Friday, July 16, 2021

Jaising Baiga of Tilaidabra

I met Jaising Baiga of Tilaidabra village in Chhattisgarh on a hot, humid afternoon earlier this week. I had gone to his house to see his daughter Jyothi, who the health worker in the village described as "kamzor", or weak.

Jaisingh Baiga with his wife and daughter in their hut
Jaising Baiga and his family in their hut
Jaising works in Pratapgarh in a brick factory and had just returned after seven months of work there. He was asleep under a thick blanket when we reached his hut, but his wife insisted on waking him up. I asked him about his job. He works in a brick factory there for 12 hours each day, he said, cleaning out the ash from the kilns after the bricks are baked. The bricks themselves are made by labourers from Bihar. For his labours he earns Rs.9000 per month, and he supplements this with headloading for trucks, which earns him an additional Rs. 3000. He spends Rs. 2200 on food for himself, he said. So does he send the rest home, I asked him. He said he was paying off the advance given by the contractor to the family when taking him to Pratapgarh, as well as the interest. So he has now returned only with a small amount of money. No, he did not have to return during the lockdown in 2020 as it is a very large brick factory and work continued even during the lockdown.

Two other Baiga men from his village also work there. 

Their mud and tile hut is falling to pieces, some of the tiles on the roof missing in one corner. In another corner the broken tiles had let in the rain resulting in the corner being washed away and leaving two walls in danger of collapsing any moment. He will be here for four months now during the agricultural season before returning to Pratapgarh later in the year, he said.

Jaising is extremely thin, as is his wife Meena who works as an agricultural labourer in Tilaidabra and nearby villages. And their daughter Jyothi is severely underweight for her age.

The Anganwadi building in the village is dilapidated and a hazard to enter, and the anganwadi worker lives far away and comes to the village once a month to distribute the month's allocation of dry rations to the children enrolled at the centre. 

I had gone to enquire about the young child, to visit the family, to ask about her diet and health, and to advise the mother if necessary, on what she needed to do to improve the child's nutritional status. 

After meeting the family and talking to Jaising, I left without offering any solutions. I found I lacked the courage to do so. 


View of Tilaidabra with Anganwadi centre in the foreground

Tilaidabra Anganwadi centre.

Monday, July 5, 2021

Ambikapur, 1987


It was the transistor radio that kept me sane that year.

It was 1987. I was fresh out of internship, and had opted to work in a hospital in a remote area for a year, before thinking of specialization. I had a room in an empty ward of the Holy Cross Hospital, Ambikapur in Madhya Pradesh. During the day, the crowded outpatients kept me busy, and before that the morning rounds that had to be conducted in the wards to check on patients. On duty nights too I would remain busy in the evenings as well as sometimes through the night. The Sisters were welcoming and gracious, and glad of an extra hand to help. I ate in a small room off the kitchen – delicious home-made food, mostly rice, daal, and vegetables.

It was in the evenings that I got lonely, missing my colleagues at Vellore, and my family. The sisters would retreat to their convent, and the other doctors to their families and homes in Ambikapur, and I would be left to my own devices. Except on the days I was on call, I would speak to no one from 6 in the evening till about 9 the next morning, and at 23, it drove me crazy. Those were the days before email and internet and cellphones and the STD booth for long distance calls was nearly 2 km away from the hospital on the edge of town. I did not have access to a library for reading material.

I paid the handsome sum of Rs. 700.00 for a Philips transistor radio from my first salary, and it brought the room alive. From being a large bare hospital room, it became a place where there was music, news and conversation. I listened to the All India Radio (English and Hindi and even the Sanskrit news bulletin to try and remember my elementary school Sanskrit), to the BBC, to the Voice of America, as well as broadcasts in a few languages I did not understand. Vividh Bharti and the Srilanka Broadcasting Corporation were my favourite stations for songs, and Vividh Bharti had some lovely instrumental and vocal classical music as well.

