A day in the life – Nursing in Kolkata

Reprinted from The Common Good, No 36, Lent 2006

I have never required an alarm clock in India. The early morning blazing sun throws its heat and light into my bedroom on a regular basis at 0520. Today again there is no cloud, the sun is bright, the day will be another scorcher, no doubt. Even though the air is warm and moist ‘my old bones’ have a very real awareness of that early morning cold shower!! Today is no different. I down my morning pills, Vit B12 and Doxicycline to prevent malaria. My understanding is, it gives an 86% protection. I also have an electrical device I activate before settling at night along with lotions applied to skin now and then so I am taking precautions. My mosquito net I can no longer tolerate. I feel too claustrophobic and just struggle to breath easily so that’s back in the pack!! There are many stories of Dengue fever which is caused from the mosquito, here and in parts of Singapore.

At 0630 I call in to pick up Lisa, a volunteer from America. We make our way to the Missionary of Charity orphanage, about a 20-25 minute walk. Freid, the old man who lives in my hotel basement was waiting for me as I set out on my way. He is not looking well again and though on Sunday I gave him enough money to have another check-up and bring me the doctor’s report, I’m not sure he understood the last bit – we will see!

The street is unusually busy for a Sunday. The streets are being swept, the street people cooking breakfast, a pot of something cooking over a small coal fire. The smoke and stench fills our nostrils, throat and lungs as we wander pass. There are areas I well know now when to hold my breath. Public male urinal sites along the street have thick yellow foam that looks like yogurt. You just want to vomit. Lisa wasn’t ready for it. It’s good to watch someone else’s expression!! Many men and boys are squatting around the various water pumps along the footpaths and gutters. They are soaping themselves up, having a wash, cleaning their teeth or filling up their water containers for the day. Others are being shaved. This is a business. Today there are at least 100-plus lined up for kerosene. More than usual in this little lane. Maybe the price is about to rise. As for the streets and lanes we walk, life is the same. The meat hanging, the crows pecking, three or four cows tied up, the dogs lying across or on the road, others sniffing through the piles of heaped up rubbish accumulated from the work of the sweepers, the goats dead and alive, the beggars seeing what might be useful in the rubbish; and the street people – little children about the ages of 6 years – squatting on the ground, bashing away, breaking up coal into smaller bits using wooden mallets. I am left in awe that in such poverty there are smiles on the faces of so many, as we exchange gestures as I pass by. It never ceases to amaze me. I love these people.

Breakfast never changes. A hunk of white bread, a banana and a cup of chai that I manage to force down. Some people actually like it, but not me – yet !!

Next we ride on the bus, rounding up those new volunteers that are coming to Kalighat. The bus rides are always interesting. The traffic and the drivers are crazy to say the least. In all cases the rule seems to be that the vehicle that will do the most damage has the right of way. I have learnt to take my glasses off as they are not likely to stay on and certainly not on top of my head!! On the bus there are seats for ladies and men. Today a wee girl about 5 –6 years old gets on. Her dress is torn, she is grubby and has two stones in between her fingers. She moves through the bus clicking these stones together in one hand and holding out her other hand for money. I don’t think she has got anything before the bus attendant yells something and she gets off at the next stop. She turns back and I wave. She smiles and the bus goes on. Does she belong to anyone? Possibly abandoned. I feel sick. As I have learnt this is often the reality.

Now to work. Today is a little different as I have been asked to work morning and afternoon at Kalighat. Usually I work on the streets in the afternoons. This is because Elizabeth, a nurse who has been here for years, wants the day off today so we need cover. You never know if a nurse is going to turn up with the daily volunteers. Sr P, who today is back from being sick, is very welcoming. She now trusts my judgment and looks to me for suggestions. It’s a good day but busy, although it could be worse.

Two beautiful patients died last night. One, my little TB lady, I had intensely nursed for several days. Sr P always used to yell at me ‘Kathryn where is your mask – she has TB’ I could never bring myself to put on a mask. She was dying. I was to be overall the last person she would see, hear or feel the touch of. No, I could not wear gloves or masks. Her eyes told me she was struggling. She had no strength to cough. I had inserted her IV a couple of days earlier. One of my first, I am glad it lasted. If a patient is conscious but unable to drink, a drip is inserted. The other patient, Fatima, bed 26, finally died. Sad but what a relief. It pained me watching her struggle.

