We Will Remember You…

…It is with great sadness that I inform you of the death of one of our best students. Kishan Kumar was a delightful, diligent, and bright young boy. At only five years old, he wasn’t given many opportunities to succeed in life. I did not give him one either. Kishan was a strong contender for a seat in the Carmel Convent School. He even made my final round of selections. However, I left him behind in the slum this year because he was the youngest boy on my final list and I thought that I would have more time to acquire resources for him. As it turns out, I didn’t have much time at all.

Kishan was healthy and happy the entire time that I knew him. I was unaware that Kishan was sick until I received the call from Mithlesh early this morning informing me that Kishan had “expired.” Over recent days, Kishan had developed a severe case of pneumonia. Last night, he was finally taken to B.K. Hospital, the main government hospital in Faridabad where I volunteered for a month. Unable to properly care for him, the B.K. Hospital transferred him to the All India Institute of Medical Sciences (AIIMS) in Delhi, nearly an hour-long ambulance ride away. After arriving at AIIMS, Kishan was pronounced dead only four hours later.

Ankit (left), whom we selected for the Carmel Convent School and is generously sponsored by Bert Graham, was one of Kishan’s best friends. Ankit and the entire slum are grieving his loss today.

–Kishan with his friends who are still waiting for a second chance–

We live in a society where education is taken for granted and where great healthcare is not just available but expected. Education can help improve our lives, but it could have saved Kishan’s. His parents cannot read or write. They aren’t even educated enough to know that they should have taken Kishan to the hospital sooner, let alone to one that could give him adequate care.

It is difficult for us to comprehend in this materialistic and luxurious bubble we live in that parents wouldn’t take their dying son to a hospital until the last minute, but they simply do not know any better. Even if they had the desire to learn what to do, these people could not read a book or operate a computer even if they had access to such items. They do not lack intelligence, they just lack knowledge and opportunity.

Kishan is survived by his parents, two brothers, and a community of hundreds of children who still might get a second chance. With less money than you can earn in a day, you can give an endearing child a second chance that he or she would otherwise never receive.

You can ignore these children just like the society around them. They will never know. But you can also take a stand and revolutionize their lives and the lives of their parents, siblings, future children, and entire lineage thereafter. For the price of an iPod or fancy pair of shoes, you might even save their lives. Donations made through Tuesday, May 15 will be accepted in memory of Kishan.

Once again, Kishan has taught me more about life than any other 5-year-old I know. I wonder where he would have gone and where he could have gone with our support. We will never know. I will always remember him and hope that you will too. Kishan, your family and friends are in our thoughts and prayers. Rest in peace.

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Goodbye India…

…When I flew to India on the night of my 24th birthday, I flew out of my comfort zone. I flew toward 1.2 billion people without knowing a single one of them and toward a culture that mystified me. As the 747 climbed away from home and the lights of Phoenix disappeared behind, I remember looking out at the austere darkness and feeling very alone. When I landed in New Delhi the next night, I had no idea where I would go, what I would do, or whom I would meet. All I was told was to meet a man outside of customs who would be holding a sign with my name on it. The uncertainty was endless and anxiety stronger than I had ever felt.

Standing here tonight, five months later, I can hardly believe all that has happened since then. It just doesn’t seem possible even though I lived through it all. I came here to volunteer in hospitals and gain a more global awareness of medicine. I never planned on exploring slums, deciding which slum children would go to school and which ones would stay behind, or scouring entire communities for handicapped and disfigured people neglected by society. I never expected that I would be taken under the wings of Carmelite nuns, that my host family would treat me like their only son, or that I would feel like a relative to dozens of slum families among the lowest castes of Indian society. I never dreamed that I would bathe in the Ganges, ring in the New Year at the Taj Mahal, or be taken in a speeding ambulance to drink hot milk fresh from a buffalo.

I came to India because I wanted to make a difference and learn something that I could not from the comforts of home. I came with a positive attitude and a desire to expand my horizons. But I never imagined that I would be rewarded so magnificently by people from nearly every aspect of society.

