Significant Changes and Important Information

This month we’ve decided to leave aside the story of our adventures in health to update you on some significant changes taking place in Dayasagar Health Services.  In the following paragraphs you will find information about  1) a Crucial Merger,  2) Decentralization of our Ambulances,  3) Expansion of Community Based Care ,  4) Relocation of Our Base of Operations and 5) our upcoming plans to visit America.

The Motorcycle Diary or The Gospel of T

            Westerners travelling or living in India tend to avoid the glances of other foreigners.  We’ve labelled this “Get out of My Fantasy Syndrome”, or GMFS for short.  Someone who believes that they are on a grand adventure to the far flung corners of the globe doesn’t like to see, purely for example’s sake, a white family holding hands (with a baby in a sling) sauntering down their Silk Route.  So we’ve made it a point to lock eyes with all tourists and flash them a big smile.  Their physical response reveals a lot about their character... in particular if they’re suffering from GMFS or not.  Last month, a grey headed Caucasian man was sitting on the edge of Bidhan Bazaar next to a tin trunk and several jholas full of supplies, I figured he must be a “local” foreigner.  He lifted his head and met me with a blank stare.  I smiled and slowly a smile crept across his face.  Rounding off the encounter with a head nod, I was getting on my way when suddenly he said,  “Where... you... from?”

            “Would you like to know what country I’m from or where I live?”

            “Yes... Where you from.”

`           “Well then, I’m from America but live a couple hours outside Kalimpong.”

            “America.  I American too!”

            It was a surprising to hear considering his broken and awkward sounding English.

            “Kalimpong.  You live in Kalimpong.  Here look.”

            He dug around in his bag and pulled out a stack of photos.  The next thing I knew there was a picture in my hands of a young Nepali girl with her breasts exposed and a large tumour on her side.  He said with an honest smile on his face, “This girl is from Kalimpong.  That’s where you live.”

Moonlit Journey

I’m no stranger to feeling my way forward in the dark. Spending five years in an un-electrified village (with a chronic shortage of candles and kerosene), living out the years since with daily power cuts, having only weak Indian batteries in my flashlight and frequenting outhouses at midnight (due to multiple mugs of chai) have provided me with ample practice in the aforementioned art. Despite having this niche expertise, it is still uncomfortable to find one’s self driving along precipitous Himalayan roads at three in the morning with the headlights... off. The discomfort approaches alarm when it is compounded by the fact that there is a man bleeding to death in your back seat. Driving slow would mean to risk his death. Driving fast would be to risk everyone’s. In such a situation, one can’t help but ask themselves once again, “How did I get here?”

The Fools' Christmas

The three who came from the east, who were they after all?  Some call them kings.  Some call them Magi’s.  Some call them wise men.  There is enough ambiguity to their tale to make one wonder about their story.  The stars had painted a map for them which led to Bethlehem.  Perhaps they really were kings because they were regal enough to be received by Herod.  Their intent for visiting his palace was to ascertain were the foretold child had been born.  It must have been surprising to find that they who came from a distant land knew more about this strange birth than the local ruler.
_____   
The Donkey was busy ferrying mothers to the hospital so Mom, Shepherd and I took the Rhino to Darjeeling.  In the office I sat down with the Matri Yaan officer and the new doctor in charge of Maternal Child Health for the District.  Not only has India guaranteed free care at the time of delivery to its mothers but also free transport to its institutions as well.  With the giant satellite map ECTA/Dayasagar created hanging on the wall, I outlined all of the technical problems inhibiting the government from actually fulfilling its promises.