She had come just prior to my arriving. I guess she had cancer on the face but on admission had very little face left on one side. It had been eaten away by maggots and worms. It was difficult to feed her with a syringe. Most she would cough back and swish all over her deformed face. It was hard to watch. Elizabeth and myself had kept her comfortable with IM pain relief and regular diazepam. Sr P and Elizabeth and now myself prescribe. I always run it by one of them. Sr P will often say, ‘Kathryn why do you want to give that?’ She always agrees once I explain the reason. So funny how she still yells ‘Why, Kathryn, why?’

Well, I give out the three IV antibiotics, check the patients and ensur the volunteers are happy and know what to do. It is important that the dressings be allocated well, and that the more difficult ones are done by a nurse. Next I give out the pills with a novice. In this place I am always teaching. The pills are in white plastic containers with the name written on the top. You administer them off the concrete floor on the raised area of the wing. I like to place a sheet on the floor first, and then work my way through the medicine book.

Not all have pills. Each page will have on it: Name: often unknown. Age: often a baby. Religion: again either unknown, Hindi, Moslem or RC. Underneath charted: Multivite 1 BD. Iron 1 am. Vit C 1 BD and sometimes other meds such as enalapril, spirolactone, lasix, haloperodol all charted.

Last week, with a novice, I sorted all the pills as there were many of different shapes and colours in the one container. A teaching lesson followed! There were 10 enalaprils with the 5mg which now I hear is a standard prescription, spirolactone 100 with 25mg, 25 their standard dose. What a shambles, but we are right for a wee while. This lot of novices now understand. Sr P thought the novices who refill the containers were aware that there were different strengths. All pills are in big boxes out the back: eg all anti depressants, all diuretics, all malaria, all pain relief etc.

Then onto the injections. Again a book set up like the medicine book. Male and Female book. These are all drawn up then given. Most have IM Ampliclox, 1 BD and Gentamycin 2cc BD that is 80 mg. The syringe for each patient lasts five days.

Giving the injection. Give the first, leave that needle in, remove the syringe add the secon syringe and inject – one injection, two antibiotics, all in the one spot. It seems to work.

I then do two dressings. Sundays are a little different Sr P likes the work done before Mass. (Nothing else matters in this place during either Mass, Sister’s prayer time, or Sister’s afternoon break.) It’s hard to cope with at times. During these times every cupboard is locked and Sr P has the keys. Today there is an awful cry, a scream from a lady with most of her foot eaten away. Celine, a wonderful nurse, demands I go and get pain relief. I can’t. I know Sr P will not be distracted from prayer, let alone the Mass. Sad but that is how it happens here. Celine gets so angry with God, the Sisters and everything. She is hurting bad as I am. We do our best with the patient. You think you can never see anything as bad then another patient comes in. Today is my first day off for two weeks. I think about yesterday and say it will never happen again, to see a patient so distressed. We should leave the dressing until the areas are reopened. We had given this patient IM pain relief but clearly not enough. The other thought I have is I will ask Sr P that I have my own emergency kit to keep in a safe place. Pain relief and sedation, oral and IM. I will check this out. I have this poor lady on a little haloperiodol and regular pain relief. We will continue to assess.

Well the afternoon is difficult as I do not travel home, just stay on the premises. It is so hot, 30.5 degrees inside. Afternoon medications and IVs and injections. Only a few volunteers but I guess it is Sunday. We manage. At 1600 a volunteer calls out. She was giving a wee lady a drink of water and she stopped breathing. I check her airway and call Sr P. She blesses the person and prays. She dies peacefully a few minutes later. The body is washed, powder applied, a nappy put on, then into a cream sheet. Then into our mortuary. As we place her into the mortuary I am taken back a little. Two other bodies lie there. Just shows me how busy I have been not to notice how busy the men’s side has been also.

With death, details are filled in. Name: many still unknown. Age. Religion: if not known, go as Hindi. Cremated. Family: Usually nil or unknown. You never see family visitors in this place. It is for the Destitute. So sad. People often say they have NO ONE, just to be admitted. They usually know they will never see family again unless they do recover, and some do. I will inquire how many one day. The only consolation they know is they are loved in this place and are grateful not to be on the streets dying alone. We don’t know we are alive. Well my day’s ended and I arrive home at 7.30 after a quick bite to eat. A shower and into bed so tired with the heat. Let’s pray for rain tomorrow, I think.

Kathryn Campbell, a parishioner of St Mary’s Parish in New Brighton, recently spent five months working with the Sisters of Charity in Kolkata, India, in a home for the sick, dying, and destitute.

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