My interest in surgery was encouraged by the Medical Superintendent who was a plastic surgeon herself, but like most surgeons in rural India, conducted surgeries of all kinds. Under her guidance and I soon learnt to do minor procedures by myself and to assist in the more major ones like intestinal and gastric perforations, or in Caesarean sections. What a thrill it gave me to see a patient who had been admitted in pain recover fully; or a mother and baby recovering well after the C-Section. The well-planned and sychronised, orderly world inside the operation theatre also appealed to me.

But outside the operation theatre I was plunged into the chaotic, untidy, real world. The emergency cases (and almost all who came outside regular hours were emergencies) were all critically ill – an unconscious child with tuberculous meningitis (the coverings of the brain), a pregnant woman with malaria and jaundice, a comatose man with severe malaria, a pregnant woman with eclampsia (seizures due to high blood pressure in pregnancy) – the list went on. These were terribly poor patients, who had been brought several kilometers on a cot to the nearest main road before being brought here in a bus or more often in a jeep that had charged them exorbitant rates. It was obvious in their thin and wasted bodies- both of the patients and their relatives; the tattered clothes they wore; the patient, almost fatalistic attitude with which they waited for care. Many of these patients died within hours of admission in spite of our best efforts, while others would have a long and slow recovery. Malaria and tuberculosis were the most serious and frightening problems I saw, in all their various forms and degrees of severity. I felt helpless and often lost – how could so many patients just come to the hospital and then die? Could it not be stopped? Why did someone not diagnose it earlier, or why did they wait till their illness became so severe?  

All these questions led me, at the end of my year there, to apply for my post-graduate studies in Community Medicine at my alma mater in Vellore.

Monday, May 25, 2020

Mubarakpur by-pass, Bhopal. Lockdown Day 53.

A lot has been written about the lockdown in the wake of the Covid19 pandemic, and I skip reading many such articles now. A surfeit of medical, non-medical and epidemiological articles in the papers, on email, and on WhatsApp makes me sick of the virus and the disease. The fear of the virus has been overtaken by the guilt, the worry, the helplessness of seeing lakhs of our fellow citizens - men, women, children, elderly , handicapped - trying to reach home any way they can. I am in awe of their endurance and determination, even as I am ashamed that we have brought them to this - forcing them to walk, cycle, hitch a dangerous ride - at the height of a scorching Indian summer, just because we as a nation did not care enough to plan better or to execute a plan to get them home in dignity. 

I learn from a friend about an organization in Bhopal that is helping citizens walking home on the highway outside the city. The Jamaat-e-Islami Hind in Bhopal has been active since the day following the lockdown (over 60 days now), feeding people who have lost jobs and their means of earning a livelihood. These include daily wage labourers, rag-pickers, the disabled, among others. At present they cook and distribute over 10,000 meals a day. 

The city is under a strict lockdown. My colleague and I have lockdown passes for work among the slums in Bhopal. We go one afternoon to observe the work being done by the Jamaat volunteers at the Mubarakpur bypass and to see whether and how we can help. We reach the highway at 4.30 pm . The worst of the heat of the day has passed, but it is still extremely hot and oppressive, like being in an oven. The hot air stings my eyes and dries my lips in no time. The highway has no trees left after six-laning, and a few thorny shrubs on the roadside offer patchy shade, if any. The Jamaat volunteers have put up a small shamiana on the roadside,and food and water is spread out on tables under it. As it is the month of Ramzan, all the volunteers are observing roza, and do not consume even water during the day. Frankly, this level of discipline amazes me: to not drink water through the day in this scorching heat and to continue to work, requires a level of will-power and faith that I am afraid I do not have.

I have taken a few first aid kits with me to the highway: bags with ORS packets, dressing materials, Band-Aid strips, paracetamol tablets for fever, a bar of soap, and a bottle of Savlon. My colleague has brought along packets of biscuits. We wait in the scorching sun, feeling self-conscious. We look like who we are - privileged enough to live through a prolonged lockdown (it is day 53) without a problem; to be able to hire a taxi to take us from our homes to this highway.

