Front Street Weekly; 818; Oregon's Passage to India

The following is a Front Street weekly special report. [Indian music] [background noises] [background noises] [Marilyn Deutsch]: What looks like medicine in a MASH unit is standard operating procedure at the ?Shanti Mandala? health clinic in Agra, India. The woman here is about to have a cataract removed from her right eye. That will restore sight she hasn't had in years. [background noises] [Male voice]: Generator going, or what? I can't go out if we're gonna-- I

can't do anything. I have no power, nothing. [Deutsch]: That surgery took place just about 2 months ago in Agra, India. In the third world, a power outage is not unusual, even when it happens during a delicate operation. Good evening, I'm Marilyn Deutsch. This past January, a group of medical and lay people from the U.S. journeyed halfway around the world on a medical mission to Agra. For 2 weeks volunteers, most of them from the Pacific Northwest, treated the poor and the sick. Agra, India is a city about the size of the Portland metro area. It's best known as the home of the Taj Mahal, but Agra is also home to some of the world's poorest people. Most of Agra's citizens live in poverty, and seeing a doctor is a luxury few can afford. We went to Agra to learn what health care is like in the third world, and to see just how well two doctors from Oregon could practice medicine without all the comforts of home.

The small lumber community of Medford, Oregon is home to Dr. Ralph Hibbs. Dr. Hibbs, a retired physician, is a veteran of 3 medical missions. Paybacks, he says, for surviving three years in a POW camp during World War II. Seventy-five year old Dr. Hibbs hoped to do more in Agra than just dispense a few pills. [Hibbs]: Leave something that the natives can have, and that's got to be education. That means breaking down of their superstitions. [Deutsch]: Dr Hibbs would not teach much, but once in India he would learn about life and medicine there. [Kern]: Have you been having any trouble with his finger at all? [Patient]: No. {Deutsch]: Dr. Stanley Kern has been practicing family medicine in Newberg, Oregon for a quarter of a century. [Kern]: She has a small cyst on her finger here that we're just going to open and drain. Should be numb now. If you have any pain, you let me know.

[Deutsch]: Dr. Kern went to Agra to see what it would be like to doctor in the Third World. [Kern]: You have a good Christmas season, Pauline. [Deutsch]: For 2 weeks, Dr. Kern and Dr. Hibbs called this clinic their office. The ?Shanti Mandala? health clinic runs year round with Indian doctors. But about once a year, the clinic imports doctors from America to tap their expertise. India's still a developing country, and many here consider American doctors the best trained in the world. [Kern]: -- completely involves both lungs. [Deutsch]: This morning in Agra, Stanley Kern meets Rasul Khan. Rasul Khan is just 55 years old, but he is too weak to work.

Rasul Khan's lungs have almost quit working, too. [Kern]: This chest X-ray is a year and a half old, 1987. October of '87. Has he been, has he been on pulmonary, has he been on tuberculosis treatment since then? [Deutsch]: Mr. Khan has an advanced case of tuberculosis, or TB. [coughing] [coughing] [Kern]: He isn't uh, moving much air, he just doesn't move much air. Rasul Khan says he has not been hungry for months. He coughs up blood, and every evening he gets high fevers. [Kern]: He's lost a lot of weight, he's very [inaudible]. [Deutsch]: Despite his illness, which is at least several years old, Rasul Khan has not

tried very hard to get better. [Kern]: He's been, he's obviously been seen in uh, clinics before, but for whatever reason he wasn't taking his medication, and the pulmonary tuberculosis has just continued to uh, go on. [Deustch]: He looks deathly. Do you expect him to survive? [Kern]: Well, um I think he could get better on treatment if it started uh, promptly. [Deutsch]: But neither Dr. Kern, nor his Indian colleague, Dr, Judeo Sharma, know whether Mr. Khan will take the medicine they prescribed. [Kern]: Well, he's gonna, if he doesn't get started treatment, [inaudible] [Deutsch]: In the Indian system of healthcare there is little follow up, and Rasul Khan