This afternoon, I went to my final class with our spectacular students. Over the last three months, I have watched them go from a destiny of illiteracy and poverty to one of renowned educations and endless opportunities. Their lives have been changed forever and so has mine.

–Neha, our first student admitted to the Carmel Convent School–

–Komal, Gudiya, and Roshan, each of whom are excelling with nearly perfect marks–

–Ajeet, who when folded is conveniently the same size as my carry-on luggage–

–Anita, the girl who will turn around her family’s incredible misfortune–


–Pooja and Manisha–


–Akshansh, Ajeet, and Sonu–

–Manisha and Akshansh–

–Our talented and devoted teachers, Deepa and Priya–

–Manisha, Anita, Neha, Gudiya, and Ankit–

–Madhu, Roshan, and Sonu–

We returned to the slum so that our students could change for my farewell party and I could say goodbye to the rest of the community.

–Manish and his mother, Dolly–

–Neha, Saraswati, Ankit, Sonu, Madhu, and me in Ankit’s home–

–Moni with her father, Dablu–

–Madhu, which means “honey” in Hindi–

–Gudiya waiting for Ajeet while he prepares his gift for me (in Ajeet’s home)–

–Ajeet in front of his old slum school–

–Rani, the widow who carries bricks to keep Anita, Sindu, Indu, and Surendar alive–

We then returned to the Carmel Convent School where the final farewell was to take place. As suggested by Crystal and Heather, I bought an entire ice cream trolley full of delicious treats for anyone who wanted one and rode around the community with the kids all yelling, “Ice cream wala!”

–The two youngest members of my host-family, Naima and Naysa–

–The ice cream cart made me especially popular–

–Sister Pushpa and the most touching family I have ever met–

–Manish’s cousin, Anisha, who can often be found taking care of the little tyke–

Then the presents started to come. Nearly every family in attendance brought me a gift. I thought I was going to need another bag just to get home with all of the packages.



–Prianka, who will have her biopsy on Wednesday–

–Manish, who will be admitted to the hospital next week for new medications–

–The sisters and my host family with our lovely neighbors. Ironically, Mamta and Meenakshe (our neighbor) had never met before Heather, Crystal, Natalie, and I asked to meet Meenakshe. Now, Mamta and she are best friends and the kids play together nearly every day–

I then handed out my own gifts. I gave each family my favorite pictures that I had taken of them as well as photos of my family and me in America.

We then started to say goodbye. All of the kids came up to give me a hug. Madhu started to cry and I could no longer hold back my own tears. These kids have taught me lessons that have transformed my own existence. Their optimism and zest for life despite the conditions in which they live have inspired me since the day I met them. I have seen them nearly every day for the past 100 days and have watched them grow and adapt beautifully to a way of life radically different and more demanding than what they were accustomed to five months ago. They have exceeded everyone’s expectations, including my own. These precious children have become my family, my friends, and my world. I cannot fathom ever working for anyone who will be as grateful or passionate about what they do as these children. I will leave them behind tomorrow, but they will never leave my mind.

This time last year, I was waiting tables in a restaurant. I had been rejected from 17 medical schools. I felt lost and unproductive. I decided to go out on a limb to a place where people needed me and where my limited resources and experience could still make a difference.

–A plaque on a cabinet door in the Carmel Convent School main office–

If I had not been rejected from my own dreams of attending medical school, these children may never have had dreams of their own. I certainly would not be here right now and would likely never have met these children, sisters, doctors, and families who have so drastically changed my life. Sometimes, even the biggest disapointments can be blessings in disguise.

I am signing off from India, but don’t worry. I have the last month to catch you up on and will do so from home. In the last five months, I’ve taken 13,320 photographs and compiled enough experiences to keep writing about for months. In case you forgot, we also have 20 stunning students to follow for the next 10-12 years as well as a half-dozen disfigured and handicapped children to watch through their medical treatments, growth, and eventual educations.

To all in India who have shown me unsurpassed hospitality, thank you for the experience of a lifetime. To my family and friends who await me at home, I can’t wait to see you and express what I could not from a distance. To those who have followed this blog and supported me throughout, I owe you a tremendous amount of posts, stories, thank yous, and photos that will be coming soon. I don’t know how I will ever convey the lessons and perspectives I have gained here but I look forward to trying.