Cedar Milan Phillips

Birth Announcement: Just Before Sunrise, by Ryan Phillips

           Just before sunrise I was dreaming. The Assistant Chief Medical Officer was sitting in front of me and we were having a discussion. In real life she’d asked us several times not to deliver our own child in Kaffer. It seemed a bit incongruent considering that she had also told us that our little birth room was better equipped than the government Primary Health Centers that are assigned to take care of the majority of “normal” deliveries in our district. But still, even being fully aware of this discrepancy, her request made me second guess myself. It made me think about how detrimental to our work (let alone our family) it would be if something were to go wrong with the birth of our own child at our center. There were certainly some legitimate reasons for concern considering Amanda’s history and that VBACs (vaginal births after cesareans) aren’t practiced in India. But yet, in my dream, I was confident in telling Dr. Lingdo that we had the baby at home anyways, that not only was it a “normal” delivery but that it was a blessed one as well. It involved a mother doing what her body was created to do, everything needed to help her do it, a midwife there to help when required or desired, a husband and family to support her, and an ambulance waiting outside in case of any complications. The room prepared for her was clean, comfortable, and safe. The baby was born into an environment of love. All went well. All was well. In my dream I was telling her that it was good enough for my wife, so it is good enough for their wives, and that I was asking for official permission to take care of all the “normal” deliveries at our center.

            Waking at six in the morning, I found Amanda sitting upright. She was having contractions every six minutes and it was finally time. Having seen a lot of traumatic births in recent weeks, a sense of foreboding had been growing in my heart, but I awoke with a sense of peace. One concrete reason for this was that Kara Rowley, a midwife from Kansas with a lot of overseas birth experience, had volunteered to come for the delivery. It was comforting that everything wasn’t riding on me, which too often is the case despite my efforts. Another more ethereal reason for my peace was my nocturnal conversation with Dr. Lingdo. Even as the contractions became more frequent, my feeling didn’t fade. I was grateful that we’d been blessed with a week of rest and preparation after a preceding month or so of mayhem. As the day progressed, everything went according to plan, in fact, better than we would have hoped for. It turned out to be an uneventful birth, but by that I do not mean boring. I mean uneventful in the same sense that when you ask someone who has been soaring at 35,000 feet at 700 mph and crossed half the globe in a single technologically-enabled leap how their flight was and they reply, “Uneventful.” My wife’s pain took off, she soared through the dizzying heights of maternal sacrifice, Kara sat as co-pilot and helped everything stay on course and, after half a day’s journey, my son gently landed in my arms in the middle of the Indian Himalayas.

            In those mountains, our village is situated in the midst of a large protected forest. It is mostly composed of Japanese Cedars: tall, straight, quick growing. In the Bible, cedars are often used as a symbol for strength and integrity. Any single tree is quite majestic, but it is much more beautiful when part of a forest. So we named our four-kilogram, twenty-and-three-quarter’s-inch son Cedar Milan (milan meaning a union or unification). We hope that he will grow quickly to be a man of integrity and find kindred spirits to stand beside him in this journey of life.

            Since the miscarriage of our daughter Leaf and the traumatic struggle to save Amanda’s life, a main thought has driven me forward, “I don’t want any of our neighbors to have to go through that.” But after Cedar’s birth, a new thought will push me on, “I want all of our neighbors to experience this.” Both thoughts are legitimate. Both are needed, but I think the second is better than the first. Our work so far in Kaffer has been like running life boats for a sinking ship. It has been a survival operation. It has taken a monumental effort just to ensure that my neighbors don’t “have to go through that” (not that this goal has even been fully realized yet). Our work to come is to give an opportunity for “our neighbors to experience this.” What is the “this”? “This” is life instead of survival. “This” is grace instead of fate. “This” is compassion instead of compulsion. “This” is love instead of duty. But we won’t be able to do it alone, like two trees standing on a hilltop just begging to be struck by lightning. We’ll need a forest of kindred spirits to make it happen.

            Just before sunrise I was dreaming but just before sunset I was holding my dream in my arms. So I think I may go and have that conversation with Dr. Lingdo in real life as well. The first part of my dream has come true, why not the second?

In Him,

Ryan, Amanda, Linda, Asher, Shepherd, AND Cedar. 

