Contrast is rife in Biraul. The very poor sit shoulder-to-shoulder with the… slightly less poor. Nervous, skinny children tag along behind their overweight parents. Modern SUVs skirmish with horse-drawn carts and rickshaws for precious road space.

Contrast is rife in Biraul. The very poor sit shoulder-to-shoulder with the… slightly less poor. Nervous, skinny children tag along behind their overweight parents. Modern SUVs skirmish with horse-drawn carts and rickshaws for precious road space. A few doors down from the HD television shop they sell maggot-ridden potatoes. The last month has seen the arrival of ‘Festival Season’ in which some of these contrasts have become even more sharply defined.

One of the larger festivals, Durga Puja, is a ten day affair that has seen the faeces-lined mud tracks outside the office replaced with mud tracks lined with stalls, banners, stands, theatres, loudspeakers and even a couple of merry-go-rounds. Bright colours settle impermanently on any available surface, even those of unsuspecting livestock.

Festive cow
Festive cow © Luke Chapman

The shops selling staples, fruit and vegetables have been complemented by a large number of stalls selling cheap jewelry, plastic toys, incense and a hundred other things generally considered inedible. I repeatedly witness an exchange which had been quite rare in Biraul up until now (but I imagine is pretty rampant this time of year in the UK high street):

Customer: “Greetings Shopkeeper, do you perchance sell things of no practical value?

Shopkeeper: “Why of course, things of no practical value are my specialty in this, my humble place of trade! How much is Sir looking to spend?

Customer: “Spend? Oh, I suppose you too need things of no practical value, and I cannot murder you or steal from you with all these people looking, so therefore I will have to give you some money. I would like this decorative plastic model of a waterfall, and I will give you one rupee for it.

Bartering ensues.

Shopkeeper: “Although I am dissatisfied at the deal just brokered, I can see we have reached an impasse. Therefore, I would be showered in blessings if we are to make this exchange in the hope that one day you will return to my humble place of trade."

Customer: "I too feel peculiarly unfulfilled by this transaction. My culture and society told me I wanted this decorative plastic model of a waterfall (which I now see to be poorly crafted and somewhat garish), so I bought it. Nonetheless, I’m not going to let a touch of buyer’s remorse spoil my day – I’ve still got a little to spend on things of practical value, like food, and besides - it is festival season. As for my return, I promise it with a smile, which unfortunately for you, means nothing of any value whatsoever."

Value does not solely lie in practicality of course. Through the miracle of trade, all of Biraul gets a bit richer, and with money comes development. But when going into work in the morning to see the malnourished kids, it’s still strange to walk past the mass sale of things they cannot eat. Maybe this is the point of festivals – a time of hope when you allow yourself to throw caution to the wind and do a few things in the name of fun rather than function. I am in no way criticizing (it would make me a terrible hypocrite!) – in this month of celebrations our programme helped families of 169 children to cure their severe acute malnutrition.

Not everyone is celebrating though. One of our patients, a seven month old we can call Sam, finally left the Stabilisation Centre after almost six weeks as an inpatient. She had had a stormy ride. Eventually we cured her sepsis and stopped her diarrhoea. My last memory of her is with a smile on her little face, happily shaking a rattle. A day later her mother took her home against medical advice: earlier than we would have liked, but in a good condition. The diarrhoea and the fevers stayed away, as did any other medical complaint. We asked her mother to at least come back to the next clinic, three days hence. She turned up after five days, by which time Sam had somehow managed to lose 700 grams. Small change if you are privileged enough to have a few extra pounds around the waist, but a mortal blow if you only weighed 3600 grams to start off with. Sam died the next day.

Her mother claimed that over those five days, she had given Sam food and fluids just as we had been doing while she was in the Stabilisation Centre, but if this is true, Sam’s fate is completely baffling. Can all our health education messages to her really have failed? Did we not give her the tools she needed to properly look after Sam? Or, to think the unthinkable, could Sam’s family really not have cared that much for the well-being of their youngest daughter?

Accepting this would, for me at least, be paramount to giving up hope - laying down and accepting that these tiny little humans are not entitled to a life. MSF reject this. Where there is no hope, they create it. Sometimes it is not cheap to do, and just occasionally the main result is the creation of hope rather than its fulfilment. What value you give to hope itself... well, I suppose that is subjective. I don't know what our hypothetical shopkeeper would charge for it, even in festival season. The more I see, the more I believe it is priceless.