The bus to Kharidanga Village left at 5:47 AM, and the moment we started moving, I knew this wasn't going to be one of those smooth government buses with cushioned seats and working suspension. This bus might have seen better days, probably back in the '90s and now it rattled and groaned by every pothole we hit.

  I sat near the back with my bag wedged between my feet, one hand braced against the window frame to keep from bouncing into the aisle every time we hit another crater in the road. The window wouldn't close all the way, and cold morning air whistled through the gap, but at least the view was something to look at. The city fell away slowly—first the tall buildings and traffic lights, then the smaller shops and residential blocks, then finally just fields stretching out on both sides. Green and brown and endless, broken up occasionally by small clusters of houses.

  Murin was sitting beside me with his earbuds in and his head tilted back against the seat. His eyes were closed, but I could tell from the way his jaw was set that he wasn't sleeping.

  There were fourteen students total, scattered throughout the bus. Most of them were from our batch, a couple from fourth year who were apparently doing this for extra credit or because they actually believed in community service or whatever. They were clustered near the front, talking in that nervous, too-loud way people do when they're anxious but trying not to show it. A girl two seats ahead of me was already looking green around the edges, one hand pressed to her mouth, the other gripping the seat in front of her like she was holding on for dear life.

  Up at the very front of the bus, standing with one hand on the back of the driver's seat and the other braced against the overhead luggage rack, was Dr. Elena Voss. She was our Internal Medicine attending, and I remembered her mostly for two things: one, she could diagnose a patient just by looking at them from across the room, and two, she had absolutely zero tolerance for bullshit. She was in her late thirties with sharp features and dark hair that was starting to go gray at the temples. She'd pulled it back into a tight bun that made her look even more severe than usual.

  The bus lurched over another pothole, that made everyone's teeth clack together, and Dr. Voss didn't even sway. She just shifted her weight slightly, adjusted her grip on the seat back, and kept looking out at the road ahead. Then she turned around to face us, and the nervous chatter at the front of the bus died immediately.

  "Listen up," she said. Another thing about Dr. Voss, when she wanted your attention, you gave it to her, whether you meant to or not. Everyone went quiet. Even the girl who looked like she was about to puke turned her head to listen.

  "This camp isn't a vacation," Dr. Voss said, her eyes scanning over each of us. "This isn't one of those feel-good medical tourism experiences where you take selfies with poor villagers and pat yourselves on the back for being such compassionate future doctors. This is real and raw medicine. The kind we don't see much of anymore in the city hospitals because we've got infrastructure and systems and safety nets."

  She paused, letting that sink in, and the bus hit another bump that made her sway slightly forward before she caught herself.

  "Out there," she continued, gesturing vaguely toward the window and the fields beyond, "you're going to see things you don't see in textbooks anymore. Diseases we've eradicated in urban areas. Malnutrition on a scale you've probably only read about. Chronic conditions that have gone untreated for years, decades, sometimes because the nearest hospital is three hours away by bus, assuming the roads are even passable. You'll see people who have never seen a doctor in their entire lives. Children who've never been vaccinated. Women who've given birth five, six times without ever setting foot in a clinic."

  The nervous guy up front opened his mouth like he was going to ask a question, but Dr. Voss kept talking.

  "You will have no labs," she said, ticking points off on her fingers. "No imaging beyond maybe... maybe a portable ultrasound if we're lucky and if the battery doesn't die. No subspecialty consultations. No attending to call when you're not sure what to do. Just your eyes, your hands, your brain, and whatever supplies we can physically carry in these bags." She kicked the duffel bag at her feet for emphasis. "If you screw up out there, people suffer. Real people, not standardized patients who get up and walk away after the OSCE. Questions?" Dr. Voss said, her eyebrows raised like she was daring someone to ask something stupid.

  I looked down at my hands, then back up. Raised my hand. She looked at me, and I saw something flicker on her expression "Ashrahan," she said.

