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

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

Friday, September 23

            Sometimes I feel like a liar. Sometimes I feel like I must be spinning yarns. Then the images, the faces, the blood, the smiles come back to my mind in high definition and I remember that the stories are true. But it is easy for the truth to be distorted. I’ve read articles on the internet and in the newspaper, which paint an overly flattering picture of our work. They skirt near to making us into saints who have fixed everything and saved the day. Just reading the articles makes me squirm, because I know the truth: that we’ve done little more than snatch a handful of pebbles from the summit of human suffering. So when a New York filmmaker contacted me early this year saying that he wanted to shoot a documentary about our story, I felt a bit apprehensive. The fear was that the truth would be spun into something that seemed to be more but was actually was less.

Chris, Manjula, Eric, and Emily emerged from the belly of Bagdogra International Airport with their trolleys of camera cases and accoutrements. Chris is a Steadicam operator from New York City who has spent the last twenty years on the sets of major motion pictures. Manjula is an ayurvedic physician who was raised and trained in Kerala (a state in South India) but later settled on the east coast of the US. Eric and Emily are from Portland, Oregon, but they grew up in Louisville, Kentucky, and Jasper, Indiana, respectively. They came along to help on Chris’s project as film production assistants. Back at Gayaganga, Sister Alphonsa guided the film crew around Navjeevan Hospital, I darted back and forth meeting patients and talking to our trainees. Lyang Mary looked like she was doing well, fortified by the blood transfusions. Biren talked with me about the patients that’d come from his village, Kolbong. Chandra seemed like he was more satisfied with the classes since I’d spoken with the instructor. Jyoti was prepping to help out with the camp in Kaffer. Simon readied the vehicle; I was glad to have him behind the wheel again. Tshering begged permission to come along for the camp. Anu, dressed in her white coat, was busy attending to patients.

            The Elephant was packed with twelve cases of camera gear and countless cartons of medicines. Eventually, the group filed into our bus and we were underway. Along with the film crew there was Dr. Sister Rhinda (a physician and Daughter of the Cross), Drs. Mr. and Mrs. Sonar (a couple who had done pioneering medical work in the remote state of Arunachal in the ‘70s), Simon our ambulance driver (currently undergoing Critical Care training at Gayaganga), Sister Jyoti (to run the pharmacy), and Jyoti Rai (who we lived with in Daragaon, now undergoing Home Nursing training). The vehicle was heavily burdened but we crawled our way up into the hills. 

Chris shot some pictures of me from the passenger seat as I was driving. The misgivings I’d originally had surged up again. The stories about Pharisees who only performed their religion to be seen, the story of the widow’s mite, and teachings such as “when you give to the needy, do not let your left hand know what your right hand is doing” popped into my head. It felt as if the eyes of the nuns and doctors sitting in the seats behind me were boring into my skull and examining the purity of my intentions. Was I just “loving the needy” for my own selfish, ulterior motives: to be seen, to be respected, to score brownie points with God and secure his blessings, or to “earn my name” as it is said in Nepali. In fact, why do I write my monthly newsletters? Love with expectation and agenda is not love at all. If I’m not truly loving my neighbor as myself, then I’m using my neighbor for myself. The difference could not be any more profound. Amanda and I had talked openly with Chris about these hesitations and also the fact that the presence of a film crew could spark jealousy and intrigue in our village. We told him that we were newcomers to the Kaffer region, just beginning our work, and that many people had been there (some for decades) doing the foundational work which made our current efforts possible. Over several long phone conversations Chris earned our trust and he agreed the film would not be about “us” but, instead, the realities of this region and all the people who are addressing those issues. 

Over the years, Amanda and I have noticed a trend. The things that we pursue fervently and try to make work, fall apart. The things which simply happen and spontaneously materialize often produce lots of fruit. Similarly, God has always provided in interesting ways: America’s Funniest Home Videos, VG Reed printing a book about us without our request, insurance checks from car wrecks, etc. This documentary film seemed to share the same fingerprints, so despite our hesitations we consented. But when the lens was actually out and vehicle drive-bys were being staged on the road to Lava, I felt again a prick of conscious. Just as when I’d driven the route the week before, I also felt a small prick of pain in my leg (this time in my left calf). Again, due to circumstances, I ignored it.

We arrived late to Kaffer. I’d booked the DGHC lodge for the doctors and crew over a month in advance. But at the last moment Bimal Gurung, the political figure head of the Gorkha Janmukti Morcha, decided to travel to Kaffer with his entire entourage and commandeer the property under the guise of “evaluating earthquake damage throughout the region.” As we pulled into the parking lot, I saw that not only had they ousted our guests from their accommodations they’d also boxed in our ambulances with their jeeps. Our drivers tried to rouse the drivers to move the vehicles in case of any emergencies in the night, but they were too drunk to even answer the door. Good thing I made a back-up plan with Zorgay, a new proprietor in town. As we carried bags and equipment towards the Hotel Alpine in the dark I pondered the irony of it: the political elite (coming into town to take much, promise more, but give nothing) taking priority over a group of doctors coming to give health and a filmmaker working to bring awareness about the region.

Saturday, September 24

            The Sai Samiti came out to cook kichardi for all the patients who’d come from far away. Binita’s SHG (Self-Help Group) stepped forward to cook breakfast and dinner for the doctors and staff. Our Small Christian Community from church erected a tarp to protect the patients that were waiting from sun and rain. They offered to cook dinner as well. The Health Club from Asher’s school picked up trash, ferried supplies, and assisted with the set up. The Shanti Kiran Sangh registered patients and policed the entrance and exit of the community hall. Binita, Jyoti, Simon, and Dawa took information and recorded vitals for the doctors. Sister Johanna and Adesh translated for Dr. Manjula and Dr. Sister Rhinda. It struck me again how little we can do alone and we were glad to have the community turn out in force.

            Over breakfast we all agreed that our goal was quality not quantity. I asked the doctors not to be troubled by the crowds, to take their time, and give full check-ups. The minor cases often get impatient and leave, but that leaves time to give good treatment to those who need it most. The crew set up and started filming. I was instantly impressed by how conscientiously and discreetly they went about their work. My phone was ringing off the hook. Bus loads of patients needed to be picked up from Git Dabling, Dabling, Middle Kaffer. The fifteen-seater Elephant earned its name by carrying a load of thirty-seven patients at one time, just to turn around and carry another full load. As the crowds began to swell and the lines grew longer and longer, it was a relief to finally NOT BE the health provider. It was a relief that our region was finally receiving something better than me. Many familiar faces appeared in the crowd: those who we’d been treating, those who we’d been unable to treat, those who we’d taken for operations. Those too weak to wait in line were guided into our little clinic beside the community hall. A fifteen-year-old girl with a raging fever and all the signs and symptoms of shock stumbled into our house. Amanda took her to lie down in the birth room. The doctors administered IV antibiotics and fluids, but her condition continued in a moderate decline. As we carried her out of the house on a stretcher, through the crowds and towards the Rhino, I winced half expecting a camera man to come dashing after us, making an enormous scene in front of everyone. I expected my Pharisaical Debut. Chris was busy inside covering the work of the Gayaganga doctors; I breathed a sigh of relief and refocused on the patient. This guy was going to tell the full story.

