Mumbai, India is not exactly a peaceful vacation destination. The metropolitan area there is about half the size of New York City but is home to nearly twice as many people. I knew going there would be anything but relaxing, but mayhem seemed intriguing nonetheless.Just past midnight May 29, my flight finally arrived at Mumbai International Airport. A disorienting crowd of shouting people greeted me suddenly as I stepped off the plane. For a moment, the chaos appeared to be a riot, but my exhausted and jet-lagged mind couldn't tell.

The purpose of my trip was to learn about health care delivery in this developing country. Most of the other students I was to meet in just an hour were American medical students. For the next five weeks, we would be rotating throughout different hospitals and clinics to observe family physicians and surgeons treat patients with infectious diseases.

Outside the airport, another mob rallied like excited adolescents behind a traffic divider at a concert. Actually, they were taxi drivers pushing and fighting for any passengers they could attract. The night air was oppressively humid. At nearly 1 a.m., the temperature was easily above 100 degrees.

I got a glimpse of one hand sticking out of the crowd holding high a paper sign with my misspelled last name scribbled on it. "Verizno," it said. Close enough, I figured. That's got to be me.

I leaned cautiously into the crowd to grasp his arm. He squeezed back, and poking through two other heads to greet me, my site coordinator Getu met me with a beaming smile.

"It's a miracle I found you!" I shouted, trying to be humorous. He probably didn't understand exactly, but shot back a short laugh and replied, "This is India, my friend! Come to the side!"

As we walked through the bulky iron gates protecting the airport, all I could do was repeat in my mind what I had previously learned about this part of the world: The rate of illiteracy is high, and prostitution rates even higher. Patients with infectious diseases common in Mumbai, such as leprosy, TB, AIDS and malaria, are rarely even examined, and those who are seen are given minimal medical attention, since supplies are very limited. Nearly 60 percent of the people in this city live out of destitution in chronically impoverished areas. But statistics are just statistics, I only later realized, unless you can put a face to them.

Although it was night, the dimly lit faces of people huddled over flame barrels were still visible. There were no street lights. As we moved along the dirt road, the noise from the airport grew quieter, and our walk to the hostel had suddenly become solemn. The eyes of families stared at me as we moved along the road. As my eyes adjusted in the darkness, I noticed piles of garbage and plastic bins of sewage outside the shacks of families gathered outside. The local physicians later told us that the sewage and exhaust from automobiles in Mumbai was so toxic that spending a day outdoors was about the equivalent of smoking 10 cigarettes. The homes were made of metal sheets conjoined like gingerbread houses with pieces of rope and rusty wire.

For a moment, I felt like I was watching a National Geographic program. Stunned by the poverty that was clearly visible, I stopped small talking with Getu and fell silent. The condition of my surroundings was too shocking to be lighthearted. My enthusiasm had disappeared. What was I supposed to do? Should I say something? Should I just pretend like it doesn't bother me so I don't make Getu feel bad? After all, he must live close to here.

But suddenly it was too late. A middle-aged woman approached me, clasping her hands together, pleading for something in her native language, Hindi. Getu heard me halt and spun around quickly to see what was happening. The woman clung to my arm with her withered hand and looked straight into my eyes. She was hunched over and looked starved, deprived of everything.

"Hey, is she alright-what does she need?" I asked Getu. He stood in silence for a moment, as if unaffected by the situation, and answered, "I'm not sure." In retrospect, I feel stupid for having asked that. There were a lot of things she probably needed. I stood there holding her hand, and when she began to moan, I lost all perspective of where I was. She coughed and struggled to speak between choked cries, as if someone she really loved had just died. Her presence was almost too much to witness, but I never thought to leave her. Suddenly, she dropped to the ground. I instinctively thought she was sick. Holding the tops of her shoulders in my hands I felt nothing but bones. Looking up at me again, she began to cry. The tears rolled down her wrinkled face and dissolved into the sand below our feet.

It was a heartbreaking sight. The woman looked as if she could be the same age as my mother. It was not so much the words she struggled to speak that caught my attention as much as the look in her eye, which revealed the saddest, most destitute expression I have ever seen in my life-the image of complete and utter poverty. No statistic could ever encapsulate the condition of that woman's life. I felt incredibly guilty for not helping her more. I simply left her on that roadside, never to see her again.

In the week that followed, the medical program got more intense as we began to interact more closely with patients. We touched protruding bones of skeletal bodies and listened to the breathing of tuberculosis patients. In some instances, the physician would say, "There is little I can do here, we'll have to wait." Limited medical supplies and testing equipment placed major restrictions on the quality of care that could be delivered. Even many of the American medical students were unfamiliar with diseases uncommon in the Western part of the world.

Still, many of the patients continued to suffer. While we took notes and glanced them over, withered patients just stared right back at us, giving up their fight for life more and more as the seconds ticked by.

At one point during rounds, I stuck behind to stay with one starving boy my own age. Looking at him with his eyes closed, his breathing heavy, I realized that some people must arrive at the brink of death like this all the time and have to choose whether it is best to keep fighting or just let go. It appeared illness is sometimes an obstacle just too great to overcome in the minds of those who experience it every day.

Most patients I saw, however, demonstrated incredible perseverance. In a leprosy clinic, one surgeon had us examine a leprosy patient whose fingers had become shrunken and clawed by the disease. As I reached out to feel her hands, she displayed a sorrowful look, immediately reminding me of the woman I had seen my first night in Mumbai.

"I have great pain here," she said, pointing to a spot on her palm.

"I know," I said, "Does it hurt anywhere else?"

"But it will be alright," she interrupted me. "Someday my hand will be better."

How could she be so hopeful? Here was a woman whose arms had been completely disfigured by leprosy. In addition to her physical ailments, she also woke up each morning in a state of extreme poverty with the understanding that her condition would continue to worsen if left untreated. The burden of unforeseen tragedies was against her in every way, yet she utilized the spirit of hopefulness. I realized that the most powerful medicine she could receive at that point was hope itself. Without the prospect for recovery, she held tightly to the notion that she would one day be healed, and that mentality was keeping her alive.

I attempted to foster that type of life-affirming optimism in my personal interactions with different patients. In conditions where limited medical supplies existed, it was perhaps the only thing I could have done.

Although the impact I made in these people's lives was probably minimal, the opportunity I was given to witness limitations in medical treatment sparked my commitment to make a change. I may never know why people must be forced to beg for food or why people suffering with curable diseases must die, but I know well enough that those things can be changed for the better. Although not always evident, the dangers of starvation, illness and extreme poverty occur everywhere in world, but having seen the faces behind those tragedies has made it nearly impossible for me to turn my back on it. Whenever I hear statistics in the news about poverty and starvation today, I just remember the faces of the begging woman and dying boy. It helps me regain a sense of what those figures actually mean for people.