Good Reads: Before and After by Brian F. Mullaney, Co-Founder of Smile Train and WonderWork.
Before and After – Chapter 20: Dr. Subodh Singh
One of the first people we turned to for advice during the early days of WonderWork was Dr. Subodh Singh, the same surgeon who operated on Pinki Sonkar in our Oscar-winning movie. Over our years of partnership, Subodh had transformed his small hospital in Varanasi into the busiest and most successful Smile Train hospital in the world. But by 2012, as Subodh and his team cleared the cleft backlog in their area, numbers of surgeries had seriously declined. G.S. Memorial had gone from performing almost 4,000 cleft surgeries a year to less than 1,500—a 62 percent drop.
While surgery numbers were going down at the hospital, the level of awareness about clefts and their cure continued to increase. Subodh no longer heard parents saying that an eclipse or a curse had caused a child’s cleft. Families were coming to him with babies as young as a few months. They understood that their child had a birth defect and that it could be treated quickly and at no cost. At his day-long screening camps for cleft patients, where he had once seen many hundreds of people, Subodh now saw as few as fifty, and the majority of those were follow-up visits from patients he had already treated.
With cleft procedures dwindling, Subodh had decided to put more of his time and effort into treating patients suffering with burns. This dovetailed perfectly with WonderWork’s third major focus.
As we were quickly learning, untreated burns are one of the biggest health problems in the developing world—bigger than breast cancer and malaria, bigger than tuberculosis and HIV combined. In developing countries, two billion people still cook and heat their homes with open fires; they use kerosene lamps for light or cook with cheap stoves that often explode. As a result, fire accidents are extremely common. According to the World Health Organizations, in India alone, one million people suffer burn injuries every single year.
For someone who grew up in the West, it’s so hard to imagine. In our world, our homes and buildings are outfitted with smoke alarms and sprinklers. We have fire alarms, fire trucks and firefighters. Our lives are insulated, protected, almost completely fireproofed. In the rare instance when someone is burned, we have hospitals and surgeons to treat that person immediately. But in India and across the developing world, not only are burn accidents a daily occurrence, there are very few surgeons who are trained to help and very little money to subsidize treatment when patients are poor.
I’ve known Dr. Subodh since 2006, the year he became a Smile Train partner, and since then, I’ve seen first hand the astonishing energy, devotion and purpose he brings to his work. Early on, I also learned that Subodh and I had something in common: a family tragedy early in life that shaped our worldview and lives.
Subodh was born in Varanasi, in a modest home on the banks of the holy River Ganges. His father, Gang Singh, worked on the railways and his mother stayed at home to take care of Subodh and his three older brothers. The family wasn’t wealthy, but they were comfortable and happy.
Then, when Subodh was thirteen, his father was taken to the hospital suffering from chest pains. It was a small hospital that didn’t have a cardiologist, and no one suggested moving the patient to a clinic with specialist care. A few hours after being admitted, Gang Singh died of a heart attack. At thirteen—the same age I was when my sister Maura died— Subodh had to help bury his father
Life was not easy for Subodh and his family after that. In order to bring in some kind of an income, his mother made soap and candles to sell to grocery stores. Subodh and his brothers helped as much as they could, but the work generated far less money than the family needed to survive. Soon after the father’s death, Subodh’s aunt came to stay with them to help.
“You should become a doctor,” the aunt used to say to Subodh. “You should make sure that no one dies because they don’t have the right medical care.”
At his high school, Subodh was a diligent student. He loved the sciences, and when it was time to go to university, he decided to he wanted to attend the Institute of Medical Sciences in Varanasi, one of the most prestigious medical schools in India. He applied and was accepted.
Even as an undergraduate, Subodh was attracted to the discipline of surgery. He loved dissection, the exactitude of it. His supervisors and advisors could see his interest, his talent, and above all, his commitment. As Subodh came to the end of his training at the Medical Institute, he learned that the university was holding a nationwide competition for a single seat as a plastic surgery resident. He applied and he was selected as the winner.
Over the next few years, Subodh learned to perform every kind of plastic and reconstructive surgery, from removing tumors to correcting clubfeet and repairing burns and clefts. Treating burns became an area of special interest for Subodh; his research work was on infections in burns and after he graduated, he remained in Varanasi, starting a small burns unit in one of the hospitals where he worked.
Now that he was a fully qualified surgeon, in the mornings, he treated patients for free at a charitable hospital on the banks of the Ganges, and the rest of the day, he worked at his own small clinic and at other private hospitals. He wasn’t earning much money, but what he could save; he set aside.
