Saturday, December 31, 2011

The Epic Slaying of the Serpent

The colossal snake slithered slowly, deliberately, forward, towards the cowering children. Nothing now stood between him and his helpless victims. He advanced in for the kill. Suddenly, a figure moved between the beast and his prey. A tall, lean man, moonlight glinting off his balding head, looked down at the snake with merciless eyes. “Not tonight,” a deep, monotone rumbled. Forked tongue flicking through the air, the now-hesitant serpent watched with his black, soulless eyes as the American drew his cheap, Taiwanese sword. The crescent moon’s dull orange light shimmered off the grade-C steel, throwing a blood-red reflection back into the snake's slitted eyes. There was no turning back now. He reared up, opening his mouth and extending his fangs. It was kill or be killed. How had it come to this?

Five minutes before this Homeric encounter, the snake had lain coiled in his dank den, brooding. He could feel the it. Tonight was the night. Finally those happy children at the PMS (Partnership Ministry Society) student’s hostel would pay. Pay for all their joy and happiness that was so unattainable to him. Learning at a great school, playing soccer and laughing after class; if he could not have that joy then no one would. He had seen them while he was hunting rats through the rice fields. Running between the palm trees in their school uniforms, playing marbles, older kids helping the younger ones; it was more than he could bear. He would share his pain with the world. This was beyond good and evil. This was about fear. This was about power. He would let nothing stop him from fulfilling his evil obsession.

With the sound of dead, rustling leaves, he extended his powerful coils, moving out of his hole and into the night. The cool night breeze barely slowed him. As he slithered toward the lights and laughter of the hostel he tasted a new scent on the air. The scent of someone other than the children and hostel workers. Someone… foreign. The smell of this new nationality gave him pause- it reminded him of something. A vague feeling of his antithesis, of an ideal long forgotten. Was it freedom? Perhaps justice? Could it be equality?

A shudder ran down his lusterless, scaly body. Such noble and altruistic ideals had no place in his foul heart. The serpent forced the thoughts from his pea-sized brain. This was no time for distractions.

He moved easily through the grass and under the bamboo fence, into the packed-dirt yard in front of the two story concrete dormitory. Krystal, a small boy, saw him first. With a blood curdling scream he took flight, dashing from the yard onto the porch. The others panicked as they followed Krystal’s terrified stare to the image of evil incarnate that seethed out of the long grass into what had been, only moments before, their care-free sanctuary. In ecstasy, the serpent paused, savoring the moment. It really was better to be feared than loved. Better to rule a hell than serve in heaven.

Reclining contentedly on a wooden sofa in the hostel keeper’s living room, Travis was quietly reading a newspaper when he heard the scream. Instantly his Nordic warrior blood was ignited. The fearsome Viking spirit, which has long lain dormant within him, was roused. Neural circuits switched over in a nanosecond from relaxed introspection to a heightened, nearly pre-cognizant, level of awareness as the adrenaline mainlined. He leapt from his seat and rushing toward the sounds of distress, grabbing the mystic blade (complete with bottle opener), which his host had shown him earlier, from beside the door as he went.

As he emerged, he saw the hideous aggregation of all things unholy gliding across the smooth dirt toward the quaking children. Swiftly, he moved forward and stepped in front of the serpent, drawing his blade. “Not tonight.”

Hissing, fangs extended, the snake surged forward. The cold steel blade swung in a swift, powerful arc through the night sky. It found its mark. Blood and sand shot forth as the earth shook. The serpent writhed in its death thralls, its malevolent head nearly cleaved from its convulsing body. The children’s cheers rose like a storm. Again, the blade traced its terrible arc and again it struck with awe-inspiring power and precision.

(If you look really closely you can see the snake in front of my feet)

Seeing the fiend’s head completely cleaved from its twitching corpse, the children’s joyous cries redoubled; their hostel was saved! Travis raised his mighty, sanguinary blade high above his head and let loose a triumphant bellow that would have made Aires himself shudder. He had slain the beast!

Drums and cameras were brought forth to celebrate and record the heroic feat. There was much dancing and merrymaking. The children laughed and sang ancient ballads as they heaped laurels and kisses upon the victorious warrior.

