I was teary eyed at the opening ceremony. So was Alex. It was the parade that led us by tribal drums down the dirt road to the brightly arranged tents, all those government officials with their incomprehensible Telugu speeches of pride and gratitude, the banner with all of our names including Austin’s, and the little girl of eight or nine reading in English her polite thank you from a sheet of notebook paper. She was so cute but still so elegant. We lit candles in front of a small alter with incense and a framed picture of Ganesh, the elephant-like Hindu God that is to start all projects. We watched as the school children sang their national anthem,

and then we sang in unison, The Star Spangled Banner. They draped shawls and scarves around our necks to honor us.

That was how the camp began. After the opening ceremony, we were led down to the school yard gates and a small tour was given to the government big wigs. Then we all took our posts and the madness began. There were so many patients. They crammed against the tall iron gate, pushing to get in, and they hung over the newly painted cement walls staring. We were grateful those officials had arranged for police guards to control the crowd.

Announcements had been made in all the papers. Banners were hanging everywhere. There had been a media blitz of advertisement for our endeavor. It was partly to bring in patients, partly for politics. The government officials had helped us to arrange things. We couldn’t have done it without them. They wanted something in return. They wanted as many as possible to know that they were helping their constituents, the poor citizens among them. India is the largest democracy, and votes count.

The result was amazing. I had one couple who had come from neighboring state, eight hours journey, to meet up with the American doctors. They were infertile and wanted desperately to have children. I’m not sure what they thought I could do for them in five minutes, what magic they thought I might have. Maybe they felt better and I gave them some hope. Maybe that wasn’t the right thing to do either. One seventeen year old girl was another of those who came for infertility. She said she had been married for five years, married at twelve. That was Austin’s age.

There was so little time. “One minute, one patient, one minute, one patient,” said one of the Indian doctors. One minute wasn’t long enough to hear their list of complaints, of which most people had three, let alone have it repeated back to me in English by the interpreter.

What could we really do for them? There was chronic back pain from hard field labor, arthritis in the elderly, frequent headaches, and perpetual heartburn from all the spicy food.

Several patients had vitiligo, the autoimmune disorder that appears to bleach uneven white spots on the face and torso so vividly against their dark skin. There is no treatment. One woman said she had heard that they were doing radiation therapy in Hyderabad for it. Radiation, used for cancer to prevent its destructive and lethal effects, has destructive and cancer causing effects of its own. Vitiligo is a cosmetic disorder. It was an awful thought that some shady character in the city might be profiting from people’s vanity at the expense of their health, maybe even their lives.

I wrote a lot of prescriptions for ibuprofen, Alleve, aspirin and other pain medicines to be dispensed for free from our make-shift pharmacy. We gave out Pepcid and other heartburn medications, at least ten pills for everyone. It was a band-aid that didn’t solve any problems. That part was frustrating.

There were some sick patients too. We diagnosed new cases of diabetes and hoped they would go for follow-up to the nearest government hospital, or more expensive, but closer local private physicians. Alex debrided leg ulcers that were deep to the bone, irrigating an infected ankle joint the best he could with the free solution we had picked up at the ACEP meeting in San Francisco. He set an open tib/fib fracture, and we had strong anxiolytics and pain medicines for that patient. Transport was arranged to a hospital where she could get orthopedic surgery.

One poor man came in with a huge parotid tumor growing out of the left side of his face, spreading back behind his ear with infection and wet necrosis. He was debrided some and got a nice, new, clean bandage and pain medicines, but there wasn’t much else we could do for him.

In my clinic, it was white discharge for everyone. Every woman had that and abdominal pain ever since her free, government sponsored tubal ligation for population control. I couldn’t do gyne exams on every one of them. Bethany and I did the best we could. She found clue cells and hyphae under the microscope. I began to treat most empirically, hoping that they were understanding my questions and that I was understanding their answers. A few of the patients had come from villages so remote that they could barely communicate with my interpreter, Rao’s wife, Baranthi.

Two little girls came in with severe bladder infections they had for weeks. One had urine like white pus mixed with blood. They looked sad, with that dull look of sickness in their eyes, listless and without energy. One of them also had a vaginal yeast infection. I imagine that she was miserable, and that after two days of antibiotics and some fluconazole, she was like a different and happy child. Just helping those two little ones made the frustrating aspects of the camp all worth it to me.

I remembered from the Nepal experience that one of the local doctors had said “Abdominal pain equals worms.” So I treated liberally for infestation with the one pill of albendazole that should cure them. I don’t know if I missed other, more serious pathology. My history, exams and lab testing were so limited by time and language and cultural barriers.

We were trying to see patients quickly. So many had come for help. Apparently we treated one thousand people in two days. Alex and I aren’t sure how that happened. I think that between the two of us we maybe saw three hundred. Some that came to us had already been to one of the Indian docs and had snuck back in line to see one of the Americans. Rao was both, and a local hero, so they were clamoring to see him, but the other two must have felt insulted. Maybe the people had come to see the American physicians, but the Indian docs were just as qualified, probably more so since they were familiar with the local pathology, the parasites and tropical medicine that we don’t have in our own country.

We were so busy that we ran out of medications. The Indian physician working as the pharmacist began to half fill the prescriptions. When I heard, I hoped those two little girls had gotten all of the medicine for which I had written, all that they needed to get better. Everyone we treated left the camp with a few pills, even if they were only vitamins. The patients loved those, even asked for them so that they could have more energy and feel better. I don’t know that the ten day supply we gave them did anything. Then again, maybe it did. There’s the placebo effect and peace of mind.

There were so many patients that had come from so far away that we didn’t have time to see. Some had walked for hours and miles to come to us. They pushed against the gates and climbed over the walls, sneaking in the lines without registration papers.

It became almost mob-like. One young man trying to push his way in got his finger broken in the gate door when the policeman slammed it. That got him in to see the doctor. The later it became on the second day, the rowdier the crowd. They began to realize that they had come so far and waited so long and would not get the chance to be seen.

Our guests began to get worried about our safety and slipped us out by twos under the guise of a chai break. We had run out of medicines anyway and had nothing left to treat all those people with.

The car took the eight of us back to Hyderabad that night. Later, we learned that Rao had stayed on alone, seeing patients privately, as many as he could, until way after dark. He took down the names and wrote scripts to be filled in the city and arranged for their medicines to be transported back to the small village of Kothur.