The God of Broken Things: Part Three, by Ryan Phillips

Here is the final of the three weeks I mentioned in the first newsletter entitled The God of Broken Things. Thank you for giving me a way to process the last month and come to grips with everything that has happened. I hope these stories bless you.

Wednesday, October 5

Monday and Tuesday provided a little time to rest and heal from my case of cellulitis (the worst pain I’ve been in for years), even though I was the only one on duty for the Rhino. Purna drove the Elephant down to Gayaganga on Tuesday with Sandeep in tow for treatment. Saran was juggling the non-stop maternity cases in the Donkey without any major hang-ups or bang-ups. On Wednesday, the last thing I wanted to be doing was heading to Siliguri, again, but there I was riding in the back of the Rhino with Purna (who was supposed to be on holiday already) behind the wheel. Despite the fact that I’d incised the central abscess with a scalpel and self-extracted the “eye,” I was far from healed. An anti-embolism stocking on my left leg was helping to keep the edema down, and a gauze pad was absorbing the fluids, which constantly leaked from the sinus. That morning I’d woken up to Amanda holding her chest and coughing. She was having strong and abnormal heart palpitations in her thirty-seventh week of pregnancy. Asher’s emergency C-section, Leaf’s miscarriage, and Shepherd’s threatened miscarriage came hurtling back into my mind. I was seized by a sense of doom, which is abnormal for me. My mind instantly started concocting dreadful scenarios.

On a broken section of road, en route to the cardiac center, we passed a body lying in the middle of a blind curve on National Highway-31A. I blurted out, “Oh, come on buddy. If you’re going to drink, at least don’t pass out in the middle of the highway.”

There was a bandage on his leg that was stained with blood. His arm was limp and outstretched. It seemed to beckon acquaintance with a tire. The cars were swerving around him, coating his body with a fine grey dust. My conscience darted back and forth. Amanda was the one to speak up, “Shouldn’t we stop and help him?”

Purna pulled over. I hopped out of the back and hobbled back around the bend towards the body. In my mind I was saying, “Oh, come on, Jesus. Are you really putting me to the test right now? How about a break today? Can’t I just care for me and my own . . . just for today?”

I was relieved to find that he was alive and simply drunk. It wouldn’t have been surprising to find he was having a heart attack or something, which would have required loading him into the ambulance. Being a bit indignant, I gave him five hard smacks on the face before he regained even a semblance of consciousness. The wound on his leg was well-bandaged . . . perhaps back at the hospital in Rambi. Doing a fireman’s carry, we stumbled together . . . his legs shaky from drink, mine from pain. He mumbled incoherent sentences about his pants to me and I gave him some sharp reprimands that were probably equally as incoherent to him. There was a nice cozy patch of grass thirty meters away. I’d like to say that I made him a comfy little bed of leaves and pillow of heather to sleep it off in. I’d like to say that I held his hand and prayed for him until he came out of his stupor. In actuality, I did little more than drop him in a heap in the first secure spot I could find. It looked safe enough and comfy enough . . . for a drunken stranger.

While Amanda’s symptoms did last for several hours, by the time we reached Siliguri and met the cardiologist they’d mostly subsided. The ECG came back clear. Her condition seemed to have been caused by high levels of MSG in the momos and barbecued chicken (chased with a strong cup of hot chocolate) she’d had the night before. Relieved but exhausted, we began the long journey home, with me hoping that we wouldn’t run across any bodies or even anybody else. Then, as we came upon the spot where I’d left our inebriated speed bump, I saw that it was empty. It looked like it was good enough after all. But would it have been good enough for my son if he were the drunk? Would it have been good enough for me?

Thursday, October 6

            The next morning brought another surprise, this time a pleasant one. I was able to walk without much pain. After breakfast, Mom and I went to wash the Elephant (which was still puke streaked from Tuesday’s mass transport). The Bengali tourists were teeming up at the lodge, taking in the views of Kangchenjunga, and breathing fresh mountain air. I brushed the road dust off the Rhino with a wand made of chicken feathers and called it a day. In between patients we spent the afternoon sipping tea and sunning in the porch swing. I even had time to read a book.