            People came from places as far away as Rambi, a solid six-hour walk from Kaffer. The earthquake had disrupted transport and redirected people’s finances away from health. The timing was perfect. Some patients saw a doctor for the first time. Many more saw for the first time what a check-up from a doctor should be like. As evening was drawing to a close, a family appeared on the public ground, the father carrying his daughter. They’d left home at seven in the morning and caught four different vehicles to arrive at the Medical Camp. The girl who was just coming into her teens looked delicate and wasted. She was an epileptic who’d suffered a case of meningitis a few years before. Since the fever, she’d been in a vegetative state. Large portions of her brain had been irreversibly affected. As Dr. Sonar evaluated her, I straddled up beside him and told him of their long journey to reach us. He looked at me with a pained expression and said to me in English, “There is nothing we can do for her. There is nothing to be done in this case. We don’t even have any anti-epileptics in the pharmacy.”

            Given the lengths the family had gone to, neither of us wanted to say it. A hundred and fifty patients had already come and gone. They’d received medicine. They would, more than likely, recover from their minor to major illnesses. Those who came from houses five minute’s walk away returned home with hope of a cure, but this family, the one who had gone to the greatest pains, the greatest expense, and risked the greatest hope, would return empty handed. As I broke the news to them their countenances dropped, again. It was obviously not the first time. The mother, still clinging on, said, “Please, she’s so weak. She barely eats anything. Look how her body is wasted. Isn’t there something you can give her to make her stronger?”

            I emerged from the pharmacy with a bottle of vitamin tonic for them to mix into her porridge. It was like handing someone a BB gun for trench warfare, but it was something. The evening was getting dim and misty. Clearly too poor to reserve a jeep, the family had no hope of a ride home; it had taken them all day just to arrive. The politicians had cleared out mid-morning, speeding off in their brand-new white SUVs. The family stood up to walk somewhere, despite having nowhere to go. Then I noticed that the wasted girl’s hair was brushed. Her nails were trimmed. Her clothes were clean. She was freshly bathed. I looked at the clothes of the family, which looked a bit shabbier and well worn. This broken, withered shell of a girl was loved. Her mother’s eyes were moist for her daughter again. This family,  who had taken the least from Kaffer that day, left behind greatest gift: a tangible illustration of unconditional love. The politicians, those who had taken the most from Kaffer that day, left nothing save empty promises, false hopes, beer bottles, and tire tracks.

Sunday, September 25

The Sabbath graced us with a little rest. We spent time getting to know the film crew and prepping for the week of training ahead. I sat down and put a hot water bottle on what was now obviously another abscess, this time on my left calf. My phone rang and Maria was on the line from Gayaganga.

“Sir, Lyang Mary had her blood transfusions and was doing better. But then she started getting these really bad fevers. The donation we brought from the private blood bank was contaminated with malaria.”

“How’s the baby?”

“Fine. But labor still hasn’t started.”

“Ok, keep in touch and let me know if you need anything.”

Monday, September 26  through Thursday, September 29

The training was in full swing. Dr. Manjula taught us how to use plants from our backyards and spices from our kitchens to cure many of the common ailments. It was impressed upon me again that God has provided everything we need but that we have to seek the wisdom to use those things properly. Kagen sat and learned what he could do to manage his diabetes. Nearby, the Hayden Hall paramedics sat scribbling page after page of notes. Many of the paramedics were illiterate women. In the late ‘70s and early ‘80s, when there was barely a road in the region, Kagen and the other Hayden Hall staff travelled from village to village setting up night schools. They walked most of the day, taught Adult Literacy classes most of the night, slept in cow sheds, and woke up to do it all over again. They would do this, for weeks on end, without rest. Most of the original paramedics were selected from this program. Kagen was too busy learning himself, with a childlike curiosity, to take pride in his handiwork coming to fruition around him. The HIMSERVE TBAs (Trained Birth Attendants) were new to the scene but fervently learning as well. Every time Dr. Manjula asked the group what plant or disease they’d like to learn about next, hands shot up all around the room. Seemingly benign household regulars such as fenugreek, teetey pati, coriander, betel leaf, black pepper, ginger, basil, and cinnamon transformed into healing agents in their minds, and ours as well. Chris and Manjula had developed a laminated flip book with pictures of all the plants and instructions as to their use. Gopal from Hayden Hall volunteered to translate all the text into Nepali so that we could give each work a copy for community teachings. Three days of scheduled training spilled over into a fourth, and still they wanted more. Chris and the crew would film some of the sessions and then nonchalantly slip out to shoot some scenics, stage some shots with the ambulance or capture the action teeming down at the weekly bazaar.

Even though everything was going much better than expected, as the week wore on an oppressive exhaustion swelled, along with the infection in my calf. It was much more than a simple abscess and I reluctantly started some erythromycin. Hot compresses weren’t bringing it to the surface and I was having a hard time walking. By lunch on Thursday, I was spent. It was a good thing that it was Amanda’s time to teach. She was giving an afternoon session on retained placentas. Four women in our region have died of retained placentas in the last few months, so this seemed the most important topic to cover. After Phulmit shared her painful experience with Sumila’s death and received support from the group, I slipped out the door and headed back to Kaffer with the crew to shoot an interview.

I called Saran to make sure he’d picked up the maps I’d had printed down in Siliguri.

“Yes, Sir. I didn’t have any problem picking them up . . . but I might be a little late. A part in the suspension cracked and I’m having it welded back on. It was about to drop off.”

“Okay, okay . . . Don’t forget to pick up the HIMSERVE folks on your way back for the meeting tomorrow.”

Friday, September 30

            The final day of activities was set for the big Unity in Health Services meeting. We’d invited all NGOs, charities, religious orders, and government service members involved in health promotion in our region. Our hope was to eliminate division and competition amongst different groups and create solidarity between multiple parties that in reality shared the same goal. We unrolled the big ten-by-twelve-foot map of our region and hung it behind the chair and table set up front for the officials to sit in. It dawned on me again at what an enormous area we are attempting to cover and that even if ALL the parties I’d invited came to the meeting, it would be a daunting task.

            Years of fruitless searching for a good map of our area had left me frustrated. But when I found Google Earth a few years back, the gears started turning. As we became familiar with our new region, I slowly added place-markers to all the unmarked villages. South of Kalimpong there wasn’t even a single name or road plotted on the satellite images. I zoomed into the areas and recognized schools I’d done health teachings at, patient’s homes which I’d visited, or landslides which had ripped a village apart. After a couple years of travel and input, the map was filling with names. Back on July 1, the first day of the Matri Yaan program, we were contacted for a maternal transport and I called the ambulance dispatch in Darjeeling.

“Where are you calling from?”

“Git Dabling”

“How far is that from Darjeeling?”

“We’re on the Kalimpong side.”

“Is that Block One.”

“No, it’s Block Two. Look, the government has a PHC (Primary Health Center) there and it is the station for one of the ambulances.”

“Oh, yeah . . . I see the name on the list now. Okay, alright.”

