I had gone for two-and-a-half months as a surgeon to India in 2003, and worked at eight hospitals to understand how surgery worked in India. I worked from the largest hospitals in Delhi and Bombay to the smallest hospitals.

This was a part of what I was trying to understand is how surgeons there just did it. Like a lot of countries in Asia, the longevity in India is now over 65 years. At the same time cardiac disease has now replaced diurnal diseases; cancers are now in the top 10 and traumas are in the top five.

If the hospitals are given only $20 per person per year and if someone arrives with a heart attack or breast cancer or a simple bladder stone, it is not clear what is to be done.

In the district hospitals there, the doctors sometimes would have about 300 people arriving at a clinic on a difficult morning. They would have to see them maybe in four hours and there would be just about two or three surgeons trying to see them all.

How they did that with the modicum of resources they had was a lesson in ingenuity to me. It was a kind of bedside ingenuity. I looked at the way they worked around the system when it was in chaos or failure. The way they tried to make things work.

I was struck, for example, by Dr Ashish Motewar. He was a young surgeon like myself. On one day I would observe large numbers of patients who would come in with perforated ulcers at death's door often because of the hot chilies they eat there. This is a problem that requires a very big operation to close up the hole and save the person.

Dr Motewar figured out that in the case of the chaotic world he had to work in, he could use older laparoscopic equipment inexpensively. He got an assistant to be personally responsible for keeping it clean and in working condition. Because it is very expensive to replace the parts, he found ways to keep it in working order without buying anything new.

Using a laparoscopic camera and a few very simple instruments, he was able to devise a whole new operation to repair the perforated ulcers. He even presented a paper at a conference which revealed the operation to have fewer complications and better and far more rapid recovery than the standard procedure.

In a very poor and dust-covered town in Maharashtra, Dr Motewar and his colleagues had become among the most proficient surgeons in the world.

Image: Two Indian women who sustained injuries in a bus accident receive treatment at a hospital in Shimla, Himachal Pradesh.
Photograph: STRDEL/AFP/Getty Images

Also see: An American Passage to India

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