A constant reminder of how lucky we are.

Celine was waiting for me, sitting calmly in her still-crisp sari stiff to the floor like the flights of a shuttlecock. She had been there for four hours having arrived from Mumbai earlier in the evening and in her typical generous way had offered to wait for me to drive back to her house for the day. The precise timings of what was needed to effect this transaction had been overlooked in our mutual enthusiasm at our impending re-union. It was only as the plane taxied to its stop that I realised how truly saintly her offer was. I hadn't even told her which flight I was coming in on, so she had been searching for flights from Heathrow arriving at 2.55. There were none, they were all coming in well after 4am. Still she waited, not knowing to check the arrival of flights from Doha. Her usual telephonic response to my slightly guilty call, as the plane wheels skidded to a halt, of "Where are you?" was never more appropriate.

In contrast to her crispness, I was crumpled, tousled, ruffled & dusty, but no less delighted to see her. We spent the day driving around and chatting. Firstly we visited my friend Victoria, who, with perfect timing, had delivered a delicious little girl two days previously, then, in a extension of her saintliness, she accompanied me to RUHSA (four hours there and four hours back). In between my brief but deep trips to unconsciousness whenever the hum of background India lured my grateful brain to sleep we caught up on all the news of the year since we had last seen each other.

Karuna Niwas continues its work. Recently a new lady has come to stay. She was a victim of domestic violence whose husband beat her because she produced only girls. Clearly, he was not up to date with biological fact. She ran away on many occasions, but he would drag her back for more beatings. Eventually he left her, destitute and degraded, with her three daughters to find a younger woman to give him boys. She has a lovely face, sweet and earnest, with soft brown eyes and a kind smile. She looks happier now. Celine has ensured the oldest two children are in an English Medium school, which she could never have afforded before. Hopefully it will give her girls a better future than they had looked forwards to before. The youngest will benefit from the gift of a teddy bear that one of my lovely patients gave me to bring out for someone. Celine is now helping the mother to find a job. Her prospects are good but even if she cannot find any work, then she could do one of the several training courses available at Karuna Niwas - beautician training, spoken english, tailoring, computing to name a few.

However, the story that troubled me the most this time was that of the newly teenaged young lad & his sister who have been under Celine's care for over 7 years. Their mother too was a victim of domestic violence which they witnessed in brutal detail. When the girl was 4 & the boy, 6, the father beat the mother to death & set fire to her. She had been holding her daughter who suffered extensive, disfiguring burns over her limbs & torso. Her scars are visible. Tangible and easy to identify. A constant reminder of her need for empathy & love. Luckily, she does not consciously remember the incident, although she does get nightmares. The boy, however, witnessed the entire incident and remembers clearly & consciously. His scars are more penetrating and eviscerating. Celine is the only family they have, but she is not a family. She is alone and a loner - part of the reason for her success in the work she does, but this makes it difficult for her to provide the unquestioning presence & constancy children who have suffered such as they need. They love her and she them, but the young boy is reaching difficult teenage years which is a different country at the best of times, without starting from such a desperately traumatised position. He does not understand anything except loss and anger. Celine is despairing because he has become so destructive. He makes no friends, he trusts no-one, he cherishes nothing. He has no idea how to invest in his future, he simply perpetuates the familiar cycle of loss, bereavement & rejection.

We talked at length about him. Two spinsters without children exchanging theories on what to do. In some ways, however, the cultural context of the UK, which attempts to be children-centric would be a kinder place than India, where expectations of good behaviour are high and deviations from the norm are treated as wilful intent to upset. This results in the poor boy constantly being told off, giving perpetual momentum to his dysfunctional behavioural cycle.
Celine is trying to teach him to be independent and look after himself, but thinking about it, that is exactly what he has had to do all his life. No-one has looked after or even nurtured him so the only person he trusts is himself and even that is fragile.

This middle group of children - not privileged and not destitute - are a forgotten segment of India's future. There are so many people to rescue in India, that those who appear not to be wanting in the most basic of Maslow's hierarchy of need are left to work it out for themselves. I have no idea what the state of child psychology is here, but judging how less than perfect it is in the UK, cannot imagine that is going to be more sophisticated. There are so many things he needs, but no-one has any idea how he might access them. I mean, that I can also say about some who come to see me at home. If the means of getting help for troubled children is obscure in Dalton, imagine how much more challenging it is here. Apparently, he did go to see a child psychiatrist once, who, on seeing his easy completion of age-appropriate motor tasks, concluded that he had no need for input because his development was normal.

In the absence of good child & adolescent mental health services, he might benefit from activity clubs where he could go to do things he enjoyed. For example, he loves cycling. Perhaps joining a club where he could meet people doing activities along side each other, learning gradually to get to know and like them through shared interests, would give him some confidence. However there are no such places like that in Bangalore, Celine says. I confirmed this on google.

In a pathetic attempt to show him that there are some people who, even if they don't know him, might care about him, I will ask my two to become pen-pals to him & his sister. I am sure they will consider it an arduous task, but it would be good to encourage them to do something for someone else's benefit entirely. Perhaps a small kindness from strangers prolonged over time may in a tiny way challenge some of his self-destructive beliefs. Of course it fixes nothing really; no doubt this is a response to being overwhelmed by the obvious contrasts between my easy life & theirs. Nonetheless, one day, I hope to bring the kids to India. If they have shared correspondence for a while perhaps it would also give them an interest to meet up.