The Worst Form of Poverty

Indian author Kiran Desai once remarked, “If you write a lovely story about India, you’re criticized for selling an exotic version of India. And if you write critically about India, you’re seen as portraying it in a negative light – it also seems to be a popular way to present India, sort of mangoes and beggars.”10

And yet, somehow “mangoes and beggars” seems to exactly summarize the comings and goings on the street below our hotel.  I wake up the next day to a symphony of horns outside the window that start at daylight and never really stop. When packing for the trip, I packed double the amount of contacts I thought I would need. After three or four days in Calcutta, however, I have run through nearly all of them.


After breakfast, we weave our way through the melee on the streets and drive back to Khalpar. Ryan, a doctor specializing in serving the homeless population in Portland, Oregon, is assisting a local Indian doctor with a free medical clinic for residents.

We enter one of the two makeshift school buildings, the front part of which has been cleared and set up with folding tables. One row holds the medicine supplies, while Ryan and the local doctor consult at a smaller table.

“The whole reason I went into medicine was similar to the reason I’m here, which is just the idea of serving vulnerable populations,” Ryan says.

“Sickness is vulnerability. I just had this feeling that in those moments, somebody needs somebody and I could be that somebody. On a personal level, it’s an access to a degree of intimacy you don’t get as a layperson. My first job was in a prison – maximum security, death row. I did that for a while and realized quickly that my gig was always going to be in underserved populations. I didn’t want to be another replaceable private practice doctor.”

Ryan spent a year doing the prison clinic, then moved to Tennessee, working at community health centers (federally funded centers for uninsured patients). He eventually moved to Portland, where he currently practices medicine for the homeless at a federally qualified clinic.

One by one the patients line up, to see the doctor, all dusty and barefoot. One woman is having cervical pain in her neck, as well as pain in her foot.

“Are you able to sleep flat?” Ryan asks. “And when you rest, it goes away?”

“Are you very thirsty?” he asks another patient. “Do you urinate a lot?”

One of the most common problems, according to mothers of the slum, is low body weight among the children. “They complain of their children not eating or sleeping,” the local doctor tells Ryan. Ryan advises another patient on an ear issue, while the local doctor also recommends a homemade remedy.

The heat bears down on the small hut as the afternoon wears on. Ryan examines an anomaly on a boy’s foot, while a concerned father explains the pain and swelling.

Next is a young boy with vertigo. “Are you lightheaded?” Ryan asks.

“All the time, or in certain positions?”

He examines one teenager’s foot, which is covered in infected bites. Another girl complains of abdominal pain and finger pain.

“Is your hand itching?”

A young girl with scabies is next.

The most challenging thing is that there’s so much unmet need,” Ryan says.

I ask Ryan about his practice in Portland. He says he sees a lot of drugs, mental illness, heart disease, diabetes and high blood pressure.

“Comparatively, here we see a lot of parasites, scabies, lesions and undernourishment. The kids here look 5-6 years younger and the adults look 15 years older,” he says.

With the homeless population there’s a much higher risk of all illness and a shorter lifespan by 10-20 years, he explains.

“Primary care for a homeless person is different than primary care for a housed person. [In the U.S.] we see a lot of injection drug use and complications like hepatitis C and abscesses, things like that that you don’t see in the normal world. It’s a totally different set. They say that between 40-50% of death among homeless patients have to do with substance abuse.”

“I’m lucky,” he says, now examining an elderly woman with knee pain. “If you ask my classmates why they went into medicine and fast-forward 10-15 years later, a lot of them will be like, ‘I don’t know what I was thinking.’ I’m lucky in that I didn’t know what I was getting into, but the same reason I went in is what I’m being rewarded by now. Knowing that there’s a lot of need and I’m trained to work in that and able to do it.”


In addition to the medical clinic, today is a special day for the kids at Khalpar. The bridge children who have stayed in school are being treated to an afternoon at Nicco Park, a local amusement park.  Ryan stays to man the clinic, but the others in our group are recruited to be extra chaperones for the kids.

We are each assigned a group of 4-5 children who instantly mob the visitors with courteous shouts of “auntie” and “uncle,” all wanting to touch the Americans and hold your hand. We line up single file like ants, and holding the hands of six young girls. And so, Auntie Mandy treks through the dusty city roads on foot to Nicco Park.

The kids are surprisingly well-behaved as we get our tickets. The inside of the park looks like a cross between Six Flags and a country fair. We start off easy on the carousel. Then everyone rides the Tiltawhirl – except yours truly.

I have a firm rule that I always honor, “No riding spinning teacups after eating Indian food.”

The children then scream and squeal with excitement as we line up to drive the bumper cars. I’m not sure what the exact strategy with bumper cars is, but I try to ram as many cars as possible before our time is up to give my young charge a thrilling ride. A group of teenage boys from Khalpar give me a thumbs up as we exit.