            If the ambulance dispatch wasn’t familiar with Git Dabling, a major bazaar with a hospital and stationed ambulance, what was going to happen when villagers called #102 from places like Katarey and Sungurey? I shuddered to think about the volley of calls and multiple layers of confusion for both ends while the patient sat there, perpetually delayed. It could potentially mean the difference between life and death for someone. The map I’d been working on for personal use sprung into mind. I’ve got to print one of these for the dispatch at the Red Cross . . . and for the health department . . . and for the Sisters . . . and Hayden Hall . . .

            Over the following weeks, I zoomed in on the satellite images as close as possible and used my mouse to trace all the rough roads I now know by heart. It was time consuming but gratifying work. In the end, I’d produced the first functional and accurate road map of our area. Lora Smith (our website designer, who has donated all of her time) painstakingly and seamlessly pieced all of the images together and created a beautiful high-resolution picture of our region. My brain was buzzing with all the ways it could be used to coordinate services in our region.

            But back at the meeting, less people had shown up than hoped. The earthquake, a spiritual retreat for the Cluny Sisters, and a meeting for the ICDS (Integrated Child Development Services) workers had disturbed our plans. Dr. Lingdo, the Assistant Chief Medical Officer of Health, arrived fashionably late but the other Block Medical Officers weren’t in attendance. Hayden Hall and HIMSERVE were well represented but the Sisters and the government workers were almost completely absent. From the PHC, a stone’s throw away from the meeting, only the pharmacist showed up. But still, there were fifty or so of us and that is a good start. Each group had a chance to share about their work: what they do, why they do it, what challenges they face, and what help they need. After lunch, I told Sumila’s story again. I spun the yarn in hopes of knitting the community together for a singular purpose. We picked a focus for the year as a health community and broke off into groups to set attainable goals and an action plan. The health workers, from their own ideas and experiences, came up with the following agenda.

Focus for the Year: Maternal and Newborn Health

Goals:

1)  To meet and form a relationship with all women who marry into the village before they become pregnant.

2)  To recognize all pregnancies early on, so as to teach all mothers about safe and healthy child birth.

3)  To get every mother to the nearest Government Sub-Center to receive her three antenatal care check-ups, vitamins, immunizations, and free Matri Yaan Ambulance vouchers.

4)  To educate the entire family on their role in ensuring the mother has a safe and health pregnancy and birth.

5)  To work with the mothers after birth to ensure the newborns receives its immunizations.

As the meeting broke up and everyone went their separate ways, I looked at the map again. Only a third of the area I’d mapped was represented at the meeting. Again, I felt like we were trying to fight trench warfare with a BB gun. I was tired after ANOTHER long day. My leg was throbbing and swollen with edema. It takes so much to even get started, and there is still so much that needs to be done. Amanda was sitting nearby, she had come through the week as well—carrying a full-term baby. I watched as the health workers packed up and headed back to the goats that needed feeding and families they’d left behind. They traced their way back to their villages across the giant flex-print map in my mind, like yeast scattered across a lump of dough. It’s a start, a small start. When looking at the overall picture, it is almost an invisible start. But yeast is like that. It is silent and unseen, but yet it sets to work and transforms everything around it. It takes time, one has to be patient.

As Dr. Lingdo, one of our greatest advocates, was prepping to head back to Kalimpong. I beckoned her over. “I wanted to give you this. I figured it would help out in your efforts.”A four-by-six version of the map was laid out on a table. It was shockingly clear. Every landside, river, rivulet, and hilltop was visible.

“Thank you, Ryan. I was looking at that big map all day. I think . . . I think this may be the best gift anyone has ever given me!”

It made me happy to be able to give a good gift to someone who has worked so hard and overcome so many challenges in her selfless service to the community. Out in the Elephant several of the health workers were waiting. Fifteen or more girls, trying to head out for the holidays, swarmed into the empty seats like a tribe of monkeys, throwing their bags and bed clothes into the aisle. It was time to head home.

Saturday, October 1

            All week we had a very full home: the camera crew, the drivers, Devaki and Sushila from HIMSERVE, and of course our growing family. It was a blessing to get to know Chris and to learn the motivation behind his project. We found that we had many strange points of connection. We both lost our fathers at the same age and were the youngest of three (with an older brother and sister). Manjula always had something interesting to share. There was no lack of conversation with her; we were Americans who’d moved to India and she was an Indian who’d moved to America. There was also an instant connection with Eric and Emily given that they, like us, had grown up in the “Kentuckiana” area and then moved west as adults.

            Elevation and ibuprofen had given me a bit of relief, but my full blown case of (what was now obviously) cellulitis was barely tolerable. Dr. Manjula applied a paste of sesame and layer of betel leaf to draw the infection up to the surface. The final interviews for the documentary were scheduled for that morning and afternoon, so I limped over to the hotel where the crew was staying for the final shoots. After dinner and more conversation, the Elephant pulled up to the DGHC lodge. Saran and Kara Rowley, a midwife who volunteered to come from America for Amanda’s birth, stumbled in the door looking rather bleary eyed. Sometimes our house feels like Grand Central Station: travelers arriving just as others are getting under way. But I’d rather sleep on a mat of cardboard in Grand Central Station than on a four-poster California King in the main vault at Fort Knox.

Sunday, October 2

            “Sir, this is Maria again.”

            “Oh, I heard that Lyang Mary’s baby was born yesterday. Was it a boy or a girl?”

            “The baby died at three this morning.”

            “Oh . . .”

            “Bahini (little sister) has to stay because she just had a cesarean. But we can’t bury the baby here. We don’t know what to do. Some family members are coming.”

            “Okay, talk it over. If you need any help just call.”

            The moment after I hung up the phone Chris appeared in the window. “Hey, we’re headed out to Daragaon now. Before we left we just wanted to give you a little something. I know there will be someone that needs some help . . . so we thought we’d leave this with you.”

            He passed a wad of gandhis (similar to benjamins) to me. “Actually, Chris . . . that someone has already called. It’s been great having you. Have a safe trip.”

            I dialed the phone as soon as Chris disappeared from the window. “Maria, I’m sending the ambulance to bring the body home. Don’t worry about the cost . . . it’s already been covered.

            In the afternoon Sandeep arrived to work out the Matri Yaan reports. As we were finishing up, our maternal ambulance driver blurted out, “Sir, I was hoping to go on break starting tomorrow. I’ve been sick for awhile now and Dashain is coming up this week.”

            “I told you that if you need a holiday you need to ask at least a week in advance, so I can rearrange drivers and cover the vehicles. Purna’s already asked off to go to his in-laws for his first puja since getting married. I also told you to tell me if you were sick as soon as you got sick. That we’d cover for you. How long have you been sick?”

            “Quite awhile now. My family said I should come home and rest a month. The doctor in Kalimpong said I should rest a year.”

            “What? A month? A year? You’re telling me a day in advance? What’s wrong?”

            “I’m peeing blood. This always happens to me after I’ve been driving a few months.”

