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.