On this day of Keti Koti, July 1, celebrated to commemorate the abolition of slavery in Suriname, I ponder on my wonderful trip to Suriname. My heart skipped a beat. On June 8, three Sewa karyakartas met each other for the first time at Miami Airport searching for Suriname Airlines. We boarded the plane and wondered, Suriname, such a surreal name, perhaps a heavenly abode since it is in the Amazon. Partly informed and partly imagining we landed at Paramaribo, the capital city of Suriname, around 9 PM on June 8, 2024.

Roberto was already at the airport wearing a Sewa T-shirt with a gleaming smile on his face, just like your own brother, to receive us. He said, “Yes you are in the Amazon forest”! Suriname is a strip of land between the Atlantic Ocean in the North and the Amazon forest in the South. It is one of the most beautiful countries. “Here Mai and Baba came from Bihar 150 years ago to work and preserve Hindu traditions. We have temples, we have Hindu names, we have bhaithak gana, we have the Bhojpuri language, we have Hindustani roti, daal and sabji, bara kip, banana chips, and cassava chips! Here we celebrate Holi as a major festival in spring. People from all walks of life rejoice in the elaborate festivities, food, and Holika Dahan,” said Roberto!

Ashwin, a Sewa volunteer from Sewa International Suriname, also wearing a Sewa Yellow T-shirt brought dinner, lovingly made by his wife Madhavi and his sister Anoushka. We were hungry and ate the delicious food enjoying every morsel. We were chatting with our two newfound brothers, Ashwin ji and Roberto ji as though we knew them forever.

Roberto lit incense that kept the mosquitoes away throughout the night, reminding us of our childhood days in India. As soon as it was dawn, we had coffee and some granola and got into the Sewa van. We bid farewell to Roberto and left to Nickerie from Wanica. Ashwin was driving the car, and Deepak accompanied him to Nickerie. Deepak brought some more food that his mother made at his home for our journey. The family woke up at 4 AM to prepare lunch for us! The food was so delicious and made with so much love that it was irresistible. As the sun rose, we drove four hours to Nickerie. The unending two-lane road divided the vast paddy fields that were being prepared for sowing. The paddy fields appeared like an infinite number of mirrors reflecting light as the squares and rectangular fields were filled with water underneath the bright sky. Alongside the two-lane road, there are miles of canals filled with “cola water” supplying the paddy fields. The cola water, as the locals call it lovingly, is the dark brown water formed from the pith of the leaves fallen into the water from Amazonian trees. The water supplies the paddy fields making the rice one of the most organic produce. The road has sunk in some places since it is adjacent to the paddy fields and water canals. Ashwin knew exactly where to slow down and when to speed up. We enjoyed this road trip so much that we took turns driving a few miles each. To feel the road and the surrounding beauty was an experience so unique. Yes, we made it safely.

This is a large country with a very small population – just about 633,000 people in a country that is 63,250 square miles in size, with a population density of 10 per square mile! Hindus, at 27.4 percent of the population, are the largest ethnic/religious group.

We went through many villages where people lived peacefully and happily. Their main economy came from the crops in the villages. They maintained the toilets for the travelers’ s convenience for a small amount of fee on the roadway from Wanica to Nickerie. On the way, we were thrilled to find many temples with “Om” and “Swastik” embossed on the flags, flying high and assuring us in many ways. As we reached Nickerie, we stopped at the Sri Vishnu Temple. We were blessed to see many deities -- Ganesh, Hanuman, Siya Ram, Mata Rani, Shiv, Vishnu, Lakshmi, and Swayam Bhagwan -- in the temple. We offered our salutations and left to Mungra Medical Center to meet with the Director, Dr. Farah, the Coordinator, Inderjeet Jaglal, and the President, Ms. Abdul. We were invited with honor. We had a few minutes of briefing about what to expect and how to work at the Mungra Medical Center. Then we were escorted to our quarters in Nickerie provided by the medical center. There were two bedrooms, a living room with a kitchen, a bathroom, and a shower, all fully equipped and furnished matching American standards. We had hot water. We had air conditioning. We had king beds in each one of the rooms with comfortable mattresses and pillows, just as a three-star hotel would offer in the United States. This was a brand-new accommodation!

