tsunami22

The Philadelphia Inquirer

JANUARY 26, 2005

Tsunami adds urgency to doctors' work.;

Couple on a mission, a world away from Phila.

BYLINE: Dawn Fallik

INQUIRER STAFF WRITER

SECTION: NATIONAL; Pg. A01

LENGTH: 1559 words

DATELINE: KHOLVAD, India

It was the first operation in Dinbandhu Charity Hospital's new operating room. Blood arrived in a plastic grocery bag. The nurse had to be taught how to glove the doctor.

In the middle of it stood E. Balasubramanian, red clogs flashing under his scrubs donated by Temple University Hospital, where he is an orthopedic surgeon. As the patient waited to become numb, Bala, as the doctor is called, sorted through a pile of tools and knee puzzle pieces - rasps, saws, chisels - many of which he had brought.

For the fourth time in less than 10 minutes, he shook his head in frustration. This was an operating room where patients got tetanus shots for fear of rusty instruments, a far cry from Temple's world.

But Bala knew that life at Dinbandhu was luxurious compared with what was ahead. This week, he and his wife, pathologist Manjula Balasubramanian, are headed home to southern India to help tsunami survivors. The couple, both 52, are traveling from western India to Madras. To Cuddalore. To Nagappattinam. To a string of cities on the Indian coast where a monstrous wave killed more than 10,000 and left 15 times that many homeless.

It took the couple 14 hours to fly to Bombay from Philadelphia. Then it took them five hours to drive 120 miles to Kholvad - crammed into a crowded minivan as it sped up Highway 8, horn blaring jarringly as it brushed perilously close to the colorful trucks it passed.

And now, with the operating-room team standing barefoot or in flip-flops waiting to complete Dhani Bhabhi's knee-replacement surgery, Bala asked the nurse for an instrument.

She handed him the wrong one.

Bala's eyes smiled above his mask; he shook his head slightly, no. The nurse fumbled, and produced another.

"That's right," he nodded approvingly.

Progress.

*

The day after Christmas, Bala was on call at Temple. At 8 a.m., he climbed into his car for the commute from his home in Gwynedd Valley, Montgomery County.

He heard the news on the radio. An earthquake had triggered a tsunami that had swallowed beaches whole in several countries.

Immediately he thought of his family in Kallidaikuruchi, at the southern tip of India. His four brothers and sisters and his parents were there. He pulled out his cell phone and frantically tried to call his wife, who was on her way to New York with their 22-year-old daughter, Swathi. Her phone was turned off.

Bala turned around and drove back home. He called a brother in India. No luck. Finally, he got through to his parents. Their family was OK, but thousands were dead, and thousands more were missing.

Soon, the couple's collective relief would be replaced by frustration. They had already planned to travel to India to work at the charity hospital, but not until Jan. 14. After a tsunami-relief meeting at the Hindu temple the couple helped found in Montgomeryville, the couple's conversation turned not to whether they should go, but how soon.

Bala and his wife consider themselves lucky. Most American doctors struggling to find a way into the tsunami-affected countries were put on hold, told to wait as crisis officials a world away tried to figure out how to best use them. But Bala has a cousin who is a pediatrician in India's southeast, where the tsunami hit, and another who runs an orphanage. It would be easy for them to get plugged in.

"I have something to give," Bala said. "Where can I give it?"

That simple statement is the couple's mantra. Three years earlier, they had begun an annual pilgrimage to Dinbandhu Hospital, where they started a blood bank, taught basic sterility precautions, and later persuaded other doctors to donate their time and money.

Volunteer work is part of their spiritual life. Devout Hindus, they do not eat meat or drink alcohol. They keep the traditions, holding prayer ceremonies on full-moon days, and, every morning, Bala prays before surgery. At the core is punya, giving oneself to others, through charity or deeds.

"Bala does it without expectation," Manju of her husband. "For me, whatever I do, I do in the hope that someone will do for my kids. And whenever something good happens to me, I believe it is because of the punya that my parents did."

