Intensive Care

Twelve-year-old Sohel, and Dinesh, who is about ten, walked ahead of us, their wiry arms flailing and gesturing wildly. They smacked each other on the back and they giggled. We had just come from a small private hospital where we’d taken Dinesh’s ten-year-old cousin, Saeeda, to see about an ugly, bulbous sore sprouting in her little mouth. He had taken much delight in the back of the rickshaw on the way to the hospital telling Saeeda that most likely she would have an operation while he made a sawing motion with his hand. Saeeda, wide-eyed, looked at us for some denial. At that point we couldn’t give her much reassurance because we didn’t know what would occur once the doctor saw inside her mouth. Upon leaving the hospital, Dinesh was somewhat disappointed that Saeeda had only been offered antibiotics, some ointment and a dash of pain reliever with instructions to come back if the sore became larger.

Saeeda

Dinesh, whose own bandaged left hand hid a nasty infection that had turned septic, acted out his week of hospital ordeals for Sohel and Saeeda.

“First, Cindy Mom watched while they stuck a needle in my butt,” he told Sohel in rapid Hindi, while sticking his butt out for effect and slapping it.

Sohel grabbed his own face and yelled, “Last year I had my whole face frozen when they took me to the dentist”.

Dinesh motioned to his bandaged hand, held his other hand up, wiggled two fingers and told Sohel that the doctor then took a knife and cut a giant hole in his hand, and then Todd Sir and Cindy Mom dragged him back to the hospital two more times to have his cut cleaned and he cried and cried because the pain was so great.

Sohel opened his mouth and pointed to his back molar, “I had so much pain in my tooth that I went four times to the dentist and had to have medicine every day.” Dinesh, whose own bandaged left hand hid a nasty infection that had turned septic, acted out his week of hospital ordeals for Sohel and Saeeda. “First, Cindy Mom watched while they stuck a needle in my butt,” he told Sohel in rapid Hindi, while sticking his butt out for effect and slapping it. Sohel grabbed his own face and yelled, “Last year I had my whole face frozen when they took me to the dentist”. Dinesh motioned to his bandaged hand, held his other hand up, wiggled two fingers and told Sohel that the doctor then took a knife and cut a giant hole in his hand, and then Todd Sir and Cindy Mom dragged him back to the hospital two more times to have his cut cleaned and he cried and cried because the pain was so great. Sohel opened his mouth and pointed to his back molar, “I had so much pain in my tooth that I went four times to the dentist and had to have medicine every day.”

Dinesh

The kids in the community love an outing and as long as it ends with ice-cream and the pain subsides, even a trip to the hospital is better than not going anywhere, but when kids fall seriously ill, the fun stops at the hospital door and fear and anxiety claim a place in our heads and our hearts. Anguish has become my first emotion in Saki Naka and anguish for others sits hard in the stomach, the head and the body. Plucking someone out of the swirling waters below a waterfall just before they drown only to have them fall back in and and drift out of reach of any potential to be helped is how we sometimes feel, especially when we are dealing with sick children in the community. Parents are delinquent about their children’s health and safety for reasons directly related to poverty, illiteracy and exhaustion. They suffer a lack of education about basic hygiene and miss warning signs of severe illness or septic infections. They believe in age-old tribal superstitions such as cutting their child’s hair when they are sick as a way to keep the illness at bay. They go to street doctors who only charge a few rupees to dispense advice and hand out antibiotics rolling around in a dirty drawer they aren’t qualified to give. For every sick child there is a barrage of advice from lane way mothers that might involve turmeric, massage, pujas and toothpaste (for burns). When home remedies and superstitions don’t work, the poor of Mumbai turn to BMC (government hospitals) where no deposits are required and fees for medicine is lower. But BMC hospitals lack even the most basic of equipment, the wards are overcrowded to such an extent that many patients sleep on the floor and in the hallways, bedding and examination rooms are filthy, needles are reused, sterilization techniques are rudimentary at best and the stench of the public toilets leave a film in the nostrils.