Finally, I must reiterate my utmost gratitude to those of you who have donated to the Squalor to Scholar Program. Without you, none of this would have ever happened. The swiftness and generosity of your donations have revolutionized the lives of everyone present this evening in only a few short months. I am happy to report that all 20 of our Carmel Convent School students are now fully sponsored for the next year! Some have been sponsored and committed to for even longer. However, this does not mean that we do not need new donations. I know more than 500 talented and deserving slum children who I am leaving behind tonight without being able to help at all. Every rupee of your money has been and will continue to be spent with great care to ensure that it makes the greatest impact possible in their lives. Everything you have seen and read on this blog to this date has been accomplished with $6,000. Imagine what we could do with more! If you’re looking to make an immediate impact, Prianka and Moni will be having surgeries within the next four weeks. Prianka needs approximately $300 and Moni $150 to cover their medical and transportation expenses. When you make your donation, please specify if you would like your money to go to one of these special young girls. Thank you.

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Race Against Time…

…I sincerely apologize that posts have been delayed recently. With only three weeks remaining in India, I am now in a race against time to ensure that our students have the best opportunities in place to maximize their success and arrange operations for as many deserving children as we can. Without giving away too much too soon, I want to give you a preview of some pictures and stories to expect in coming weeks.

After only eight weeks in school, our 18 students from the local slum are surpassing even my own optimistic expectations. In February, they could hardly write their ABC’s and had never attended a day of school in their lives. Today, they are reading with moderate fluency, writing with better cursive than my own, and showing potential to rapidly become some of the best students in their classes.

These children, their parents, and this entire slum community of 25,000 people are extraordinarily proud of our students and grateful for your continued donations and support. Without you, these students would have likely never set foot inside any school, not to mention the best private school in town.

What began as a small endeavor to help Manish find a cure for his disfiguring case of infantile hemangioma has now turned into a full-fledged medical support network. We no longer have to search for children to help. They are coming to us from as far away as Bihar, a state 600 miles away.

I have so many meaningful experiences to share with you now that I would hate to spoil them by rushing to get posts out the door. On behalf of our enthusiastic students, trusting patients, and dedicated volunteers, thank you for your patience and continued benevolent support. None of this would be possible without you.

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Moni, Manish, and Chandni…

…On Sunday, two new highly motivated volunteers joined us. Merril Guzman of South Lake Tahoe, California, and Win Le of Vancouver, Canada, could not have arrived at a more inspiring time. Yesterday, they met our slum children as we accompanied them to school for the first time. Today, the three of us took Moni, Manish, and Chandni to the hospital to see the plastic surgeon.

When we arrived in the slum, all of our patients were waiting with their mothers and one grandmother. We walked a few hundred meters out of the slum to the nearby Delhi-Agra highway that serves as the main road through Faridabad.

Like crossing any streets here, there are no crosswalks, street lights, or stop signs. Even to cross the main road between a city of 18 million people and a city of 2 million people, the common procedure is just stick out your hand and signal traffic to stop while you start walking. This is partially the reason why it takes so long to drive anywhere in India. Even on the main highways, traffic is always stopping for pedestrians, animals, and slow vehicles to cross the road.

Once safely on the other side of the highway, we became the center of attention for passing traffic as we waited to flag down an auto-rickshaw going our direction.

There are two ways to take auto-rickshaws here. The most common way is to take a ‘shared’ auto. Starting at 7 rupees (14 cents) per adult for most distances within 5 km, you just hop in with up to 17 strangers going the same general direction. The other option is to hire a ‘separate’ auto. The cost for separate autos is essentially what it would cost to buy all 8 seats to go the same distance.

After a few tries and only about 60 seconds of waiting, we found a shared tuk-tuk going directly toward our destination. We jumped in with two families who must have wondered what in the world was going on with three foreigners and three disfigured children boarding their auto.

–Chandni with her mother, Reena–

–Manish with his mother, Dolly–

Down the road, we stopped at the gas station so the driver could fill up on diesel while Manish appeared to try some calculations.