A steady procession of trucks (large and small), small pickup vans, autorickshaws, motorcyles, all go by. Today the traffic is mostly from Gujarat, though there are quite a few vehicles from Maharashtra too. Each is packed beyond capacity by workers returning home, sometimes with families. 

As the vehicles stop at the Jamaat stall, the volunteers on the ground rush to them with packets of food, biscuits, and sachets of water. Throwing up sachets to reach men sitting on the roof of the truck above the driver's cabin; or in the truck (the driver would rarely allow the passengers to alight) has been honed to a fine art by the volunteers. Since there have been many people on foot whose slippers had broken or had worn out, a sack of new footwear in all sizes is also available for those who needed a replacement pair.

I go up to the driver of any vehicle that stops, and hand over the first aid kit, explaining what each item in it was for. In all cases, they listen attentively and store the kit carefully, and I sincerely hope they will not need to use it.  One has heard of so many road accidents and deaths of the returning workers. In most such accidents, my little kit will be of very limited use.

I soon run out of the kits I have taken with me, and spend the rest of the time talking to some of the people who I meet. Most of the vehicles from Gujarat are from Surat, and I feel a kinship with them, recognising many of the places they work in: Ved Road, Anjani, Diamond Nagar.

Komal Prasad and other textile workers from Surat head to Allahahabad
This mini-truckload of textile industry workers - weavers, embroidery workers, textile market workers, are headed from Surat to Allahabad (nobody calls it Prayagraj). Komal Prasad who is seated is older than the others, spends his day folding sarees in the textile market and says he will not return to Surat. Eighteen years there is enough, he feels. The rest of the men say they will return as soon as work resumes. Komal modifies his statement - well, maybe next year, he says, but certainly not this year. 
None of them has been paid since March - not even for the 24 days before the lockdown on March 25th. Their names appeared on the list of train passengers four times but each time they were told it was a mistake - they are convinced the tickets were sold to someone else at a higher price. They themselves have paid Rs. 1500 each to an agent to get a ticket. Now 48 of them have each paid Rs. 3500 for standing (and occasionally sitting) in this mini-truck for the journey home. 
I tell them about Aajeevika Bureau, the organization that works with migrant labour and provides legal support in issues like non-payment of wages, or compensation for injuries; and about their office at Katargam Darwaza in Surat. Komal and two of his friends note down the number of the office and of the co-ordinator there. When they return they may visit the office to ask about how to get their pending wages, and any other problems they may have. 

Nallasopara to Sultanpur by road. The Jamaat stall in the background
These two friends set off on a motorcycle from Bombay to Sultanpur. The person in the helmet works at wiring buildings in Nallasopara, and informs me they will return to Bombay once things "settle down". They have been on the road since the previous evening. 

More textile mill workers from Surat's Diamond Nagar head to UP.
Meanwhile, several other trucks passed by from Gujarat, like this one. These textile workers live in Diamond Nagar in Surat, and are headed to Allahabad. 60 of them have paid Rs. 3100 each to travel in this truck.The day after they left, fellow workers in Diamond Nagar protested about wanting to go home, resulting in a police lathi-charge in which a worker from Odisha died.

Anand, walking from Kalyan to Damoh.
Anand looks remarkably cheerful for someone walking with his family from Kalyan to Damoh district in Madhya Pradesh. When I saw him he was barefoot as his slippers had broken on the way. Perhaps his cheerful look is because he has got a brand new pair from the the Jamaat stall. 

The Jamaat is very well organized here - tables with water sachets that have been chilled with ice; fresh food brought in every few hours, with spiced puris and pickle packets provided for dinner as well. The young volunteers are tireless, and the stall runs day and night. Sometimes there is a treat - someone in the city donates bananas or cucumbers and so these are distributed as well. 

The heat grows more oppressive as the sky grows overcast. I perspire freely and take a drink of warm water from my water bottle. It does not quench my thirst. A sudden heavy shower begins just as this truck from Surat arrives. The passengers try to shelter under a tarpaulin sheet while also collecting water and food. Everyone collects as much water as they can. 

