The McRae family, with two-year-old Mark and now sporting a new pair of twins, rolled up to the house. Crystal said, “I guess Lisa is still here.” Lisa is a friend of the family that offered to house-sit while Colin and Crystal picked up their twin boy and girl in India. Unfortunately, Crystal had texted Lisa that they would be arriving January 1, 2011, but they were rolling up on New Year’s Eve instead. It’s hard to believe you can catch a 5 am flight from Mumbai and arrive at 3 pm the same day at Dulles International Airport near Washington, DC. But that is what happened, due to the time difference. This surprised Crystal, but more importantly it was going to catch Lisa completely unawares.
|Alec and Elle in their bassinet|
Taking the key and inserting it into the front door, Colin didn’t quite know how to announce their arrival back home. It’s his house, so you don’t ring the door bell, right? He opened the front door and walked in. Lisa must have thought there was a slight chance this was a home invasion or something, as you always wonder when you hear someone just walk in the front door but can’t see them yet. She called down, “Who’s there?”
|Mark on the flight home|
Lisa had been cleaning and changing sheets getting ready to turn the house back over to Colin, Crystal and the kids. She was ahead of the game for the McRaes’ previously announced arrival time, but lingered another hour or two to make up for the day lost in the transition. Meanwhile, the neighborhood caught on to the fact that the new twins had arrived in the country, and trickled in with offers of champagne and food. It was a welcome impromptu party. The neighbors melted away quickly out of respect for the long trip home, but Colin would have liked the party to continue. It was New Year’s Eve, and after you have been up for 72 hours or so, what is a few more hours?
One of the neighbors asked Colin, “You got back fast. I guess it went well?” Colin replied that it was like winning a leg of The Amazing Race. Which – if you’ve watched that show – could be considered going well, but it sure wasn’t smooth or easy.
Rules of the Game
Colin and Crystal were parents of twin surrogate newborns, Alec and Elle. In Indian surrogacy cases, the parents have to pull off three challenges. (So maybe it is like Survivor, not The Amazing Race). The challenges are a birth certificate, citizenship and an exit visa for the baby, in that order. I’ll speak from a U.S. perspective when it comes to the McRaes, because they are Americans. The babies were not U.S. citizens at birth but they had a right to become citizens because Colin is their biological parent. Parents travel with the birth certificate from where the baby was born to the closest U.S. embassy to get the baby a passport and Consular Report of a Birth Abroad. Those are the American documents. The birth certificate and exit visa are from the Indian city and state of birth.
For Colin and Crystal, the game was to obtain each of the three documents as quickly as possible to avoid running up the hotel bills. They had cash for about two weeks in India, though the money had initially seemed like a month’s worth (blame the hotels; more on that later). They knew parents from countries that frown on surrogacy that had waited months for citizenship, but they didn’t have those kinds of resources.
Prem the Fixer
To obtain the babies’ birth certificates and exit visas, everything depended on Prem Saluja and, to a some extent, on Prem's friend Gentibahn. Genatibahn works at the Nayana H. Patel clinic in Anand. (The real name of the clinic is Akanshka, but for foreigners at least it’s the Patel clinic). Prem doesn't work there but he knows how to smooth the way to birth certificates and exit visas. Prem got into the game because he is good friends with Nayana Patel’s husband. Prem can get you the birth certificate in a couple to three days, and the exit visa in one day if you send documents ahead.
Prem’s rate is whatever you think his service is worth. Preferable terms of payment include Johnny Walker as well as cash, because his home, Anand, lies in the dry state of Gujarat. Prem picked Colin and Crystal up in the domestic airport of Gujarat’s capital city, Ahmedabad, after their one-hour flight north from Mumbai. He hugged them and helped take their bags to his new Toyota van. Prem went years back with the two new parents. He handled the driving and paperwork for their first son, Mark, who like the twins had been born in the Patel clinic.
