India's Hospital Train

This programme contains some strong language

SHE READS ALOUD IN DIALECT

This boy can't hear the lesson, but he's too shy to tell the teacher.

He's behind in his studies and without an operation on his ear

he will probably go completely deaf.

But in rural India, where the poor have little access

to medical facilities, there is a unique way of providing treatment to the sick and hope to the disabled.

It's based on the simple concept that if the people

cannot reach a hospital, then the hospital should reach the people.

This is the story of a train, a very special train - the Lifeline Express.

The train is known as "The magic train".

Hundreds of poor people

who are disabled, who've never seen a doctor, they come.

They're so trusting. They'll come with a little packet of vegetables,

of flowers and put it in your hand.

"Yours is a magic train.

We have come for magic. Make the miracle."

The Lifeline Express was the world's first hospital on rails.

With two fully equipped operating theatres, treatment rooms, offices

and accommodation for the Lifeline crew,

it uses 70,000 kilometres of Indian railway track to reach the remotest corners of the country,

bringing free treatment and state of the art surgery to India's rural poor.

The train was the brainchild

of Sir John Wilson, a British campaigner for the disabled

who founded Impact India, the charity which runs the train.

With the help of the railways and the Government, volunteers and sponsorship,

to date it has treated over half a million rural people all over India.

Each mission is a complex exercise in planning and diplomacy.

The Lifeline Express has its own permanent six man staff

and they travel with the train and they live on the train.

The leader of the Lifeline team is Colonel Vishwan, retired.

And the location for this Lifeline project and home to the Colonel

for the next month, is the small District town of Mandsor

in Madhya Pradesh, slap in the middle of India.

And soon, from all over the country, volunteer doctors and surgeons will converge on Mandsor.

Over the next four weeks, they'll perform hundreds of operations

and thousands of health screenings right here on platform number two.

And it's all for free.

The Lifeline Express will change some lives forever.

And it all begins with a promotion, country style.

MAN SHOUTS IN DIALECT

In villages around the district, the first priority

is to make people aware of the train and get the message out.

After a two day journey, the Lifeline Express slipped into Mandsor Station almost unnoticed.

Each week, a different specialist team of volunteer surgeons will travel here to operate.

First ears, then the polio surgeries.

In the third week cleft lips, and finally the eye surgeries.

And it's all taking place on a train in a station in the middle of India.

Padliya Lalmua is typical of over 200 scattered villages in the district

just fifty kilometres from the town of Mandsor.

Eleven year old Dashrath is the third child of an extended farming family and he's going deaf.

The family own their own house and a field, some goats and a bullock,

and though it's a hard life, they're not on the bread line.

Dashrath's hearing started to deteriorate after a series of infections,

since when, his father says, nothing seems to have worked.

With a referral from his doctor, Dashrath heads for the Lifeline Express.

It's just an hour and a half by bike across country but it may be the journey of a lifetime.

Sanskar Gardens, normally a marriage venue, has become a registration and screening centre for the train.

Dashrath is one of over a thousand would-be patients

with ear, nose and throat problems who have turned up on this, the first day of the Lifeline mission.

But only a minority can ever be operated on.

And that decision is made by the volunteer surgeons who have come from Delhi.

They will screen every one of the hopeful patients, but there are just four days of surgeries

so the odds are not in Dashrath's favour.

After the ten minute examination, Dashrath has been approved for surgery on one of his ears.

He now has a file, a number and the operation is fixed for the following day.

He'll stay here overnight in the makeshift ward in the marriage hall.

And in the morning he'll get his operation.

On board the Lifeline Express, the team of top Delhi surgeons and anaesthetists

are waiting for their first patients.

Dr Vikash Malhotra and the team are aiming to operate

on a lot of patients today, but he's quietly confident.

By the time Dashrath reaches the train the temperature on the platform is already over 40 degrees.

The heat is building up to the summer monsoon rains.

Perhaps it's nerves or the medicine or the heat, but Dashrath is feeling sick.

On the train, the ear operations have begun.

The most complicated procedures are first on the list

and Dr Vikash and his surgical team have set a target for the week.

At 4pm, after waiting on the burning station platform for five hours,

Dashrath's feeling much better.

Today, he's going to have one eardrum repaired

and the other one will have to wait until he's a little older.

Through this microscope I can see the small hole in his eardrum.

What we will be doing is just putting some chemical

along the margins of this hole and sealing it with a paper patch.