These images are repeated many times - autos from Gujarat, as well as a truck full of workers from Gujarat that comes through the checkpost at the Mubarakpur bypass. Almost all are going to UP and Bihar. 

Chandra Bhan (in yellow gamcha) and his friend head from Ahmedabad to UP.
Chandra Bhan and his friend are both diamond polishers who work in Ahmedabad, now heading home to UP on their motorcycle. We will return, said both, when things are more settled, and we know what is going to happen. Things are very uncertain at present.

Muskaan and Rubina with their father Kamal Hassan.

As it gets dark, I meet Kamal Hassan and his two daughters - Muskaan and her older sister Rubina, all headed from Kalyan to Gorakhpur on their motorcycle. He says he is very fortunate that he has his own means of transport. His wife died some years ago, he tells me. 

I am relieved to find only two families still going home on foot in the time I am there. Apparently the previous week, the majority of people were walking home. Now they are in their autorickshaws (from Surat and Bombay), motorcycles, small pickup vans, trucks. What is better - to risk your life standing in a crowded truck, baking in the sun for three days, with a likelihood of fatal accidents, or to embark on what should be considered a death walk in the summer heat, dodging police checkposts, uncertain of where you will find water and food? Why am I even asking myself these questions? A person will take the best option he or she has. Lucky enough to have family who can send across money to buy standing room on a truck? - it is quicker. Too poor to do so? - you walk. 

The past few weeks find me distracted. How can I help more directly, in addition to monetary support to organizations that are providing food and drink to the people migrating home? How has the lockdown affected them - physically, emotionally, mentally, and how can I make amends? My big regret from today is that I did not take down any of their mobile numbers, so I cannot find out whether or not they reached their homes safely. 

The biggest migration since partition, is what some have called it - this movement of our workforce, of the drivers of our cities, heading back to their villages.


Thursday, December 5, 2019

I sit here past midnight, waiting for the reassuring sounds of the CPAP machine as my father breathes with it. There is a gradual slowing of the breathing and then a frightening silence that lasts 10, 15, 25, nearly 40 seconds till he takes the next breath. A few rapid breaths, then a slowing, and there it is the long pause again. Initially I used to run to his bedside to wait anxiously each time he stopped till he resumed breathing, but now I expect it.

This is called Cheyne Stokes breathing and is often present in patients with advanced cardiac failure, among other conditions. It is also associated with a greater risk of sudden cardiac death. Being a physician I know this, and it does not help me deal with it. He is on a cocktail of medicines.

In the silence of the night I hear the ticking of the clocks in the house. The train that goes by.  A dog that barks. The silence of no drills and machinery that surround us during the day. And I hear his breathing.

My father is six months short of being 90 years old. He is diabetic and hypertensive, has had a cardiac bypass, and is on a pacemaker. I know his heart is very tired. I know he cannot live eternally, but - I cannot bear the thought of him not being around.

But when I see him as he was today - feet and abdomen swollen, his face puffy, him breathless with the least exertion, my heart goes out to him. I do not want him to suffer like this.

He continues, even now, to take care of himself as much as he can: using the toilet, bathing, shaving, etc are all done independently, though slowly as he has to pause frequently to catch is breath. How I wish I could breathe for him.

On days he feels better he reads the news on his iPad, watches news on TV and watches one TV serial that he enjoys. He watches TV on mute as his hearing is very poor  and he dislikes using his hearing aid.

I am watching my father wind down.

Thursday, August 16, 2018

Answers, anyone?

Shehzad drives an auto-rickshaw in Bhopal and has a daughter in school. Last year all the children were asked to open a bank account through the school, which he did by providing them the necessary documents. A sum of Rs. 400 per year is to be transferred by the Government into each student's SBI account for purchase of school uniforms. The money was transferred and the full amount immediately deducted by the bank as penalty for not maintaining a minimum balance required for a metropolitan bank branch. In spite of repeated requests by Shehzad that he does not have the money to keep two bank accounts running (one his own and one joint with his daughter), and that he had not asked for the second account, the money has not been refunded.

