Update: India 2
A type of Hindu holy man called a Sadhu (picture: long scraggly hair, unkempt beard, turban, faded
robe) reportedly walked into the no man’s land between India and Nepal to bury himself in the ground. A
local newspaper later reported he led a large crowd demanding that Nepal become a Hindu state.
Bottom-line - a horde of people descended upon the border; Nepali police arrived and were pelted with
stones; the police responded with automatic weapons and tear gas. Welcome to Raxaul in the Indian
state of Bihar.
But--- it is not every day one gets to avert an international crisis.
In my last update, I wrote about HCH, the mission hospital north of Delhi, and even though it is a lovely
place, it was not very busy and I did not feel that I was contributing enough. Therefore, I requested a
transfer. Dr. Sunil, the medical director and surgeon at the Duncan Hospital in Bihar jumped at the
request. I arrived two weeks ago after a 36-hour journey taking me by car over mountainous passes,
then by train to New Delhi station, by auto rickshaw to Old Delhi station, a 26-hour overnight train to
Raxaul, and a final bicycle rickshaw in the dark to the hospital.
For those of you familiar with Bihar, don’t worry, everything is fine - really. Duncan Hospital is a 200-bed
facility established in 1930 by Dr. Cecil Duncan, a Scottish physician, as a mission hospital to help treat
the local population both in northern Bihar and in Nepal. In the early days, missionaries were not allowed
into Nepal. To this day, half of the 200,000-catchment population comes from the Nepali side of the
border, from the planes region known as Terai. Moreover, yes, that region has been making the news
lately, and for the record, I do NOT intend to head north.
Duncan Hospital is close to the rather dirty, uninspiring and mosquito infested border town of Raxaul.
The compound is set behind high walls with multiple structures constructed of brick painted with a color I
can only describe as burnt sienna; the feel exudes castle, fort, and monastery. Dark narrow corridors
and twisting paths passing through open courtyards with numerous squatting locals wrapped in brightly
colored shawls end at multi-bed wards providing a mixture of old world thick walled claustrophobic
structures with the poverty of the surrounding populace. I just read that of the 80 million people in the
state of Bihar, only 40 million have a toilet in their home.
So yes, Bihar is a poor state, actually the poorest in India. And although the border has been
intermittently closed for the last few weeks due to the unrest in Nepal, I have been much busier. The
staff here has had little trauma training and I have given one formal presentation in addition to a great
deal of informal and bedside general surgery and trauma instruction. I have also performed almost 50
operations including multiple abdominal cases for perforated ulcers, obstructions, and even pyloric
stenosis, lots and lots of c-sections (more than 20), a few laparoscopic cholecystectomies (gallbladder
removal), numerous upper endoscopies, and a slew of interesting trauma cases; including one involving
a man whose clothes got caught in a machine and it tore much of the skin off his neck and shoulder. We
also operated on a man brought in initially claiming to have had an occupational injury. I guess it
depends on how you define your occupation. On inspection, he had a classic pattern III landmine-type
injury: his entire left hand was blown away and his right hand was shredded – the result of an explosive
device.
We are also a bit of a regional burn center. As there are few other health facilities in the area, many
patients (about a dozen) have presented while I have been here. We manage them with an open
technique where the wounds heal and dry with a minimum use of resources. The main issue is that the
wounds tend to become stiff and form contractures so I’ve been trying to encourage more physical
therapy and exercise for the burn patients – it’s working on a limited scale.
The most interesting case resulted from the Sadhu/Nepali police-shooting incident. While we were in
casualty treating a man with multiple severe rib fractures after being run over by an ox-cart, a 20-year
old man was brought in with a gunshot wound to the upper chest. On closer inspection, it was a high
velocity wound with the entry just below the left clavicle (collarbone) and a much larger exit wound out
his back, through his scapula. He was initially stable and as this is a rural hospital with few resources, we
briefly entertained thoughts of referring him to the state capital in Patna where there is a medical center
with more resources; however, his rapidly deteriorating condition did not enable us to do that. Given that
without surgery he would certainly have died, we elected to operate. We made an incision in his upper
chest, removed a portion of his clavicle, dissected down to a bleeding vein, and sutured it. Luckily, our
patient survived, especially since scores of locals anxiously waited outside the hospital anticipating a
bad outcome. The follow day the regional police director thanked us for saving the man’s life and
thereby averting an international situation. That was satisfying.
On another note, my Hindi is slowly improving; however, the other day people were reduced to tears
when instead of telling a patient his wound was OK: Ap ka ghao thiik hai, I said instead, Ap ka ghai thiik
hai: the translation - Your cow is fine.
Namaste,
Adam (also known here as Lumba Wallah – tall guy)