After an eye-opening week in Nepal, we fly back over the Himalayas to India to spend a couple days in New Delhi. We’re going to visit a very successful club foot program which is run by the best orthopedic surgeon in India. And tour one of the largest burn wards in the world.
After we land, we are greeted by a thick grey blanket of smog that is smothering the city. Quite a shock after a week in Nepal where the air was crystal clear, and it was sunny.
Another shocker is the overwhelming number of people – New Delhi has a population of 22 million. It has almost three times the population of the most populated city in America – New York City – which has around 8 million people. And five times the density of New York.
There are huge numbers of people everywhere.
Not just people, but really poor people.
India has more poor people than any other country in the world.
And its capital, New Delhi, with its 6,343 slums, has more poor people than any other city in the world.
To see it first-hand is shocking, distressing and depressing.
One out of every three resident of Delhi – 7+ million people — live below the poverty rate which is $1.25 a day.
In America the poverty line for a family of four is around $71.23 a day. ($26,000/yr)
32% of Delhi residents sleep in one-room apartments.
Those that can’t afford $50 a month for a dilapidated apartment, sleep outside on and in the ground, pavement, parking lots where you can rent blankets for 25 cents a night, railway stations, streets, alleys, tents, hovels, shacks, rickshaws, etc.
The poorest of the poor sleep, eat, cook, bathe, defecate, beg, pray, fight, work, outdoors, in full view as we drive by on our way to our $300 a night hotel.
Recently, it was front page news when three young girls, ages 2, 6 and 8 years old starved to death in Delhi.
Their father was a working rickshaw driver.
It caused an uproar in Delhi – how could this happen in India’s 2nd richest city?
How the Indian Planning Commission defines who is poor makes it easy to understand.
By the Planning Commission’s definition, anyone making 33 rupees or less a day is living in poverty. That equates to just $0.52 per person a day, or around $80 a month for a family of five. What does this buy you?
33 rupees might buy three bananas or one kg of tomatoes. But to get to a balanced, sustainable diet of 2,000 calories, one would need at least 200 rupees.
Cut out the meat and cheese as most of these families do and that figure drops to 100 rupees, 3 times what the Planning Commission considers poverty. This explains why a third of all the world’s malnourished children live in India.
After this very depressing 1.5-hour drive to our hotel, we all go to our rooms and skip dinner – no one is hungry.
The next day we wake up early and arrive at one of our partner hospitals which runs a first-class club foot program that has saved thousands of children from a lifetime of pain and suffering.
It is run by Dr. Mathew Varghese who is one of the best orthopedic surgeons in India and a renowned club foot expert. Dr. Varghese graduated with a master’s in orthopedic surgery from Maulana Azad Medical College of Delhi University. He is the Head of the Department of Orthopedics and former Director of St. Stephen’s Hospital. He examines hundreds of patients each week and has helped train thousands of doctors in the serial casting for clubfoot patients. He serves on the advisory board for Global Clubfoot Initiative, CURE International and is a National Advisor to the Indian Government in the areas of paralytic poliomyelitis, cerebral palsy and traumatic injury.
As he gives us a tour, he explains that millions of children in India are waiting for the miracle treatment that can cure club foot.
This dreadful birth defect can cripple a child for life and make it impossible for them to stand, walk or run.
They are never allowed to attend school, get a job or marry and raise a family. The miracle treatment that can cure clubfoot costs just $250.
Instead of a series of painful surgeries that may or may not work, this new treatment involves a series of casts which are placed on the patient’s lower legs and changed weekly over the course of a month or a month and a half.
These casts can straighten even the most twisted ankles and feet in as little as six weeks. After that the patient needs to sleep with their legs in a brace for about a year or so to make sure the legs stay straight.
It a truly is amazing that all of this can be done for as little as $250! That’s all it takes a to save a child from a lifetime of pain and suffering.
After the club foot clinic, we head over to a very large public hospital which has one of the largest burn wards in the world.
Burns are probably the biggest global health problem that no one’s ever heard of. Everybody talks about AIDS, tuberculosis, malaria, polio etc. but no one ever talks about burns. They are the poor forgotten stepchild of the global health world.