–Moni with her grandmother, Pyaree–

After about 20 minutes and less than a dollar spent for the entire ride, we arrived at the hospital and waited to see the surgeon.

Manish was the first to see the doctor, who took dozens of photos and measurements of Manish’s hemangioma and called the pediatrician to let him know we were coming to see him too.

Before today, Moni had never been to a doctor. Cleft lips can usually be repaired as early as 3 months old and cleft palates as early as 6 months old. Now, she is 5 and is suffering socially and psychologically because nobody around her seemed to know that such surgeries were even possible. She wasn’t very happy about her first visit with the doctor. Little does she know how much a surgeon is soon going to change her life.

In government hospitals like B.K. Hospital where I volunteered for a month, cleft surgeries are free. However, we are treating these children as if they were our own. I want to get them the quality of care and service I think they deserve. Unfortunately, here at this hospital, the cost for a cleft lip surgery is Rs 45,000 ($900).

That’s when the doctor got on the phone. Thirty seconds later, we were scheduling an appointment with another doctor at a well-regarded hospital in Delhi who operates in partnership with the US-based charity Smile Train. We will visit him on Monday to schedule a surgery generously paid for by Smile Train.

The crying and waiting finally wore Moni out. She slept for most of her visit with the pediatrician.

Chandni, who is 6 months old, was next. We learned that she has a condition called hemifacial microsomia (HFM). HFM is the second most common facial birth defect after clefts, with an incidence of about 1 in 4,000 births. It is caused by lack of oxygenation or blood supply to cells that have already differentiated to become parts of the face during about the 4th week of gestation.

Nothing can be surgically treated yet for Chandni. If the surgeons operated now, they would risk exacerbating the problem by damaging growth centers. Chandni will have to wait until she is seven for her face to develop to an extent that surgery will be safe and maximally beneficial.

In the meantime, we will get Chandni a Brainstem Evoked Response Audiometry (BERA) test to ensure proper functionality of the inner ear as well as an ultrasound to check for renal and cardiac malformation (other defects occasionally seen in combination with HFM).

–Chandni’s underdeveloped ear is called a microtia–

To me, what is even more shocking than these deformities themselves is the fact that all of these children live within an area only slightly larger than a football field. It makes me wonder just how many children are out there just like them.

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…This morning, we returned to Fortis Escorts Hospital to see the plastic surgeon, receive a full diagnosis, and discuss different treatment options for little Manish. For the first time, Manish’s father Kusun was also able to come along.

It is apparent that Manish’s condition is quite unique. The chief radiologist, chief plastic surgeon, and chief pediatrician at Fortis Escorts, as well as physicians at the All India Institute of Health Sciences in Delhi, have had difficulty pinning down what is causing the tumor on Manish’s face. Is it a vascular malformation or a hemangioma? I wish we could say with certainty, but even the best doctors in Faridabad and New Delhi cannot definitively diagnose his condition.

While three of the top doctors in Faridabad stopped their other patient flows to discuss the case even further, we had Manish’s blood drawn for a CBC (complete blood count). The doctors wanted to see if Manish’s tumor was hogging platelets. Manish was adorable as he looked with such curiosity at the needle before realizing the pain that it would inflict.

The doctors finally agreed that, given the flow patterns on the contrast MRI scans, the tumor is most likely a hemangioma. The pediatrician prescribed Manish (9.52kg) with tablets of Omnacortil (20mg) to be taken once daily. This is a strong steroid treatment that will hopefully slow or even stop growth of the hemangioma until it enters the involution stage.

The bad news is that Manish may have to live looking like this for the next 5 to 8 years. We could perform a surgery now, but any hemangiomatous tissue left behind could still continue to proliferate. The risk of infection, especially so close to the eye and brain, caused by opening the tumor is prohibitively high. It is far better for Manish to be disfigured for his youth than to become permanently blind, develop meningitis, or die. This has been an incredibly educational few weeks for me. I had no idea something that looks so out-of-control could actually take care of itself with time. Although I feel somewhat powerless, this is yet another lesson that we are all just human. Life, even if it is disfigured, is still beautiful.