  "Dr. Voss," I said, and I had to raise my voice a little to be heard over the engine. "What do we do if we get a case that's... borderline? Something that could be medical or could be surgical? Like abdominal pain that might be gastritis, might be appendicitis. Who makes the call on something like that?"

  She nodded slowly, like I'd asked exactly the right question. "Good question," she said. "You're going to learn to differentiate between those presentations very quickly, because you won't have the luxury of hedging your bets. Out there, you can't just order a CT and let radiology tell you what's going on. You're going to have to trust your exam skills and your clinical judgment, and yes, you're going to be wrong sometimes. That's part of learning."

  She shifted her weight as the bus took a sharp turn, her hand sliding along the luggage rack to maintain balance.

  "Dr. Okafor is handling surgical cases," she continued. "I'm taking medical. But like I said, the lines blur. A belly pain could be peptic ulcer disease, could be cholecystitis, could be a bowel obstruction, could be a ruptured ectopic pregnancy. A fever could be malaria, could be typhoid, could be acute cholangitis from a stone. You'll learn to make those calls based on history, exam, and context. And when you can't make the call, you'll learn to collaborate. You'll find me or Dr. Okafor and you'll present the case and we'll figure it out together. And if we still can't figure it out, we'll evacuate the patient to the district hospital. But that's a last resort, because the roads are bad and the nearest hospital is hours away and sometimes patients don't survive the trip. Any other questions?" she asked.

  Nobody said anything. Dr. Voss looked at us for another moment, then nodded and sat down heavily in the seat behind the driver. She pulled out a notebook and started writing something, her pen moving steadily across the page even as the bus jounced and swayed.

  I looked down at my phone, making sure I was angling it so nobody else could see the screen, and activated the System.

  150-300 XP over three days. That was more than I'd earned in the entire previous month. But it also meant working my ass off, making real decisions, and dealing with the consequences if I was wrong.

  Two hours passed. Then two and a half. The girl who'd been looking green finally gave up and threw up into a plastic bag she'd had the foresight to bring, and the smell made a couple other people look queasy. Someone opened a window despite the cold air, and the driver yelled something in a dialect I didn't quite catch, but the window stayed open.

  At three hours and fourteen minutes, the bus finally slowed down and turned off the main road onto an even smaller dirt path. We bounced along for another ten minutes, and then we rounded a corner and there it was: Kharidanga Village.

  I'd been expecting something small. Maybe a few dozen houses clustered together, some fields, that's it. But this was... bigger. There was an actual market area, a street lined with small shops selling grain and kerosene and brightly colored plastic goods. A small school building with yellow paint that was peeling off in long strips.

  The bus lurched to a stop in front of a building that had a faded sign reading Primary Health Centre. The windows had bars on them but no glass in some cases, just empty frames. The front door was closed, and there was a chain and padlock visible even from the bus.

  "We're here," Dr. Voss announced, standing up and grabbing her bag. "Everyone out. Start unloading supplies."

  We filed off the bus, stiff and sore from three hours of being rattled around like dice in a cup. I stepped down onto the dirt and immediately felt the difference, it was colder here than in the city.

  Dr. Okafor was already there, standing next to a white SUV that looked absurdly clean compared to everything else around it. He was talking to a man in his fifties wearing a white shirt and vest, someone who looked official or at least important. They were speaking rapidly, and I couldn't follow most of it.

  "Start unloading," Dr. Voss said again, this time directing it at all of us. "Medications, IV supplies, equipment. Everything comes off the bus. Carefully. If you drop something and it breaks, we don't have a replacement."

  We formed a chain, passing boxes and duffel bags from the bus to the ground. There was a lot—more than I'd expected. Cardboard boxes labeled Antibiotics, Antipyretics, Antimalarials, ORS. Plastic bins full of IV bags and tubing. A large duffel bag that, when someone opened it to check, turned out to be full of sutures and basic surgical supplies. Another box full of bandages and gauze. A portable ultrasound machine in a carrying case that looked like it dated back to when I was in primary school.

