Sitting in the car today, I had one of those “oh shit” moments, and it occurred to me like a slap in the face that I may be over my head this time. Most of the time I have some kind of handle on we are doing in Munnekollal (migrant blue tent community), or if not some kind of handle, at least some level of certainty that what we are doing won’t be harmful to anyone, including ourselves.

But today was different. It started off being a quick trip to Munnekollal to pick up 5 sick children and their mothers along with 3 pregnant women for a visit to Apollo Clinic. But this work being what it is, you never know what is awaiting you once you step into the waste management site AKA migrant community. What was a crisis yesterday does not seem like that big of a deal once you see today’s heartbreak, pain, and trauma.

Wednesday we met Kajal, age 17, who has an 11 month old baby girl (she thinks that’s how old she is) and a 2 year old boy, who is pregnant with her third child. She doesn’t know how she got pregnant. She sorts trash for a living, and the babies’ playground is the trash mom sorts through to earn a few rupees to keep the family fed. According to the elderly neighbor who looks out for Kajal, her husband is mentally unstable, burned himself, and is MIA. She is on her own. As far as we can tell, Kajal has never been to the doctor for herself or her children. But once we met Maina today, Kajal’s life seemed fairly stable.

While getting 5 children, their mothers and 3 pregnant ladies in the cars to take to the hospital, Raj, my driver who has become on of our most helpful and consistent volunteers, was approached by Maina’s mother. Maina, a woman probably around 20 years old was in severe pain. Her leg was swollen to three times it’s normal size, she was moaning, and her cries sounded a lot like the desperation of an animal with its paw caugh

t in one of those metal traps. We didn’t know what was going on, but it was clear that this woman needed immediate medical attention. But how to get her from her home to the car when she couldn’t walk? Fortunately, her father had a bicycle and a cart. Maina slowly, and in great pain, loaded herself into the cart, and we pushed it over mountains of another person’s treasures to the waiting Innova.

Unfortunately, Apollo Clinic wouldn’t be able to treat Maina. They don’t handle severe emergencies. The best option seemed to be the ER at VIMS, a private hospital on the way to Apollo. As we headed there with Maina, Kajal, her two children, and a car full of the other kids and mothers following behind, I asked Urvi to ask Maina’s mom in Hindi about her medical issues. Her mom handed me a bunch of medical documents, including x-rays of her lungs. She said that Maina’s TB was so bad that it attacked her body, and she had to have implants put in from her knee to her hip two years ago. Apparently for the past few days her leg had been infected. At this point I wasn’t able to fully focus on what I was hearing since a woman with potentially active TB was in the back of our car with a pregnant woman and her 2 babies, who were definitely not vaccinated, breathing the same air!!!! We found a mask in the car and asked her to put it on, I rolled down the windows, prayed we’d all be okay, and let the panic settle in. When I woke up this morning, it never would have occurred to me that I could put myself and others in such a potentially dangerous situation. What we are good at is responding immediately to crises in the community, but this can also be potentially dangerous, like today, when we don’t have all of the information that we need. Fortunately, most of the time, the cases aren’t this severe or at least aren’t potentially dangerous to us.

To continue Maina’s story, at VIMS we pulled up to the ER, and two men with a dirty stretcher with no guard rails let her load herself onto it, and slowly wheeled her up the ramp to the tiny ER. The doctors there said they would examine her and get in touch with us to let us know what she needed. We had to continue on with the other 8 individuals to their Apollo appointments, and would circle back once we were finished. While in traffic on our way to Apollo, the VIMS doctor called to tell us about Maina’s condition. He said that she would probably die. She needed the implants removed surgically as they were severely infected, would need 4 weeks of antibiotics and surgery again to have new implants put back in, or, if the infection had spread too much, would need an amputation of both of her legs. The doctor said that the infection may have spread to her bloodstream, and that if that was the case, she would have multiple organ failure, and die. The cost to treat her at VIMS would be about $10,000. As much as we would have liked to have her treated at a private hospital, that price tag was so far out of our budget, not even a campaign on Ketto could save us. VIMS agreed to get an ambulance to take her to a much more affordable government hospital, which is located in downtown Bangalore, about 2.5 hours away. On Friday night with 3 kids home and rush hour traffic it’s just too far for me to go tonight. But without us there to support the family, the doctors will not give a poor, dying woman from the slum the attention she needs. The best I can do at this point is promise Maina’s mom that I will talk with the doctors, once she is actually examined by one, to be an advocate. But it’s not enough, I know.