Sheila works as a domestic help and lived in Bhopal till last year when she moved with her husband to Bairagarh when her slum was demolished as part of the city's replanning. Her son has joined a school there and the teacher wanted a bank account opened in her son's name through the school. Now the boy's identity documents are all from Bhopal - birth certificate and Aadhar card. So are hers and her husband's. They own no ration card. The teacher refuses to open the account saying a bank account cannot be opened till they show proof of living in that locality, ie in Bairagarh. As the family is squatting on some land near a forested area, they have no address there. Sheila said she does not need her son to have an account and will do without the Rs. 400 assistance annually, but the teacher will not hear of it - every child must have the account she insists. And Sheila says she is helpless as the son was born and the Aadhar card made when they were in Bhopal. Things are at this stand-off now.

Meanwhile Chintamani in Hyderabad is unable to get her granchildren into a Government school as they do not have an Aadhar card and the school refuses admission without one. Her son is an alcoholic, not bothered about the family, the daughter-in- law and she work from dawn to dusk as domestics to keep the house going. Meanwhile the grandchildren, 5 and 6, are out of school. I thought no services or facilities were to be denied for want of an Aadhar card till the Supreme Court gives its decision, but the Government school authorities think otherwise. Or am I mistaken?

Anyone with any answers for these parents, please write in.

Sunday, July 29, 2018

Two men

Patients attending the clinic yesterday at the 90 foot road in L ward of Bombay came with a variety of complaints. One woman probably had malaria and looked sick. A man with hypertension and heart disease; one with chemical dermatitis due to working with paint; several with skin infections. All of them looked tired and were thin, most wore clothes blackened by the grease and dirt at their workplace, most had calloused hands and grimy fingernails. But Vishal (name changed) looked unlike the others. Fresh-faced, very  young, clean, he had come to Bombay from Bahraich district in Uttar Pradesh 2 months ago after his 12th standard examinations to join his brother in the Kajupada slum, to earn Rs.7000 a month for working 12 hours a day and sometimes longer.
I asked him why he left his studies and came here, and also why for such a low wage. He looked at me in silence for a few seconds, and then said his mother had been diagnosed with breast cancer and needed weekly injections (chemotherapy, perhaps), each of which cost them Rs. 10,000. There was, simply put, no  Government facility nearby where they could access free cancer treatment, so they had to travel over 300 km to the Kamala Nehru Trust Hospital in Allahabad for treatment. There was no money, so Vishal had to stop thinking of applying for college, and travel to Bombay to earn what he could to pay for the treatment, along with his brother. 
The cancer is disseminated, he told me  - his mother had not told anyone about it till the festering wound became too much to conceal. 
I explained as gently as I could that for someone to survive disseminated breast cancer is not easy. And told him that whatever happens, he must try and go back to studying as soon as he can. 

I wonder if he will ever be able to. 