When Travis reached down and picked up all 30 enormous inches of the now headless snake's body, its scaly length slowly wound itself around his calloused fist. An ebbing embrace that seemed a final acceptance of the superior moral might that had ended his brief reign of terror. Unnoticed by the crowds of cheering onlookers, a single tear ran down Travis’s cheek, falling from his beard into the sand and mixing with the serpent’s blood. Freedom truly is not free, he thought. You’re welcome India.

(Not to be wasteful, we cooked and ate it afterwards)

Saturday, December 17, 2011

In Search of the Green Helix

You know what sucks? 40,000 kids dying everyday as a result of inadequate nutrition. That sucks. Unfortunately, unless we start getting creative or stop reproducing so much, this horrendous statistic is only going to get worse. Our planet can only support so many people.

According to the Economist, the world’s population should stabilize around 9 billion. Not everyone agrees with this analysis, but even if this conservative estimate proves to be accurate, and we really should hope that it does, then that means adding another 30% to the 6 billion souls the earth is already struggling to support.

The reason we should be worrying (and many are) about this is because the finite resources on our little blue sphere are rapidly dwindling. If everyone consumed as much resources as the average American we would need about 2.5 earths, and the middle class in the developing world, and their desire for western luxuries is growing quickly. China is buying up huge swaths of arable land in Africa to help supply its 1.3 billion citizens with food but a great deal of the ‘Forgotten Continent’s’ land is also threatened by the creeping menace of desertification. Companies that mine potash, the base for most fertilizers, are seen as some of the best prospects around to invest in. Add to that the changing weather patterns and glacial melt that is caused by global warming and it starts looking like future wars might be fought over farm land and fresh water instead of oil.

So what do we do? One strategy that could help is to grow more edible algae. Specifically spirulina. A lot of you may already be familiar with this little green helix. Humans have been using it for over a millennia and it has been at health food stores in the US for decades. In spite of this it has yet to receive a true, large-scale following.
This is unfortunate because this incredible stuff is some of the densest complete protein you can get. It doubles its biomass every 2 to 5 days and provides 400 times more protein per acre than beef. It thrives in warm temperatures and can grow in high alkaline water (up to a PH of 11) and brine; environments where almost nothing else can survive. This means it can grow in deserts and coastal areas and, unlike most crops, does not require the clearing of any fertile land. Because of its high quantities of vitamins and minerals --particularly vitamin A, iron and zinc- when a group of 500 malnourished children in southern India received a supplemental tablespoon of spirulina a day for 150 days the prevalence in new cases of common eye disease dropped from 80% to 10%.

Goverments all over the world, particularly in Asia, started to recognize the algae potential as early as the 1970s and began large-scale, commercial production. Our lovely green friend, however, has yet to find more than a niche market in rich countries.

The government of India has set a good example in the developing world with an inter-departmental program, called the All India Coordinated Project on Algae. The AICPA is designed to encourage small-scale algae production across the country for both human and livestock consumption. The project is a start but it, along with the rest of the Indian agricultural sector, still has a long way to go before it reaches its potential. Even though the subcontinent has enough arable land to become a major food exporter, because of politics and lack a of resources, it is barely self-sufficient.

So, up in northeast India, we have decided to do our own small part to trying to help the situation. I am going to figure out a way to both grow spirulina and trap carbon!

The only issues to overcome are to figure out a way to pump CO2 through the water, circulate it enough to get the maximum yield of algae, and heat the water- the northeast is cold in the winter. Now, these wouldn’t be problems if we had money; you could just build a green house and buy CO2 canisters. But money is tight and the point of this project is to make a sustainable example that’s easy to replicate.

So my idea is to kill 4 birds with one stone. I want to use the exhaust from our 35 kW generator to heat the water, circulate it, provide the necessary CO2 and trap some of the carbon from the exhaust in the spirulina. My idea, which is still very much that, is to get a barrel of water, fill it with spirulina, snake a heat transfer pipe carrying the exhaust through the tank and bring the exhaust to a gas separator to isolate the CO2, then bubble it through the water. If the water is not circulated enough by the bubbles then I’m thinking to use a paddle wheel that is either powered by the generator itself or by the exhaust. I would use the exhaust by putting a spin-wheel in the tube; which would then drive a crankshaft to spin the paddle wheel. The carbon from the generators emissions would be trapped in the spirulina itself, which is 3 times as efficient at fixing carbon as a forest of equal area.