We then make our way to one of the park’s marquee rides, a wooden roller coaster. There is no attendant checking height, and I am concerned about some of the kids, who look awfully small, like they might fall out. We definitely don’t want anyone to die on school reward day. It is some of the kids’ first time on a roller coaster. You’d think they’d be terrified, but the squeals are shrieks of pure delight as the coaster streaks off down the tracks.

The next is a mummy boat ride through a pyramid, for the most part historically correct with Indian-Egyptian tombs and mummies, with the exception of a random appearance by Darth Vader, which elicits applause. We ride the log flume, and the kids somehow instinctively know to make me sit on the outside edge where I am sure to get soaked. We finally ride the skylift, lifting us high above the amusement park as the sun starts to set on Calcutta, turning the sky a hazy pink.


When we arrive back at Khalpar, the clinic is over and being packed up. I ask Ryan his thoughts about the clinic.

“There are different things that struck me,” he says. “One is that the human spirit breaks through circumstance. When we go to the slums, we saw this sea of smiles…I’ve been moved when I go back into work [in Portland] and it will be cold and raining and people will be crawling out of tents and the first thing they do is cheerfully greet me. There is a sort of human spirit that transcends all those bad circumstances. There is a human spirit that cannot be explained that sort of rises above.”

There is no ‘homeless person,” he says. “The most striking thing I see in the population I serve – a misconception with homelessness, is that it was a series of bad choices. Yes, there’s different degrees, there’s different reasons, but the majority of the people I see were really dealt a bad hand from the first breath they took. As a result, they had no stability from parents who maybe didn’t plan them, didn’t want them, didn’t have any idea of what to do.”

“The obvious things that you need are education, but take it all the way back to birth,” he explains. “When you’re not loved from the first breath you take, you don’t have what it takes to pull yourself out. Which kind of goes against the American dream, which is ‘just pull yourself up by the bootstraps.’ Maybe that happens, but it’s an extraordinary situation.  And it requires things that you and I may have gotten from our parents. You and me being here is a cumulative effort of love, purpose and a sense of self and if you take those very basic things away, all you have is survival. It’s just day by day.”

I ask Ryan what motivated him to come on the trip and he stops to consider.

That’s one of the biggest questions – the first thing I asked was ‘Why India?’ Why fly to the other side of the world to serve needy people? There’s something kind of dramatic and exotic about traveling to India and doing this kind of work, whereas it’s less of a sexy thing to say, ‘What about Nashville? What about down the street? What about in my neighborhood?”

“Is there a more practical use for the resources? And I don’t have a good answer yet. There’s a great quote by Mother Teresa that the worst form of poverty is loneliness. And in whatever way you can figure out how to give a sense of belonging is one of the best things you can do – someone who just has dignity. The gift of dignity, of belonging and association is a powerful one.”


Back at the hotel my mind wanders back to the caste system. To some urban Indians, the caste system is an unmentioned tradition, kind of like segregation in the American South – a stereotype they would like to move beyond. To others it is an unspoken way of life. You live with the cards you are dealt, and do the best practically with those cards. Because Hindus believe in reincarnation, there is less urgency about being in a lower caste than a Westerner who believes that we only have one life to live.

While it’s not desirable to be in a lower caste, there is an implied hierarchy, that those in a higher caste have perhaps earned it by living admirably in previous lives. Consequently, those in lower castes are presumably either just starting out or have behaved abominably in previous incarnations, earning them a lower position on the ladder. Thus, being poor, in a way = your fault. But if you act admirably within in your caste, keeping within its laws and customs, there is the hope that you will rise in the next life.

While the caste system seems foreign to us as Americans, I wonder if we aren’t somewhat guilty of the same thought. That poverty in a capitalist society is somehow an individual’s fault. As Ryan points out, sometimes it is, and sometimes it isn’t. You can’t judge someone else’s house by the tools you were given to build your house. Someone who only had a saw and a tree might some to a different outcome than someone with power tools and cement, through no lack of effort or moral failure on their part. And if you were given an instruction manual on how to build a house, would it be right to judge someone who had never seen a floor plan?

I believe Jesus knew all of this when he told us to love our neighbor. All at once a conciliatory mandate that impels us to act, while smashing through caste systems and socio-economic structures. A great deal of chaos caused in five words.

Love God. And love…your…neighbor.

No disclaimers, no caveat…no specifications on who, not if they deserve it, not if they live close to you, not if they’re in the same religion or if you bump into them halfway around the world.

It is awkward, polarizing, elementary and magnificent at the same time.



Read Next: Remembering the Enemy

Or start at the beginning: read the full journey here.