Prem has a way of winning you over. It seemed to Colin that each day he would say something like this: “You know these guys [the Indian bureaucrats], they are in it for the money. I am only for you.” He would also remind you that he is a Christian that depends on faith and the power of good works coming back to reward him. He once said “You know, Colin, you cannot get out of bed without faith.” This statement of faith was inspired by their visit to a Hindu shrine some hour’s drive from the airport Colin could only reach with Prem at the wheel. So naturally Colin replied, “Well, right now my faith is in you”. Prem has never let his clients down. You might think he is just playing the good cop to the bureacrats’ bad cop, and maybe he is. But he delivers in the end.
Colin would try discussing questions of India with Prem. “I see bulls in the street”, he said. “In Pamplona [Spain], people run from the bulls and sometimes die. How can it be so different here?” Prem said nothing. Colin continued, “It’s the same way with the dogs. Many dogs in the U.S. scare at least some people. Yet with the dogs here, I can’t imagine anyone being scared.” Prem replied, “This is true”, deepening the mystery for Colin.
Poverty and Traffic
When Prem picked up the McRaes, it was an hour after dusk. The car lights lit up enormous clouds of dust. Had it been daytime, the source of the dust would have been visible: nearly every road except the major highways has a border of 10 or more feet of dirt that makes its way onto the road for the cars to kick up. Often the dirt is strewn with garbage. Later Nayna Nagath, the twins' surrogate mother, would remark on how nice it was for Mark at age two to take a wrapper to the trash bin. “Adults don’t even do that here”, she said in Gujarati.
In addition to the garbage, the dirt strips (or occasionally, sidewalks) host slums in all the villages and towns. The slums have walls of plywood and plastic, corrugated metal roofs, and of course no water or sanitation. One slum Colin had noticed on day trips had shelves lined with shiny, new-looking two-level pots for cooking traditional Indian dishes. Another had brand new commodes lined up in front for a family that must have been in that business. Many times the slum was not a residence but a vendor selling packaged foods with Hindi labels an American would never see outside India or buy in India. To complete the day-time picture, vendors with pushcarts line the dirt margins selling vegetables and fruit. You can buy a pineapple the vendor held with his bare hands, last washed Lord knows when, to cut up into a special ornamental shape that the market must demand.
But this was night time, and Colin only remembered the daytime picture from his last visit two years prior to pick up Mark. Crystal had been back several times on her surrogacy facilitation business, but Colin had stayed back home caring for Mark. Traffic ranged from pedestrians to bicycles on up to motorcycle, camel-drawn cart, autorickshaw, sedan, and finally large trucks. The sedans are what you would see in the west. The rest isn’t. The trucks are not semis. They are Tata dump trucks usually laden with fruit or vegetables. The autorickshaw is an immensely practical three wheel vehicle, about 10 feet long, often with families of six bursting out the sides. Motorcycles are the family car for many Indian families. You’ll see men, women with saris that could catch the spokes any second, and young children share a motorcycle. Of course no one wears a helmet. Bicycles are always one speed, and they are the commuting car for manual laborers like the grounds keepers at your hotel.
As always, traffic weaved together in a dance of friendly horn toots. Colin saw just one aggressive driver, weaving past traffic with quick lane changes, in the whole trip. It must have been a Washington beltway driver on vacation. The rest of the time it was toot your horn if you are not giving way; toot your horn if you are passing. Just about every vehicle with more than two wheels – except those fancy sedans – says “Horn OK Please”.
There are lane markings on many roads, but drivers ignore them. There was one forlorn sign on the trip from Ahmedabad asking drivers to stay in those lanes. Drivers not only ignore lane markings, they routinely drive in the wrong direction for their side of the road. If you can’t cross traffic right now but want to get going, just start off pointing the wrong way for a bit. To cross traffic, and at traffic circles, drivers signal with speed and horns to show their determination to cut other traffic off, or their willingness to give way. Whether taking charge or giving way, the drivers’ faces are serene.