There are several hurdles in between me and my fully-functioning, model mini-spirulina farm. Probably the biggest is the gas separator. I have no idea if you can even make something that can effectively filter diesel exhaust, let alone how to build one. It’s also very important to get this part right as the algae absorbs everything you put in the water. A catalytic converter, if it’s not already in the generator, would help but would still leave me a long ways from isolating the CO2. The other problems aren’t so much whether or not I can do it, but how. I need to figure out how much water the exhaust can heat (the generator uses about 6 liters of diesel an hour), how best to position and shape the heat transfer tube and how to set up the tank itself. The problem there is that the more I insulate the tank the less sunlight it will get and visa versa. Spirulina needs a lot of sunlight and temperatures between 25C and 40C to grow. The generator is also in a brick shed so attaching the tank directly to the unit won’t work.

My formal education in physics stopped in high school, and in thermodynamics it’s non-existent, so I don’t even know where to start on figuring out the heat problem. Physics message boards require a greater understanding of the terminology than I have and, since I don’t have time to teach myself thermodynamics, I have enlisted the help of several of my elite network of physicist friends (made up of a very smart cousin and an equally gifted Beloiter). However, I am also appealing to you, the reader. If you or anyone you know has any knowledge that might help with this I would very much appreciate any guidance. I’ll even carve your name into the tank.

Monday, December 5, 2011

The Ethics of Trying to Help

There is a very important question that anyone who wants to work in an NGO/charity needs to ask themselves . Why do I want to help? On the surface this may seem a simple question, but I have found that finding a satisfactory answer is anything but.

To start with, there is a degree of narcissism just in the assumption that you can help. That I, the white savior, can ride in and help usher these poor, backwards people into modernity. Help them to become more like me. But what makes me so special? Why do we know what’s best for them?

Our culture feeds into this idea of American exceptionalism. Take movies like The Last Samurai, Dances with Wolves or Avatar. A disaffected, ruggedly individualistic white hero is assimilated into a group of noble savages whom he then leads to salvation because they are incapable of achieving this themselves. Avatar was the highest grossing movie ever. We eat this stuff up.

The problem with this is, as the old saying goes, ‘the road to hell is paved with good intentions.’ Our feelings of God-given superiority, often coupled with the desire to save the aboriginals from themselves, have led to such shining examples of western values as slavery, colonialism and the U.S.A’s genocide of the Native Americans. Well, you may say, that was a long time ago we don’t do that kind of thing anymore. Well, I would hypothetically respond, there are several billion people who may disagree and say that structural adjustment loans and sweatshops are just new paint on old ideas. That crux of Samuel Huntington’s Modernization theory, that all underdeveloped states need to do is mimic the ascent of the US and western Europe, does not seem too effective or popular to the people that it was designed to help.

The desire to do good and help can have negative consequences even when our hearts are in the right place and the ideas seems good. One example of this was when an NGO set out to empower a group of African women by introducing a new species of yam into their village. Harvesting yams traditionally had been the role of women and it was thought that this new super yam, which was bigger and required less space and water than its indigenous relative, would give these women something to sell. Since they wouldn’t be as reliant on their husbands for money they could start taking more control over their lives. Sounds great right? Well it didn’t quite work out that way. The men saw that the women were making real money on these yams so they took it upon themselves to harvest the plants themselves. So the women went from having a little to having nothing. That, and it turned out that in that type of soil the yams produced cyanide, which then ran off into the local water sources.

Another more large scale example of the best intentions run a muck can be seen in African famine relief. Everyone probably remembers the terrible famine in east Africa in the late 1990s (there is another one happening now if you need a refresher). The pictures of skeletal children with blank stares and flies in their eyes with captions asking for your donations. The news reports about how many hundreds of thousands had died and how many million more were at risk. Well if they are starving then lets give ‘em food! That’s what you do when people are hungry, right? And that’s what we did, and in the short term it probably saved thousands if not millions of lives. So what’s the problem? Well the problem is that we shipped all that food from America and Europe, we didn’t buy any of it there. That meant that, since it’s pretty hard to compete with free, what little agricultural infrastructure was left was destroyed. All those 50 and 100 pound bags of grain with USA stamped on the side was just a band-aid on a broken leg. Because of it when the next famine came it was far worse.

There is a whole school of thought that preaches that trying to help in poor areas only creates dependency. That in the end it only perpetuates poverty by undermining the target groups self-esteem and creating a self-fulfilling prophecy by implicitly saying they are incapable of doing it themselves. Though this can and does happen, if aid is done right it doesn’t have to.