Thanks to Soniya ji, our Sewa karyakarta from Pittsburgh, we went to a grocery store nearby and brought milk. We then had our dinner provided lovingly by Deepak’s family, from Wanica. We then slept soundly in our comfortable beds. The next morning, we were at the Mungra Medical Center by 7 AM to receive the handover from the night shift staff to prepare ourselves to meet our patients in the wards. We introduced ourselves as Sewa international volunteers coming from the United States to the other doctors after the handover. The doctors and staff were very happy that we were there, although for a short time.

As an internist, I had the opportunity to make the rounds with the chief of internal medicine, Dr. Reyes.

We rounded in the internal medicine ward along with the medical ICU. Two medical students were rounding with us. We saw about 20 patients in the men’s ward, 15-20 patients in the women’s ward, and about six patients in the medical ICU. The infusion pumps are manual. They are not automated. The blood pressure cuff and the pulse oximeters are automated. The beds are not powered hospital beds. The wards are not air-conditioned. They do have fans to circulate the air. Gloves, masks, and hand sanitizers are all used very carefully. The examination of patients is done very carefully. The medications are bought by the patients, in the hospital pharmacy, just like in India. Most of the expenses are paid by the insurance that the patients carry. If not, they will pay out-of-pocket. Some of them refused treatment because they could not afford it.

In the medical ICU, there is telemetry available. Bi-Pap, CPAP, and non-rebreather masks are available, as well as oxygen. Unfortunately, the infusion pumps are all manual. The lab is not equipped with lactic acid/ABG/ in-house blood culture reports. There is no microbiology lab to perform Gram stain even, making it extremely difficult for physicians to treat complicated conditions. The physicians must rely on empirical methods. The patients are transported to Paramaribo, which is four hours away from Nickerie in case the patient’s condition deteriorates. There is an anesthesiologist to perform intubation as needed. The patients are transported to Paramaribo once they are intubated or placed on pressors or in anticipation of such critical procedures. One patient had to wait for a blood culture report for one whole week. She was being treated for staphylococcus pneumonia with Meropenem. Vancomycin is very expensive and is rarely used. This patient was also on a non-rebreather mask for oxygen. Her respiratory rate was 32 per minute and she was transported to Paramaribo for further management of a simple staphylococcus pneumonia. Thankfully, she was maintaining reasonable blood pressure and urine output and did not need pressors. Every day feels as though it is the impending end of life in this medical ICU. With many uncertainties haunting the patients, their families, and the physicians, this Medical ICU needs serious upgrades.

We also had a young woman with aortic valve replacement who went into SVT (Supraventricular tachycardia or SVT is a type of arrhythmia, or abnormal heart rhythm, that causes the heart to beat very quickly), but thanks to the cardiologist, she was administered Adenosine and revived her in the ICU. There was also a patient with DKA. The bold Chief of Medicine was skillful enough to treat the patient with minimal tools. There is no Arterial blood gas (ABG) available in-house. The next day we went to the outpatient clinic that they call “poly”. Each doctor has their poly. Each polyclinic serves 25 to 30 patients a day. They’re all seen within about six hours. Most patients spoke in Hindi, Surinamese, and Dutch. There is a nurse who could translate Surinamese to Dutch and vice versa. The blood pressure is measured on a mercury-sphygmomanometer. Yes, they have, two sizes larger cuff and a regular cuff. Most of the patients are overweight or obese. They eat a high-carbohydrate diet. Lean meats and high-protein foods are expensive.