They had plenty of doubts about the trip. It meant leaving without properly sending off their daughters - Swathi and Anusha, 20, a junior at Carnegie Mellon University in Pittsburgh. Swathi was to go to Moscow, where she will learn Russian, and Anusha, to Namibia for a semester working at a women's shelter. Their son, Karthik, 25, is to join them this month for the 80th birthday celebration of Bala's father.

And then there was the simple matter of whether they would be able to cope with what lay ahead - emotionally as well as medically. Although their families were safe, many of their childhood touchstones were gone.

"I think about what happened to the beach that I grew up on," said Bala, running a hand over his light gray beard. "That wasn't just where we went to play; that was where we lived as children. I don't know what I'll think when I see it."

*

Back at Dinbandhu Hospital, Manju wasn't thinking about the trip to southern India. She was ready to strangle someone immediately. A pathologist at Hahnemann University Hospital, she had spent much of her time in India last year teaching the pathology lab how to set up quality-control standards, to make sure the machines were reading the samples correctly.

A month after she left, the techs dropped the standards. It took too much time, they said. Manju, a petite woman who is not quite 5 feet tall, lost her usual good humor.

"To work without quality standards is just wrong," she told the lab technician. "You might as well close the lab."

The hospital's new pathologist, a young woman, walked in the door.

"How often do you check the machines? Do you check the machines when the electricity goes off?" Manju asked her.

The pathologist shook her head.

"There's only so much we can do when the electricity goes off three or four times a day," she said. "We check it once a week."

"Maybe you could do it once a day," Manju suggested firmly.

"Maybe," said the pathologist.

Later, Manju took a deep breath and tried to appreciate small victories.

When Manju first came here, the techs were sucking blood into pipettes by mouth, to test it.

"At least they don't do that anymore," she said.

*

The Balasubramanians found Dinbandhu Hospital through friends in Philadelphia, Arvind and Hemu Bhakta. Arvind Bhakta's father, a doctor, started the 50-bed hospital to serve the local community: Many of the 40,000 villagers work in the sugarcane fields or factories, living in cardboard-covered huts patched with brilliant swatches of turquoise and magenta saris.

The Balasubramanians had sought to volunteer at a hospital in India; the Bhaktas had a hospital. Perfect.

This year, Manju has big dreams: a wellness program for every woman who comes to get a Pap smear, a hospital blood bank, and an international bone-marrow registry for Indians, who often are hard to match.

The hospital serves patients of all incomes, drawing from a region of one million. It is the only hospital in town and carries a patient load of about 300 a day.

Working at the hospital is a mixed blessing. The couple love treating the patients, teaching the young doctors, and watching the hospital improve - with such things as a new neonatal unit and a retina-surgery ward.

The couple would usually spend at least two weeks at the hospital and then enjoy some vacation time with their family. But not this year.

And this time, they have come back to find the staff has changed, and many of the lessons lost.

Still, in about 10 years when the couple retire, they plan to spend several months a year here.

*

It was almost midnight. Bala was riding in the backseat of an SUV after finishing a talk in nearby Surat on hip replacements to other orthopedic surgeons. He never rode in the front - the oncoming headlights and constant near-collisions with village traffic unnerved him.

Everyone was tired, having been at the hospital for surgery and meetings since 8:30 that morning. The ride was quiet. Bala stared out the window.

"I've had a change in attitude," he announced, breaking the silence. "I want to give more than I take."

In the seat opposite him, his wife opened her eyes and touched his hand with her knee.

"That's always been your way, Bal. What made you say that now?"

"I don't know," he said. "That's something I've been thinking about. I guess I've been doing it the past few years, but I want to give more."

And that was it. A quiet resolution uttered without the pressure of New Year's or a life-altering accident.

He did not know how he would keep his promise, or to whom. It was just a need that arose, under starry skies, as the SUV drove past the shanties of his homeland, and into the night.

Contact staff writer Dawn Fallik at 215-854-2795 or dfallik@phillynews.com.

About This Series

Inquirer reporter Dawn Fallik will follow the Balasubramanians, a Gwynedd Valley husband-and-wife doctor team, as they return home to India's southern coast to help tsunami victims. They are spending a month in their native land.