She’s in her 80’s, this fragile slip of a woman who buckles under her own negligible weight. We used to see her every day curled up inside the cup of a plastic tub chair, so small is she. Since the demolition of her family’s home, she and her family have moved to the other side of the community in an area they never ventured to before, to a one-room home stacked atop another, 15 feet above the ground. We rarely see her now because she needs to be helped up and down the metal ladder, until the other day, on my way home for the night, two of her relatives dragged her past me, carefully lifting her above cats, holes in the laneway, children and stray dogs, to get her to the side of the road. They explained to me that they needed to take her to a hospital because she was suffering from diarrhea and vomiting. They held her up between themselves and called out to passing auto rickshaws to stop. When they were unable to hold her up any longer they lowered her to the ground, her body resting like a crumpled origami bird in the dirt while they continued to call out to rickshaws. She sat there, serene and unperturbed while foot-traffic, cars, trucks, auto rickshaws and bicycles swerved around her. Her family members ran up and down the street calling out to rickshaw drivers who kept passing them by. I tried calling an Uber car for them and watched helplessly as the app tried to track a car - no one wants to drive in Mumbai traffic between 6 pm and 8 pm. Uber failed, rickshaws kept passing by, people kept walking around her, until finally a rickshaw stopped to take her and one family member to a small hospital a few kilometres away. As the rickshaw pulled away, the end of the woman’s sari fluttered out the side and then abruptly laid limp when the rickshaw stopped, stuck in heavy traffic. I walked by them. It would be a long ride to a close-by hospital.
A government hospital ward.
Illness and poverty are a brutal combination. The poor often avoid going to hospitals, preferring to use street doctors, over-the-counter medication or herbal remedies passed down through families. Medical emergencies are filled with anxiety. Most families don’t have money to go to a hospital; they don’t have money for medicine; they don’t have money for doctor’s fees and they don’t have money for transportation. What is available to them are street doctors with unknown qualifications sitting arrogantly in claustrophobic clinics dispensing antibiotic pills or giving injections of unknown substances costing a few rupees. If their illness becomes critical they grab their plastic bag of medical records, flag a rickshaw and try their luck at one of many BMC government hospitals which have low fees, few doctors, unhappy nurses and no standard of hygiene or dependable medical testing facilities. Family members, who are required to stay with a patient to fetch medicine, sleep on floors that have rarely been mopped. Rats roam the hallways, blood stains are evident and paan spit stains the stairwells. Medication, once prescribed, has to be purchased by a family member at nearby medical stores and brought to the room to be dispensed to the patient. Rusty metal beds, stained sheets with patches and holes, filthy bathrooms and overcrowded wards are the norm.The fees at a private hospital are on average four times more than the charges for the same medical issue at a BMC government hospital. The wait times at a government hospital are hours long in filthy waiting areas. We’ve wandered the halls of many of these hospitals, trying not to lean against walls or touch handrails, when we’re called to help a family who have a loved one admitted there, or when no other clinics or hospitals will take one of our patients because they are from a low caste. If the family is able to borrow money, the next choice is one of many small private hospitals nearby.
Relatives wait in the hallway of a government hospital.
When we’re involved with someone in the community who’s ill, we make the decision to go to one of a handful of small private hospitals in the area, and on occasion, to a large modern hospital nearby. These hospitals provide better care in cleaner environments but still lack a standard level of hygiene that leaves us gob-smacked every time we enter one starting with the mandatory removal of shoes at the entrance. Recently we attended the bedside of a teen boy after being called by his distraught parents. They took him to a small hospital owned by an efficient, soft-spoken surgeon who treats his patients with dignity. Situated on the second floor of an office building down the road from the slum community, the hospital is undergoing a renovation. The entrance is a jumble of wires hanging from newly installed drywall with barefoot construction workers installing new tiles, lighting and benches and building new treatment rooms. We removed our shoes and kicked them under the benches with some of the workers’ tools and walked through the drywall dust, ducked under low hanging electrical wires and found our patient in a small space on a narrow bed. The bed opposite his was being used to store a television, also covered with drywall dust, some blankets, and other odds and ends that didn’t belong in a patient’s room. Under the boy’s bed was more storage of machines, empty containers, medical tools and more dust. An orderly came and went from the room to get supplies of cotton balls and bandages housed in plastic containers with flower decals normally used to store dry goods in a kitchen, sitting on a table beside his bed. His drinking water was provided in a re-used plastic soda bottle. His condition was pancreatitis and he was seriously ill. The miracle that is India, he recovered in this unsanitary, dust filled, cramped space because of the skill of his doctor and I’m still shaking my head.