What the above examples show is not that people shouldn’t help each other, or that we in the rich world don’t have a responsibility to help those less fortunate than us. We do. The point is that we need to stop, think and check our ego before we try. Most of the time the easiest solution is not the best one and it’s the people in the effected communities that know best what’s going to help them, not us. If really we want to help, we should be focusing on empowering people by finding out, from them, what they need. Helping communities them to help themselves.

Thankfully, this is starting to happen. The World Food Organization is now buying whatever relief supplies they can from the effected areas and investing in infrastructure that should help soften the impact of the next crisis. NGO’s are now asking the communities they serve how they can help rather than telling them how they will. But even with this, the line between genuinely helping and hurting through creating dependency is very thin.

As for me, I keep asking myself this question of why and I don’t always like the answer. Yes, I’m asking people what they need and what they think the best way to get it is, but I would be lying if I said that how the project will reflect on me isn’t a criteria. There is deep, almost desperate need I feel to prove to myself and the world that I can be good at and find meaning in something other than the academic studying that has filled my life to this point. An articulation of a sort of early mid-life identity crisis of who am I, and integral to that, where do I belong? And though most of the stuff I’m working on looks really promising, at the end of the day there is a part of me that thinks, "who the hell am I to help these people?" I haven’t been out of college for 2 years and have almost no practical experience to speak of. I’m basing hospital HR policy on my experience working the graveyard shift at a gyros restaurant! But there is a bigger part of me that says that if it works it works and you have to start somewhere.

In the end, I think a very wise Peace Corp. volunteer best summarized volunteering when he told me about his time abroad. He and his fellow workers had arrived in country with amazing visions of how they were going to make a big, lasting difference. They were fresh out of college and had all kinds of innovative ideas on ways to bring prosperity and engagement to the little country that would be there home for the next 24 months. This optimism, however, quickly slammed into reality. The enormity and complexity of the issues started to come into focus. “By the end of it,” he told me, “you realize that, at best, you will improve the lives of a handful of people and that the people you meet will probably have a more positive and lasting effect on you then you will on them. They were the best two years of my life.”

Wednesday, November 30, 2011

Horrifying Parasites (part 2)

So we were up in Nagaland, the state north of Manipur, this weekend for a few days visiting some of Johns friends. One of them was a doctor, who has been practicing for decades, and he had a story about an operation he had done two weeks prior that was so gross and amazing I can’t keep it to myself.

Beware: it is not for the feint of heart.

A Burmese boy came into see him (the Indian border with Burma is so porous you can walk in and out as you please) who was about 14 years old, with a seriously swollen belly. He told the doctor that it had always been swollen but that it had gotten worse recently. Worried that it was a tumor and in constant discomfort, he had made the several day trek to get it figured out what it was and hopefully get it removed. A CT scan and ultra sound were inconclusive; they could see that the poor kids intestines had been shoved to the side and that one of his kidneys had moved down to the front of his pelvis to make room for whatever the object was but they still couldn’t tell what had done this.

They decided to operate to figure out what was going on in there and see if they could safely remove it. After cutting in through the abdominal wall they still weren’t sure what they were looking at. It didn’t look like any tumor they had seen before. It didn’t look like any kind of swollen organ or infection either. Then they saw hair.

Not believing what their eyes were telling them they cut further in. A circulatory system, collapsed, never-used bowels. A brain. This teenage Burmese kid had been walking around his entire life with his twin growing inside of him!!!

This isn’t like Big Fat Greek wedding where the aunt talks about getting a small lump on her neck biopsied and finding the dead, unborn fetus of her twin. No, this thing was living in him and had been for over a decade! It didn’t have a heart, it was attached to the boys circulatory system so it didn’t need food either, thus the collapsed bowels. I didn’t get details on the brain, like how big it was or if it was functioning at all, but good lord! And for some reason this thing had recently decided to start a growth spurt. Was it trying to made its final Alien-esque escape? Its like Kuato in Total Recall only on the inside. I’m getting the shivers just writing about it.