is one of roughly 150 patients seen during just one day's sick call. The sick and he needy here are strangers coming in, strangers on their way out. [Female voice]: We'll find your parents. [Deutsch]: There was not much time to get a good case history on this patient. Here's what the doctors know. About 6 months ago this little boy was in some kind of an accident. He suffered a compound fracture. That became infected. [Hibbs]: Just, you know, a horrible contraction, there's all fixed, the tendons in the bone, and he had a skin graft on it which did nothing. [Deutsch]: And according to Dr. Hibbs, if this treatment had happened back in the states, 1 result would have been one whopping medical malpractice lawsuit. [Hibbs]: Always ?contract?

[Deutsch]: As it is now, this young boy is left with one scarred, withered useless arm, in a country where the maimed are usually seen begging for rupees. Dr. ?Ati? Sharma tells the boy's father to go to the bigger government hospital because his son will need a series of operations and also lots of therapy. [Hibbs]: And he needs, you know, sophisticated reconstructive surgery, over a matter of years probably. He can get a functional arm out. I'm depending on the, the surgery, and that type of uh, facility being available here as it would be in the States, but if-- he could get a functional arm out of it. [Deutsch]: The child will be referred to the government hospital for the poor in Agra. But his chances of getting in are slim. Some estimate that India's government hospitals serve just 10 percent of the poor,

that many of those who do get treatment are not poor at all, but have money and connections. On paper, India's system of health care looks pretty good, but in practice it's a mess. There are free health clinics all over India, but the facilities are meager. And medicine, too, is supposed to be available to the poor, but it often gets to the black market before it gets to the sick and the needy. [Dr. Ahmed]: There are crooks and dishonest people, uh, in- in- in that system. [Deutsch]: Dr. ?Aftab? Ahmed should know. A heart surgeon from India, Dr. Ahmed now lives and works in Portland. [Ahmed]: There are some dishonest people, you know, who take advantage of their positions and certainly, you know, they have been doing things like diverting the medicine and other stuff to a black market. [Male voice]: More emergencies. [Deutsch]: For the fortunate few who go to the government run hospitals,

here's what they get. [ Hibbs]: --portable ?oxygen? And the intravenous of -- The father stands watch and observes as things work, he's-- it's real dedication. Do you have patients that have had eye surgery? [Deutsch]: Along with Doctor Ralph Hibbs, we walked through the hospital for the poor in Agra. [Hibbs]: These are just open beds in a big ward. On-- laying on a bare mattress, there's some patients here you see scattered along, looks like there's a little, little pot maybe for water or food. You really don't get uh, you don't see any nurses or any help being given. Let's see what there's out here. Some eye patients here.

And I don't know from looking at them what they've had done but, well, by our standards, this isn't even the bare necessities, but this is what we have for the eye ward. I see the heart clinic coming up there. That was nose and throat here. [Deutsch]: This was an uninvited tour of the government hospital. 20 minutes after it began, we were asked to leave. [Male voice]: Have you taken the permission to take this video? [Hibbs]: No. I'm a physician from the United States, and I'm here in India by permission, and I'm working in the ?Manlick? hospital. I just came out of ?inaudible? [Male voice]: ?inaudible? without the permission ?inaudible? I think it is not possible. [Hibbs]: Whatever's -- [Male voice]: How can we allow this? [Deutsch]: To be poor in India is to be unhealthy. Dr. Hibbs says if you could improve the diet, personal hygiene, and sanitation of the poor,

you could eliminate more than two thirds of their medical problems. Walk through Agra's neighborhoods and you see what he means. [Hibbs]: It's the still, stagnant water, debris just uh, scattered all over in a random fashion. This thing here is an open sewer drainage, in fact it's got everything in it. It's not running. It's about as good a reservoir for germs and diseases as one could construct. [Deutsch]: What do you notice about the children? [Hibbs]: Their, their clothes have old dirt and new dirt. Now, you don't mind a little new dirt, you come in and take a bath or clean yourself up, but I, I don't like old dirt that's been there. After one day I think the old dirt should be gotten rid of. In other words it-- and they don't have soap. These people don't have