Eventually Subodh had cobbled together enough money to purchase a small piece of land and build a small two-floor hospital of his own. The new hospital’s doors opened in 2001. Subodh named the hospital G.S. Memorial, for his father, Gang Singh. From the beginning, Subodh made sure that to reserve a number of beds at G.S. Memorial for burn victims, but for the last several years, he had been so busy with clefts that burns had been a secondary priority. Now Subodh wanted to refocus, and he wanted to tackle burns.
In March 2013, DeLois and I traveled to Varanasi to meet with Subodh and attend our first burn screening camp at G.S. Memorial Hospital on behalf of WonderWork. Subodh had told us to prepare ourselves for what we were about to witness, but we were confident that after our years traveling the world visiting cleft hospitals, we’d seen it all and could handle anything. We were wrong.
That day, we entered the familiar iron gates of G.S. Memorial to be confronted by close to 600 severely burned children. Each child had come with a parent, a sibling, a grandparent, more than a thousand people in all, crowded into the hospital courtyard. When people saw Subodh in his white coat, they surged toward us, a great mass of burn victims, the skin on their faces and bodies blistered, scarred, raw.
We saw men, women and children, all them with injuries. When the burns were new, the flesh was bloody and exposed. When it had had time to heal, the scars that remained created harrowing disfigurements, skin that was rippled and fused, as if the flesh had literally melted and reformed, like lava cooling after an eruption. Parents were holding up their children, reaching out to us, pleading. A father held up a baby whose face had been burned away, with only exposed flesh remaining.
I glanced over at DeLois. Though she looked ashen, she was bravely smiling as always. I resolved to do the same, feeling fortunate to have my camera with me, so I could use it to shield my face whenever I couldn’t manage to fix a grin.
In the thick of the crowd, Subodh remained impressively calm. There were so many people clamoring to speak to him, yet the doctor wasn’t flustered and he didn’t rush. He stopped to talk gently to each family, putting a hand on a shoulder or arm, reassuring them, in his thoughtful and steady way, that he could help.
Subodh explained to us that these patients had come from some of the most remote and rural villages in India. “These families are so poor that when they arrive here, we have to show them everything, even how to use the latrines,” he explained. “They live in villages without electricity, without running water. When I bring them into my office for a consultation, I have to indicate that they should sit down in the chair— and not on the ground. They’re not even accustomed to furniture. Caring for these patients begins at the moment they arrive and continues for twenty-four hours a day until they leave.”
Whereas every cleft or clubfoot patient gets his or her deformity the same way—they are born with it -—every burn patient has a different story to tell. That day we heard about flame burns, scald burns, acid burns, burns caused by high-voltage wires.
We met a ten-year-old boy whose mother had been going in to say goodnight to him when she accidentally tipped over a kerosene lamp. The kerosene engulfed their small hut in flames, and the boy’s parents both died, as did his sister. Incredibly, the boy had survived, but his disfigurements were severe, extending across his face, neck, and torso. His chin was fused to his chest, which had the effect of pulling down the skin on his face to the degree that it had almost completely closed his right eye. The accident had happened when he was three years old—this child had been suffering like this for seven years.
We met two sisters who had been sleeping on the same small cot when their hut caught on fire. They both had extensive scars, and one of the sister’s arms had become fused to the side of her body. Their father, who had brought them to the hospital, told us, “No one will marry them in this condition. Please, please help.”
We met a fifteen-year-old boy who had worked in a farm carrying tanks of kerosene all day. The tanks were leaky, so by the end of the day his clothes were drenched with kerosene. His friend thought it would be a good joke to light a match and toss it at him.
“He needs many, many surgeries,” Subodh told us. “A lot of help.”
We met an older man who had been moving a tank of gas down from the shelf when it crashed on top of him and lit him on fire. His eyelids had burned off. This man hadn’t closed his eyes in five years.
We met a twenty-year-old who had been working at a factory when there was an explosion. His face, chest, and arms were severely burned. It was a miracle he survived the explosion. His employer gave his wife $100 and wished them luck.
We met a baby who had been left alone at home because both parents need to work in the fields, and he crawled right into a cooking fire. His parents told us that they rushed him to a hospital right after the accident, but because they had no money, the hospital turned them away. They wept while they told us this story.
We met all these people, wading through the massive crowd. In each case, Subodh stopped, listened, comforted, assured.
INSERT PHOTO: DrSubodh
“I can give her new eyebrows,” he told one mother.
“I can fix his hands and heal this scar,” he told another.
“I can separate his fingers and release the fused skin,” he said. “I can heal this scar. Please don’t worry. Everything is going to be okay. ”
Not for the first time, I thought: Subodh isn’t just a surgeon; he’s a magician.
