Barefoot surgeons

Have you ever seen a house that’s also a hospital? My paternal grandparents’ home is a large, cuboid building in a walled compound, in Bihar, India. At the front is a portico where we spent much of our time during our childhood holidays, sitting on chairs of wood and wicker, while elderly locals would stop by to catch up with my grandparents. I remember that portico floor so clearly: a mosaic of broken shards and off-cuts of marble, set into concrete, a wordless monument against perfection. Against waste.

When my grandfather retired as a Professor of General Surgery at the local government university hospital, he spent more time at home, but work still came to him, whether he liked it or not. In a state where healthcare is still scarce – and, where available, often expensive – the reputation of a good surgeon travels far, and lasts a lifetime.

So it was that my grandfather – known within the family as ‘Baba’ – decided to set up a pro bono clinic at home to serve the numerous locals who still came to him begging for medical attention. It was not unusual for patients to arrive without warning, and casual conversations halted so that he could press on tummies and give advice.

Patients often returned on the anniversary of their operation, to say thanks for the care they had received from Baba. I remember one man lifting up his shirt to reveal a scar under his ribcage and holding up a pouch containing his gallstones, before tucking them back into the waistband of his lungi. He and his wife had walked nearly 300 kilometres from their village in Nepal just to pay homage to the doctor who had cut away his pain, for free.

Lalitji commanded proceedings with assuredness: spinning the forceps around his thumb and cutting as if the scalpel was in fact a sixth digit

Over the course of several visits, over two decades, I saw how the house was becoming more and more a mini-hospital: first the garage was used as an operating theatre, and then more and more rooms got built on top to accommodate growing patient numbers. There was always a small posse of staff looking after post-operative patients, who soon became as familiar as my relatives. I never asked why they were there or what exactly they did. All I knew was that they were the ones who did most of the caring for the patients before and after my grandfather performed the surgery, and were – functionally – family. One man, Lalit, stood out for his intelligence and diligence, and I assumed he was a trainee doctor, as even my father would refer to him with the honorific suffix ‘-ji’. It would have been rude to call him Lalit. He was always Lalitji.

Entering the clinic

Once, when I was 19, after spending some hours eating and chatting with my grandmother, I asked her about the clinic and she invited me to go and take a look for myself. It was an intimidating thing, even – or perhaps especially – for a young medical student. After all, this was meant to be my world, and yet it felt like another reality to what I had seen in hospitals in the UK. I walked in past a queue of patients staring at me, a strange, brown boy who moved and dressed like a Westerner. A staff member caught my eye, ushered me up a twist of concrete stairs, and then asked me to take off my