Friday, October 7

            Within an hour we received four calls for maternal transports: one from Lolay, one from Pochowk, one from Nok Dara, and one from Nimbong. Two were in labor and needed transport to the hospital and two were postpartums needing a ride home. There was an extended volley of calls and misunderstandings. The four parties were, of course, located at four distant corners of our region of service. The Lolay group was by the roadside and ready to roll, but the Pochowk group had called first. They had been “going to arrive in Buddhabare in five minutes” for well over an hour. In reality they were rigging plastic over the homemade stretcher to protect the mother from a freak fall shower.

            Saran returned from Kalimpong later that evening, transporting both postpartums at the same time. We met at Deorali around sundown. He headed off towards Nok Dara with one family and I headed off towards Nimbong with the other. We were both alone and had rough roads ahead. There was still a large open sore on the back of my calf, but fortunately I could operate the clutch without pain. Halfway there, the newborn began to cry. Pulling over the Rhino in the middle of the jungle, I told the new parents that the baby was hungry. The first-time mother jostled the baby, still adjusting to feeding a child. The father smiled and played with the baby’s cheek. The forest was illuminated with bright moonlight and was alive with cicadas and bird calls. For fifteen minutes we sat in the semi-quiet as the baby suckled deep draughts. It dawned on me that I do actually love my job.

            The new parents lived only a stone’s throw from Basil’s house. Of course it would mean a late night but I ducked in to see them just as they were getting ready for bed. They made me a hot cup of Nescafé and we chatted after a long absence. Jen Boyd and a team of medical volunteers are scheduled to come in late November. Basil and I plotted together where to have the camps. Would Ghanti Dara be best, or how about Paila Line? Let’s not forget Sungure and Manzing! Would the vehicle make it? We chatted about politics, faith, and health. As they tucked in for the night, I headed home, listening to good music and the roar of the diesel engine.

           

Saturday, October 8

            In the morning, I received multiple calls from Dabling and realized that the first week of our “month of rest and preparation” had blazed by at a furious rate. The first case was only “thirty minutes below Dokan Dara” and it sounded like congestive heart failure. Thirty minutes didn’t sound that bad . . . but it ended up involving around 1,500 feet of descent. I wondered how long it would take to head back up, and there were still the other houses to visit. Inside the kitchen, the family was gathered. The grandmother sat on a bed, propped vertical by pillows, swollen like the Stay-Puft Marshmallow Man and fighting for breath. Her bronchi sounded like a waterslide. Her hands were the size of grapefruits which retained two-inch-deep pits in them after I let them go. After a good evaluation, I gave her a Lasix (furosemide) injection for the swelling. It was only when the family beckoned me to come for tea in the main house that I realized the full story.

            The traditional mud and stone walls were spider-webbed with cracks from the recent earthquake. Part of the rear wall and the supports for the upper story had collapsed outward. They served me tea and biscuits in their broken home.

“Look,” I said, “I can’t come down here every couple days to give her this injection. Even if I did . . . I’m just doctoring the symptoms here. Her heart is failing. If you do nothing, it could be a slow miserable death.”

            “Yeah. We would like to take her down to Gayaganga, but our house is ruined and we’ve got to fix it as well. We’re just figuring out how to manage it all.”

            “Okay . . . but I really think you should go on Tuesday. If you need any help, we’ll find a way.”

            As I headed out the door, the grandmother was heading to the toilet. The fluids had already begun to drain from her body. By evening she would be breathing normally and able to fit inside her skin again.