("Open your Miiinnddd Mr. Quaid")

Its super gross I know but I had to share. Its one of those things that seems so insane it has to be real. I mean this doctor is a very well-to-do surgeon that runs a big hospital. Very respected in the community and with no reason to lie to us. He said he had pictures but that they were at the office, and I couldn’t quite bring myself to ask him to send them to me. I mean it’s a human being that had this and it seems grotesque, though certainly not below me, to gawk. But more importantly I still want to be able to sleep at night.

Horrifying Parasites (part 1)

(Swollen stomachs are one of the most obvious signs of worms)

Intestinal parasites. Worms. 2 billion people have them. 562 million of those are kids. 300 million of that 2 billion have severe or permanent health problems because of them, and over 50% of those are school-age children. And how much does it cost to treat these sinister little invertebrates? Between $0.02 and $0.20 a year, depending on the type of worms you have.

Other than iodizing table salt this is perhaps the single cheapest, easiest and best public health investment a developing country can make. And it seems most of the table salt in northeastern India is already iodized. So if we give every PMS student (the unfortunate acronym for Partnership Ministries Society) one 400mg pill of Albendazole, with a Praziqantel if they are near a body of fresh water, once year it will decrease the total burden of the parasites on the community by 70%. To treat those 8,000+ kids will cost us around $200. Not a bad investment.

We hit on this idea while I was meeting with my boss, John, and Ronnie, the V.P of education. The topic of discussion was if there was anyway to make a vitamin campaign at the schools effective and sustainable. Not really was the answer we came up with. It would cost tons of money if we didn’t them as a donation, and even then it would be difficult to secure more than a few months supply. And a few months worth wouldn’t be enough to make any meaningful difference anyway. Ronnie brought up the idea of deworming instead, which would accomplish more than vitamins at a fraction of the cost. Vitamins are not too useful if you have a swarm of helminths wriggling through your gut and consuming half the nutrients, and if kids can start getting the full benefit of the food they eat then, in comparison, that’s almost as good as giving them a supplement.

I was pumped. This was the embodiment of that annoying business/NGO term ‘low-hanging fruit.’ Like some proverbial, ripe melon on a waist-high branch, we hardly had to expend any effort to get a big reward. So I rushed off to my computer and did one of the few tangible things my degree really taught me to do well- research. Turns out that, along with the stuff I mentioned at the top, kids that get treated for worms will make an average of 43% more as adults than those with persistent infections. And the deworming campaign in 1950s Japan is one of the reasons credited for its subsequent economic boom.

(Me and John with a dead snake, its like worm only bigger and not)

We also certainly weren’t the first group to realize the benefits of deworming. WHO gives it special mention as an integral component in reaching the UN’s Millennium Goal of universal primary education. India currently even has the largest deworming program in the world. An awesome NGO call Deworm the World (a great idea for a Christmas present if you want to make a donation in someones name that will actually make a difference) partnered with the Indian government and are now treating 17 million kids for worms in the northern state of Bihar

Putting together a Power Point to train the teachers and nurses who would be administering the drugs was next. Though fascinating, learning all the fun facts on intestinal parasites and seeing dozens of photos of worms crawling into healthy skin and out through open sores brought on a paranoia similar to classes in abnormal psych. I began wondering if my lack of weight gain, in spite of impressive consumption, might be due to more than just a fast metabolism. Could it be that on one of my third world trips I had picked up a malevolent passenger? Could it be that for the last few years I had one or two silent monsters living inside of me? That, the satisfying thought of Albendazole starving a worm of glucose till it died what I hoped was an agonizing death, and the fact that the pill is only 2 cents led me to decide it was better to be safe than sorry. Though the deworming pill definitely made me sleep easier I am still finding myself thinking twice before wearing flip-flops outside.

Now that the slide show is done, and I am confirmed worm free for at least 6 months, its time to move on to the logistics of training and drug purchase and distribution. Deworming day isn’t until early January, which should give us more than enough time.

Monday, November 21, 2011

Organized Chaos

Sielmat Christian Hospital, the site of the aforementioned week-a-thon health clinic, has only been the current 36 bed, 1 full time doctor and 20 full time nurse incarnation for a few years. Before the construction of the maternity wards, optometrist office, lab and operating theater it was little more than a mud hut. That all changed when John decided to make the hospital a central part of the ministry. Funds were raised, plans drawn up, concrete was poured and, voila! A modern (by Indian standards) hospital was raised. The freshly hired nurses and doctors began treating the sick with the newly purchased modern medical technology housed in the clean, white tiled rooms; in short the hospital was transformed. The reception and billing office however, apparently didn’t get this memo.