The operation was successful and the prognosis is that,

in just a few weeks, Dashrath's hearing will be nearly back to normal.

It was a typical day for all departments of the Lifeline Express.

Dashrath's surgery was just one of 25 ear operations today,

and the surgical team are confident of meeting their target

before the handover at the end of the week.

But bad news is coming in on the TV.

Events in the bordering state of Rajasthan are about to cause a major problem

that could upset all of their plans.

A minority caste are demanding tribal status and calling for better education and better jobs.

They're known as the Gujjars and they've blockaded the main railway line between Bombay and Delhi.

The disruption has caused the cancellation of hundreds of trains

including all the doctors' tickets from Delhi.

It's a major headache for the Colonel and it's put the polio surgeries planned for next week in jeopardy.

No trains. The doctors who left the day before yesterday, remember, they're still in Bhopal.

Although the trains are still running on the branch line through Mandsor,

with the main line closed and the surgeons stuck in Delhi, the polio operations cannot begin.

Dashrath was lucky that his passage through the Lifeline system went according to plan.

And by the end of the first week,

the surgeons had almost reached their target of 100.

But with the rail network in chaos, no-one knows what's going to happen next week.

Today, according to the astrologers, is the most auspicious day for a marriage.

Tonight, in every village across Mandsor district, there's a wedding.

Brides on horses, grooms on tractors, it's a time when the whole community shares in the celebrations.

Whatever your caste or religion, it's a matter of honour to ensure your daughters are married off.

Marriages in rural India are traditional, arranged early and normally with a dowry attached.

But for those who are poor and disabled, the prospects of marriage are far from good.

40 kilometres south of Mandsor town lies the village of Daloda.

Like many places in India, it bears the legacy of the polio virus.

Once upon a time, almost a third of all polio cases in the world were in India.

But today that's been reduced to a just a few hundred new cases a year

and soon it will be eliminated completely.

Sapna is 17 years old and she lives with her family here in Daloda.

But since the age of two, she's been disabled as a result of polio.

Between the chai shop and the tractor repair shop,

lives Bharat, a six year old boy who cannot walk at all.

His family is poor, his father unemployed.

Treatment on the Lifeline Express may be Bharat's only chance to see a top specialist

and to get an operation.

So his father is taking him on the train to see Mr Meena,

an orthotist and prosthetics specialist in Mandsor.

His recommendation could help Bharat see the polio surgeon for a screening.

But they don't know what, if anything, an operation might achieve or if there is any hope of a cure.

At Sanskar gardens, the polio screenings have begun.

It's an opportunity for a new prognosis from a top surgeon

like Professor Agarwal from Lucknow Medical College.

He's an esteemed paediatric specialist and teacher and the leader of the team.

And he's the first of the polio doctors to make it through the blockade.

Over the next two days, he'll screen hundreds of disabled people

to see who is suitable for orthopaedic surgery and who is not.

Bharat has come to Mr Meena for a screening.

He's hoping to get a referral letter from him for the Lifeline train.

But it's turning out to be much more intense than expected.

By midday, Sapna has been accepted for an operation by Professor Agarwal.

But there are conditions.

She'll be in theatre tomorrow, only if all the doctors arrive in Mandsor and the professor is insisting

that his patients are moved from the converted marriage hall to the district hospital.

And, after a day of screenings, he's called a meeting with the organisers on the train.

You are the responsible person and you are responsible.

You understand my point?

I don't share any responsibility on this issue.

Colonel has asked me to come from Lucknow.

You know how much travel that is?

28 hours I have travelled by train, only for one cause, to do good work

for the poor people.

The district hospital in Mandsor serves almost a million people.

It's short of beds and short of doctors.

But, somehow, the Lifeline Express works its magic

and they manage to clear a ward for Professor Agarwal's polio patients.

With a referral letter from the physio, Bharat's hoping for an operation that will make him walk.

I am sorry, I have nothing to offer.

The point is, it's God's will

and if it is God's will, we cannot stop it.

So don't keep attachment.

The emotions are very disturbing.

Just make him happy as far as possible.

Bharat has finally been diagnosed properly, with myopathy, not polio.

Under a harsh regime of physiotherapy in the coming years, he may yet gain the ability to walk.

But it will take a miracle to cure the boy.

GUNFIRE

The Gujjar protest has taken a violent turn.

The main railway track remains blocked by 60,000 angry protestors and with so many trains cancelled,

the Government has sent in the troops.

So far, 39 people have been killed, and it doesn't bode well for the Lifeline train.