The great news is that Manish is otherwise healthy and will hopefully respond to the medication in time for it not to proliferate to the extent that it covers his right eye. Manish was on medication previously, but not a proper dosage. If you live in a slum in India, you can’t just call up the public hospital to ask about your prescription. They would laugh at you on the phone. It sounds like Dolly and Kusun have been confused about proper use of the steroidal syrup they were prescribed before. Since Manish showed no typical signs of steroid medication (such as swelling, lack of appetite, or gaseousness), the doctors here at Fortis Escorts believe that Manish’s previous treatment has had little if any impact.

We bought Manish’s tablets at the pharmacy and his parents will start his treatment today. Next Tuesday, we will return to the hospital to see how Manish is reacting to his treatment and determine the extent of its side effects on him.

Manish isn’t just a celebrity in the hospital here. He is quickly gaining medical attention on the other side of the planet. I am working on having Manish’s MRI scans uploaded to radiologists and a renowned leader on infantile hemangiomas in Canada. Many thanks to these generous doctors for helping to provide truly global care to Manish.

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…On behalf of seven-year-old Kajal Kumari, I would like to now thank Sarah Watson of Paradise Valley, Arizona and Dane Vrabac of Kansas City, Kansas for their thoughtful generosity. Because of Sarah and Dane, Kajal has everything she needs to not just enter into but thrive at the Carmel Convent School for the next year.

Sarah and Dane, ages 25 and 26 respectively, know a little bit about the power of education. Sarah, a friend and classmate of mine from Phoenix Country Day School, went on to study Psychology at Yale University and is currently earning her Juris Doctor at the Benjamin N. Cardozo School of Law at Yeshiva University. Dane attended my other alma matter, Washington University in St. Louis, and went on to graduate school in Applied Mathematics and Statistics at Georgetown University. Understanding the enormous value of education, Sarah and Dane have selflessly passed on their knowledge and resources to this deserving young girl.

–Kajal on her first day of school…ever–

Kajal, age seven, is the youngest of five daughters and one son. Although her parents Lalita and Tuntun claim they have always wanted to send their children to a government school, that goal does not seem to have been achieved. Severely limited finances, absence of initiative, and lack of knowledge about local opportunities severely constrain the educations of many children here. For instance, Savita, Kajal’s 10-year-old sister, is still a student in our slum school. Pinki, Kajal’s 15-year-old sister, attends our vocational courses to learn sewing but is otherwise unskilled and illiterate.

–Lalita, Kajal, and Tuntun–

–Kajal holding tightly her new uniform and backpack–

March 4, the day Sarah and Dane made their donation, was also the day that Pinki, Kajal’s sister, was married in the slum. I felt proud to be invited to such an important milestone in their family’s life. However, although I had expected a simple wedding, I had expected it to be more celebratory than it seemed. I must put this observation in perspective, however, by pointing out that we were not able to stay for the entire event. For fears about safety, we returned home from the slum before dark, long before the main festivities geared up. From the early ceremonies that we did participate in, I found the mood was strikingly routine and austere.

I can imagine why Pinki did not have a big smile on her face. To be young, poor, uneducated, uncertain about the future, and exported to another slum with a man whom she knows little about but will spend the rest of her life with must wreak havoc on her emotions.

–Savita’s bare feet, with those of many other girls and women, were painted like this–

–Pinki with her new husband one day after the wedding–

Pinki’s new husband lives in another slum upstream of ours, in Sector 3. Pinki will soon move there permanently, where she will likely live for much if not all of her life. I would not also be surprised if she is already a mother by this time next year.

–Kajal holding a toothbrush donated by my dentist from Scottsdale, Dr. James Stowitts–

Six weeks ago, Kajal suffered from the same absence of opportunity as her sisters. Were it not for the Squalor to Scholar Program and donations like those from Sarah and Dane, Kajal would likely follow in the footsteps of her sister, Pinki. This not to say that there is anything wrong with being illiterate, poor, living in a slum, and serving as a housewife for one’s entire life. This is exactly how most of the women live here and provide vital and loyal care to their children and husbands. However, I believe such a lifestyle should not be Kajal’s only choice.

