Snake bite, motorbike accident and organophosphate poisoning. If you want to place money on what patients will present to casualty at Herbertpur Christian Hospital on an average day, any of these three is a guaranteed winner.
Snake bites are rare in the UK, so seeing them in India is a new experience for me. Reading up in casualty's emergency medicine textbook, I learn a useful lesson. Due to a reflex they possess, snakes are able to bite you up to an hour after their head has been decapitated from their body. Next time I go snake hunting, I'll be sure to wait before playing with my spoils…
Motorbike accidents are similar to any trauma in the UK. Except that helmets are like gold dust in rural India, and the capacity of a mission hospital to cope with head injuries and massive blood loss is a lot less than a tertiary centre in England. Especially when you factor in the obligatory hour-long discussion of the relatives as to whether to donate blood, whether they want admission or whether to take their rapidly deteriorating loved one to the larger hospital, an hour away by auto rickshaw (ambulances don't exist here).
Organophosphate poisonings in India have a completely different meaning to the occasional farming accident in the UK. Here OP poisoning means suicide. It's a recognized method of disposing of oneself, of which most Indians are aware and have the means.
The first OP poisoning I see is a twenty one year old girl who I'll call Anjali. To my untrained western eye, she seems intoxicated as she stumbles through the double doors of casualty, leaning an obviously concerned male relative, her eyes barely open and her mouth foaming with saliva. For the Indian doctor, all it takes is a look in her eyes to recognise the pinpoint pupils which, when combined with her symptoms, are characteristic of OP poisoning. A few questions to the relatives confirms the diagnosis and the atropine is ordered, everyone dons a pair of gloves, and a nasogastric tube is inserted in order to begin the laborious task of a gastric lavage. This is the first time I've seen this performed and I get the job of pouring small amounts of water down the NG tube until the stomach contents is forced back up the tube into a bucket on the floor… or onto my shoes… and repeating this until all the gunk appears to have cleared. It takes a long time.
Anjali is typical of the sort of person in India who drinks the liquid insecticide – a young woman, beautiful but deeply unhappy. Although more and more women here are attending university and entering high-powered professions, there remains an undercurrent of repression, particularly evident in rural areas. Go back a couple of hundred years and it was widely practiced that women became suttee, obligated to throw themselves on the funeral pyre of their husband as they were considered worthless without a husband. On the labour ward the delivery of a baby girl often brings disappointment rather than joy, and it is illegal in India to disclose the sex of a baby before birth due to the real risk of a pregnancy being terminated if it is thought to be a girl. Apparently, because of the number of girls abandoned at birth, the state of Punjab is running short of women, forcing its men to travel to other states in search of wives! I've heard of families accusing hospital staff of swapping the babies when shown their newborn baby girl, insisting that theirs was a son and refusing to accept a daughter. But it isn't just male chauvinism, women are equally harsh on their own sex. When a woman reaches a certain age, if she has borne a son she earns the right to become the oppressor, being cared for by and making demands of her daughter-in-law. India is a land of contrasts. Of course this isn't true of all Indians and the increasing Western influence ensures that, in the cities at least, an impression of equal rights is maintained.
Anjali is admitted to the small four-bed intensive care unit as more relatives arrive. Over the next two days we observe her devoted husband keeping vigil at her bedside as she slips in and out of consciousness. It turns out that unlike many women, it isn't a restrictive husband who has motivated Anjali's attempt on her life, but “mother-in-law problems”. She doesn't seem to be making much progress, and as I spend an afternoon with the on call doctor we receive a phone call. Anjali has arrested. We arrive in ICU to find her curtain drawn round, behind which the nurses are trying to resuscitate her. The doctor takes over bagging, trying to ascertain exactly what happened, while I relieve the nurse doing chest compressions. This is the first time I've done this for real, and I wish it was only another clinical skills session in Southampton with Annie (the CPR dummy)'s artificial skin beneath my interlocked fingers rather than Anjali's patterned kurta. After what seems like an eternity we stop. She is pronounced. The relatives drift in. I'm in a daze – this is the first time I've been present at a death. The staff don't seem so surprised. They see patients “expire” every day. Later I wonder whether it would have made a difference if the hospital's defibrillator hadn't been broken and sent to Delhi for repairs.
In my room I read Philippians 4:4. Confused, questions flood my head. How am I expected to rejoice when a girl my age is driven to poison herself because of her differences with her mother-inlaw? How can I rejoice when her husband is now grieving the loss of his beautiful young bride? Then I remember the day I spent in Delhi, receiving my orientation before traveling further north. Men sitting in the subway, missing limbs or parts of limbs, a few coins at their feet from passersby. Women pulling at my sleeve, showing me their malnourished babies. Children in rags tapping at car windows as they stop at traffic lights. All of them asking for food, money, anything. Driving to the railway station early one morning as the time comes for me to leave Delhi, we pull out of my hotel into a wide boulevard lined by palm trees. Large, plush hotels and offices crowd either side of the road while the central reservation is home to scores of families in rags, some sprawled out, others huddled together, a few stirring in the early dawn light. India is a land of contrasts. Again I begin to question why. Why do I get such a comfortable life?
I can't pretend to have gained any great insight or understanding of suffering. But thinking about it I realised that there can be joy in suffering. Suffering highlights the fallenness of this world and makes it even more amazing to me that Jesus would choose to come into that same sin-marred world, riddled with injustices. He chose suffering – not only physical but spiritual. He chose poverty and pain to bring a real and living hope to a world that was without hope.
As I look around India I see a country with many different faces. The face of suffering – people weary and prematurely aged, struggling to survive the difficult hand they've been dealt. The face of aspiration – endless time and money devoted to the gods, in the hope of a better future life. The face of acceptance – unquestioning acknowledgement of position and status, however low it may be. The face of ambition – the young, beautiful models and actors of modern India, staring out from billboards. India is a land of contrasts.
The face I see very little of here, in this predominantly Hindu state, is the face of certainty – assurance of purpose and a future. Herbertpur Christian Hospital is much more than just a medical service for the poor, it is a light in a dark place – its influence can be seen in the dedication and love that radiates from the staff. The UK is a world away from rural north India, yet the same spiritual darkness is just as prevalent. We may not have mission hospitals, but I see now how any hospital can have a ministry when just one member of staff decides to be a missionary in that hospital – and surely we have the perfect profession in which to reflect Jesus' love and healing. What a privilege!