Nobody gets burned in developed countries. All our homes and buildings have fire detectors and sprinklers. Cars don’t catch on fire anymore. All our clothing is nonflammable. And all of our gas cooking stoves, and laundry machines are state-of-the-art and safe.
Within the developing world, hundreds of millions of people still like cook, heat and light their homes with open fires.
They use kerosene lamps that tip over a for lighting. Cheap cook stoves that explode for cooking. Large vats for cooking that children fall into and sometimes adults who have seizures fall into also.
And all kinds of dangerous methods to steal electricity that they can’t afford to buy. They live in huts and shacks that are extremely flammable and where saris and other clothing that is also extremely flammable.
The result is tens of millions of children and adults get severely burned every year.
After they get burned the race to hospital which often turns them away if they do not have any money. And even if they are admitted, most hospitals in developing countries are ill-equipped to properly treat severe burns.
The hospitals that do have skin banks and special dressings that are needed for severe burns, provide these only available to patients who can pay.
As a result, more than half of the children and adults who are severely burned die from their injuries. To be more accurate, they die from their poverty – people with the same burns in the United States would never die.
And “lucky” ones who live, are almost always seriously disfigured and crippled by their burn scars. These burn scars when melted skin fuses together. It can be a chin h that is fused with a chest, a hand were all the fingers are fused together, a leg in which the lower part is fused with the upper part making it impossible to walk, etc.
There is a simple surgical procedure called a “release” that can fix these burn scars and rescue severely burned children and adults from the lifetime of disfigurement. That is the burn surgery we focused on at WonderWork.
But today we are just going to meet patients who have been recently burned and are struggling to survive with minimal treatment and help at one of India’s largest burn wards.
We go bed to bed and meet patient to patient and hear their horrific stories of how they were burned.
We meet a teenage boy who is severely burned on the side of his face, chest and arms. Is left eye is destroyed and no longer works. It will take many surgeries to try and reconstruct his face.
We need a 12-year-old girl who has severe burns on her face and head chest and arm. She is lucky that her left eye escaped injury and still works. Someone threw acid on her.
We meet a four-year-old girl who fell into a fire when her mother wasn’t watching.
We meet a mother of five who has burns over 85% of her body and probably will not survive.
She was very depressed and try to kill herself.
She walked into the middle of the field and doused herself with kerosene and then set herself on fire.
This happens a lot. Depression is a huge problem in developing countries and there is no treatment or support for people who are depressed and want to kill themselves.
We meet a young man who is covered in bandages up to his neck with burns over 70% of his body.
He’s the victim of an explosion at the company he worked for. This happens a lot also.
The companies usually pay nothing for their injured employee’s treatment. And of course, they fire the employee also. This young man faces daunting prospects because he can not afford to purchase the artificial skin he needs to survive. His burns are so extensive there’s no place they can graft from. This hospital does have a skin bank and that could save him but like many of the others in here, he is poor and can’t afford to buy the treatment he needs to survive.
We meet another mother of five children. Burns cover 70 to 80% of her body.
Like the young man, she desperately needs artificial skin and special dressings to survive. As the surgeon is telling us this in English, she was staring right at us and my camera as you can see. Her husband was standing right next to her. The surgeon told us she will most likely die within a week or so. She will not receive the treatment she needs to save her life because she can’t afford it. The surgeon said her husband makes only $35 a month.
It was very depressing to learn that most of these people were going to die — not from their burns – but from their poverty.
We met another woman who was covered in bandages who was back in the burn ward after being released a few weeks earlier. The doctors told her she had to make sure that she changed her dressings every day religiously to guard against infection. She didn’t do that because she couldn’t. She works 14 hours a day and has four children. So, she did the best she could, but it wasn’t enough because she’s back in the Burn Ward with some very serious infections. The surgeon told us there was little chance she would survive.