            While still climbing back up from depths of Panditgaon, the second house was already on its way to fetch me. It was Michael’s house, where I’d delivered a baby just a month earlier. His mother had been in the hospital the day of the delivery and was now home. They’d spent thousands on her treatment but she hadn’t had an ounce of relief. I perused her meds and paperwork and found that she’d been treated for an ulcer. There were multiple other meds that didn’t match up, including Lasix. I didn’t find any gastric symptoms in her checkup, but she did have a cardiac problem. Her heart sounds were shockingly loud, and there was a pulsating bulge between her ribs just beside her heart. Although she was a grandmother, she was still in her mid-fifties.

            “Your mother has a very serious heart condition. In fact, there is no telling when things could take a turn for the worse. She really needs to go to the hospital.”

            “We just spent so much on her treatment, for nothing. They didn’t say anything about a heart problem. They treated her for gastric.”

            “I know, but look . . . she is really in a fragile state. It would be best if she went today.”

            “We can’t go today . . . but perhaps we can go on Tuesday to Gayaganga with the others. That’ll be cheaper.”

            They brought out tea and biscuits, of course, along with the new baby. I had to give the new parents the breastfeeding talk again: No, babies can’t digest cow’s milk, and yes, mother’s milk will be enough. I looked over the meds again and it clicked.

“Hey, you have Lasix tabs here and your mother doesn’t need them. Take them down to Panditgaon . . . that will help the other patient make it to Tuesday.”

After making arrangements and saying farewell, I was led on toward’s Sugen’s in-laws house. In between rapid difficult breaths, Sugen’s father-in-law told me, “I get this sharp pain in my chest. Then everything goes black. There is this tingling sensation that rushes over my face and shoulder’s. Everything feels so tight and it’s hard to breathe.”

            “Oh, and he also has really bad diarrhea,” Sugen interjected.

            His heart was arrhythmic and his pulse had skyrocketed. His breathing was painful to listen to. I told Sugen, “Look, he’s probably having a heart attack. We need to go to the hospital now. I’m really concerned for him.”

            Sugen studied the floor for a few moments, “Sir, the rest of the family isn’t here. We really can’t make that decision alone. There’s money that has to be arranged and someone to go with him.”

            I told Sugen again, “I’m really concerned for him. I can’t say what will happen if we wait.” flashing eyes which strained to silently say, “This guy could kick the bucket any minute.”

            “We’ll talk about it as a family and let you know this evening.”

            The tea and biscuits came again. It was hard to enjoy them, listening to the not so old man gasping beside me. I taught them how to deal with the diarrhea and the warning signs to watch out for (at this point little more than clutching his chest and sudden death) and headed on towards lunch. During the five-minute walk, we passed a home for which Amanda had done a delivery. The mother-in-law was lying on a mat in the sun.

“I threw my back out working this morning. I can barely stand up. Got anything for that?”

            “Um . . . sure,” I said, half chuckling to myself at how ridiculous this day was getting.

Up at Purni’s a feast was being prepared. As I was sipping another round of tea and munching on biscuits, it turned out that Grandma was sick. In fact, she was having an asthma attack and, oh yes, her daughter had a 103 degree fever as a result of a case of tonsillitis so bad that her airway was half obstructed. Good thing there was an entire case of medicines up in the Rhino.

            Back in Kaffer, I decided to sit in the sun for a bit and also that it was time for a haircut. Still prickly and unbathed . . . my phone rang.

            “This is P.B. Sir. My brother-in-law is quite sick. In fact, he’s really bad. Would you come down to the house and check him out?”

            “Umm . . . I just got home . . . and I’m covered in hair . . . I mean I just had a haircut. Let me get a bath. I’ll try to be fast.”

            The Dashain festivities were in full swing. All the far-flung family members had come home and it was time to celebrate. But when I arrived at my neighbor’s house, the local shaman in residence was circling a bronze plate with a burning lamp around the patient. I waited patiently for the flowers and rice to be cast into the air and the mantras to finish. The shaman’s work done, D.B. exited the room. I joked, “Now that the local doctor is done, its time to try the foreign doctor as well!”