A week ago I was sitting at dinner with Lawm, John’s pregnant wife, when she said, “Travis the hospital’s office doesn’t run well. I want to make it more efficient. Come down tomorrow, watch how the office works and tell us what to change.” I was a little dumbstruck. I mean, one of the principal reasons I came here was to have work that was stimulating and challenging (a bill the food service industry wasn’t quite fitting), but reorganize the structure of a hospital’s reception and bookkeeping system? Despite my 2 college biology classes (one of which was marine bio) I can barely fill out medical paperwork, let alone organize an efficient way to run an entire hospital office. So of course I said yes, I’d love to, and hoped that in the next 12 hours, 8 of which I would spend sleeping, some blinding flash of organizational insight would hit.

It didn’t. After introducing myself to the staff the next morning I sat down on a stool, sweaty palmed, and observed. At first, what I was watching didn’t make any sense. So I asked one of the English speaking staff to explain it to me.

During her explanation I was reminded of an anecdote Gen. Jimmy had told me about when Soviet advisers had first arrived in India. They had promised to look around the subcontinent and present the government with a 5 year plan to modernize India. After a month of traveling the country they came back to Delhi and gave an eagerly awaiting audience of government officials their report. The Russians said, “We have no idea how your country functions. We don’t believe in God but he must be running this country because its obvious no one else is.” Then they got on a plane and went home.

Though certainly not quite as extreme, my first impression of the how the hospital office ran paralleled this pretty closely.

The hospital hadn’t changed their system since they were a 5 bed mud hut, and at that time the system had been more than adequate. Now, however, as real medical center, by any western standards it wasn’t a system; two ladies, interchangeably, gave out money for expenditures, collected receipts and gave OPDs to patients. They then handed the hospital copy of the OPD to a guy who checked the bill then stuck it an envelop with the rest of that months cases and piled it in a corner. Though this may sound overly critical, the fact that the hospital managed to continue functioning deserves the highest praise I can give its employees; they are so honest and hard working that they somehow make it work. That and they are too busy/had no experience or reason to change the way it was.

In many ways this is like a microcosm for India- they somehow derive a kind of order from chaos. I think if the world ended tomorrow and all government broke down, America would implode, but life for the average Indian probably wouldn’t change that much. While we rely on the rule of law, they follow the law of rules. While our everyday life is governed by legal institutions, theirs is governed by far more durable social institutions.

Though the system worked, it was anything but efficient. So I set to work, talking with each of the workers about what they think works and what should be done to make it run smoother. After getting their input I planned it out. I based the filing system on what I remember from visits to my optometrist and orthodontist (6 years of braces and being legally blind without corrective lenses means I spent a bit of time in both). The patient payments and expenditure reimbursements now go through separate people and with a system based on the hyper-paranoid and time-tested one anybody who has worked in a restaurant knows. Filing is now to be done chronologically and alphabetically, with each patient getting their own folder. The men’s are a subtle forest green and women’s a dark ugly pink. The goal is to make the institution strong enough that it will function well even with employees that don’t have the experience or ethics of this group.

Now, in the second week, things seem to be starting off well. A bit slow and confused at times because of the change, but it seems that the staff realizes it will make their lives easier. Of course, it still remains to be seen if this system will have any long-term staying power, but it’s a start.

Now, it’s certainly not that the hospital administration could not have come up with this, or probably a far better system. It’s that, being a charity, they are understaffed and overworked, dealing with issues like making sure life saving medicine gets in and that there is enough money to keep the hospital open. Seeing that I, with no meaningful organizational or NGO experience, can do this in less than week doesn’t speak to my ability so much as to how easy it is to make a positive difference, however small, when you decide to focus and do it.

Sunday, November 13, 2011

Ducky Wrist-Bands

“Does she have a ducky band?”
“She says she has been waiting here for a long time.”
“Does she have a ducky band?”
“She says she waited yesterday too.”
“Does she have ducky band?!”
“She says she also has abdominal pain… What to do?”
“Varte! Does she or does she not have a ducky band?!”
“No, but…”
“Then tell her she has to wait in line like everyone else!” I say with as much calm as I can muster after having this exact same conversation 8 times in the last three days.