We met another woman who tried to kill herself. She was a little older. She did the same thing, walked into the middle of the field, dumped a bucket of fuel over her head and then lit herself on fire. They told us that now she wants to live although she still looked very depressed when we met her. And she faces a long road ahead with many skin grafts and other surgeries.
I apologize if any of these pictures and/or stories are too graphic and/or upsetting. I decided not to use many photos and stories that are even more horrific.
At the end of our tour the surgeons a medical team told us they had one more patient they wanted us to meet.
She was a 16-year-old girl that had been kidnapped by a group of 14 men who held her hostage for 10 days while they repeatedly gang raped her. When they were done with her, they poured a bucket of acid over the top of her head.
It’s a miracle she is still alive. The acid destroyed her eyesight so she cannot see. It destroyed her vocal cords so she cannot talk. The surgeon told us how hard the entire team has been working to keep her alive. Despite the fact that the girl has made it clear that she wants to die.
Her poor mother had been sitting at the end of her bed, round-the-clock, praying for her recovery, for weeks as the team did everything, they could to save this girl.
The surgeon told us all men had been arrested and would face justice. I never found out what happened to the girl or her attackers.
Ironically, I thought about this girl today when I read the newspaper this morning. There was an article about a woman in India who had been raped. And when she was traveling to the courthouse to testify against the men who raped her, she was abducted by two men who poured gasoline on her and lit her on fire. The men she was going to testify against were involved in this attack. They were arrested and released on bail. She has burns covering 90% upper body and will probably not survive.
The surgeons and medical team painted a very grim picture. They told us the hospitals usually allocate very little OR time for burn patients and few resources.
It felt to me like they are just warehousing these patients until they either die or recover enough to be discharged.
They told us about 50% of their patients die. And the rest face very difficult lives with major burn scars and disfigurements.
I must say it was one of the most depressing of hospital visits I’ve ever had, and I have visited hundreds of hospitals.
Burns are very different than the other surgical problems I’ve been involved with over the past 30 years.
Every cleft patient I ever met had a big smile and a great result after surgery.
The same is true with clubfoot. After every treatment, the clubfoot was always completely cured and every patient could walk, stand and run just like every other kid.
And nothing is more wonderful or inspiring than taking the bandages off of a blind patient and watch them open their eyes and see again.
But unfortunately, burns rarely have happy endings.
This visit two one of the world’s biggest burn wards was like a wake-up call to all of us.
Creating a new charity program to help severely burned children and adults was going to be extremely difficult, expensive and challenging.
But I knew, we were up to the task.
THIS IS AN EXCELLENT ARTICLE FROM THE HINDUYSTANTIMES NEWSPAPER ABOUT POVERTY IN DELHI.
How the other half lives in Delhi: 4 stories of poverty, crushed dreams
Most of the city’s poor are migrants — they constitute about 33% of the population of Delhi — who come to the city attracted by the promise of a secure livelihood and better life. But their hopes and dreams are, more often than not, belied. A peek into how they get by
Last month, Delhi, the second wealthiest city in the country — with a total wealth of $450 billion according to the World Wealth Report — was shocked by the starvation deaths of three little girls aged 2, 6, and 8 years.
The girls’ father, who plied a rickshaw, was from West Bengal and moved to Delhi about 15 years ago. He hasn’t been found since the deaths, which medical experts have confirmed were caused by malnutrition. The mother was found to be mentally unstable.
Many find it unthinkable that anyone can starve to death in the capital. Such deaths may be rare, but facts tell a deeply disturbing story of poverty in the city of 17 million people. Almost 1.7 million live below the poverty line, or survive on less than RS 1,134 per month, according to the latest Delhi Statistical Handbook, which is based on 2011 census data. A 2015 report by the Directorate of Economics and Statistics, Delhi, said the city has about 6,343 slums with 1.02 million households.
Most of the city’s poor are migrants — they constitute about 33% of the population of Delhi — who come to the city attracted by the promise of a secure livelihood and better life. But their hopes and dreams are, more often than not, belied.