Prem, like the other drivers, showed no strain as he negotiated this traffic on the 90 minute trip from Ahmedabad to Anand, home of the Patel Clinic and the new babies awaiting Colin and Crystal. Prem knew the challenges the couple were facing this time. But he was confident they could finish in under two weeks, including travel. “Today is Wednesday”, he said. “You left Sunday. You will be back home with the twins very soon. Do not doubt it.” It had not been quick to get Mark out of India two years prior, when the exit visa was one simple stop at the Anand police station. In their favor this time, apart from being savvier, was the holiday schedule. Mark was born just before an important holiday, Diwali. This time all that stood in their way was Christmas and New Year’s Day.
Meet the Twins!
The couple would not visit their twins that night, instead settling in at the Madhubhan Resort some 15 minutes from the hospital where the twins lay. This may seem cold, but Prem, who had dealt with so many parents of surrogate babies, didn’t even raise the possibility of visiting the twins. He knew the McRaes were still tired from the flight from the U.S. to Mumbai, where they had laid over for a day before flying to Ahmedabad. And he knew the focus was the paperwork, not bonding with the new babies who were in good hands anyway.
Once they arrived at the resort, the McRaes were told that they did not have a reservation. They did have one, but not in the computer system. (This would happen at the next stay in Mumbai at the Leela too; in India, you should confirm your room several times to be sure!). It looked like the McRaes would not get a room, because with wedding season the whole place was booked. Out of the blue, though, a manager appeared that Crystal knows. Starting from no reservation, the manager got them a room for most of their stay but they'd be kicked out one night. By letting the matter drop right there, the McRaes figured no one would have the energy to kick them out later, and indeed that's how it worked out.
The McRaes had wasted no time requesting the birth certificates for the twins. On Tuesday, Colin had scanned birth certificate request forms sent them to Prem, who had already done much of the legwork before coming to Ahmedabad to get them.
While Prem continued to expedite the birth certificates, Crystal and Colin went to visit the twins Thursday morning at the hospital. This was not the clinic where the twins had been born; it was Apara Hospital, about two blocks away. The twins had been born at 36 weeks of pregnancy – full term by Indian standards – at 4 pounds 10 ounces and 5 pounds one ounce. Though she was the “fat” one, Elle was the one that needed more help. She had initially experienced trouble breathing and was under the lights for jaundice. She was the better eater, but both were eating well enough to leave by Friday.
As the couple had expected, the experience of meeting the twins left them flat. For months people had stopped them and asked, “Are you excited?” But parents of foreign surrogacy babies don’t even see the pregnancy develop, let alone feel it. They bond when they begin caring for the infants. Colin recalled bonding with Mark, their older surrogate son. It was Mark’s utterly sincere, wide-eyed urgency in gobbling down milk in one 4 a.m. feeding some weeks after he was born that really cemented the bond. Crystal had bonded a bit earlier with Mark, starting by seeing his birth and hearing him scream with his first needle at Apara Hospital. But this time the couple had come after the birth and bonding would set in over the coming weeks.
Crystal tried to take passport photos of each twin. The requirement is to show the whole face with both eyes open and both ears visible. Alec was the easier of the two. Like all three-day-old infants, he flailed a bit and moved his head from side to side. By holding the camera and taking photo after photo, she finally lucked on a couple views meeting all the criteria. Elle, on the other hand, had to be taken out from under the lights. The mask she had been wearing to protect her eyes made her very slow to respond and Crystal gave up. Crystal took the photo of Alec to a shop one block away, where they would clear the background away and add a missing ear on one of the shots. “How much will this cost?” Crystal asked. “90 Rupees’, the shopkeeper answered (two dollars). “For each, right?” she asked, surprised at paying about a tenth what it would cost in the U.S. “No, it’s 90 Rupees for both. Come back at noon.” Later, Prem had a professional photographer from the same shop return to get beautiful shots of each twin.
