Karaikal, India: Thursday, January 22

The boy with the haunting eyes peering out over the shirt collar yanked up to his nose like a veil is just about the worst case the Rotaplast doctors have ever seen. A kerosene stove explosion a couple of years ago left sixteen-year old Rajkumar with tight bands of mottled scar tissue around his neck pulling his head down, the chin melted away and lower lip fused to his chest; A painfully open cavity gaped where a mouth should be.

It’s mid-afternoon at the Vinayaka Hospital and the boy and his father are wordlessly watching doctors Angelo Capozzi and Ron Gemberling trying to figure out if there is anything they can do for the kid. The team is here in India mainly to repair cleft palates and lips, but Angelo says they often fit burn cases into their schedules if they see a way to get a child functioning better.

It’s all part of the triage process performed on the mission’s first day to determine who is going to receive surgery over the next ten days and who won’t. Hopefuls began lining up at 8:00 am on wooden benches, in saris and dhotis, gold nose pins and earrings, clutching number slips in the shady garden corridor outside. Many of them came with their entire families. The sight of so many deformed kids in one place, many of whom still manage a crooked, toothy smile for a Westerner, has an effect over time, reshaping one’s ideal of human beauty. It’s a long day for the heart.

Luckily for everyone involved, the team made it safely to Karaikal yesterday in a fifteen-car convoy from Chennai airport with all fifty-two boxes of critical medical equipment and supplies. The Karaikal Rotarians and the fabulous Paris International Hotel produced a traditional Tamil welcome: flower garland for each arrival, a dish of red powder and oil with flaming bits of camphor waved three times in front of the face, red tillak smudge between the eyes, a streak of sandalwood paste, and a sprinkle of rose water from the hotel’s lovely assistant manager, Lalitha.

The weary group, after 30 hours on various airplanes and a another seven hours by car on scary roads, accepted the honors graciously but seemed bewildered by the hubbub in the lobby. It wasn’t the red carpet at the Oscars but probably as close as this little south Indian burg by the Bengal Sea gets. Cameras flashing, videocams rolling, and assorted handshaking VIPs, Rotarians and dignitaries. A musical combo added some flavor with a wailing wooden horn, thrummed ivory fingercaps on a tabil drum, and brass tallam cymbals jingle-jangling.

Everyone was happy that Rotaplast had at long last arrived, especially Rotaplast. But staggering around in their blue and white Rotaplast t-shirts, it seemed like most of the team really just wanted to go pee and lie down. Instead, everyone loaded back into the cars for the official inauguration ceremony out at the Vinayaka Hospital where there really was a red carpet leading into a big auditorium.

Rows of seats were filled by students and teachers from the Vinayaka teaching college, including eager-beaver interns signed on to assist at the Rotaplast clinic next day. Speeches by Rotarians and hospital chiefs, capped by the awarding of gifts and mementos, highlighted the importance of the Rotaplast visit and the fact that the hospital is, in the words of one speaker, “hoping to find its place in the world as a plastic surgery center.” This would be interesting from a Hollywood point of view.

Karaikal Rotary’s ever-flowing generosity provided food and cocktails under the stars on the roof of Mr. Baraivan’s nearby factory, followed by a caravan back to the luxurious Paris where a long day ended in shared rooms, mosquito bites and strange snoring for most, and the hotel’s Thunder Bar for a die-hard few.

At 8:45 am this morning, a Mr. Pakirasamy and his five-year old daughter were among the first patients registering in the lobby of the Rotaplast clinic at Vinayaka Hospital. He’d traveled by bus from a small village 25 dusty miles away to get his daughter’s cleft lip fixed up after reading about the Rotaplast visit in a local Tamil newspaper. Louise Capozzi, in charge of charts and aided by Tamil-speaking Vinayaka interns, handed the man a form and he began filling it out with great care.

An older woman sat nearby on the row of metal folding chairs with her fifteen-month-old granddaughter who needed to finish a lip repair job done a while back in Mysore. Grandma solemnly avowed that “sins committed in the past” had caused her granddaughter’s deformity. Next to her was another little girl about the same age with what the surgeons like to call a “virgin lip,” one that had received no medical attention until now. Both girls sat without complaint in pastel dresses like any other kid in a doctor’s waiting room, despite their karmic burdens.

Down the line was little Vaishnery Sayamanny jamming her tiny fist into the space where lip and gum ought to be, a gesture common among the kids in this crowd. Her dad Rajendran, a 35-year-old farmer, said he wanted the operation for his daughter so that she could go to school unbothered and get a good education. His 22-year old wife wobbled her head back and forth from left to right. It looked like she was disagreeing with him, when actually it’s the regional way of showing assent. This disconcerts nearly everybody on the Rotaplast team.

By 9:15 am, Dr. Capozzi was noticing a lot infants weighing in well under 10 kilograms, the desired weight. “Either they are not thriving, or they have parasites, we’re just not sure why,” he says. Maybe the people here are just smaller, he notes. But they have to find out; the anesthesiologists don’t like working on kids who are underweight.

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