            “Okay, okay . . . you’ve put me in a tough place here. Tomorrow . . . you’ve got to drive. Saran won’t be back until evening from taking the crew to Rimbick. Purna’s not experienced enough to run on Matri Yaan yet and I can’t drive. Tuesday, I’ll put Saran on your duty and you are going to Gayaganga. After that you take the rest of the week to rest and I’ll look at your tests. I’ll manage here somehow”

Looking down at my swollen inflamed leg, I wasn’t so sure. In fact, I’m never so sure. It was October 1. October was to be “the month we gear down and rest up for the birth of our own child.” Yet there I was again, on the brink of what would prove to be another epic week. Could I even operate the clutch of the ambulance? I was exhausted. Did I even have anything left to give? Did the family of the epileptic child at the medical camp have anything left to give? They’d spent it all. They’d risked it all. They hadn’t even planned for the return journey and yet they gave me a priceless picture of love. They loved their daughter extravagantly in the midst of their nothingness.

So, could I?

Yes, so could I.

We aren’t hopelessly fighting trench warfare with BB guns. We’re sowing seed and dusting yeast in hope that life will spring forth again, that things will be transformed. I spin my yarns and tell my tales to remind myself of that. Every month, I have to tell these tales so that I don’t forget. My hope is to knit people together with them, to remind them. If these, the last and least of these, can do and give so much, then perhaps we, the privileged, can leave more than tire tracks and empty bottles when we leave this world. My friend and former pastor Peter Hiett used to say, “When you have nothing left to give . . . give your nothingness.” When we invite the god of broken things into that nothingness, he lays his broken form aside and becomes again The Creator. Just as when the universe was created, he speaks in to the blackness—the void—and there is an explosion. I'm not a liar. I just see something where many see nothing.

In Him,

The Phillips Family in its present form 

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

Perhaps a film crew following us around for the last ten days has tempted me to lure you into reading this newsletter (my longest ever) with a flashy advertisement involving nothing less than

a close shave with a landslide, vehicle smash-ups, brake failure and near accidents, a massive earthquake, a terrifying nighttime encounter, a heroic team of doctors, leopards and monkeys, storms and floods, life and death sequences where many survive but some do not, a pregnant wife at home, battles with illness, evil conspiracy, and the triumph of good.

 The last three weeks have been indescribably full.  All of these things did happen, but we aren’t trying to make a Bruce Willis movie here.  It is in sharing these stories that I am able to process all that I’ve experienced and find the truth in the midst of it all.   I would like to share these stories with you.  I need to share them with you.  It is good to have friends that read, friends that listen, friends that care.  Here are the stories from the first of those three weeks.

Thursday, September15:

            The medical camp in Kolbong started off with sniffles and sore knees, but the patients seemed to grow more serious as the day wore on: the teacher’s wife who was suffering terribly from gallstones, the pregnant mother with the UTI and the older lady with hepatitis and hemoglobin count of three.  We arranged for them to be picked up by one of our ambulances (the Elephant) on Tuesday, packed up, and headed back home.  A light rain was falling which slicked the already treacherous road.  We spun our way up and out of the valley.  Immediately after saying, “Man, I don’t know what we’d do if we met another vehicle on this road,” we smoked around a corner (after four failed attempts) and met an overloaded jeep.   It backed up and wedged itself into the nook of a cliff.  The ambulance we were in (the Rhino) nearly lost its footing on the red clay of the embankment.  There were two inches between us and the jeep and little between us and the cliff.   The rear right tire of the Rhino was knocked out of alignment and was rubbing the body of the vehicle. The fat off-road tires we’d put on for our trip to Kolbong only accentuated the problem but without them we’d have been stuck.  Every bump and left hand turn, of which there were many, reminded me that something was broken. There was audible friction.

After a long day of travel it was time to let the Rhino rest in the parking area beside the government lodge.  Home was not far away but a storm had whipped up in the dark.  As lighting crashed out in the jungle, memories of the family in Dabling who had been recently struck by lightning came into my nervous mind.  While gathering up my things, something caught my eye and I glanced to the right.  A detached face was floating like a specter in the darkness, inches from the driver’s side window.  I lurched back and screamed.

 “Uncle!  I sleep down stairs?  I sleep?  I sleep?”

When I realized it was Sagar I broke out laughing uncontrollably.  The village idiot stood patiently in the deluge.  I grabbed my bags and realized that my flashlight was missing.  Sagar and I were still cackling as I exited the rear of the ambulance.  It was rainy.  It was dark.  There was no way to see the path.  He put his arm around me.  His pants were soaking wet but sweater was, oddly enough, mostly dry.  There was a flash of light, so we dashed forward as far as we could see and then waited for another bolt to illuminate the sky.  I half expected to be struck dead in the middle of the field and imagined the villagers finding our intertwined corpses.  But in this fashion we haltingly progressed towards the house, laughing all the way.  There was an empty plate sitting on the front door step.

  At the house the story came together.  The storm had knocked the electricity out and everyone had been getting ready for dinner.  Suddenly and silently Sagar had appeared in the dark hallway and scared everyone half to death. Sara made him plate of food and had him sit on the stoop to eat.  Just about the time he was handed his plate, the Rhino pulled in.  He devoured his food in about ten seconds and ran splashing across the flooded ground (hence his soaked pants).  He left his dry spot in the storm and ran out into the night because his friend had come.  He went to bring me home.  

Saran, one of our ambulance drivers, was covering the maternal ambulance in Git Dabling, so his room (where Sagar usually sleeps) was locked.  I broke the padlock off the door with a hammer, took Sagar inside, dressed him in a warm dry pair of fleece pajamas, and tucked him into bed.

_____

Friday, September 16:

            It was market day and, as usual, many patients came sauntering down to the clinic.  After hurriedly eating my belated lunch of momos I quickly headed out the door before another patient came.  I had been called about another mother in Dabling who had been heavily leaking amniotic fluid for three days without any labor pains.  The Rhino (with its tire incessantly rubbing against the body of the vehicle) took me as far as Dokan Dara and the rest of the trip was on foot.  A beautiful, healthy, glowing young mother emerged.  We gave her a good check up. She was doing just fine. 

            “Don’t worry," I said. "The baby’s heart is strong, the placenta is in a good spot, and you still have sufficient waters.  Labor should be soon.  Call us when the pains begin.  Amanda Miss should be back by then and if not I’ll do my best.”

            They paid me for my trouble with two kilos of squash, several tomarillos, and a pouch of homemade cheese.  I left an emergency birth kit on their table and headed home.  By the time I reached the lodge the tire was really digging into the body.  On Wednesday, Sandeep had backed our original ambulance, the Donkey, into a van. This was only days after a breakdown in which the Donkey had cut off traffic.  Fortunately, the owner of the vehicle was a friend from HIMSERVE and there wasn't the normal barrage of accusations and demands.  It seems that there is no end to the upkeep of an Indian-made vehicle on Indian-made roads.  At least the Elephant was doing fine.  After dinner a call came in from some patients at the Kalimpong Government Hospital.

            “Our buhari here needs some help.  The doctors here are saying that she is too weak and anemic and won’t let her deliver here.  They referred her to the Medical College but we’re terrified to go there.  We were hoping to take her to Gayaganga tomorrow morning instead.”

            “Okay…. I have to go down to pick up Amanda tomorrow anyways.  The vehicle will be empty on the way down.  I’ll take you.”