Thanks to Sarah Watson and Dane Vrabac, living her entire life in a slum will not be Kajal’s only option. I see Kajal improving rapidly every day. On behalf of Kajal, Savita, Pinki, Lalita, Tuntun, and the rest of their massive family, thank you Sarah and Dane for sharing what you know is the most powerful tool for progress, knowledge.

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Manish Goes to the Hospital…

…On August 6, 2010, Manish Pasman was born at home in a tiny village in rural Bihar, one of the poorest states in India. He had a small “chickpea-sized” growth on the right side of his nose. Only days after his birth, Manish and his family moved to Faridabad as his parents searched for higher wages and a better lifestyle in the slums of Sector 4, right where I found him.

When I first saw Manish, he was being held by his mother on the side of a road in the slum. When I stopped, she scurried off down an alley with Manish in her arms. When I asked Mithlesh about the little boy with a growth on his face, he did not know whom I was talking about. Although Mithlesh knows almost everyone in the slum, he had never seen or heard of Manish before. Luckily, Manish had been out of the house just as I walked by. When I returned with Mithlesh to translate for me, Manish’s family was pleased to learn that I wanted to help.

–Manish on February 10, 2012–

At two months old, Manish’s defect had grown slightly. His parents took him by bus to the All India Institute of Medical Sciences in Delhi, the best public hospital in India. The doctors told him to come back in four months. When they returned, the growth had spread across Manish’s cheek. The doctors scheduled an MRI, for which Manish and his family had to wait four more months. Now ten months old, Manish’s condition had proliferated substantially. The mass on his cheek and nose seemed to be growing out of control. Even after the MRI, doctors seemed torn as to what the condition really was. Favoring a conservative treatment, the physicians placed Manish on standard corticosteroid medication for the next 100 months (8.3 years!).

Since then, over the past nine months, Manish’s condition has stretched and swollen even faster than before. There is even noticeable difference between when I first saw Manish on February 10 and now. Obviously touched by Manish and in disbelief that more could not be done, I set out to help him as if he were my own son. I made calls to numerous locals and was put in contact with Dr. Amitabh Singh, the leading plastic surgeon at one of the best private hospitals in town. Dr. Amitabh was enthusiastic to help. He said, “Bring him to me at 11am tomorrow.”

Fewer than 18 hours later, I was sitting in Fortis Escorts hospital with Manish, his mother Dolly, Dolly’s father’s friend Vikram, and Mithlesh. Dr. Amitabh’s first reaction was one of slight surprise. I don’t think he anticipated the case being so advanced. However, his warm personality and extensive knowledge were immediately apparent. I felt confident in Dr. Amitabh’s ability to provide the best possible care to Manish.

Dr. Amitabh explained in great detail what the condition could be both in English (for me) and Hindi (for the others). His clinical impression, given the compressibility, rigidity, appearance, and temperature of the growth is that it is a vascular malformation, more specifically a venous malformation. However, we needed more evidence. Since Manish’s last MRI was nine months ago, unavailable, and difficult to obtain, we opted to undergo a new battery of tests.

Furthermore, Dr. Amitabh wanted to specifically find the answers to multiple questions. He wanted to know if the vascular structure is being fed or drained by vessels to or from the eyes or brain. He also wanted to ensure that other vascular malformations are not present in Manish’s other organs, especially his brain or liver.

Dr. Amitabh personally escorted us to the radiology department. On the way, I was introduced to the chief of the hospital. Sixty seconds later, Dr. Amitabh and I were standing with the chief radiologist, Dr. Nirmesh, in his control room. After a run-down of our challenge, Dr. Nirmesh asked, “Is he ready today?” After fasting for a few hours, Manish was prepped for his MRI. He was given a dose of chloral hydrate syrup as a mild sedative and an IV line was started for the contrast agent.

Everywhere we walked, Manish was the center of attention. Even surgeons came out from their other work to see him and investigate his condition. Slowly, the sedative set in and we were ready to begin the MRI.