            We both had a good laugh, but I stopped quickly when I saw the patient. I listened to his heart sounds. Every time the arrhythmia flared up, I watched him wince in pain and clench his fists.

“I get so dizzy and this tingling feeling shoots out to my extremities. I get breathless and throw up. There’s this pain in my chest.”

            I sat speechless for a second. Part of me wanted to scream out, “What the heck is going on here? Why is everybody’s hearts broken?”

            The speech I gave to the family was starting to sound really canned that day. Tea and biscuits came out again and I wondered if I could handle anymore caffeine and sugar. The brother-in-law ran out of the room and wretched repeatedly. He sat down holding his chest with his hand and his head with his knees. This family decided to go “immediately” because, well, because they had money. Any of the other families would have chosen the same if they’d had the resources. I readied the Rhino and got out the AED (automated external defibrillator). How was I going to monitor this patient and drive at the same time? [Sign of the cross.] Cross that bridge when you come to it. Drive.

As I drove, I thought about the other cases. Why had I hopped up at an instant and traveled to Siliguri half-hobbled when my wife had the least palpitation? Why was I willing to spend every last rupee and dollar to my name for her? Because she is my wife. Because I love her. But what about these others? Why wasn’t I willing to do the same for them? Why was the man with a monthly government salary the only one to reach the hospital in his time of need? Why did the others have to wait till Tuesday, fighting for blood and for breath? Are those with more valuables more valuable? Are those closest to us more human? Is the stranger a lesser creation?

Sunday, Monday, and Tuesday provided enough rest for my leg to heal up most of the way. There was a steady stream of patients at the house but fortunately no more heart attacks. We tried to rest and prepare for our own upcoming birth.

Wednesday, October 12

            The most common reason I wake in the middle of the night is my phone. The second most common is the racing of my own mind. In a not so distant third is nausea complemented by sulfurous belches. That is why I was not too surprised at three a.m. to awaken to the gaseous discomfort. After fifteen minutes of the standard denial, I stumbled over to the clinic to get some Metronidazole and an anti-emetic. At sunrise I woke again, this time due to my second most common reason. But the thought which was racing around my mind said, “I’m not going anywhere today. I’m not doing anything.”

I rolled over and went back to sleep. It was not simply a result of the giardia still churning my gut and zapping my life force; September had spilled into October and it was hard to shake the exhaustion. It was going to take more than a few sunny afternoons sipping tea to recover. Even in bed I could hear the patients coming to the door and asking for “doctor.” Amanda took care of them all. The Matri Yaan paperwork, which had to be submitted in Pedong, was delegated to Saran. After barely stomaching breakfast, I meandered into the office to check some email, to do some writing. Not too surprisingly my phone rang soon after I sat down. It was a call for the maternal ambulance. I let the party know that I would dispatch it immediately but then something unusual happened.

“My wife wants to say something to you. Here . . . here she is . . .”

“Dadju (older brother),” she said, “Please come. Please come for me quickly.”

“Okay . . . I will.”

It was an unexpected exchange. I’d never received a direct appeal from the mother. It was always the men who spoke on their behalf. There was something in her voice. She called me older brother, instead of “sir” or “doctor.” It sounded like Amanda calling me from a different dimension. The feeling of doom came over me again, but even stronger than before. Before I knew it the Matri Yaan papers were back in my bag and Saran was taking me to Deorali to meet up with the Donkey. There were multiple frantic calls en route asking us where we’d reached, but when we got down to Hari Golai . . . the family wasn’t there. We waited for awhile before a girl came up to inform us, “She’s better already. It happened while they were carrying her. Don’t worry about coming.”

Still not able to shake the feeling, I grabbed a birth kit and BP cuff out of the Donkey and started walking. The sun was hot for the fall and it was melting away the little bit of strength in my reserve. In the bushes beside the trail, I spotted an enormous snake hissing at me. It was a sisirey, five to six feet long and fat as a ferret all the way up to its head. Sandeep hit it with a large rock full force but it only jumped and slithered back into the undergrowth. “What’s up, does this kind of snake not die or what?” he exclaimed.