_____

Saturday, September 17:

            I awoke at midnight and couldn’t go back to sleep.  So many events were swirling in my head and I realized that it was less than a week until the Gayaganga doctors and a documentary film crew would come to Kaffer.   There were still so many preparations: the road map I'd made of the region needed to be downloaded for the printers, flyers needed to be made and distributed, food, and the welcome committee!   Around three thirty in the morning another call came for the Maternal Ambulance. 

            Yohan and Sumila live in Katarey which is a few hours walk from Dokan Dara in Dabling.  At ten o’clock the previous evening, just as I was going to sleep, the mother’s labor began.  They had been told by the Government ANM (Auxiliary Nurse Midwife) to go to Kalimpong a month early to rest and eat, because she was severely anemic.  But in the village it is rarely so simple.  There was the farm to run.  Who would tend the goats? Where would they stay for so long in Kalimong?  They were entitled to stay in the maternity ward but few can tolerate the overcrowded conditions for such a long period.  How would they pay for it all?  On Thursday Augustina and Somit two HIMSERVE TBAs (Trained Birth Attendants), came to visit.  They recognized latent labor and advised her to head to the hospital, or at least to our place in Kaffer.

            The mother responded, “No, I’m not in labor yet.  I’m fine.  Plus I’d rather die than go to that hospital.”

The following evening, at ten o’clock, true labor began and Yohan, being an attentive husband, began to carry his wife.  He carried her up out of the deep valley, through the dark in yet another torrential downpour.  By one in the morning they’d reached lower Dabling and went to the house of Phulmit (a Hayden Hall paramedic).

When Phulmit saw the mother she said, “No, this mother should have gone to the hospital.She shouldn't deliver in the village.”

          “What can we do?  We started to carry as soon as it began.  The baby is coming soon.”

By one thirty the child was born but the placenta was not delivered.  A few thin mealy pieces emerged but the bulk was retained.  Phulmit called the ambulance to Dokan Dara to pick them up.  But the mother protested.

“NO! I won’t go.  I’d rather die than go to that hospital!”

Due to the rain and dark they were unable to continue carrying her until sunrise.  They lied to the mother, telling her that they were taking her home.  The stretcher didn’t emerge at the road head until seven thirty.  When I saw the mother, I turned almost as blue and cold and she was. 

Blood Pressure: 0/0

Respirations: Agonal gasping with throat spasms.

Pulse:  Faintly palpable at the carotid artery.

            My heart dropped into my stomach for I knew what I was about to witness. Hoping against hope, oxygen and saline were employed in my endeavor.  Yohan had a contented smile on his face because Sumila was in the ambulance.  She was with the big “foreign daktar.”  She was on her way to the hospital.  Everything was going to be alright.

            Ten minutes down the road I knew that things were not all right.  My flashlight revealed fixed pupils and I glanced back at the father’s eyes which were alive and hopeful.  Lacking the heart to do the needful I prayed, “God, I know it is your will that all be well and whole.  You created us for health.  I want death to be crushed today and life to triumph.  Lord, you raised Lazarus and the girl that had died from the fever!  Why not this one?  It would be easy!  I don’t want bragging rights that I prayed and someone resurrected!  Please do not let this baby be deprived of its mother’s milk.  Please don’t let this husband’s efforts be in vain.  Please, Lord. Please!” and hoping that my persuasive concoction of words and obstinate prayer would pay off, I sat for fifteen more minutes, not looking at the body, as the Donkey carried her towards the city.

Sandeep pulled over in Lolay and I checked.  Yohan was just starting to nod off from his sleepless night when I said, “Bhai, she’s passed.”

            In a fog of exhaustion and disbelief he asked, “What did you say?”

            “She’s passed.”

            “What?  I didn’t understand.”

            “Her life has left her.”

            It was as if a landslide had dislodged above us, the full force of which hit him broadside.  He wept, writhed in anguish, and pounded his fist against the wall of the ambulance as I removed the impotent oxygen mask and limp saline line. Sandeep turned off the engine.  The oxygen meter rested on the zero pin.  We waited for him to emerge from the rubble of his emotions. 

            “Can we.. (guttural sounds) …take the body home now?”

            My mind began to race.  If we were to take her directly home we would be giving those who are against us an opportunity to lay false blame.  But I barely dared to imagine the firestorm I may have to walk into at the hospital.  This was uncharted territory.  Having just finished reading a report published by Human Rights Watch entitled, “No Tally of the Anguish,” I remembered the systemic resistance to and non-cooperation in reporting maternal.  Nobody wants that blood on their hands, so it is better to cover it up.  Though we had done everything possible and there was nothing we could’ve done to save her my gloves were bloody.  It was a terrifying decision but her story had to be known.

“We have to take her to Kalimpong and file for an official report.”

The rear leaf spring of ambulance began to rattle, as I launched a volley of calls to all the Medical Officers throughout the area and told the officials the story. The ACMOH (Additional Chief Medical Officer of Health) told me to take the body to Emergency/OPD and register it with the MOIC.  So I did.  As soon as I walked into the room, I saw both the doctor’s faces cringe.

“I need to speak to the MOIC, who is on duty today?”

Under furrowed brows and through clenched teeth she responded, “What do you want?”

Assuming that I’d found the right person, I recounted the tale from the onset of labor to the present moment.  When we reached the point where I administered oxygen and saline, she expounded, “Oh that was completely unnecessary and wouldn’t help at that stage.  What you should have done was CPR." She slowed down her voice for my ignorant ears. “That is c-a-r-d-i-o  p-u-l-m-o-n-a-r-y  r-e-s-u-s-c-i-t-a-t-i-o-n.”

“Yes. I am familiar with CPR.  But if someone has bled to death and there is no volume in their system… there is nothing left to pump.”

“Yes… anyways you won’t be allowed to bring the body in here.”

“Oh… then where should I take the body?”

“You take it back there somewhere and have some local doctor make a death certificate.”

“I already told you that she lives a couple hours walk from the nearest road… there are no doctors there.”

“Well if you bring the body in here it will be a long process.”

“I want to do things officially.”

“You see it is not our responsibility the death happened elsewhere.”

“You are the closest hospital.  We want to register this.”

“These villagers are careless and come to the hospital too late.  Then there is a long process involved for us.”

“Her husband began carrying her as soon as she went into labor.  He carried her all night in the dark and rain up a mountain.  Do not call him careless.  He did everything he could.”

Obviously frustrated she consented to something, “Fine.  We will contact the Ward Master and there will be a postmortem at the Dead House.  The baby had already been born, so we will treat this as a "brought dead."  Take him to the Ward Master.  You give him this.”

  Any maternal death within six weeks of delivery for ANY reason is supposed to be reported as a maternal death.  But being obviously too ignorant to communicate for myself, the doctor proceeded to write down everything I’d reported smattered with Indian Medical English jargon.

“You show him this paper and say these words, okay?”

Waiting outside the Ward Master’s office, I watched two men doing puja for the ambulance.  There was bronze plate full fruit, peanuts, and smoking sticks of incense.  They waved it around engine and intoned prayers.  A man who obviously worked there straddled up beside me.

I asked him, “What is this a new vehicle or something?”

“This is Viswakarma Puja.”