Whereas Dr. Patel has been on Oprah and comes to the top for many surrogacy search terms in Google, it is almost impossible to find Apara Hospital on the web if you start off knowing something about it but not its name. Yet its function is very significant in the community. It serves hundreds of the neediest patients every day at pennies apiece, or for no fee at all. The driving force behind the hospital and the names at the entrance are Doctors Anita and Ajay Kothiala. Parents of surrogate babies get to know Anita, because she is the pediatrician. Though well-traveled in the west at the start of her career, she weighed her opportunity in terms of how many she could help rather than how much money she could make. She knew the opportunity she wanted was back in India.
To visit Apara Hospital, parents walk or take a rickshaw from the Patel clinic to Shubhlaxmi Shopping Center across Station Road. The rickshaw drops you off a short block away over a dirt alley with a few mud puddles that must really be tiny cesspools. Someone may have a large fire going with nothing cooking over it. Scruffy men, some chatting, some with carts selling unfamiliar foods, dot the sides and often the middle of the path. Skinny stray dogs that never approach people and never bark pick at garbage. Some vacant storefronts and others with unclear purposes line the alleyway, validating (I suppose) the area’s designation as a shopping center.
Colin and Crystal walked up the stairs to the second floor of Apara Hospital and entered the waiting room of Dr. Anita Kothiala. As always, thirty or forty barefoot people with young children lined the solid granite benches waiting for the doctor, but Colin and Crystal did not need to remove their shoes or wait. They were ushered into the doctor’s office, where Anita got up to hug Crystal and Colin. She knew them from when Mark was born and cared for at Apara. Dr. Kothiala explained the conditions of the babies and estimated a total bill for both to stay 9 days in NICU at $700. Though it’s a bargain by U.S. standards, Crystal figured that this kind of fee is princely by comparison and was the reason they never had to wait.
Far more emotional than their first meeting with the twins was the reunion with their surrogate mother, Nayna Nagath. Nayna had also delivered the couple’s two-year-old son Mark before delivering the twins, and had cried when she said good-bye to him as a weeks-old infant. Colin and Crystal could have left Mark with his uncle or grandparents for the current trip. A big reason to bring him instead, in spite of his being perhaps the worst age for travel, was to reunite Mark with his surrogate mother, at least for a couple of visits.
Colin and Crystal made their way back through the dirt alleyway, then crossed busy Station Road, to the Patel Clinic. Nayna Nagath was resting up from her Caesarian delivery in a room with a dusty tile floor, four clean cots and a filthy bathroom on the second floor of the Clinic. Nayna’s husband Gabriel had brought food in the same kind of two-level pot that Colin had spotted on the shelf of a well-kept slum. When the couple entered the room with Mark, at first Nayna smiled, hugged him and kissed him. Mark squirmed of course, and when he turned away Crystal and Colin saw tears in Nayna’s eyes. Mark was thriving, and Nayna knew this right away. Everyone cried a little bit. People in the room tried everything to get Nayna some quality time with Mark. The direct approach didn’t work, like “Mark, go give Miss Nayna a hug.” Later though, Nayna’s husband Gabriel broke the ice with a game you could call “throw-the-fruit”. He placed three ripe Mandarin oranges and several miniature lemons on the cot next to Mark. Mark started throwing the fruit, and people around the room tried to save it from landing on the floor and bruising. Win or lose, Mark squealed in delight with each throw and his enthusiasm caught on. Colin – not liking waste of any kind – picked up each orange as it hit the floor, which they all did eventually. He peeled the skins and separated the sections, then offered them around. Finding no takers, Colin ate most of the oranges, but tried to hand a slice or two to Mark. Nayna would have none of it. She intercepted the handoff and removed every piece of zest for a toddler’s sensitive palate and stomach. Then she handed it to Mark.
Crystal waited to be alone with Nayna and Gabriel. She handed them $1500 to supplement their surrogacy fee, which the clinic handles but Crystal knew to be in the range of $5000 to $7500.