It took almost a half an hour to get to the house, and my head was really foggy by the time I did. The blood-covered mother was sitting on a dirty burlap sack beside a Hindu temple, her child between her legs. Everyone was standing at a distance shaking their heads and tssk-ing. The tssk-ing was like the hissing. Looking at the mother’s condition and the situation, it felt like sometimes the snake and curse just won’t die.

“How long has it been since the baby was born?”

The father came near, “The baby was born at ten oh-five.”

It had been an hour already. In front of the small crowd that had developed, I had the mother squat and I tried a little cord traction, expecting it to drop right out. The placenta wasn’t budging.

“We’ve got to get this mother in a house and get this placenta out. Whose house is that?”

An old lady sheepishly said, “It’s mine but . . . how can we bring a sutkeri (unclean postpartum mother) into a temple house?”

“She’s already delivered here beside the temple! The blood is already here, it’s already polluted. What’s going to happen?”

After hearing something mumbled about it not being permitted, my temper flared, “Look, do you think God takes pleasure in sending people to their death or saving people’s lives. Taking care of this mother is God’s work . . . now knock off that silly superstition and open the door.”

The mother moaned, “But the baby’s still attached . . . how can I walk there?”

After breaking open the birth kit and clamping the cord, I heard the mother protest, “Don’t cut it. Don’t cut it. The cord will go back inside and it’ll never come out.”

I said, “No, it won’t go back in. Look how long it is. It will come out.”

As soon as the cord was cut, the father grabbed a hold of it for dear life. The baby was very lethargic and had some significant swelling in its face. A bit of massage brought on some weak cries. It was wrapped in a clean, warm blanket and handed to the father. We headed in doors. Just as the mother was lying down on the clean sheet of plastic the government ANM (Auxiliary Nurse Midwife) from Lolay arrived. She instantly spotted the problem and got out a catheter. It took a few minutes for the bladder to drain and I had the mother’s sister massage her nipples to stimulate contractions. Anu finally removed an intact placenta and I administered an injection of methergine. The uterus began to clamp down and the bleeding stopped. It was a good thing too, her dress was soaked with blood up to the back of her neck. Neither of us had everything we needed to do what was required. I was thankful for Anu, and she was for me. The ANM started in on the usual postpartum dialogue, “Why didn’t you go to the hospital earlier. This baby was forty-three weeks! Why were you so careless?”

The exhausted and aching mother said simply, “I didn’t want to go there. I didn’t want to go. All they do is cut you and stitch you back up.”

The ANM decided to accompany her up to Kalimpong. There was a significant risk of infection and the baby was presenting some abnormal signs. I made the stiff walk back. Saran came from washing the Elephant to pick me up. The Matri Yaan reports still had to be submitted in Pedong. Within minutes, I was asleep in the back of the ambulance, in a giardia induced coma, barely able to be roused when we reached our destination. A few days earlier I’d given Sandeep a big lecture about how he needed to care for his own health, that if he wasn’t healthy himself he couldn’t contribute to the health of others. The hypocrisy was running thick but what was I supposed to do? While submitting my reports to the Block Accounts Manager, he received a call. A Matri Yaan operator from Algarah wanted to meet me. Alarm bells went off in my mind. Hadn’t some people from Algarah been involved in the scuffle over the Samthar vehicle? Who was this and what were they up to?

On our way home, we passed through Algarah and Dushant was waiting for us at the chowk. He led us to his home and sat us down in the receiving room., saying, “I’ve wanted to meet you for a long time. I heard about your work even before Matri Yaan came up. The medical officers are saying that you’re doing an incredible job and have the best ambulance around. My hope was that you could show me how to do this job better.”