Viswakarma is the patron god of blacksmiths, mechanics, vehicle owners, tool vendors, petrol pumps, etc.  He is bribed once a year with offerings and petitioned to keep everything mechanical working, gears meshing, and systems functioning.  I thought about the concerning rattle in the Donkey, the rubbing tire on the Rhino and the Elephant en route from Kaffer whose spring bushing we’d been trying to get changed for weeks.  I thought about Sumila’s systems failing and my desperate prayer and said to myself, “I wish I could blow some smoke and throw a handful of peanuts at God and he’d keep everything running smoothly.  I wish he’d make things work.”

My companion said, “You brought that Lama who fell off the cliff last year didn’t you?  I did that postmortem. Whoa, what a mess.  Ok… well now we have to go to the police station.  Come with me.”

  We hopped in another rattletrap van/ambulance and as I shut door, it fell off.  Good job, Viswakarma.  As they were struggling to reattach it, the Lyang Mary’s guardian  emerged from OPD.

“Sir, will you take us?  Will you take us to Gayaganga?”

“Yeah, I’ve just got to go to the police station first… you work on the discharge and we’ll get you out of here as soon as possible.  Hey… your patient is from the same village as the mother who died this morning are they related.  Yes, her husband is our girl’s cousin.”

Two in the same family, I shook my head.  Two from the same village, I shook my head.  Ambulances whose doors fall off, I shook my head.  Headed to the police station, I shook my head.  I recounted the tale again to the officer on duty. He was surprisingly more attentive and concerned than the doctor on duty at the Hospital.  He kept shaking his head as well and saying, “Oh, dear.  Oh, dear.”

After the tale was told I requested him, “Can you please come quickly for the investigation.  I have to take another weak mother to Siliguri and they are waiting. They are from the same village and I don’t want this to happen to another mother.”

“Yes… surely.”

After expressing my thanks, I turned to rush back to the hospital when the officer spoke up.  “Come sit and have tea.  It has just come.”

Despite the stress and urgency something signaled me to stay.  As we sipped together the officer began, “You said that one of the Hayden Hall workers helped with the delivery.  Did you know Father Burns?”

            “Yes, briefly.”

            “My mother was in a terrible state and about to die when she was a little girl.  Father himself picked up my mother took her back to Hayden Hall and had her nursed back to health.  Later, our entire village was wiped out during the slide of '68.  Father bought a big piece of land, resettled us all, and helped us build houses.  I’m glad to know that there are people like you in Kaffer as well.  We’ll get your investigation done promptly.”

            Back at the hospital Saran had arrived and Sandeep came running up to me. “Sir, I’m going to talk to a patient up in Maternity.  I just got another call.  We have to transport another mother home today.  I’m going to tell them they have to wait a bit.  We can’t take them at the same time we take the body back!”

            “Okay, Okay… Saran will go with you to help.  Plus I’m worried about that spring and don’t want you to be alone.”

            Down in the Dead House the mother lay silent and cold.   The officers circled her and made a perfunctory report about this "brought dead" case.  And while there were lengthy descriptions of her appearance, and "reason" for death, I wondered if anyone would ever inquire into reasons for her death.  She had gone for her check-ups, taken her vitamins, and had her shots. She interacted with HIMSERVE and Hayden Hall health workers, her husband had done everything humanly possible (more than most humans are capable of), and in the end she ended up in the best maternal ambulance in the District with the best trained attendant in the region. Yet she died.  Things didn’t work.  The systems failed.  Who failed?  Who is guilty?

The Chief Medical Officer had already reassured me that there was no human guilt in this case.  So was God to blame?  It would’ve been easy for him, the creator of life to prevent or correct it.  Did all the parties involved neglect to appease him with incense and bribe him for good favor with fruit on a bronze platter?          

_____

            As I transported Lyang Mary to Gayaganga I noticed that all of the vehicles were decorated with ribbons and balloons.  Wisps of fragrant smoke trailed from every window save ours.  Yet, the road seemed little more than a slalom course through broken down semis marked with withered branches.  Each of the thousand ruts and potholes caused a disquieting clang under my right foot.  I made another of the what would eventually be 104 phone calls that day.

            “Saran, was the spring clanging on the way from Kaffer?”

            “Yeah it started on the way.  We lost the rest of the bushing.”

            “Did you check it… is everything tight?”

            “I checked it.  It sounds bad but you’ll make it.”

            Further down the road the disc brake for the same wheel began to fail as well, which, of course, added another layer of stress to the day.  I imagined complete brake failure and the Elephant ramping off a cliff hundreds of feet above the Teesta River.  Even if Viswakarma didn’t pull through on the mechanics, I thought that the addition of multi-colored fluttering ribbons, balloons breaking free in the sudden acceleration, and a vapor trail of incense would’ve really added to the effect.   Three ambulances and three malfunctions.  I was half tempted to buy packets of peanuts and a bunch of bananas from the roadside stalls along the way. A small lump on my inner thigh was rubbing against the edge of the driver’s seat. What I’d mistaken the day before as a pimple was turning into something. Considering the chainsaw, torch, poison-tipped dagger, and bowling ball I was already juggling in my mind… I ignored the pain.

Sunday, September 18:

Amanda and I woke early at the hotel in Siliguri.  She’d come in the evening before from the community health worker training in Buxa with HIMSERVE.  We couldn’t return home do to a lame Elephant and a driver bordering on delirium from sleep deprivation.  As we sat on our clean double bed with the fan spinning overhead we talked about everything: the events of the previous day, our work, our family, our parenting, our coming child, and the motherless baby in Katarey.  The family can’t afford formula for the long term.  Powdered milk and cow’s milk are insufficient.  Bottle feeding often leads to death in underdeveloped settings.

            “Whose going to feed the baby?”

            Without a thought nor look of feigned effort or false piety Amanda simply said, “I will… after my milk comes in.  We’ll have to work out what to do for now. We’ll raise the child if need be.  Pastor Simon in Suntalabari has seven kids of his own and three adopted children.  He feeds and educates them all on 1,400 rupees a month.  I think we can manage if we need to adopt this baby.

            Amanda was willing to endure suffering to bring life from her ripening womb.  She was willing to sustain that life, and that of another’s child, with her breast (which is already beginning to produce colostrum in preparation for our coming child).  To be willing is the ultimate courage and I was humbled by my wife again.  So, after a nice cup of coffee, we decided to go shopping for our baby and for Yohan’s .  The only problem was that I’d locked the keys in the Elephant in the midst of my delirium the previous evening.  Fortunately, Saran was on the way in the Rhino and had the extra key.  We headed back into the silent and lifeless restaurant attached to the Sachitra Hotel and waited for a waiter to materialize.

As the plates were being cleared and the tea arrived my phone rang, yet again, with a North American number.  A friend had been emailing for a couple weeks saying he would call and I recognized his voice immediately.  He needed someone to talk to because he’d been out of work and a place to stay for very long time.  He’s been living out of his car and was frustrated and depressed.  He’d become tangled in a web of doubt and theology which he’d woven in the midst of his crisis.  His pain had reached such a level that I became seriously concerned for him as he elaborated his plight over the phone.