Children play barefoot in lane ways full of hazards

The only choice for Indu’s two-year-old daughter Aagya, who suffered a serious breathing problem a few months ago, was a private hospital with neonatal intensive care beds, no line-ups, and no shortage of on-call doctors. Her breathing problem became a grave concern while we were at a nutrition clinic with another mother and child. Aagya was sprawled over Indu’s crossed legs. Using her legs as a hammock, Indu bounced her daughter up and down, first one knee, then the other, while keeping one hand cupped around Aagya’s head. This is routine in India; the bouncing on a mother’s lap of their children while patting their forehead in deliberate motions to quietly calm a child who is hurt or to put them to sleep. It works most of the time. But this time Aagya was at once wild-eyed and agitated, and then exhausted and eerily quiet. Her little chest barely expanded with each short, shallow breath and her nostrils flared to grasp any air she could fill them with. Indu was on auto-pilot, doing what she normally does to comfort her child, unaware that Aagya’s alternate agitation and exhaustion was because she was struggling to breathe. I have witnessed my own children’s struggles with asthma and knew we needed a good hospital with the right equipment in a hurry.

Aagya in Intensive Care at Seven Hills Hospital

Seven Hills Hospital is near the community and is one of Mumbai’s premier hospitals if you have the money to pay the fees. It also houses an overcrowded wing for the poor with substandard equipment, unfinished space, a wait of many hours, and caring but overworked doctors and nurses. We opted to push through the fancy door, the door where we would get immediate attention. Aagya was admitted to Seven Hills Neonatal Intensive care ward immediately and put on a ventilator, hooked up to an IV drip and her oxygen levels monitored with a clip on her finger. Once she was stabilised, the doctor turned his attention to Indu. He yelled at her. How could she not know her daughter was so sick? Why didn’t she get her to a hospital earlier? Indu was frightened by the hospital, the doctor, and the fast depreciating health of her tiny daughter. The doctor was insistent that Aagya was critical - that we could lose her. Indu’s husband, Akhilesh, arrived. He cried and looked like a lost child himself. The doctor berated him. We intervened and told him that she had been fine until a few hours ago and he decided to believe us. He took more tests and ordered x-rays, gave her more medicine and then bypassed Indu and Akhilesh and directed his concerns to us as we paced the hallway. We settled into the hard chairs in the hallway leaving Indu and Akhilesh by their daughter’s bedside, anxiety and worry increased by the minute. Then Indu came to us, crying and confused. They had just been told that Aagya had to be moved to another hospital. I was numb. This is one of the best hospitals in Mumbai. Why would they risk moving her? My mind immediately went to the noise and confusion of the gridlocked traffic in Mumbai and I didn’t want to imagine us in it with a seriously ill child. We talked to the doctor and he confirmed she must be moved immediately.

Aagya

“Why!” was our anxious reply. He looked to the floor and then nodded towards the room with Aagya and her parents.

“This hospital is not for them. They will never afford the fees or the deposit. They must move her to a government hospital where the fees will be much lower. She is stable for now, but they must act quickly or she won’t make it.

”This would mean unhooking critically ill Aagya from her ventilator, removing the IV tube, putting her in her parents arms and walking out of the hospital to find a rickshaw or a taxi to take her to a government hospital, the closest over an hour away in heavy traffic, thick with pollution from car exhaust. If that hospital failed to take her, we would have to try another one. The doctor reminded us that she was gravely ill.

“So it’s only money that is the problem," we cried. “Please leave her here. We will be covering the fees.”

Indu collapsed into a chair as distraught as any mother can be while her husband stood eerily still, shifting his eyes to the doctor and then to us, waiting for a miracle. The doctor, once satisfied that we would be paying her fees, turned and gave instructions to the nurses hovering over Aagya’s bed, ready to remove the life-saving tubes, to instead keep her comfortable.