Rice is the major staple food. Although the land is very fertile, Suriname lacks human resources. The fish are untouched even though available right on the seashore, uneaten by humans. Food is abundant, but not much is available for the people on their plates. The President, Cham Santokhi, seems to be coming up with projects to encourage young adults to become entrepreneurs and develop the nation. The efforts are in the very initial stage. The reasons why people are sick may be many. The most common conditions are diabetes type 2, hypertension, hyperlipidemia, cerebrovascular accident (CVA or stroke), ischemic cardiomyopathy, peripheral arterial disease, obesity, non-alcoholic steatohepatitis (NASH), and kidney failure.

One of the striking conditions we came across was “antiphospholipid syndrome”. Pregnant women with this condition are treated with Heparin from the early stages of pregnancy until delivery of the babies. Many mothers lost their babies during pregnancy due to this condition going untreated.

Our young Sewa Volunteer from Pittsburgh had a chance to rotate with one of the doctors in the pediatric ward at the Mungra Medical Center. Anoushka, a high school student from Pittsburgh, experienced one of the toughest situations possible in her life. She witnessed a teenage boy succumb to presumably drug overdose. The boy was from a broken family and was quite neglected. This young volunteer’s mother, Soniya ji, is a social worker who played a key role in our visit to Suriname. She was moved and made a significant effort to learn about the social structure of Suriname, which is unfortunately not immune to inequality, child labor, and child neglect, just as any of the downtown areas in the United States.

The Mungra Medical Center does have a dialysis center, called the “Brahma Dialysis Center”. It serves about 50 dialysis patients. The center has 25 dialysis machines, 2008 models. They are in working condition and have dedicated staff. It was heart-rending, however, to know that at least 25 dialysis patients died during COVID-19 times in this hospital.

The Mungra Medical Center is also the premier Institute in Suriname and is hailed as one of the best hospitals in the Caribbean and South America. Unfortunately, due to economic decline and financial struggles, the Center has been deprived of funding. Affluent people fly to the Netherlands or other developed countries to get their treatment or move to other developed countries to live a better lifestyle.

The general medical ward treated patients with an enormous number of medical conditions, including stroke, diabetic foot, pneumonia, uncontrolled hypertension, hypertensive emergencies, valvular heart disease, congestive heart failure, chronic kidney disease (CKD), asthma, chronic obstructive pulmonary disease (COPD), etc. Those with cancers go to Paramaribo for treatment in an academic medical center. Specialists are only available in Paramaribo. According to reliable sources, there is only one gastroenterologist for the entire country, with a population of 633,000! Vascular surgeons, gynecologists, neurologists, and orthopedic surgeons fly from the Netherlands or other neighboring countries to Suriname from time to time. Patients in Suriname are waiting for vascular access to get on dialysis. Patients are also waiting for upper endoscopy and colonoscopies. Patients wait for elective surgeries for many months at a time. Some of them elect comfort measures. However, it is unclear how comfortable they would be at the end of life in a place like Suriname.

Sewa Suriname provided a bed and a mattress to a person affected by a stroke. They not only delivered a bed but also assembled it for this person, who felt very grateful. Sewa International Suriname has been serving at the grassroots level to bring a sparkle to the eyes of those suffering from illnesses.

We had a very nice dinner with Ramanujam ji and his wife Dr. Reena in their beautiful home along with their two children in Paramaribo. We then took a little tour of the downtown, thanks to Ashwin who also showed us the city lights at night from a famous bridge. Words cannot describe the affection and hospitality that was showered on us by the Sewa Suriname team.

The oceans, the rivers, the birds and the butterflies, the greenest land of the Amazon forest, the sky that showers billions of tons of rain a year, the vast paddy fields, and the enormous treasure hidden in the ocean, the gold mines, the oil refineries, everything looks incomplete without adequate medical care for those in need. The physicians are overworked, but they pull through. They remain resilient just like the rishis and sages in India with the conviction to serve humanity. It is their calling.

--Dr. Sarvalakshmi Uppuluri