Accident and Emergency in Calcutta

Abstract

In November 1987 I answered an advert on the hospital notice board for a volunteer to work in a street clinic in Calcutta, India. Less than 4 weeks later I was on my way. Middleton Row is a street in the heart of Calcutta. On a stretch of its pavement, 2 x 30 metres, Dr Jack keger conducts a unique clinic. His patients are the destitute-those who live and die on the street and possess nothing. Many of these destitute people are illegal immigrants from neighbouring Bangladesh, refugees from poverty in their homeland. The homeless, whatever their origin, are not entitled to ration cards giving access to subsidised food, and without ration cards they may be refused treatment in the already overcrowded state hospitals. It is estimated that there are at least a million such people living in Calcutta, and without the clinic many would not receive any kind of medical aid. I arrived in Calcutta on Sunday and walked down to what I now know as 34, Middleton Row. It appeared no different from any other street in Calcutta-dirty, smelly, noisy and dusty, with the water pump marking the washing area, not even a hint of the makings of a clinic that I was to work in less than 24 hours later. The clinic is open 6 days a week from 7.30 a.m. until the last patient is seen. In the winter the natural light fades dim mid-afternoon, and it becomes nearly impossible to work during the monsoon. The patients all arrived at the start of the clinic positioning themselves in the appropriate queue, with dressing clinic patients on one side and medical patients on the other. There were between 100-150 patients to be seen each day, and with members of their family who came along it could at times get very crowded. Each patient who had attended previously had a reference number written on a small piece of card which they kept in their clothing. This was often their only means of identification and they treasured it greatly. Numbers having been collected, the patient’s record was pulled from the simple numerical order filing system and they then waited to be attended to. Just before 9.00 a.m. we started removing the dressings, doing our utmost to maintain an aseptic technique, something that seemed impossible with the numerous flies moving from wound to wound. There was no privacy and all the dressings were done whilst the patients sat on a blue plastic sheet placed on the pavement. All of the instruments were sterilised using a small primus stove with a pot of boiling water. Dettol was used for cleaning wounds, and ointments were mixed. For example Gentamyacin ointment was made from 13 ampoules of intramuscular Gentamyacin mixed with a large tub of Vaseline.