soap in their home. There's a little girl doing her job-- there, take a bath and drink out of the same faucet on the same platform in this same nozzle. You know I think they, they Really ought to be separated between the dirt and cleanliness, whether you're going to wash it or whether going to drink, drink it. Well, there's a -- There's a little activity there. You have 2, 4, 6, 7 pigs around, Trying to get their lunch and um, pick up any goodies. I saw a little boy the other day with a plastic sack right where the pigs, he was gnawing around trying to pick up the same stuff. There's just no, no way you can reconcile that as, "it's not very bad, or oh we're used to it," I just think it's, it's not even debatable. I think it's horrible. [Deutsch]: In these neighborhoods there's no indoor plumbing.

Diseases that can be eliminated simply, by immunizations and vaccines, often go unchecked in India. [Pastore]: It's polio. [Deutsche]: Lizanne Pastore, a physical therapist from Connecticut, is also part of the medical team working here at the clinic. [Pastore]: You lie down. When did he get polio? [Deutsch]: He is 4 years old and he has had polio for half his life, [Pastore]: Um, he has very little uh, muscle power in his legs at all. He can barely-- He's got some, because he can begin to hold himself, but he's basically flaccid. He can kneel, or he could, he could stand on all fours on his hands and knees for a short while. So he's got some muscle strength there, but very, very little. [Deutsch]: Lizanne tells the boy's father intense physical therapy might help his son regain some strength. While polio has been virtually eradicated in the U.S., in India there are still tens

of thousands of cases a year. ?Owen Prakash? lives in a crowded neighborhood of Agra with his wife and 2 sons. [background noises] Owen Prakash, ?Opi? to his friends, eats and speaks without benefit of teeth. They fell out a long time ago. Opi is a rickshaw driver. In fact, at 65, he is the oldest rickshaw driver in Agra. [Opi talking] Opi often works from 5 or 6 in the morning until 10 or 11 at night, 7 days a week. [Pastore]: How long have you been driving a rickshaw? [Prakash]: Eighteen years. [Pastore]: Eighteen years? [Prakash]: Yes. Now much problem. I'm old man. I'm poor man. No other business. [Pastore]: Not other business? [Prakash]: Yeah, no business. No money. Money much problem. [Deutsch]: Opi is a member of one of the working castes or classes. Sometimes he earns

just 70 cents a day. It takes quick reflexes and a sharp eye to navigate through Agra city streets. Opi is not as quick as he used to be, and now he has trouble seeing his way through traffic. [Prakash]: ?inaudible? [Pastore]: I see, you can't see far way, you can see close by though. [Deutsch]: Opi has needed glasses for a long time. Today he decides he will spend the money to get his eyes examined. The process at the health clinic will take him most of the day. There is little that is systematic or efficient about health care in India. 5 hours later,

Opi gets his eyes checked. [background noises] After a day of lost rickshaw fares, Opi is told his glasses will be ready in a few weeks, but Opi has been told this before. He hopes, but he's still not sure, that this time he will get his glasses. Like others, Opi has little trust or faith in his country's ability to deliver health care. If life for India's poor is full of obstacles, so is the practice of medicine in India. For our 2 Oregon doctors, their daily routine became a lesson in perseverance. While doctors examined their patients on the first floor, the clinic's second floor was being built

one brick at a time. Noise was a constant distraction, but it was the lack of modern medical equipment that proved an insurmountable problem. [Kern]: He does not have a chest -- this man does not have a chest x-ray. Very few patients actually get actual chest x-rays. [Deutsch]: For Dr. Stanley Kern, that meant rarely being able to rely on scientific data from X-rays and lab tests. Instead, Dr. Kern played his hunches. [Kern]: Uh, that's been the difficult part for me, and so I think if it-- you come away feeling like your diagnoses are very superficial. [Deutsch]: Because there's not-- nothing to back it up. It's, it's guesswork. [Kern]: Yeah, there's not a lot of laboratory or diagnostic uh, clues to -- [Deutsch]: To confirm your suspicions. [Kern]: Yeah, to confirm the diagnosis. this. So, where is the pain? [Patient]: ?inaudible? [Deutsch]: Another problem: cultural differences. Indians do not undress when they see a doctor. Women are especially timid, and reveal, at most, only about 6 inches around the belly.

