Sashan
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Signboards for businesses in Lajpat Nagar advertising in both Dari and English to appeal to the large population of Afghans in the neighborhood.
NEW DELHI – Three years ago, the family of Rohullah Afzali, 23, a medical student at a university in Herat in western Afghanistan, noticed changes in his behavior. He was often brooding, anxious and sometimes angry. He would stay awake for three, even four nights on end.
Doctors suspected he had a bipolar disorder and possibly even schizophrenia. But the medicines they prescribed weren’t helping. On subsequent visits to clinics and hospitals in Kabul, doctors told Mr. Afzali and his family that there were no options in Afghanistan for further treatment.
So the Afzalis did what hundreds of thousands of Afghans have done in recent years, which is to travel to New Delhi for treatment in the city’s private hospitals, which offer sophisticated treatment at far lower prices than in developed countries.
“India is famous in Afghanistan for its modern hospitals and availability of medicines,” said Boman Ali Afzali, the father of the medical student, in an interview earlier this week. “Everyone we spoke to told us success stories and suggested we come here.”
The staggering influx of Afghans traveling to Delhi is partially the result of India’s introduction of a special medical visa for Afghans in 2005. These medical visas are free and do not require applicants to provide financial statements or proof of medical insurance.
According to the Indian Embassy in Kabul, over 100,000 medical visas have been issued just since the beginning of 2010, about half the number of total visas for travel to India from Afghanistan in those three years.
Twenty flights operate weekly between Delhi and Kabul. In the fall, as the weather in Delhi cools, airlines use bigger planes and sometimes add extra flights to accommodate increased traffic.
Several Afghans I spoke to explained that the vast majority of the Afghans who visit India on medical visas do not have life-threatening or serious ailments. The mild weather in Delhi provides an escape from the bitter chill of Afghan winters, so from mid-October and March, Afghans combine visits to orthopedists, ophthalmologists, dentists and even cosmetic surgeons with family vacations in the Indian capital. Only the most severe prognoses bring patients to Delhi in its punishingly hot summer.
Mustafa Shojaee, 20, from the Panjshir Valley, has been in Delhi for around two weeks. His mother has had persistent but mild stomach problems. Mr. Shojaee and his brother accompanied her and consulted doctors at the upscale, privately run Max Hospital in the Saket area in south Delhi.
These days, while she is at the hospital accompanied by his brother and an Afghan translator, Mr. Shojaee wanders about a few streets in the Lajpat Nagar neighborhood, which are the epicenter of Afghan life in Delhi — a little Kabul. Restaurants like Kabul-Delhi and Afghan Darbar are interspersed with pharmacies, travel agents, barbershops and moneychangers, all advertising in Dari, Afghanistan’s lingua franca.
A street vendor selling Afghani naan, a popular flatbread, in Lajpat Nagar, New Delhi. Many Afghans said naan is what keeps them in the relatively expensive part of the city.
The ethnic network is what the visiting Afghans rely on. Cab drivers at the Delhi airport bring the Afghan arrivals straight to Lajpat Nagar, where signs in Dari are like open doors, greeting them.
If they can’t speak Hindi or English, most Afghans rely heavily on the established presence of Afghan refugees. The office of the United Nations High Commissioner for Refugees in Delhi estimates that over 11,000 Afghan refugees reside in and around Delhi. Roughly a third of them are Muslims of ethnic Afghan extraction, while the rest are Hindus and Sikhs who used to be part of sizable minorities in Afghanistan.
Refugees run many of the businesses that line Little Kabul’s streets in Lajpat Nagar, providing the comforts of home as well as services tailored to the needs of medical tourists.
Most essential to sick Afghans and their families are the tarjuman, or interpreters, who help them negotiate the health care system and the city.
There are two types. One kind operates privately. Clients often contact them before arriving from Afghanistan, having gotten their names from a friend or relative. These tarjuman often meet clients at the airport, and then charge a daily fee, usually between 500 and 1,000 rupees ($8 and $20).
These private tarjuman, while sought out, are sometimes disdained by Afghans. Many of them enhance their earnings by asking cooperative storeowners and service providers to mark up prices and then give them a cut.