24 hours after screening, and despite the protests, Sapna is in pre-op on the Lifeline Express.

By bringing the doctors on lengthy detours and avoiding the rail blockade,

the Colonel has managed to scramble a skeleton team for Dr Agarwal.

So now he can operate on the village girl from Daloda, for whom the stakes could hardly be higher.

Professor Agarwal typifies many of the volunteer surgeons who join the Lifeline Express -

taking time off from big city hospitals or private practices to work with the poor for free.

And this is his tenth year.

And I'm very God fearing.

Every time I feel somebody's watching.

If I do something wrong,

don't think that nobody's watching.

Over the next three days, Sapna and 19 more polio patients

were operated on by Dr Agarwal and his skeleton team.

It may take some time before their plaster casts are removed permanently,

and only then will they find out

whether their operations have been successful

and whether they'll ever walk normally again.

As the project reaches its halfway point, the Gujjar demonstrations are still causing disruption.

The surgeons are coming from Lucknow and the anaesthetists we're trying to get

from Madhya Pradesh only, either from Bhopal or Indore or any of the medical colleges.

That effort is on. The only thing, we realised yesterday, they'll not be able to make it, so we are...

Colonel Vishwan faces the problem of how to get his polio surgeons home

and to get the plastic surgeons to the Lifeline train.

All planes are full and the alternative routes are overbooked.

50 kilometres north of Mandsor town, on the edge of Sabakehda village,

lives a small community at the bottom of the economic ladder.

Deeply religious, illiterate and dirt poor, they live a hand-to-mouth existence.

Mohan Lal's family were delighted when their first baby, the boy Shiva, was born to them.

But all was not well.

Shiva was born with a cleft lip.

For Shiva's family, news of the Lifeline Express

has given them hope of an operation to rectify the cleft lip.

So, having successfully passed a local screening at their primary health centre,

the whole family heads for Mandsor station and the Lifeline train.

There are no guarantees he'll get his operation, but they believe that Shiva is a God,

and that he's blessed, and that the doctors on the train will change his life forever.

At Sanskar gardens, the lip screenings have started.

Dr Faisal is one of the three plastic surgeons who have finally made it

to Mandsor after a circuitous, 36-hour train journey.

With only a few hours sleep, he now has to screen

hundreds of would-be patients for corrective lip surgery.

And Shiva is in the first batch who are waiting to see him.

For Shiva, corrective surgery on his lip

would be completely unthinkable, had it not been for the Lifeline train...

..yet some Indians believe that such surgery is undesirable

because the body you are blessed with is the gift of God.

Amongst the peoples of India, religious beliefs and observances

are central to life.

Whether Hindu or Buddhist, Sikh or Muslim,

all believe that life is sacred.

And its strictest adherents are the Jains.

Nimbod is an old established village in the south of the district,

and home to a large community of Jains.

They believe that all life, no matter how small, is worthy of respect.

THE CHILDREN SING LOUDLY

Orthodox followers wear a mask,

so they will not swallow any living creature or insect.

Eleven-year-old Vishal comes from a typical Jain family

who have lived in this village for generations.

BELL RINGS

Vishal was also born with a cleft lip, but it never used to bother him.

Tomorrow, Vishal and his father will travel to Mandsor,

hoping to get an operation on his cleft lip.

Despite the Gujjar troubles and all the train cancellations,

so far, the project has completed 99 surgeries.

And with the colonel's emergency planning,

nearly all the medical volunteers eventually arrived.

So today is the first day of the cleft lip surgeries

for Doctor Faisal and his team.

I have been on the Lifeline in previous two projects,

and I love to come here.

Every time Colonel Sahib calls us, I am the first one to volunteer,

and I'm always enthusiastic to come here and do some work.

But that work is suddenly interrupted by a new crisis.

At Mandsor district hospital, the entire staff have gone on strike,

because somebody hit a doctor.

The police have moved in with riot gear,

as such incidents can easily escalate,

and until the crowd disperses, the hospital is closed.

But at Sanskar Gardens, the clock is ticking away at the surgeon's time,

so the screenings must continue.

Vishal's operation has been approved, along with baby Shiva.

BABY CRIES

But with no medical staff willing to work

until the demonstrators have been dispersed,

even the ambulance has been locked in,

and now the Lifeline patients are stranded.

The ambulance, which was coming from the hospital,

was supposed to bring the patients from the transit camp to the train.

That is...er...really making us...

a bit problematic.