Manish was positioned and aligned as Vikram stood watch. Vikram had removed the metal from his clothes and pockets in order to stay by Manish’s side. With all systems ready, Manish was slid into the tube.

At my request, I was generously given permission to join the radiologists and technicians in the control room. For the first 20 minutes, everything went perfectly. Hundreds of cross sections were taken of Manish’s head to search for feeder vessels, vascular structure, and any potential vascular malformations within his brain.

Manish then began to show his tremendous vitality. With only ten minutes and the contrast scans remaining, Manish awoke. The test was shut down.

Manish was given one more dose of syrup and his IV line was cleared with saline while we waited to see if he would sleep once more.

After one pleasant nap and unexpectedly waking up inside of a loud claustrophobic tube, Manish showed no signs that he was going to fall asleep again. Now late in the afternoon, we were sent home and scheduled to continue the tests at 9am the next morning. Via a tuk-tuk, we returned to the slum.

The next morning, we returned to complete the contrast MRI. After 30 minutes, Manish was out cold again. However, he woke up just before the scans commenced. He fell asleep 30 minutes later, and then woke up again as he was rolled into the tube. The next time, he woke up while he was being covered with a blanket on the MRI table. After two days and five attempts at an MRI, Manish finally cooperated and slept peacefully through his contrast MRI. Noticing conflicting potential diagnoses between the contrast and standard MRI’s, Dr. Nirmesh freed up the CT scan for a third evaluation.

Dolly stood watch over Manish with a lead apron as the CT scan was completed. Next, we took Manish to a high resolution ultrasound to search for any vascular malformations in his other organs, notably his liver, kidneys, gall bladder, intestines, and urinary bladder. I am happy to report that, other than his face, Manish is perfectly healthy.

However, his face seems to be discouragingly difficult to properly understand. Although the growth clinically presents as and is supported by standard MRI to be a venous malformation, the contrast MRI patterns suggest structures more typical of a proliferating hemangioma with some features of involution.

If the growth were strictly a venous malformation without any feeders to or from the eyes or brain, clotting agents could be injected to collapse the vasculature from the inside out. If the growth were strictly a hemangioma, multiple paths could be taken but most likely nothing surgical or invasive. Surprisingly, an infantile hemangioma even of this size will eventually enter a stage of involution in which it slowly collapses on itself. However, Manish would be left with permanent scaring and excess skin not to mention the social and emotional burdens of looking like this for the next 8 years!

Dr. Amitabh had departed the hospital by the time our scans were complete. On Monday, we will return to see Dr. Amitabh, determine the complete diagnosis, and discuss treatment options. I look forward to learning how we can help this precious and unfortunate young trooper. I am happy to learn that Manish is otherwise healthy but wary that our options may indeed be limited. Rest assured, we will do everything we can do for Manish. As you saw today, we’re not holding anything back to care for him. He is already a celebrity at the hospital and is receiving red carpet treatment from all of the physicians. Even if we have to let nature run its course, that course will be heavily monitored. Stay tuned as we learn more!

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The Word is Out…

…Word has spread that I will help provide care to children with deformities. Today, I went back to check on Manish, the two-year-old boy with a large growth on his nose. The doctors at the All India Institute of Medical Sciences in Delhi were still unable to determine the cause of the growth. They have given him 40 more days of medication, after which they will discuss surgical intervention if the growth does not dissipate.

While talking to Manish’s family, a woman brought me her daughter, Chandni. Chandni was born without a right ear. However, it sounds like an MRI showed evidence of an ear canal and normal inner-ear structure. With a surgery to open her ear canal, she might regain proper hearing. The family is going to investigate surgical options next month. I offered to help in any way that I could and will investigate cosmetic options. Again, I’ll keep you posted.

Next, a beautiful little girl named Chanchal came by to visit. She was born with a cleft lip but had it surgically repaired when she was younger. A story like that made her sweet smile even more precious.