“When I first came here 10 years back, I was young and energetic and thought Delhi is a big city and I would be able to make something of myself, but look where I have ended up,” says Prem Chand, a casual laborer at Bara Tooti, one of the city’s oldest labour chowks, in the heart of the city. “All I own are the clothes I am wearing; I sleep on the footpath; and I have no one to share my pain with.” Prem Chand’s story illustrates that poverty does not just engender a myriad deprivations, but also a stifling solitude. Just talk to the men of Bara Tooti, which is like an open-air museum of shattered dreams and defeated aspirations of the poor.
Mohammad Abbas, a bespectacled rickshaw puller who talks like a philosopher, says the biggest disadvantages poverty causes is that it ‘deprives people of opportunities’. “I wanted to study, but could not. I could not send my children to school beyond class 6. So, people like me need some superhuman effort or extraordinary luck to break free from the vicious cycle of poverty,” he says. “Many young poor people come to the capital thinking they can work hard and strive for success, but end up just struggling for survival. And Delhi can be shockingly indifferent to them.”
Poverty, he adds, can also redefine the meaning of relationships. “My family lives in the village. In 42 years of my marriage, I have not lived with my wife for 42 months, and that is the biggest regret of my life.”
In fact, Delhi has countless stories like this. Here are four of them.
Mohammad Abbas
Mohammed Abbas, a rickshaw puller in east Delhi’s Mayur Vihar, loves his hat, which is his most prized possession. “This was bought in Paris,” he says, as he takes it off to show us. “No, don’t be confused; mine is not a riches-to-rags story. A kind, old gentleman gifted it to me four years back. He said his son had brought it from Paris for him,” says Abbas as he waits for passengers at the Metro station.
A few minutes into the conversation and it becomes clear that Abbas is a great storyteller, and loves to tell his own too. Born in a village in Begusarai district of Bihar, he used to pull a rickshaw in Kolkata before someone told him that he could make more money in the national capital. So, he arrived in Delhi on a foggy January morning in 1992 with a satchel of clothes. “I was barely making a couple of thousands in Kolkata and it was hard to support my family in the village. Besides, pulling a rickshaw by hand was breaking my body,” he says.
In Delhi, he lived with a relative in Tilak Nagar in west Delhi. “But within a few days, he asked me to look for my accommodation. I didn’t know anyone in the city, so I moved to Usmanpur and requested a rickshaw garage owner to allow me to sleep in his garage. Thankfully, he agreed.”
A month in Delhi and Abbas realised that the shift to Delhi was not going to change his life. He was not wrong.
After 26 years of hauling rickshaw on the city roads, all that he owns is a few utensils, two shirts, two pairs of trousers. “The only additional assets that I have collected since I came here are a mobile phone, and, of course, this hat, ” he says. “And, yes after many years of sleeping in the rickshaw garage , I have moved into a shared 6×6 ft rented room, for which I pay Rs 800. Unlike in Kolkata, people in Delhi haggle even for five rupees, not realising pulling a rickshaw wracks one’s body.”
Abbas got married in 1976 and had his first child in 1978. His dependants include a disabled son, a daughter-in-law, a daughter and four grandchildren, who live in their village. “I manage to send them only Rs 3,000 a month. In 42 years of my marriage, I have not spent 42 months with my wife and children,” he says. “ I could not afford to take them to Kolkata, and I cannot afford to bring them to Delhi. I have had to spend my entire life away from my wife and children for a few thousand rupees.”
Abbas leaves his window-less, hovel-like room in a dingy street in Patparganj village at 7 am, has a breakfast of tea and biscuits, his lunch and dinner at a roadside dhabha any time between 1 and 3 pm (each meal costs Rs 30) and returns home at 10pm. “At 60, it is becoming difficult to haul a rickshaw. Sometimes, my body just gives up and I don’t feel like stepping out of my room. But there is no retirement for poor people,” he says. “ In fact, there is no childhood, no youth, no old age for us. You remain a labourer from the beginning to end.”