We trailed the doctor through the crowd for the next two hours, talking to patients, learning about their stories. By the end of the morning, DeLois and I were completely exhausted, both emotionally and physically—but Subodh seemed almost energized by the experience. For him, being here in this crowd, with these people, was his calling.
“You know, in my work I do not earn a lot of money, but I earn a lot of love,” Subodh told me that day. “When you care for your patients, when you are concerned for them, that care and concern comes back to you. The love you receive is a different kind of currency—it has a special value, more valuable than money. That is what I believe.”
That visit, we learned that Subodh’s major challenge in treating burns was one of capacity. The more people learned about the availability of free surgeries for burn victims, the more people came, but with only 80 beds at G.S. Memorial, there was nowhere near enough space to treat everyone. Burn surgery can be especially labor intensive for hospitals. Although individual surgeries cost as little as $300, patients may require multiple operations over a period of months. Often, burn victims arrive in a critical condition so need to be closely monitored over several weeks. In order to address such overwhelming need, it was clear Subodh needed more space.
In 2015, on our most recent visit to Varanasi, DeLois and I drove out of the city with Subodh, along a crowded dusty road, alongside overloaded trucks and buses, rickshaws and bicycles, horns honking, engines firing. About a half hour later, we turned through a crumbling brick entryway, and along a narrow driveway. Ahead, was a large abandoned lot, overgrown with mango trees and weeds and with high-tension power lines hanging slackly over our heads. The lot wasn’t much to look at and yet for Subodh, DeLois and I, it was as if we had just stumbled on Nirvana.
We picked our way across the lot, and Subodh explained his vision. He was going to build his dream here: a brand new hospital with 225 beds, almost three times the size of G.S. Memorial. The new hospital would more than triple his annual surgeries, from around 4,000 a year to more than 15,000. With a new hospital Subodh would be able to provide the entire range of plastic and reconstructive surgeries, with a special focus on treating burns. When it’s built, Subodh’s burn center it will be the largest of its kind east of Delhi, serving a catchment of more than 500 million people.
Between DeLois and I—if you take into account in the surgeries we helped provide over the years at Operation Smile, then Smile Train and now at WonderWork—we’ve helped provide surgeries for more than one million children. But we’ve never built hospital. Bricks and mortar. Operating rooms. An emergency room. A blood bank. Until now, we’d always insisted that we didn’t need to build hospitals or clinics, because there were already hospitals and clinics out there in the world—they just needed a little help. Our role was to work with them to increase capacity and improve infrastructure. Building a hospital from scratch had never been part of the mission.
But we have always trusted Subodh, and whenever he talks, we listen.
Two of our biggest donors, Bill and Nancy Thompson, have made a donation large enough to cover the majority of the cost of the new hospital. WonderWork is working closely with Subodh to build the facility, and will then raise funds to pay for the surgeries that will be performed there.
“We will do a lot of teaching here,” Subodh explained, gesturing at the air, as he continued to show us around the lot. “One of the biggest challenges with burns is that most hospitals don’t know how to treat them. As a result many patients die. Most of the ones who survive end up disabled for life.”
Pointing and gesturing, Subodh indicated where on the lot, he planned to have the hospital’s main entrance, along with a registration area large enough to accommodate the many hundreds of patients who were going to come to the hospital for treatment.
“This is where we will have the kitchen,” he enthused. “With this many beds we’ll need to provide more than 1000 meals a day. So many of patients come here with little to no money and so we have to feed them and take care of them while they receive their treatment.”
As Subodh continued to walk around the lot, DeLois and I decided to take shelter from the midday sun against short brick wall. Beyond the wall, in the back, there were open lots of land that Subodh told us he’d like to purchase down the line if he needed to expand even further.
“This hospital will stand in one of the poorest places in India,” Subodh reminded us that day, “helping the poorest of the poor. It’s going to have an enormous impact.”
Walking around that field with all the crumbling brick walls that might’ve been built 100 years before in the weeds that had overrun everything that had been there before, I thought about the years that had passed since I first started this work. Twenty-five years ago, when I first started helping out kids in New York—at the height of my yuppie years—I couldn’t have ever predicted that all these years later, one of the most exciting things to ever happen to me would be discovering this overgrown, abandoned lot in the middle of India.
Now, amidst the broken bricks and rubble, standing in the heat of the afternoon sun, with DeLois and Subodh, I took out my phone and snapped a “before” photo of the overgrown lot.
One day, in the not too distant future, I promised myself, I’ll come back here to take a photo of “after.”
Good Reads: Before and After by Brian F. Mullaney, Co-Founder of Smile Train and WonderWork.