My cynicism faded and the tea came. As we munched on the biscuits he continued, “I’ve wanted to talk to someone about my experiences. Listen to what happened on my very first transport. There was this mentally handicapped lady up in Lava. Her neighbors called in the delivery and we headed out to pick her up. No one knew who the father was. She didn’t have any family or friends . . . so I made the neighbors come along. I don’t have any experience in this or any training after all. Then, halfway to Kalimpong, the baby was delivered in the vehicle but not all the way . . . it was kind of stuck. I had no idea and was totally shocked, so we rushed on . . .”

He continued his tales and two plates of chow mein came out for Saran and I. We prayed before starting. “Oh, I see that you are Christians as well. I am too. I wanted to do something for my community . . . to provide a really good service.  Then this opportunity came along. I’m not in it for money like the others. Can you help me? Can you help me do a better job, perhaps get some training?”

“Let me think a bit and talk to some people,” I said. “We’ll figure something out. Every driver should at least have some basic training and a couple of birth kits on hand.”

It was getting late. We had our Small Christian Community meeting/dinner scheduled at our house that evening. It was time to head home. On the way, I thought about the day’s events. It was a huge relief to meet an ANM who kicked off her heels and ran barefoot on a rocky trail for a mother in need. It was a blessing to meet Dushant, a man of faith who was putting his belief into action. We live in a world that teaches to care for ourselves first, those nearest and dearest second, our community third, and the global situation last of all. There is logic behind it just like there is behind a mother putting on her own oxygen mask before her child’s in an in-flight emergency. But when does it come time to break from logic, to scrap wisdom, and to act anyways? If it is my own wife, I would gladly hobble to Siliguri on an afflicted leg without a second thought. So what if it is their wife instead of mine? What if we are sick and run down after one of the hardest months of our life? How do we know when to draw the line, to say enough’s enough?

We like to philosophize and theologize about obscure scriptures, doctrines, and dogma. But I’m still trying to crack the most basic teaching in the whole darn book: Do to your neighbor as you would have done to yourself. Love your neighbor as yourself. Why couldn’t there have been some more law: Thou Shall Have Sunday Off. Thou Shall Work Only Forty Hours A Week. Thou Shall Take Sick Days. But instead of a law we have freedom; freedom to love in an ever deepening definition of the word. I hope that I never have to pick a bleeding stranger up off the side of the road again while rushing my wife to a Cardiac Center. That is surely a once in a lifetime event, right? But if I do, I hope I do it in a spirit of love and freedom instead of submission to a law.

While that exact set of circumstances will more than likely not happen again, we are all faced with that decision every day. Who do I love first? Myself? My kin? My community? My nation? All humanity? And if we pick to love all humanity equally because of our “high ideals,” are we ready to face the ramifications of that decision. But if we pick “me and my own” today, we will soon find that our security is on shaky ground. In a world striving for individualism, we think of health as an individual, private matter. The reality is that no one, not even a very small group, can be independently healthy for long. Think small pox, think tuberculosis, think polio—as long as one is ill we may all become ill. The only way to achieve health for “me and my own” is by achieving health for all. The only way to achieve health for all is for us to wholly embrace a reality that we only pay lip service to. His wife is as important as mine. Her children are as valuable as mine. He has just as much right to life, liberty, and health as I. Why are there so many people who are sick, so many hearts that are broken? Perhaps, it is because some can buy for cash what others can’t even get for blood. Perhaps, it is because even though we acknowledge that all men are created equal, we do not live lives of equality and justice. The only way for anyone to be healthy is for ALL of us to love our neighbor as our self. So when it comes down to it, even if your wife’s life is on the line, or even your own health . . . yes, we are still called to help the stranger bleeding on the side of the road. The entirety of the law and the prophets hang on it. Thank you for reminding me, Amanda.

In the end all I can pray is, “Father in heaven you are holy. Your kingdom come. Your will be done. Let it be here on Earth just as it is in Heaven,” even as I am half terrified, half elated to find out how good Heaven really is.

In Him,

Ryan and family