“…and I just don’t know what to do.  I’ve done everything.  Everything!  I’ve tried to be patient and to trust in God but it seems like every time I get an opportunity he just throws a roadblock in the way.  I need a job, Ryan.  I need a place to stay.  I just don’t know what to do to make everything work out.”

Everything that Amanda and I’d been discussing for the last several hours seemed so pertinent.  I shared with him my experience with Sagar, the events of the previous day, and the thoughts I’d had about Viswakarma Puja as I drove down National Highway 31a.

“I’m sorry but I don’t have much to offer you.  I don’t have any advice that will make things work.  I can’t even make my own life work.  Sometimes I wish our God was more like Viswakarma.  That we could bribe him with our offerings and get an assurance that everything was going to run smoothly.  But he’s not like that.  All of your religious offerings are just like the fruit on that bronze plate and he doesn’t want that… it’s not going to work.  But Jesus is a lot like Sagar.  When he sees his friend coming home in the night he will run to him… even in the midst of a lightning storm.  He comes in a broken form into broken situations and throws his arms around us.  He’s content to get soaked with us and be scared with us in the dark. He’ll walk with us arm in arm until we finally make it home.”

“I don’t know, Ryan… there’s so much double talk and everyone gives me different advice.”

“That is what I believe about God.  He is the God of compassion.  We cannot do and do not need to do ANYTHING to earn his love.  It is always available to us.  It is always free.  But as long as we try to make everything work, as long as we try to fix ourselves, we’re blind to him.  If we can’t come to peace with the fact that we are broken, how will we ever accept God in a broken form on a cross?  Or as a Sagar? We’ll hate him because we hate ourselves.” 

            By the end of the conversation and small spark of hope had rekindled in my heart for my friend.  I thought about the keys locked in the Elephant.  If everything had worked and we’d gone shopping as planned, I wouldn’t have been there to receive his call.  While the phone was still warm from having been pressed to my ear for over an hour, it rang again.

            “Sir, it’s Saran.  You know that big slide above the Teesta?  Well as I was driving across it I heard this noise.  I looked up and tons and tons of rock and mud were coming down at me so I gunned it.  The slide came down right behind me. Then I was going so fast that couldn’t avoid an Army convoy.”

            “Is everyone ok?  Is everything alright?”

            “Yeah it didn’t do anything to the army truck but I damaged the new ambulance.  Everyone saw what happened, so it’s not a problem.”

            “It’s fine.  Don’t worry.  Come on down to Siliguri.”

____

            The damage was minimal but I noticed that the entire interior was soaked.

            “Sir… all the windows leak from around the seals.  It has been raining so hard.”

            The roads were all flooded but still I protested, “This is a brand new vehicle! It rains half the year here!  What are we supposed to do with leaking windows!  I’ve had it with these vehicles!”

Finally, charged with a cup of coffee, we headed home.  Saran stayed back to tend the Elephant at the workshop.  At the petrol pump, the smiling owner greeted us with steaming plates of kichardi on broad leaf plates and invited to pay homage at the shrine he’d erected.  Between the celebrants, I could just make out the deity frozen in clay and gilded in bold colors.  Having just eaten a big lunch, we folded up the prasad and saved it for the monkeys near Coronation Bridge.  The rains had brought down a host of small slides along the way and we worried about the trip home.

We passed Lava around sunset and headed off on the rough road towards Goempa Dara in the dark.  As we turned a corner in the dense forest, an adolescent clouded leopard sprung out of the jungle and ran down the road ahead of us.  It was odd behavior for that species and it caught us off guard.  Amanda grimaced and held her belly against the vehicle which was violently rocking back and forth on the rough road.  Every major bump and depression of the clutch pinched the growing abscess on my thigh.  Just as I was telling myself that the pain was getting unbearable for the both of us, the towering cedars started shaking which sent down a shower of branches and dead clusters of pine needles.

“Boy it must be windy huh?”

“Yeah,” we both said. 

Despite the fact that the windows were open and the night seemed calm.  The phenomena lasted for little more than thirty seconds.  Near Deorali a the wide-eyed driver of an overloaded pickup stopped us and asked, “Is the road OK?  Can vehicles get through?”

“Yeah, no problem.”

Figuring that the rains had caused a major slide on the Lolay route (which we’d been expecting to travel on all season) and had diverted him, the Rhino rumbled down the homestretch.  Upon reaching the bazaar, everyone including a large group of tourists was wandering around in the dark with bewildered looks on their faces.   A thirty five second long, 6.9 magnitude earthquake, the epicenter of which was not far away in Sikkim, had rattled the village.  The ever-rising Himalayas are prone to earthquakes but it had been the largest in our region for decades.  It was felt as far away as Delhi, Dhaka, Lhasa, Kathmandu, and Thimphu.  Our home was undamaged but the walls, which had seemingly turned to jelly during the quake, sent Mom and the boys running out the door.

That evening Mom told us, “When we got outside it sounded like a freight train.  Even after the shaking stopped we could still hear it as it moved away.  It was as if the Earth was growling at us.”

Amanda and I have experienced three significant quakes here.  The first was in early 2006.  It was just before sunrise and my wife was having a dream.  She was walking through an enormous house with more beds than she could count.  In each bed there was a mother who’d died in childbirth.  A voice was telling her that this would remain the reality in India unless she decided to act.  It was the vision which convinced her to become a midwife.  We awoke to a 5.1 and ran from our little cabin in Daragaon.  The second took place on Christmas morning 2008.  We’d just decided to resign from IDEAS and start what would eventually become ECTA, so that we could begin a maternal health service in this region we now call home.  The third and strongest quake wasn’t even a surprise after the caliber of the recent events, which seemed to be happening non-stop.  Everyone else slept outside in fear of aftershocks.  We ate dinner and went straight to the comfort of our own beds.

Monday, September 19:

The electricity was out and the communication networks were down.  As I sipped my morning tea I imagined people crushed and injured in the quake.  I imagined them trying to dial through the dysfunctional networks to call the ambulance in their time of need.  But my phone was silent.  The village was as still as it was the day after the Forest Department complex was burned down.  There was a silent fear of unseen and unexpected forces.  Drunken vandals who appear out of nowhere to burn down the heart of your village, regimented police who arrive without warning to indiscriminately arrest and torture, invisible waves that shake the foundations of your home and take the ground out from underneath your feet, all seem to have the same effect on most folks: Fear.  Everyone assumes that if you keep silent, if you stay hidden, if the village looks abandoned, then the forces won’t find you.  In people’s hearts the force of destruction always has a target: Life.  

Our friend and mentor Vicki Penwell was the first to put words to a trend we’d already observed, that evil has a specific agenda against mothers and children.  If God is the author of life and creation then Satan is the conspirator of death and destruction.  The Achilles tendon of humanity lies in the vulnerability of pregnancy and the delicacy of the first months and years of life.  Is it any surprise that the Devil decides to hit below the belt?  The main headline the morning following the 6.9 seemed little more than a novel sidenote to what was probably the hardest weekend of my life, but it still rattled something in my subconscious.  

