Street Clinic

img_0048by Robert lanz LCSW





Sometimes a cigar is just a cigar-  Sigmund Freud


And sometimes a vacations is just a vacation unless you are a social worker far from home on the Indian sub-continent traveling alone. Then it is an adventure.

As per my plan, I entered India in stealth mode, late in the evening on a flight from Bangkok, Thailand directly to Calcutta- that would be the place referred to as the “black hole of Calcutta” for as long as I could remember  The most grinding poverty. The most grinding homelessness. The worst slums.  Maybe it’s better now but this was the middle 80’s and poverty was pervasive all over India-  it was just so much more obvious in Calcutta. I’d done some serious slumming in Mexico and Guatemala and Belize and Ecuador and all over Brazil so it’s pretty hard to shock me, but still it was a major transition, leaving the outrageous night life of Bangkok straight into the outrageous night death in Calcutta.

Part of adventure travel is, well, adventure. It is my preference to enjoy serendipity rather than security and I rarely make hotel reservations on my adventures but the whole black hole thing sort of had me on guard and I actually did make a reservation at one of the last of the Raj hotel.  Raj, being the somewhat pejorative term referring to the British dominance of the  area- Raj in Hindi, the local language, meant rule.  Although the Raj officially ended in the forties thanks to guys like Gandhi, the hangover of the social caste system remained, with the bottom dwellers referred to and often treated as untouchables by the remaining Brits and locals alike.  Hardly an acceptable solution to any self respecting social worker.

But there I was in the Raj hotel with an aging British marm who owned the place and served as the social director for wayward westerners like me. It seemed a different century to her and her family and obviously they wanted it to be that way.  I was more accustomed to budget travel, low dollar and low key. To me it was better to spend a month on the cheap than a week of predictability with umbrellas in my mixed drinks and foofi linen from Egypt.

Coming into the city from the airport, bonfires burned in trashcans everywhere but it was still very dark and the street life was muted.  My taxi had driven through the giant gates of the hotel and I was transported back in time, servants and maids fussing over me, causing a vague sense of discomfort I wasn’t used to.

When I got up at sunrise, inside the safety of the hotel walls, all was peaceful and I paused a moment to take in the sounds coming from beyond the gigantic gates.  That might have been a good time to go back to bed, but I didn’t, moving to open the small wooden door that would transport me into the maelstrom that was the street life of Calcutta. Teeming hardly describes the activities I witnessed. Imagine if everyone in your neighborhood lived in glass houses and acted like it wasn’t glass and you could see them in the kitchen and the bedroom and the bathroom.  On these mean streets, the morning bathroom was the gutter. The morning shower was a fire hydrant and a bucket. The kitchen was a hibachi fueled by dry cow dung. Yet somehow there is a sense of modesty- a lot of practice I guess…

This was a city where the people lived on the sidewalk. Everything in daily life took place on the sidewalk, except walking, of course.  People slept on the sidewalk, ate on the sidewalk, were born on the sidewalk, died on the sidewalk and in a scene I didn’t even want to imagine, were conceived on the sidewalk.  All under the watchful eyes of the ever present cows who were regarded as holy and got to do whatever they wanted to do whenever they wanted to, including blazing a trail through hearth and home on the sidewalk.  I hadn’t had that kind of sensory overload since the band I worked for in the sixties played a gig at the famous psychedelic Fillmore Auditorium in San Francisco. Wow man. What a trip.  I had to go back to the Raj hotel and take a nap.

That night, at the communal dinner table Hindu men in white gloves cut and served roast beef to all the westerners gathered, where I’d like to say, almost ceremoniously, we enjoyed a multi-course and lavish meal. We were all in good spirits while just outside the gates people were dying of starvation, having babies on the curb who might also starve or die from lack of medical care. I was starting to feel like my karma might be suffering.

“Well Bob, what do you do in America?” a clean cut young guy about my age asked.

“I work in a busy emergency room. I’m a social worker.”

“So you know a lot about medical care?”

“Well, I’m a social worker. I rarely touch patients, except to give them a hug or a reassuring hand on their shoulder.”

“You should come with us” he signaled that the ‘us’ included several attractive women at the table who turned out to be a wandering group of European nurses who apparently moved from desperate medical situation to desperate medical situation in third world countries kind of like what I did when I was younger except I was looking for some warm water and decent waves to ride.

“We’re going to be working at Dr. Jack’s street clinic. I usually run a big hotel in Bangkok but I do my vacations here every year. Working on my karma.”

What’s a guy to do? Say no? All those karmic opportunities. All that social working. All those pretty nurses. Sometimes spontaneity and serendipity lead to great adventure. Sometimes they don’t.

The sun was barely peeking over the Himalayas and it was already ninety degrees, sort of like leaving a Las Vegas casino at dawn, the outdoors is so different than indoors it is almost confusing-but there was nothing confusing about this crowd.  These were the untouchables, lined up as far as I could see, unable to afford the six cents it would cost to go to the government clinic.  How lame is that? If it wasn’t for all those wandering European volunteers, the black hole denizens  wouldn’t have any medical care at all. And there I was, lined up with those nurses all ready to do some serious touching of the untouchables.

I got partnered with a cute Dutch nurse who spoke decent English and had a dry sense of humor. Our first patient had a huge festering wound on his leg-cancerous the Dutch nurse observed.

“We’ll be doing some debridement and a dressing change. Try to ignore the smell.”

I’m pretty tough. Been a lot of places, done a lot of things but I like to do them right. Good hygiene. Universal precautions. Infection control.

“Where’s the gloves?” I asked sincerely.

The dry sense of humor dryly slid away -replaced by what looked like a dour expression.

“No gloves.”

“No gloves? How do you practice infection control?”

“See that tub of Matar over there?”

I knew what Matar was. In the very modern ER where I worked it was used to disinfect the trauma room after patients were admitted or died.  Dangerously caustic stuff. Our protocol was to double glove and use protective eye wear when cleaning with Matar.

“Just dip your hands in it before your touch the patient. Then dip them again when you’re done. Wipe off with that towel.”

When I was in the army that was called “field expediency”. Do what you have to do with the resources you have. Good training. Learn to think clearly.  For me it provided the clarity of a vacation moment.

“How much would it cost to buy a case of gloves around here?”

Rolling her eye’s slightly she said, “About forty American dollars.”

“Here’s two twenties. Thanks. It’s been real.”

I went over and took a walk through the Queen Ann Park where wealthy Indians were busy playing cricket and drinking gin and tonic over by the polo club. The park was still Raj. No homeless untouchables in sight. An old trolley passed through on rusting narrow gauge track, an advertisement painted on the side promoting a new brand of laundry soap.  The image showed a perfect message, It Pays to Buy Surf.  Or gloves I thought.

I went back to the hotel and packed my bags and went to the train station where hundreds of people and several cows had taken up residence.  I got a first class semi private cabin (air conditioned) ticket on the 187 Up train to Varanasi, where I’d get my camera stolen by one of the infamous Durga Mandir temple monkeys and then watched as cremated remains were pushed off a wall into the sacred Ganges river while I suffered vigorously at both ends from some train food I had mistakenly eaten..

That was a welcome relief compared to Calcutta.


But that’s not the end of the story. Home safe a year later I got wind that a co-worker was headed to Thailand. I packed a nice bag of medical supplies, including three boxes of gloves and sent them to the hotel guy so we could both get a karmic upgrade.






About robertjlanz

Author and health care professional.
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