Abbas says that while he continues to work as hard as ever, the advent of the battery-operated rickshaws in Delhi has led to a steep fall in his earnings. “Earlier I used to make about Rs 300 to Rs 340; now barely Rs 150 to Rs 200 a day, of which Rs 40 goes towards rickshaw rent,” he says. Abbas never went to school, but he says he has taught himself a bit of English. “I sign my name in English only and can read all English signboards. I learnt it by scrawling words and letters on dusty footpaths in Delhi. The rich don’t understand what you become in life is not always about ability; it is about opportunity and exposure. With a little luck on my side, I could have certainly done better.”
In his spare time, Abbas likes to listen to music. He also sings. “I mostly sing Mohammed Rafi songs. I don’t have many regrets in life, but I wish I had spent more time with my wife and children. I am 60 and I have spent the entire life living without her. I think I have been unfair to her, or perhaps life has been unfair to me.”
Prem Chand
It has been a bad day for Prem Chand, a casual labourer at Bara Tooti Chowk Delhi, one of the city’s oldest labour chowks, where manual labourers, masons, porters and house painters gather every morning looking for work. On the day we met him, Prem Chand arrived at Bar Tooti at 7am, but could not find work. He made only Rs 30 in the late afternoon by lending a helping hand to fellow labourers pushing a cart over a road that climbs from Sadar Bazar police station to Bara Tooti.
He is quite reticent, unwilling to talk. But after much prodding, he speaks.
“ I am a dog,” he says, looking blankly into space, his voice laced with pain and anger. “I don’t have work, or a home. I do not care if I die tomorrow. I am not married; my parents, siblings, have all died one by one.”
Prem Chand hails from a village in Shahjahanpur in Uttar Pradesh. His mother died when he was a toddler, his father remarried, his maternal uncle adopted him, and the uncle died when Prem Chand was still a child.
“ I could never go to school, though I wanted to. At 15, I first came to Delhi to find work. I stayed with a relative, but within a few days, he asked me to leave,” says Prem Chand.
Over the next few years, Prem Chand would come to Delhi , do odd jobs, and return after making some money. But ten years back, he decided to stay on, and has since pulled a rickshaw and, worked at construction sites as a casual labourer. “I don’t earn enough to rent a place and sleep on the rat and dirt-infested footpath at Bara Tooti,” he says showing a hand full of mosquito bites. “At night, ruffians steal my money.” So why does he not open a bank account? “I have no address, no identity card, so why will they open an account for me?”
Prem Chand says that when he first came to Delhi, he was pretty hopeful, had dreams of starting a small business, and marry. “But look where I have ended up. My only possessions are the clothes I am wearing; I wash and wear them every day. Now I think of survival, not success,” says Prem Chand, who eats at the Gurdwara Sis Ganj on the days he does not have work. “This city has no empathy for people like us.”
Talking of his life as a homeless labourer, he says there are times when he gets fever and doctors advise rest. “But can I rest? I keep working even when I am sick. We at Bara Tooti push our body to its limits every day,” he says. “A lot of people in Delhi believe we are all drunkards, but many like me drink not to get drunk, but to relieve the pain. The footpath is not the place to sleep when you are sick and have worked hard through the day.”
Delhi, Prem Chand says, is a ‘city of deceptions’. “Many people come to Delhi, young and hopeful. But their hopes are dashed sooner than they expected; they get old and die here on the footpath, unclaimed,” says Prem Chand. “I know in 15 years, I will meet the same fate.”
Idris Ansari
For Idris Ansari, who hails from a village in Motihari district in Bihar, poverty is nothing but a quirk of fate. Ansari likes to often laugh at himself. “I guess I will be 50 or 55,” he says, when you ask him his age.
But he remembers that he came to Delhi in 1993, hoping to earn a decent living and improve the lot of his family. “I immediately fell in love with the city. I spent the first few days seeing all the sights; I thought I had come to the right place.”
But 25 years on, he has a different opinion. “This city, like all big cities, is very good at enticing you; it seems to offer many possibilities, but they never become a reality for most poor like me,” says Ansari who has worked as roadside tailor since he arrived in the capital. “ I have ended up as a much sought-after tailor of rickshaw pullers,” he laughs.
