After 27 hours of travel, Dr. EJ Caterson and I landed in
Guwahati, India. Even though neither of
us had ever been here, the place has the familiarity of any town in the
so-called “developing” nations. It
reminded me of the border towns in Lima, Peru, of the South countryside of
Dominican Republic, of the Mayan towns away from touristy Yucatán, of some of
the forgotten towns around my own hometown in Puerto Rico. The half-painted, half-roofed and half-built
buildings, the dust that deposits in everything living or nonliving, the entropic
flow in the narrow streets full of motorcycles, cars, cows and many street
dogs, all avoiding collision and the road holes with miraculous success.
But we were decidedly in India, with the women in saris coloring
the streets, the incense in the air, the glimpses of gold against the beautiful
dark skin, the cricket fields and the ever-present crowds. We had gotten the first welcome to the
Monsoon when we landed in Mumbay with a loud rain at 2 am. Now the rain had passed and the tropical
humid air damped our foreheads as we went from the airport with a quick stop to
drop our luggage and into the hospital to start the real adventure.
What had started as a dreamlike conversation on evaluating
delivery of surgical care in low-resource settings one afternoon a year ago in
the HMS green lawn with my mentor, Dr. EJ Caterson, was finally having a home
with discrete GPS coordinates in the real world. The home for this project was located in the public
hospital of Guwahati, in a ward donated by the Assam government to Operation
Smile India, as part of a public-private collaboration between the two. This collaboration expanded beyond the
hospital, as the community health care workers, known as ASHAS, were trained by
the personnel of the center on how to recognize the condition and refer it to
Operation Smile, reaching statewide coverage and even neighboring states.
As you walked through the hospital, bare-bone conditions
with windows overlooking trashed green areas transitioned to the newly painted
murals and order of the Operation Smile Center.
Inside the glass doors that led to the center, blue painted walls
sheltered a waiting room, the administrative offices, dental, speech pathology
and nutrition offices and even a play area with toys and facemasks for the
children to familiarize themselves with the strange objects they will be in
contact with in the operating room.
All shoes off and scrub shoes on, we get into the
perioperative area. The operating room
consists of a large room with 5 operating tables with their ventilator
machines, like Siamese twins, all lined-up, with that aseptic smell and look,
universal to operating rooms. In the
operating rooms, I relax, as I watch or assist the attending surgeons, as this
room is familiar and a respite from the over stimulating of colors, odors, and
movement in the busy streets of Guwahati.
I secretly preferred being in here, where I felt useful versus the
streets of Guwahati, where in Yesterday’s walk to the hospital I had
encountered a 3 year-old child with sunken black marbles for eyes laying on a
dirty blanket with a tin bowl by her side and a head bubbled by untreated
hydrocephalus, among piles of tropical mangoes, guavas, bananas, and street
trinkets for sale.
Inside the operating room, I marveled. I marveled at this well-oiled machine of
cleft surgeries biting away at the more than 30,000 untreated cleft cases in
the state of Assam. Biting 1/3 of the
burden of the disease in only 2 years! Firm
and steady bites of well thought, protocoled, state of the art, high-standard
surgery. This is what I wanted to see,
this is what resonated right in my heart, the idea of the best we have to offer
for all, the truism of the universal declaration of human rights soft murmur,
now in the loudest decibels screaming “it can be done” in the off-the-map and
off-the-beaten-path and off-the-charts Guwahati.
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