A street doctor's clinic in Saki Naka

Aagya stopped breathing in the middle of that first night in Seven Hills Hospital. Because she was in a private hospital in intensive care she wasn’t overlooked and the nurses and the on-call doctor managed to revive her just in time. The cost of care at Seven Hills Hospital versus going to a government hospital where we would only pay for medicine seemed to find a balance in those few terrifying minutes it took to save Aagya that night. She spent a week in Seven Hills with three days in intensive care and the rest of the week in their economy ward — which was also in a state of decay, but still much more desirable than a government hospital.

Indu and Aagya

Dinesh had hidden his painful, infected hand from his parents and came to us instead because he knew we could help. He was frightened to tell his stressed father about his injury because the family can’t afford hospital bills. His hand continues to heal. We took him to the doctor twice a week to have his wound cleaned and bandaged in clean dressing. A few days later, his sister came running to us, yelling that Dinesh had fallen from the ladder leading to the cement pad below their one-room home. He was bleeding. When we arrived his brother had already taken him by bicycle to a street doctor who tied a dirty rag around his head, gave him some pain relievers and told him not to sleep. Once back home, Dinesh sat against the wall, his arms wrapped tightly around his knees, looking down at the floor. He was distressed from the pain and fearful of a beating from his father once he found out about this latest injury. Poverty stress is the reality of living packed into hot, tiny rooms, with the danger of injury lurking outside around every nook and cranny. There are very few children in the community who don’t sport bandages, cuts, large bruises, infections and heads full of lice.

This family lives surrounded by a moat of overflow from the public toilet block

Living in a city as crowded and polluted as Mumbai will test Aagya’s lung capacity for years to come. Keeping her from getting germs in a slum community will be ludicrous feat of constant exasperation. For the poor of this city, having a chronic condition, or a sudden accident requiring medicine, or a stay in a hospital, means to live with unbelievable stress. They carry loans with ridiculous interest rates to pay medical fees or they don’t go to a hospital hoping that tribal wisdom will cure all.

Sohel and his brothers and sister bathe in front of their home that is surrounded by gutter overflow

Every year we take numerous people from the Saki Naka community to every kind of medical clinic and hospital depending on the severity of the wound, disease, or sudden or chronic illness. For most of our patients, the healing begins when they realise we can manage their profound stress with the funding to keep them where they need to be to heal properly. Their families can continue to work their jobs, keeping the family in dal and rice for another day, while their loved one gets the care they deserve.

Playing safe and keeping clean is difficult for the children of the community

Aagya, Dinesh, Sohel and Saeeda are active, rambunctious kids living in dismal, dirty laneways where human feces flows like lava through the gutters. They have immune systems that deflect some of the germs that gorge on their tiny bodies, but when tribal medicine, folklore and spicy water don’t work, Dirty Wall Project is able to help. Thank you Donors!! Aagya Seven Hills Hospital Fees: - lab charges: 13,580 rupees (CAD $271.60)- room charges:18,600 rupees (CAD $372)- registration: 270 rupees (CAD $5.40)- procedures: 3,280 rupees (CAD $65.60)- Doctor consultation: 9,130 rupees (CAD $182.60)- Medicine: 7,896.97 rupees (CAD $157.93)Total for one week stay at Seven Hills Hospital: 52,756.97 rupees ($1055.33)Home Ventilator Machine/meds: 2,781.00 rupees ($55.62)(will allow Aagya to have on-going treatment at home preventing emergency treatment) Dinesh Cuddles and Care Private Hospital - Doctor’s Fees: 600 rupees (CAD $12)Medicine: 285 rupees (CAD $5.70)Dressing changes: 800 rupees (CAD $16)Konkan Hospital: surgery to remove infected lesion on hand/Doctor’s Fee: 3000 rupees (CAD $60) Saeeda

Cuddles and Care Private Hospital - Doctor’s Fees: 600 Rupees ($12.00)Medicine: 285.75 Rupees ($5.71)(Saeeda will require more medicine and possible removal of the sore in her mouth)