[Kern]: Well it's just false modesty, it's just ridiculous. If you're going to come in, and I don't care what sex you are, take your clothes off and give the doctor a fair chance to examine you. The delivery of healthcare to an underdeveloped country of almost 800,000,000 is no easy task. And it's a job that will likely get tougher. By the year 2000, India's population is expected to reach 1 billion. But the reasons for India's failure to improve the lives of the poor may be rooted in something deeper. [male voice]: This my Krishna. This my Krishna. The religion of most Indians is Hinduism. And Hindus believe in reincarnation. Again, Portland heart surgeon, Dr. Aftab Ahmed. [Ahmed]: And they really believe that if their suffering is war in this life, then God, a creator, will probably improve their next life, you know. And they are just paying, sort of a price, for some of their misdeeds.

[Deutsch]: While in Agra, in the back of the Taj Mahal, we saw a body in the river in the Yamuna River. We were told it was a suicide, that that was common, and that some people are all too eager to get to the next life. [Pastore]: We were struck almost by the feeling that life did not seem to be worth as much over there as it does over here. [Ahmed]: For the people who are underprivileged, uh, your, um ?inaudible? is totally correct. That the people who don't have money, who don't have any uh, important connections, they are basically totally destitute, and uh, not just in terms of medical facility, but in terms of basic need, like food and shelter. I think uh, nobody is paying attention to those. The one thing, you know, that they have no choice. And as I said, you know, they're

used to misery, they are used to, uh, their uh, limitations, uh, and there's nothing they can do about it, so all they do uh, is just to accept things as they are. [Deutsch]: Still, there are some small victories in this country where it seems so difficult to change anything. Here's the woman you saw at the beginning of the story, when the lights went out during eye surgery. [Kern]: The eye was just operated on yesterday and it's nice and quiet. Yeah. They see. She's pointing to you. She sees you. [Deutsch]: 10 minutes ago ?Tufan Singh? arrived at the ?Shanti Mangala? health clinic,

by oxcart. Neither he, nor his wife, nor the oxcart driver, tried to get help. No one noticed them, except for us. We called for help. Twice Lizanne Pastore tried, and failed, to coax a doctor outside to examine Tufan Singh. [Pastore]: Can you help me? Can you just help me take him? Wait, wait, wait. Don't hurt your back. [Tufan talking] OK. [Deutsch]: His words are cries of pain. With his blanket as a stretcher, 70 year-old Tufan Singh, too weak to walk, is hauled in to see a doctor.

Tufan Singh has been feeble and ill like this for a month now. But this is the first time he or his family has sought medical care. Tufan Singh came to get some medicine. He hoped he could just take a few pills, then go back home. [Male voice]: So we can get a ?temp? on him now. Let's get a thermometer in his mouth, if he'll hold it. Temperature, yeah, please. [Deutsch]: Tufan Singh is emaciated and dehydrated and he is burning up. They never did find a thermometer, so no one knows exactly what his temperature is. [Male voice]: He has to go to the hospital today. [Deutsch]: Dr. ?Ati? Sharma

tells the oxcart driver that Mr. Singh should go to the government hospital. "Tell everyone not to worry about me," Tufan Singh tells his wife. To get to Agra's government hospital, Tufan Singh has a 4 mile ride. We figure by oxcart, it might take him 4 hours to get there. The next day, and the day after, neither doctors here at the clinic, nor officials at the government hospital, seem to know what happened to Tufan Singh. To the people who could save his life Tufan Singh simply disappeared. But the story of Tufan Singh is the story of India: a dying man, an ox cart for an ambulance, and a hospital that might turn him away when he gets there.