Still Managing to Smile…

…Yesterday, while walking through the slum to meet Gudiya and Neha, I noticed a small child I hadn’t seen before. I knew I hadn’t seen him because he has the most striking facial deformation I have ever seen. He was being held by his mother, who maneuvered back into the shadows. I took note of the location so I could come back later with someone to translate for me. One of my dreams is to work for a project like Operation Smile, which is devoted to repairing cleft lips in children around the world. Although this wasn’t a case of cleft lip, it was something just as significant.

I returned last night and found out that the boy’s name is Manish. He is two years old and was born with a small “chick-pea sized” growth on his nose that has progressed slowly to its current state. The family had saved up for an Rs 5000 ($100) MRI but seems to be avoiding surgery. Doctors have had him on 15 mg of Predon every other day for 80 days. The growth seems to have stopped enlarging but has not decreased in size.

I took my photos to a few doctors in the hospital today to see what they thought. They seemed baffled by the little boy as well. Manish is due for a checkup tomorrow, so I will report back with their findings. Regardless, I offered to help fund a surgery if one is necessary. His family seemed very grateful for the offer.

Even Manish managed to let out a smile:

Ortho Surgery (GRAPHIC)…

…This post is another highly graphic one consisting of blood, bones, needles, and power tools. Consider yourself appropriately warned. Another post will come on the heels of this one and is about little kids in the slum and ways you can get involved. So, just hold on for the next post if you’re a little queasy. In case you’re on the fence as to whether or not you want to read on, let me use this picture to sum up what you’re about to see:

It might look like something out of a horror movie, and I kind of felt like I was in one. At the same time, however, the atmosphere was incredibly casual. Even the patient was smiling and congenial as the surgeon used an over-the-counter power drill and an arsenal of tools to reconstruct her arm. This woman was in a car accident four days ago in which her humerus was cleanly fractured. Having never observed an orthopedic surgery before, I was very eager to see one.

This was the situation when we arrived. The surgeon was cleaning off the broken ends of this lady’s humerus as she seemed to happily study our curiosity and presence. In America, a patient having this type of procedure would almost always be under general anesthesia. To see her looking at us while we looked at her bones, nerves, and arteries was an almost surreal experience. She had been given only a supraclavicular nerve block, which actually seemed to work just fine.

Once the ends had been cleaned and debrided, they were put together like a puzzle and then fastened in place with a titanium plate and screws. Even with all the drilling, clamping, and torque being placed on her arm, she never flinched. She just looked around as if she were waiting for someone in a coffee shop.

–Drilling holes–

–Threading the holes–

–Selecting the right screws and tools–

–Tightening down the screws–

–A little cleaning–

–Just like new. Well…almost–

–Total cost: Rs 3500 ($70)–

Next patient!! But wait a second! But what do you do when the next patient is a boy with a fractured trochanter who can’t stand up.

You guessed it! The woman stood right up so they could trade places. Wow! These people are tough. We said shukriya and goodbye to the woman. She gave us a big smile and head wobble as she was wheeled into the hallway.

The next patient had a more serious case. His prep took more than 30 minutes as an x-ray machine and all sorts of equipment were brought in to operate on his fractured trochanter. To show you just how hospitable the staff and doctors are here, one of the technicians offered me his lead apron. There was no way I was going to take it from him though.

Instead of being inundated with radiation, we moved to the next room to see what we actually came for: a skin graft to repair a ruptured tympanic membrane.

I checked back in to see how the boy was doing with the broken trochanter. Over an hour into his surgery, things looked pretty ugly.

Come on!! You knew it was coming! Looking at all these bones and flesh all morning and afternoon was making me hungry for some drumsticks. I know what you’re thinking: “This guy is sick!” Believe me, I thought the same thing too. I was laughing to myself under my mask as soon as the thought came to my mind. But once it was there, it just couldn’t be ignored. My co-volunteer and I went to KFC and devoured 14 pieces of fried chicken. All of my KFC friends were there to welcome me back and meet someone else from America. We were treated like royalty and had a splendid multi-course mid-afternoon KFC extravaganza.

–Customer satisfaction survey from KFC–

Some more intriguing photos:

–A new and confusing OT footwear: plastic shoe covers as socks inside flip-flops…hmm–

–Line to get three days worth of medication outside the OPD–