Varte, my translator, does not want to be the bad guy. No one likes telling a 60 something lady with a swollen goiter on her neck that she has to go to the back of a line 200 people long to get reading glasses, then wait in another equally long line if she wants her neck looked at. But that’s our job. I guess it pays to have an MD when you volunteer at a once a year health clinic in northeast India. But neither me or Varte do, so we get to be the bad guys that tell old ladies, who have probably never seen a western doctor before in their life, that because they don’t have the ducky wristband that says a doctor wanted them to come back in, they can go wait in the sun for 3 hours. How did I end up here?

The trip didn’t start like this. When my parents and I arrived in steamy Calcutta, our first three days were spent at the Hope Home orphanage/school hanging out with and teaching the cutest kids I have ever met. I usually hate kids but these guys were so open, nice and genuinely excited to see you every morning that even my cold lump of a heart thawed a little. They are so different from kids in the USA. American kids are spoiled and because they have no idea how bad it can be they take their privilege for granted. These kids either grew up in about as bad as it can be, and remember it, or they see it often enough on the street outside that they take everyday in Hope Home as a blessing. When my kids are born they are coming here for a year.

Arriving in Darjeeling (unfortunately not aboard the Darjeeling Limited), our second stop, was preceded by a careening 3 hour car ride up through tea plantations dotted across 45 degree slopes on roads only wide enough for a single vechile at a time. The road ended in town crammed with Tibetan refugees and 3x the population it was designed for. The concrete and corrugated aluminum structures that line the narrow roads are built literally one on top of the other and most looked so precarious it seemed a stiff breeze would blow them right off the mountain. Though the Himalayas were not as close I thought they would be, waking up to an unobstructed view of Kanchenjunga, the third highest peak in the world, wasn’t too bad.

Next on the itinerary was the stay with Jimmy Singh, the retired Indian general with 50 years of service under his belt. This was been the part of the trip I had most looked forward to, here was a high ranking Indian military officer who had served during the entirety of the Cold War! And here I was! A fresh International Relations graduate with a diploma from the mighty Beloit College. What debates we would have! We didn’t actually the General in person until our fourth day, when we left his estate for our stay at his farm house. By this point I was practically salivating. Three days of looking at portraits and photo albums of him during his victorious campaign against Pakistan and the astonishingly large collection of ceremonial sabres that adorned his wall had only peaked my interest.

And he didn’t disappoint. In fact it quickly became a apparent that this tall, distinguished Sikh had probably forgotten more since he woke up that morning about world affairs than I had learned in what I though was four years of rigorous study. I ended by just listening, slack jawed as he told about how the world actually worked. How China gave Pakistan nuclear technology but that wind patterns on the subcontinent make using a nuke impossible without the fallout blowing back, how India had almost invaded Tibet before Mao had entrenched himself and how to negotiate with a Thai officer. These were just a few of the areas covered.

The trip from Gen. Jimmy’s idyllic farm house near the Nepalese and Bhutanese borders ended with us in the forgotten northeastern state of Manipur. Our arrival coincidental coincided with one of the areas biggest events of the year- the annual free health clinic. This clinic is held by Jewish Voices Ministries International, an incredibly efficient Zionist group that is both trying to bring Jews to Jesus and unite the lost tribes of Israel. The Benne Manasha, a Jewish tribe that lives in the hills close to Sielmat, my current home, have been genetically identified as belonging to one of these lost tribes, hence JVMI’s interest in Manipur. The hospital hosting the clinic belongs to Bibles for the World, my current employer and host. And since my actual work for John Pudiate, BFTW’s vice-president, couldn’t start until after the clinic, I find myself, pockets stuffed with multi-colored wrist bands and Sharpies, shoving old ladies to the back of a bamboo fenced line.

As I watch the poor woman angrily waddle away, I find myself thinking longingly of the possible projects I will be working on in weeks to come. Projects which, hopefully, will not involve yelling “reading glasses!?” questioningly into the uncomprehending faces of polite locals. John has given me some ideas but nothing set in stone. I could be coordinating with Doctors Without Borders, I could be organizing getting multivitamins to school children, I could be investigating a pre-pay electrical system that uses generators and solar cells, or it could end up John realizes I’m completely incompetent and has me raking leaves for 3 months, but I’m hoping for the former.

Well, that’s not for another three days, when this clinic finally ends and after my parents leave. Right now its thirty minutes until the clinic closes and I can’t even see the back of the line.