Tandoori Summer: July 2010

During our hours of waiting in government offices in Delhi on Monday, Kerry and I quickly planned our week. We decided to visit Bihar, the poorest state in India. The number of infant deaths in Bihar accounts for 20% of all infant deaths in India (which account for 25% of all infant deaths in the world), so there is obviously a great need for assistance in the state. We bought our plane tickets from the government waiting areas, and took off for Bihar that evening.

If you mention to an Indian you are going to Bihar, they ask why. It’s not a well-kept place, and crime is rampant during dark hours. Women are not allowed to walk alone at night, and strongly suggested to stay in their homes unless they have a male companion (even in the daytime). Water is bottled locally (ie unsafely), there are very few restaurants, and even fewer hotels. We stayed at the Country Club International – the name was its fanciest attribute. Mice in our rooms, stained sheets, no hot water, miniature toilets, lizards, grime, dirt dirt and more dirt. And it was the longest stay I’ve had in one place since arriving in India – four whole nights!

Our office manager in Chennai had arranged a driver and translator for us, who also happened to be our hotel manager, and later turned into our prison keeper. Bilash was extremely traditional, and saw no reason for women to be out of the house, let alone wandering Bihar. He also had a strange infatuation with me and Kerry, and memorized our passports, including where we’d been, when, our visa numbers, etc. Even claimed he had taken a picture out of my passport to keep for himself. When we would stop to get gas or water, I would get out of the car to take pictures. People were very friendly, and definitely stared, but seemed merely curious. Bilash eventually told me I wasn’t to get out of the car. When we’d ask to pull over to get a banana, he wouldn’t let us get out of the car to pick our own bunch; he’d lock us in the car and make us wait. Even worse, he would interrupt doctors while they were talking, translate answers and questions incorrectly, and randomly, carelessly flip switches on equipment in the Neonatal ICU. During our meetings he’d leave us to go home or run errands, and we’d find ourselves stranded for up to two hours until he decided to show up again. I finally let him have it one afternoon – even seeing him pop up in my pictures from the trip makes my blood boil…

Anyhoo, from my meeting with Unicef on Friday, we had some great connections with local Unicef people in Bihar. After meeting the Director of the National Rural Health Mission (who sits in a big, air conditioned room with 3 phones on his desk, two cell phones, and a chair that is strategically higher than the chairs for his visitors), we met up with Unicef community workers at a variety of hospitals. They have set up Special Care Newborn Units (SCNU’s) in a number of district hospitals – shiny, modern equipment randomly placed in the middle of rundown hospitals littered with trash and rubble, people lying on the ground, and no AC. It’s both very inspiring and very disheartening … A small fix, but for those who need it most, I guess.

Per our request, Unicef also arranged visits for us at private hospitals, and rural clinics. We visited a private hospital run by a warm man, who had basically set up his own Neonatal ICU in his house. We sat on his bed (across the hall from the NICU) while he pushed fresh mango, water, Indian masala tea, and strange Indian marzipan desserts on us. Hundreds of patients waited downstairs. He told us he was “honored” we had come to visit, and the single piece of equipment he would buy if he had more money would be a phototherapy device. He is currently treating 150 babies/month with one device, and each baby needs approximately 3 days of treatment.

We took a 100km with Bilash to rural Bihar to visit some of the smaller clinics. While none of Bihar is particularly developed, the setting quickly turns to tropical farmlands dotted with round huts made of sticks. Colorful sarees hang lifelessly on clotheslines. Goats, cows, and chickens wander around freely. The clinics are insanely depressing – delivery rooms consist of steel tables with stained, thin black pads, and buckets placed below the holes in the tables. Walls are stained, surgical equipment is rusted, and electricity is unreliable. Plus, despite delivering thousands of babies a year, doctors see “nil” cases of jaundice. Statistically, they are missing hundreds of babies.

At the clinics, we would quickly gather a crowd of up to 20 people. Some told Bilash we were the first non-Indians they had ever seen. Word quickly spread through the village that visitors had arrived. Policemen would show up in packs of 8, unloading themselves with their rifles from jeeps in front of the clinic. We would tour the facilities, followed by a procession of curious patients, doctors, police, and villagers. When sitting down to discuss the operations of the clinic, they would form a circle around us while we were served masala tea, crackers, and fried dahl snacks. The order of hierarchy is most evident in these rural areas – only the Director answers questions, while he drinks directly from the 2-liter Sprite bottle before pouring us all our own small servings, and throws his little bowl of snacks on the ground for a servant to hurriedly pick up.

The entire four days, there was nowhere we could eat that looked sanitary, so Kerry and I subsisted on protein bars for breakfast, lunch, and dinner. A couple nights we ate bananas and crackers. So unsatisfying.

One of Kerry’s Stanford friends is from Bihar, so our last night in town we met her parents for dinner at a hotel. They were very kind and very traditional – and invited us over to their home for breakfast the next morning. We stopped by on our way to the airport, greeted by children servants who unlocked the assortment of padlocks and chains on the entry gate. The house was open and airy, with a large bed in the living room/eating area for the servant family to sleep. A girl of about 10 cooked away furiously, while her little brother served us the traditional Indian breakfast. Very different experience …

I can’t say I will ever return to Bihar.