Ansari works at Mirdard Marg in central Delhi, where he comes every day with his sewing machine, and lives in a jhuggi in front of Mata Sundri college. He makes about Rs 150 to Rs 200 a day, saves and sends about Rs 3,500 every month to his family back in his village — wife, two sons, aged 12 and 8, who go to a government school. He also has a married daughter. “It is so hard to save even Rs 100 a day here. I live with eight other people in a 7 x 7 ft jhuggi, which is horribly hot these days. Each one of us contributes Rs 300 towards the rent.
My wife has a hard time running the house with the money I send her,” he says.
Most of his customers, he says, are causal labourers and rickshaw pullers looking to have their clothes altered. “I charge RS 10 to 20, and sometimes they cannot afford even that much. Young rickshwallahs buy their clothes, jeans and T-shirts at the roadside markets. If these do not fit, I help them. They no longer want to wear-ill-fitting clothes,” says Ansari showing us a satchel full of old and new pairs of jeans. “But the older ones want me to keep mending their clothes till those are beyond repair. On certain clothes I have worked 20 times in two years, altering, stitching, over and over again,” says Ansari. “But I cannot alter their wretched lives; nor mine, for that matter,” he flashes his characteristic smile once again.
Dhruv Pal
Dhruv Pal, 30, has lived in Delhi for the past 15 years, but has never been to Connaught Place, hardly 8 km from his hut on the Yamuna banks. “I have heard it is some big, expensive market; but I don’t have a reason to go there. I do all my shopping from a nearby roadside Monday market,” says Pal, lying on a cot under a guava tree in front of his mud and thatched hut in agricultural field. His 11-year-old son Vijay, dressed in his torn school uniform, is playing with his friends, all scantily dressed; his wife, Saroj is busy doing the laundry.
Pal is one of the hundreds of poor farmers, migrants from UP and Bihar, who grow vegetables such as cauliflower, okra, bitter gourd, carrot, and radish on rented agricultural fields on the banks of the Yamuna in east Delhi. But like Pal, most live in penury. His hut has a few utensils, a cot, a few clothes and a trunk.
“ I pay about Rs 75,000 annually for the 12 bighas that I have rented, but I am lucky if I earn Rs 70,000 to Rs 80,000 in a year,” says Pal. “Yesterday, I had to borrow Rs 500 from a neighbour.”
Pal says like farmers everywhere, he is exposed to the vagaries of the market, the weather, and an indifferent government. “Unlike rural farmers, who at least get some minimum support price for their crop from the government, we get nothing. During Holi, the price of the cauliflower dropped dramatically and I had to sell my crop at ₹3 per kilo and sustained heavy losses,” says Pal.
In 2013, Pal says he lost his entire crop and his hut to floods, and had to live, for over a month, on the Mayur Vihar-Noida link road in east Delhi. “We lived on the edge of the road, and I was afraid that my children might get crushed by the fast-moving vehicles,” says Pal. This year too, as the Yamuna swelled, he, like other Yamuna
farmers, were asked by the authorities to leave.
“But I only moved a box with our important belongings to a camp. We stayed put here; it is not easy to live on the road with school-going children.”
Pal says not just floods, his family also lives with the fear of his huts being demolished by the government. He has no idea whether the patch of land he cultivates belongs to the man he pays the rent, or to the Delhi Development Authority, which, he says, wants hundreds of families on the Yamuna floodplains to move elsewhere.
His hut has been bulldozed a few times in the past by the authorities. “I have nowhere to go, and nothing else to do. In a big city like Delhi, farmers have no identity and respect,” said Pal, “ The only benefits is that sometimes I go and sell my produce directly to people on cart, making about Rs 300 a day , but it is just not enough to run a family of five and meet farm-related expenses.”
Pal has no electricity, water or gas connection . This is another India in the heart of the city — from his hut one can see the soaring skyline of Noida. As we talk to Pal, his son Vijay comes and tells him that he wishes to celebrate his birthday in school (Both the father and son are not quite sure when it is), but the father instantly shoots down the idea. “These are the useless rituals meant for the rich.”