thoughts. They have changed my view of the world and the obligations one has to others. They have taught me not only to be grateful for my status in life, but the experience also broadens my commitment to help others in less fortunate circumstances.