Last night, traveling home from the airport in Bhopal, I asked the driver, a young man, where he was from. He had come to Bhopal three months ago from Ashoknagar where he had been with a travel agency for three years. The owner had eleven cars. When I asked why the move, he said he had had a quarrel with the owner. I did not ask anything more, but then Sushil (name changed) told me what had happened. He had not been paid for two months, he said and when he had asked for his wages, the owner had laughed and said he did not need the money urgently as he was not married. 
I kept begging him for two months, said Sushil - I had my rent to pay, I had to eat, I was supporting my family. When he did not pay me for the third month, I was very angry . When I was driving him somewhere, I stopped the car, pulled him out, and hit him. I hit him with a stone on his head, then with a stick on his back, then I ran away.  
How is the owner now? I asked after a few minutes. 
He got up and drove himself home, and lodged a police complaint. I had to go to Ashoknagar two days ago to appear in court. I explained to the judge what had happened, and the judge said I should have lodged a complaint, not beaten the owner. The next hearing is six weeks from now. 
I told him the same thing- that beating up someone is not the answer, that next time he loses his temper he may kill someone and that will land him in jail. 
Sushil told me he is from Rewa district, his father was a contract labourer for the railways and died suddenly of a heart attack some years ago. He is the oldest and has to provide for the family. From his wage of Rs. 10,000 a month in Rewa he had to support his mother and siblings. When he was not paid, he had to beg the owner of the rented room where he stayed, not to throw him out. He felt ashamed to do this, as well as for the fact that he was not able to send money home. He himself ate once in three days, and survived on cups of tea in between. 
Now in Bhopal he earns Rs. 12,000 a month as a driver, and has taken a one-bedroom flat on rent in a multi (Government built multi-storied houses). The multis have a parking space where he and 12 other drivers keep their cars at night and the colony has a security guard arrangement, so the cars are safe. He is delighted with the running water and electricity, though he has to spend Rs. 2500 on rent each month. His home is open to anyone who comes to Bhopal from Rewa  for Government work or looking for a job. 
Why should they spend money on staying at a hotel when they can ill-afford it? he asked. I can help them this way. At present he has a family of four from Rewa staying in his flat - The woman has a preterm baby (7 months) and they have come to Bhopal for the child's treatment. They need to be here for at least 2 weeks, and I have given them the key to my flat - they can come and go as they please, and cook their own food. 

Would you judge this young man?


Saturday, February 24, 2018

A tale of two migrants in Surat

Ramesh Kumar (name changed) is 19, and from Panna district in Madhya Pradesh. His high school certificate states he is Ramesh Kumar Lodhi.  Two years ago, after passing his 12th standard examination, he came to Surat and found work in a factory that makes razais with synthetic fibre. He works one of the machines that produces the fibre, which is then sucked away through a pipe and taken to where the razais are made. 

Fibre produced by the machine is sucked into the pipe seen at bottom right.

On 20th December last year, he was trying to clear out the mouth of the pipe that was clogged with fibre, when his right hand was caught in the machine, as a result of which he has lost all fingers of that hand. The owner refused to pay him any compensation for his injury. I met him two days ago, when he told me he had gone to the Civil Hospital in Surat for a disability certificate but was denied it as his Aadhaar card says he is Ramesh Kumar but does not state his caste. This, despite his Aadhaar card being made in Surat. Ramesh already has an Aadhaar card in in his hometown in Panna district, but like many migrants, he has another one in the city where he works, as otherwise he has no access to any service, including a job, a bank account, or a local SIM card for his phone. (So much for the unique ID of Aadhaar!). Here, though, in spite of having a local Aadhaar card, he was denied the certificate as it did not carry his caste name. When I met him and his father - both are severely underweight - they were still in shock at the turn his life has taken.( The Medical Superintendent agreed to issue a certificate, but only after the Aadhaar card can be validated against another ID proof).

Like Ramesh Kumar, Subhash Gouda (name changed) was also a migrant,though he had moved to this city ten years ago from Ganjam district in Odisha, working in one of the many powerlooms here, producing synthetic textiles. Working twelve hour shifts with no days off, living in crowded conditions, on a poor diet, he was one of the many thousands drawn by the need for a livelihood. He developed tuberculosis and had begun treatment in Odisha, but found it impossible to continue medication here - was it paperwork? was it the time needed to access services? - after working the night shift for 12 hours in deafening noise, most workers sleep the whole day and wake up only in the late evening when the Government hospitals are shut for the day. Those in the day shift start work at 7 am and come out of the loom sheds only at 7 pm - again with no time to go to the hospital. his wife told us that he wanted to get better and each time he was home (once a year), he would start treatment, but it would stop once he when to Surat. As expected, he got sicker and sicker and yesterday developed sudden breathlessness. He was rushed to the hospital where he died within the hour, and was cremated soon after. He was 28 years old.

I saw a photograph of him laid out on a stretcher after his death. A young pale face with straight hair falling over his forehead. I wondered how many thousands and hundreds of thousands like him live and suffer and die, far away from home and family. And thought of his wife and children in Odisha who will never see him again.