Ali Sher, 20, a private tarjuman, said he and his ilk are unfairly branded as thieves. “In the jungle you can find every kind of animal,” he said. “Some of us are definitely corrupt, but other Afghans should understand that as refugees, we only survive here because of this business. What else would I do? We’re chained to this life like prisoners.”
Mr. Sher said he fled Afghanistan after the Taliban jailed his father when he rejected their request to employ his five sons as day laborers. In jail, he said, guards beat his father until he vomited blood, and he died soon after.
Now, Mr. Sher said, when he sees men with flowing beards in the style of the Taliban, he wants to kill them. Instead, he takes his revenge by occasionally overcharging them as a private tarjuman – a rare deviation from his principles, he assured me.
An Afghan man crossing a street in the neighborhood of Lajpat Nagar in New Delhi on Oct. 30.
The second kind of tarjuman works in the gray area of hospital officialdom, wearing an approved ID badge as they wait in the hospital lobbies for prospective Afghan clients. Some Afghans allege that these middlemen receive a percentage of all costs incurred by the patients they are assigned to help.
In an email, a spokesman for Apollo Hospital, one of the most popular facilities in Delhi for Afghan medical tourists, said Apollo paid no interpreters but issued the IDs after doing a background check.
Boman Ali Afzali chose Medanta Hospital for his son’s preliminary examinations after seeing an advertisement written in Dari posted on the wall of their hotel lobby in Delhi. They hired a tarjuman waiting in the hospital lobby.
At Medanta, the younger Mr. Afzali was prescribed antidepressants similar to the ones he had taken in Afghanistan and was told to return in three days. Uninspired by the doctors at Medanta, the former medical student quickly gave up on Medanta and turned to the next hospital he knew of, Apollo.
There, a tarjuman wearing an Apollo ID convinced the elder Mr. Afzali that his son needed an M.R.I. scan and an EEG. The tarjuman said the doctor was insistent, but the younger Mr. Afzali objected. From his studies he remembered these examinations’ purpose and knew they were both costly and unnecessary.
His father prevailed. “We cannot compare money and life,” he said.
But after acknowledging that the two tests alone cost him 15,000 rupees – equivalent to $245, a great sum in Afghanistan, where the average annual income is $470 — he asked me, “How would you feel if this happened to you?”
By this point, the initial upswing in mood that his son felt in India had long worn off. They spent 5,000 rupees at a pharmacy for three months’ worth of antidepressants and decided to return home. But the travel agent contacted them later that day with a proposition.
Mehdi Mahrammi, who prefers to go by the name Ilham, or “innocent” in Dari, is of Hazara ethnicity, like the Afzalis, and hails from a neighboring district within Ghazni Province. Mr. Mahrammi persuaded the Afzalis to postpone their flight and give the treatment one last shot in India – without the “help” of a tarjuman — at a smaller private hospital in Lajpat Nagar that specializes in mental health.
When the younger Mr. Afzali arrived at the new hospital, he began to have a nervous breakdown in the lobby. Five guards couldn’t restrain him when doctors attempted to inject a tranquilizer. Only his exhausted father’s soothing words calmed him down.
Later that day, Boman Ali Afzali sat with his hands in his lap on a bench in a gray hallway, looking blankly at the door to Room 15, where his son slept inside. A man in a gray uniform unhurriedly mopped the hallway. A line of sullen looking patients waited at one end to be served food near two others, who played chess at a syrupy pace.
The father stood and walked into his son’s room. Dr. Shivani Aggarwal had confirmed the younger Mr. Afzali’s concerns at Apollo Hospital, finding that the M.R.I. and EEG were unhelpful in reaching any kind of diagnosis.
Dr. Aggarwal had also told the elder Mr. Afzali that they would need to stay in the hospital for at least one more week. She explained to me that certain mental conditions like psychosis and schizophrenia can make the patient a danger to himself and to others. “He may be imagining things that are not there and thus acting contrary to reality,” she said. “He is very unwell.”
When the father came out, he said his son had something to tell me. I went in, shook the young medical student’s hand, which was trembling, and sat down.
There was no need to sit, he said: “I have one sentence to say to you — I want to go back to Afghanistan today.”
Max Bearak is a freelance journalist based in New Delhi.