It made me wonder, “Every time we make a major decision to protect mothers and children there’s an earthquake.  If it is anything more than a coincidence, what does that mean?  Is it evidence of divine source of our decision or is it a warning from the powers that be?  Is such primary application of the basic tenant, ‘Do to your neighbor as you would have done unto yourself’ enough to make the foundations of a broken world quake or are the ‘powers and principalities who have dominion over the Earth’ growling at us?”

Perhaps it is all a coincidence?  Perhaps I spend too much time sipping chai as an excuse to over-analyze/over-spiritualize everything?  Perhaps it is all plate tectonics?  Perhaps the prayers of the faithful do move mountains?  Perhaps it is the Devil shaking his fist at any that dare block his punches?  Perhaps.  Even if we can’t grasp the full reality of what’s happening in the depths, there is still something left in our hands, a choice.  If we choose fear then we will be as good as dead: silent and unseen in our tomb of protection.  If we choose life, we may be setting ourselves out there as a target, but at least we’ll live as long as we’re alive.

Tuesday, September 20:

The Elephant was traveling on cracked and destabilized roads to Gayaganga.  The patients from the Kolbong camp (the wife with the gallstones, the severe UTI in pregnancy, the old lady with the hemoglobin of three), and a possible case of breast cancer from Kaffer needed to go to the hospital even though many of the routes were blocked from the damage.  My abscess, now ruptured and weeping, meant I had to stay home.  Purna, our newest driver, went along to learn the ropes. Saran called from the jungle not far from where we’d unknowingly experienced the earthquake.  

“Sir, a rock shot out from the tire and shattered the water separator. Diesel was leaking out all over the place.  We’ve had had to tie plastic bags tightly around it to keep the fuel in.  I think we can make it to Gayaganga now.”

            Palm plastered to my forehead, finger and thumb rubbing my temples, I responded,  “Ok, Ok… get the patients to the hospital.  Fix it on your way back. Let me know if you need anything.”

Wednesday, September 21:

            The phone rang early, as usual.  

            “Sir this is Maria.  Lyang Mary needs blood. Do you know anyone with O Postive.”

            “We’ll look around and try to get someone for you. Let me call you back in a bit.”

            After hanging up, Sara informed me, “My sister in Siliguri is O Positive.  I’ll send her over to help out.”

With the amoxicillin in full swing and most of the pus drained, I covered my inner thigh with some DuoDERM and was finally up for a long walk.  I’d been meaning to go to Katarey for days to deliver the needed supplies to Yohan in hopes of preventing the common problems which arise in these cases.  Amanda and I discussed the option again and were unified.  I took off down the trail with a waterproof bag on my back not sure if I’d come back with a baby strapped to the front as well.  In the midst of all the mayhem of Saturday, I’d forgotten to even ask the gender of the baby and wondered what I’d find.

            Somit and Augustina met me along the way to show me the right path. A piece of freshly turned earth encircled by white scarves met my eyes to show me the right house.  Inside, Yohan was coddling his baby.  He had been carrying the child over ridge and mountain twice a day so that his aunt could nurse it.  In between he’d been using formula but, as I suspected, had been making it much too thin.  After showing the proper concentration and teaching him how to clean the bottles, I crunched some numbers.

            “Yohan, if you do six feedings a day the formula is going to cost you 1,200 rupees a month.  As the baby gets older, so does the volume.  The cost will keep going up.  I don’t know how you’ll afford this.”

            The father looked concerned and the conversation volleyed for awhile.  But in the end Yohan came up with a solution.

           “Sir my aunt has a two-year-old son.  She is going to wean him and feed my baby.  I’ll go to live with her and help out on the farm as thanks.  That way I don’t have to buy the formula and the baby will be healthy.” 

            I watched the young widower gently playing with his daughter as the tea came.  He was enraptured with his firstborn.  In our hearts we’d already prepared for the chance that we may have had to raise this child as our daughter and as a result couldn’t help but feel some attachment and disappointment.  But these feelings were soon replaced by peace.  It was good that this little Lepcha girl would be raised by her family and her village.  As I left the house, the aunt arrived.  She had a heavy load.  There was a healthy boy slung on her back and her breasts (having been re-stimulated by the distinctive suckling of a newborn) hung heavy with milk.  Despite the beads of sweat on her forehead, she was smiling and went in to feed the baby.  I took off for home lighter than expected.

            When I got back home, Maria called, “The blood donor didn’t work out.  She was on her cycle.  We are going to have to buy some from the blood bank in Siliguri.”

            “I’ll be in Siliguri tomorrow to buy supplies and repair the vehicle.  I’ll try to give you a ride back out to Gayaganga.”

Thursday, November 22:

The following day, was full of repairs and preparations.  When Maria called again, saying that she’d picked up the blood, I wasn’t even half done with the tasks on the list.  She headed back in the hot and crowded local transport as I continued to buzz around the bazaar.  A documentary film crew was due to arrive the following day.  I would pick them up along with three doctors and several assistants from Gayaganga the following morning.  We needed food to feed them all, a spare tire for the Rhino, and a radio to endure the long drives, extra springs for the Elephant to endure the roads, and I had to meet the printers of the gigantic regional map we had prepared. 

By the time I reached Gayaganga in the evening, the ward seemed like a better option than the hostel considering my condition.  I peeled the bordered gauze from my inner thigh.  It was soaked after a long day of exertion but at least the abscess was almost healed.  Despite my exhaustion, my mind seemed to be spinning as fast as the fan overhead.  How many would come for the medical camp?  Were there enough doctors, enough cooks, enough helpers?  Would the maps be ready in time?  Did I have enough money to lubricate all the gears?  Would Purna and Saran make it back safely after leaving Siliguri so late?  Would the vehicles hold up on the new, expanded routes?  Would this film crew set off a torrent of jealousy and intrigue in the community?  Would this film generate a broader spectrum of interest and support for our work?  Would all of these projects and programs I’d been working so hard to set up work?  Would they fix the health situation in our region? 

A voice reminded me that I’d already walked this road; I already knew the answers.  No. I will not fix everything.  No.  Everything will work out.  No.  Things will not turn out like I envision.  No.  Suffering will not end.  So is it all a hopeless waste of time then?  No.  Father Burns did not eliminate the problem of landslides wiping out villages in our region.  He did not eliminate the problem of sick neglected children.  But even as a finite mortal man he decided to act.  He decided to live like his Lord by stepping as a broken man into a broken situation.  He clothed the naked, gave shelter to the homeless, nursed the sick, and fought for justice.  Although he did not fix the world there are still invisible ripples.  A compassionate and concerned Police Officer, a village health worker that wakes in the middle of the night to handle a high risk case, a host of paramedics preparing for more training despite having decades of experience: they are the aftershocks of Father Burns's life.  To choose to live and be willing, rather than survive obstinately, is the ultimate form of prayer.  There are so many no's but that doesn’t mean we cannot say yes.  The prayers of the faithful do move mountains.  I feel them shaking everyday.

"'The times are bad! The times are troublesome!' This is what humans say. But we are our times. Let us live well and our times will be good. Such as we are, such are our times!"---Augustine of Hippo (Thanks for the quote, Maren)

In Him and continuing the journey,
Ryan, Amanda, Asher, Shepherd, the one to come, Mom, Sara, Saran, Purna, and all the others who compose our family.