A couple of hours later, the hospital protest is over, so Vishal and Shiva

can be delivered to the operating theatre on the Lifeline Express.

SHIVA CRIES

Finally, Dr Faisal and some of the best plastic surgeons in India

can use their expertise, and work their magic.

Each surgery may take anywhere from 30 to 45 minutes,

if everything were all right,

and for Shiva's father, it's an anxious wait.

If there is any inadequate muscle repair,

it's going to give a very unhealthy scar, and the child

might not get another chance to get a revision done. OK?

And if the muscle repair is right,

the pieces of the two parts of the lip

will automatically fall in the normal positions.

It's like a jigsaw.

-DOCTOR SPEAKS IN HIS OWN LANGUAGE

-Vishal.

There is muscle suppression inside.

Baby Shiva is brought to his father.

It's ten o'clock, and he's already the sixth operation of the morning,

and Vishal is out of surgery too.

All today's patients have been transformed

by the Lifeline experience, and so too have the volunteer doctors.

It's very difficult, it's very difficult.

But when it's good, it's always worthwhile.

Small children used to bring paintings and drawings for me

when they were operated, and... the love and affection that you get

from such kind of patients is just fantastic,

I mean... I cannot express that in words.

SHIVA CRIES

After 48 hours, baby Shiva and Vishal Jain have their scars examined,

their plasters changed, and if Doctor Faisal approves,

they can go home.

For baby Shiva and his family,

it wasn't just Doctor Faisal who made Shiva well, it was their God.

So the family is making a pilgrimage to a holy shrine

to offer their prayers for Shiva's salvation.

-DOCTOR:

-Religious? Yes, I am religious.

Everyone in India is religious!

-Yes, everybody is religious!

-Underlined and...!

They're praying God.

Vishal Jain will suffer no more jibes at school.

His self confidence will grow, and his faith has been strengthened.

THUNDERCLAP

In an isolated area of the countryside,

Shiva and the family have begun their observances at the holy shrine.

A local shaman has been engaged to conduct the ceremony.

Shiva's family believe that his operation was only possible

by divine intervention, and that he really IS a God.

Tonight, by offering up their thanks,

they pray the Gods will bless his life forever.

For the train staff, it's been three weeks of continual operations.

In the last four days alone, the plastic surgeons

have completed over 50 lip operations.

Now the plan is that they leave in the morning,

and the eye surgeons should be arriving by train from Delhi...

..God willing.

THEY SING

Tonight In Sabakheda village,

73-year-old Mangunath and his wife Gajribai are celebrating.

They're almost blind with cataracts.

They're penniless, with no possessions, no home, no children,

and they rely on an extended family to support them.

But tonight, they're happy. They've both got doctor's letters

for an eye operation on the Lifeline Express.

HE GROANS

At Sanskar Gardens, the response to the Lifeline Express

is almost overwhelming.

Thousands have turned up for the eye screenings,

with every kind of eye problem, from children with squints,

to the totally blind.

For Mangu and his wife,

this is probably their last opportunity for eye treatment.

They're old and confused, but with a little help,

they make their way through the screening process.

Without an operation, Mangu and Gajribai face a future

where they can't possibly work and will have to depend on charity alone.

Outside, the crowd has grown so large that it threatens to overwhelm

the volunteers and security,

and the police have to be called in to keep order.

The main line between Mumbai and Delhi is still blocked,

and the Gujjar protests have now spread to Mandsor.

THEY CHANT ANGRILY

Now, the colonel is having to find ever more inventive routes

to bypass the blockade and to make sure the doctors get here on time.

A few of the eye surgeons have made it from Delhi,

but there's still no sign of any anaesthetists.

Heading the team is Doctor Zia.

I'm a practicing strabismologist and a neuro-ophthalmologist.

Strabismologist is a squint specialist.

That's my area of specialization and training.

And after the age of 40 - this is for senile cataract -

after the age of 40, they start getting opaque,

so that is what we basically call a cataract.

Something that comes in the way. Cataract means "waterfall" in Latin,

"cataracta," from the waterfall. Something white

that comes in front of the eye, waterfall in front of the eye. That's what it means.

Cataracts are the world's leading cause of blindness.

Some estimates are that almost 20 million Indians suffer from it.

-But it is curable.

-..E...S...L...

So, Doctor Zia and her two senior surgeons

are getting on with as many of the cataract screenings as possible,

without a full team.

They're hoping that medical support will arrive tomorrow

in time for the surgeries.