  By the time we'd unloaded everything and stacked it in a pile on the dusty ground in front of the health center, twenty minutes had passed and I was sweating despite the cold air.

  Dr. Okafor finished his conversation and walked over to us. "The building has been unused for approximately two years," he said, addressing all of us. "The previous medical officer was transferred and never replaced. The villagers have been using traditional healers instead of the government health system. Our contact here" he gestured to the man in the white shirt "is Rafael Tanatos. He's the village council representative. He'll be helping us if needed."

  Rafael nodded at us but didn't smile. He looked tired, or maybe worried, or both.

  "Let's get inside and assess what we're working with," Dr. Okafor said. He pulled out a key that Rafael must have given him and unlocked the padlock on the front door. The chain rattled as he pulled it through the handles, and then he pushed the door open. Stale air and dust and bird droppings and something that might have been mildew or rot. Dr. Voss coughed and waved her hand in front of her face. "Windows," she said. "Open everything. Let's get some air moving through here."

  We filed inside. The main room was larger with examination tables lined up along one wall. Or what used to be examination tables. They were covered in dust and bird shit.

  The walls had posters on them, faded and peeling, showing vaccination schedules and information about tuberculosis and handwashing, all of them dated 2015 or earlier. There was a desk in one corner with a broken chair behind it. A filing cabinet with one drawer hanging open, empty. "God," someone muttered behind me.

  "Get to work," Dr. Voss said. "We open for patients in ninety minutes. This place needs to be functional by then."

  We split up without being told. Some people went for the examination tables, wiping them down with cloths and disinfectant we'd brought. Others swept the floor, sending up clouds of dust that made everyone cough. Murin and I, along with two other students I barely knew, took on the back room—which turned out to be even worse than the main area. It had clearly been used for storage at some point. There were old boxes full of broken equipment, shelves with empty medicine bottles, and an examination table that had been turned on its side and left there.

  We hauled everything out into a pile in the corner and started cleaning. My hands were filthy within minutes, covered in dust and grime and God knows what else, and I kept having to wipe them on my pants because I'd forgotten to bring gloves.

  "This is disgusting," one of the other students said, dumping an armload of garbage into a bag.

  "Yeah," Murin said. He was sweeping the floor with a broom we'd found, pushing accumulated dirt toward the door.

  An hour later, the place looked almost functional. The examination tables were clean. The floors were swept. We'd set up the pharmacy in a small side room, organizing our supplies on shelves that we'd wiped down. Dr. Okafor and two interns had claimed the back room and turned it into a basic surgical area—just a table with good light positioned over it, a tray of instruments that they'd sterilized with the portable autoclave we'd brought, and basic supplies within reach.

  By 11:30 AM, we were as ready as we were going to be.

  Dr. Voss stood in the main room, surveying everything. She nodded once, a sharp gesture of approval. "Good. Now we wait."

  She walked to the front door and propped it open with a piece of wood someone had found. Sunlight streamed in, illuminating the dust particles still floating in the air. Outside, I could see the market area. People moving around, going about their business. Some of them glanced toward the health center but didn't approach.

  We waited.

  11:45. Nobody came.

  12:00. Still nobody.

  I stood near the window, looking out. A woman walked past carrying a basket of vegetables on her head. She looked at the open door, at us standing inside in our white coats, and then she looked away and kept walking.

  12:15. One of the interns shifted his weight from foot to foot, looking uncomfortable. "Should we... go get people?" he asked Dr. Voss. "Let them know we're here?"

  "They know we're here," she said. She was standing near the door with her arms crossed. "They know exactly who we are and why we're here. They're choosing not to come."

  "Why?" someone asked.

  She didn't answer. She just kept watching the empty street. Finally she said, "Because they don't trust us. And they have no reason to."

  At 12:35, finally a woman appeared in the doorway.