Aagya waits for our patient in the hallway of a small popular clinic.
Slum dwellers often ignore symptoms because they can’t afford medical costs or time-off from their daily wage jobs to go to BMC hospitals and wait in long lines. The demolition of homes this year has brought on a tsunami of ills which include rashes, blood-pressure issues, depression and accidents, brought on by a lack of drinking water, more rats running through homes that are still standing, anxiety and poor nutrition while getting resettled, apart from the usual bouts of dengue and malaria. After the demolition we travelled to other slum areas following leads as to where some of the families had found places to live. On a casual visit to the Patil’s home above a shop in Saki Naka we found the mom, a woman in her late 30’s, groggy and fragile. Her son said she had not been feeling well and they had taken her to a street clinic. Her blood pressure reading at the clinic was 250. The doctor gave her pills that were making her feel nauseous and neglected to instruct her about the seriousness of her condition. We insisted she go to the hospital with us immediately. We felt she was in a critical situation and made a quick decision to take her to a large private hospital with proper medical equipment and short wait times. The doctor there was alarmed at her blood pressure reading and gave her different medication to lower her blood pressure, a lecture about her diet and a caution about lifestyle - good intentions - but not possible in her living situation to get daily exercise, eat more vegetables and de-stress. Doctors at big private hospitals often are tone-deaf about the realities of a life lived in a slum. After a few days at home with new medication, she was feeling better, until we got a call from her oldest son that she was in distress and vomiting. We were in the south of the city with some children on a day out so the son took her back to the same hospital hoping to have her admitted to the government ward - a low cost BMC ward for the poor attached to the main hospital. By the time we arrived, she had been admitted to the emergency ward but the BMC ward was shut for the night. A few hours later she was admitted to the main hospital and over the course of three days she was given numerous tests including an MRI, renal doppler, ECG, echocardiogram, urine tests, and visited by many specialty doctors. Her blood pressure was lowered, but the tests revealed that she has had a few small strokes, heart problems, eye problems, and is in danger of a major stroke or heart attack. Our anxiety over her health and the mounting costs of her treatment in this hospital had every one on edge but also relieved that she was getting excellent care. She left the hospital in much better health than when she entered and remains stable at home, although the threat of another major health calamity is an ongoing concern for her.
The bedside of a young patient in a small private hospital undergoing renovations.
At another small private hospital where we take most of the kids to be patched up after a fall or have fevers checked, we watch our sweet patients get injections in a space that is relatively clean, but the vinyl bed on which they sit or lay the patient for injections is never wiped between patients, nor does it have a removable paper covering. We hold them still, ourselves barefoot, in this room that is actually a pass-though space, while the nurse, who never washes her hands or wears protective gloves sticks them with a needle and casually leaves the bloodied cotton balls on the metal table where she prepares the injections for numerous patients at once. When she finishes she throws the cotton balls and syringes at an overflowing receptacle leaving a trail of bloody medical paraphernalia that didn’t make it to the bin. It’s at this point that we eye our shoes in the doorway, too far to get to without stepping on something we don’t want to step on.
A street clinic in Sakinaka
With every patient we take to a hospital there comes great responsibility on our part, both to the family and to our donors. At large hospitals they get care because we are with them and pay large deposits to have them admitted. We’re acutely aware that families go into debt to moneylenders or relatives to finance hospital stays or pay for medicine. While we sometimes cringe at the expense of some of the patient’s hospital stays, or the cost of medical tests, we also know that the only alternative is a government hospital with lousy infrastructure and blood-stained hallways. It’s not a place we would want to be a patient and that’s how we make our decision. For the families, the gift of good healthcare in an emergency situation without the burden of how to pay for it provides immense relief. To be able to take a child or a parent to a better hospital when the call comes is a gift that donors provide to us. It’s a great day when a patient is discharged from a hospital with their health renewed and their dignity intact.
Total cost of health care for 16 patients: 140,943.84 rupees - (CAD $2,762.12)
(Includes hospital stays, doctor’s fees, medical tests, blood work, medicine. The health issues included: high blood pressure, gastritis, pancreatitis, throat pain, hole in the ear, smashed toe, AIDS medication (provided monthly), colonoscopy bag (provided monthly), fungal rashes, high fevers, dengue, gynaecology issue, eye tests)
One third of the total amount spent went to the treatment of the woman with high blood pressure who was treated at a large modern hospital.