Mangu and Gajribai are here to get their blood pressure checked,

and for their final pre-op examination by Doctor Zia.

As the head of the team, only she can decide

if they'll get their operations or not.

Gajribai is through, but Mangu's tests

show he has high blood pressure, and Doctor Zia is worried

it might cause complications if she were to operate.

Mangu's operation is off, and Doctor Zia

is growing increasingly concerned that if the anaesthetists

don't get here soon, there will be no eye operations at all.

As tensions begin to mount on the train,

there's more bad news for the colonel.

Faced with a long and uncertain train journey from Delhi,

the anaesthetists have pulled out.

So the situation on the train has gone critical.

Without them, Doctor Zia cannot operate.

Luckily, the colonel has persuaded an old friend, Doctor Tripathi,

a semi-retired anaesthetist from Mandsor, to step in.

But the problem is, he can only work part time.

I am out of this after this. No, I'm not into this.

No, it's not I, your Caesarean...

It's a camp, it's a national level camp, it's got to be done properly.

We cannot do it without anaesthetic cover. It's for them to discuss.

You discuss this with them.

I'm not irritated.

I don't want to talk any further.

Talk it over with them.

Talk it over with them.

-Bye.

-Absolutely.

Even with the blockade on the main line from Delhi,

local train services through Mandsor are still unaffected.

The Lifeline project is in its last week.

The Gujjars are in talks with the government,

and there is hope of a settlement soon.

But on platform number two,

the Lifeline Express is faced with abandoning the cataract surgeries

unless the colonel can find more anaesthetists

and negotiate a truce between Doctor Zia and Doctor Tripathi.

THUNDERCLAP

Tonight, the first of the monsoon rains

bring some relief from the intense heat.

STORM RAGES THROUGHOUT

Gajribai will have her operation in the morning,

but if Mangu loses his sight,

then she will have to become the breadwinner...

..and for this dignified old man, it's a harsh reality to face.

After a busy night of phone calls,

the colonel's determined efforts have paid off.

Doctor Zia and Doctor Tripathi have reached an accord,

and two more anaesthetists have been secured,

so tomorrow, the eye surgeries can begin.

Gajribai had pleaded for her operation to be given to Mangu,

but she was told it wasn't safe for him...

..so her operation is next on the list.

Doctor Zia has had to scale down the number of operations to 150,

because she still doesn't have a full team.

Nevertheless, this is her first day of surgery, so she's happy again.

DOCTOR ZIA SINGS IN HER OWN LANGUAGE

SHE CONTINUES SINGING

Under local anaesthetic, and using state-of-the-art surgery,

Gajribai will get back the vision in one of her eyes.

But she also knows her husband will slowly go blind.

Helpless people, you know, who have come with expectations.

Something is promised to them.

It doesn't really matter to them what we think or what we do,

what matters to them is that they have a problem,

and they have come here with hope.

God knows, they suffer a lot.

Gajribai's operation was successful, and in a few weeks' time,

she will be able to see clearly enough to work again.

Over the last month, the Lifeline Express

has performed its minor miracles.

Thanks to the volunteer surgeons, doctors and nurses,

thousands more lives have been touched by the magic train.

In four days, the plastic surgeons

performed more than 55 cleft-lip surgeries.

Vishal's scar is healing well,

and Doctor Faisal even got to operate on a God.

Dashrath was just one of 80 ear surgeries on the train,

and thanks to the operation, he can hear better,

and now he's doing really well at school.

Doctor Agarwal and his team performed 19 polio surgeries,

including Sapna's operation. Now she's out of plaster,

but it will be months before she'll be able to walk

without the aid of a crutch.

Doctor Zia and her team eventually operated on 148 cataract patients.

Gajribai was lucky, but Mangu was not.

Despite all the problems, the Lifeline Express

managed to screen thousands of people

and performed over 300 operations, which have changed peoples lives.

Now Gajribai has decided it would be best

if she and Mangu move back to the village where they were born,

to their native place,

and the Lifeline Express is also moving on to its next mission,

a thousand miles away from Mandsor,

but where the people share the same hopes and the same dreams of a cure.

The train has become the symbol of a miracle.

A hope.

And when it goes away, we've had people sleeping,

lying on the sleepers, won't let the train go away.

"Don't go away. My mother is sick, my father is sick."

They don't know what to do.

This train is blessed.

Somebody is up there, watching us, telling us what to do.

Subtitles by Red Bee Media Ltd

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