salma

faithful, devoted, gentle. salma is all of these, and more. chews up everything in sight, drags me on the leash morning and evening while i attempt to walk with some dignity instead of rushing along in the neighbourhood, cries like her heart is breaking when we leave her behind and go anywhere.

a timid puppy who was bullied by other dogs in the street, she took a while to come inside our garden gate to eat. then more regularly when she was pregnant, till she had her litter. wet weather and no shelter gave her pneumonia and she almost died. we moved her and the puppies to our verandah and looked after her. that was in january this year, and she has lived with us ever since. when we moved from bilaspur to bhopal in may, no one in the street was keen to keep her. if she was a pedigreed dog we would have, but why care for a street dog? they said. so along she came with us.

though she looks forward to her daily walks on a leash, hers is a free soul, and she loves nothing better than to walk free when she can race ahead, come back to meet us, then dash away again.

It makes a difference.

Picture of Choitram Baiga of Bahaoud village, taken last week. He is on treatment for multi-drug resistant tuberculosis. I had written about him here six months ago. I can hardly believe it is the same man. Shows what food, rest and medicines together can achieve. 

Lakshmi seeks care.

i first met Lakshmi Sabar in 1994. i had suspected her of having tuberculosis in the small village clinic i ran at Koinpur in the Mahendratanaya hill range, and when her sputum was negative for TB, i sent her to government district hospital at Parlakhemundi for a chest X-ray. she made three visits there - the first time there was no electricity, the second time there was no X-ray film available, the third time the X-ray technician was on leave. 

Lakshmi Sabar with her second baby, 2006

each visit required a walk down from the hills to the nearest bus stop three hours away across the border in Andhra Pradesh, then a bus ride to Parlakhemundi, and then the journey back if she caught the bus in time. given the demands of trying to eke a living on the deforested patch of land they lived on, and her own poor health and lack of money to make the bus journey and to pay at the hospital, each visit was made at an interval of two or three months. 

her 2 year old son, who had also started coughing and becoming thinner and sicker, died in the interim. she took him along once to the district hospital where he was prescribed expensive tonics which she did not buy. on her fourth visit (a month after her son died) she was finally started on anti-TB drugs. 

three weeks later, i got a frantic call from the field staff - lakshmi sabar had gone mad, and was running around the village shouting and tearing off her clothes. could i come and see what could be done? 

i realised this was INH pyschosis (a drug reaction sometimes caused by one of the anti-TB drugs) and persuaded her husband to bring her back with me to the main campus outside Berhampur where we had a small dispensary with in-patient facilities. there were three other patients admitted, recovering from severe malaria and from pneumonia. i was a bit hesitant to introduce this woman with an acute psychosis in their midst, but told them that her behaviour was due to the medicines she was taking. 

the other patients were surprisingly welcoming and considerate of Lakshmi. one day she would lie all day underneath the cot. the next day she would manage to climb on top of the medicine cupboard and sit there most of the day. she took about ten days to return to a near-normal state of mind, but it did not seem to disturb the others at all. they empathized with her. anyone who lost a baby would be mad with grief they said. if she wants to hide under the bed all day, how does it bother us? let her be. you may say that this is due to medicines, but we know the grief of losing a child. 

there was a lesson for me there. 

Lakshmi became completely normal in a few weeks' time and we re-started her anti-TB medication. she recovered completely, and i followed her through her second pregnancy the following  year. 

i wonder how Lakshmi Sabar and her family are now. 

fellow creatures

returning from a field clinic on friday, we spotted these deer on the roadside inside the Achanakmar sanctuary, almost merging with the brown of the falling leaves in this season.


and this fox kept us company for over a kilometer before running away into the forest.


my photography, of course, leaves much to be desired.

the scourge of hunger and tuberculosis

Raja Baiga is 9 years old and weighs 10.8 kg. That is the normal weight of a two year old child. He has tuberculosis, as do both of his parents. His father has completed treatment, the mother was only recently diagnosed to have sputum positive TB, and weighs 27 kgs herself.

A passive and sad looking child, Raja spent three weeks at Ganiyari with us. At discharge he weighed 12.4 kg, his appetite had improved, and he was more active and cheerful.

He and his mother will not go back immediately to their village Kurdar which is on top a mountain and inaccessible, but will stay at the foothills in the village of Karhikachar where his grandmother lives. There he will be enrolled in a day-care centre run by JSS (normally only for children between 6 months and 3 years of age). His diet at home will be supplemented by daily eggs and khitchdi with oil, as well as sattu.

We hope that the anti-TB medicines and the improved diet will help him overcome this infection. Is there some treatment for his chronic hunger as well?

hungama over hunger

the recently released hungama report tells us what we already know: almost 50% of children are underweight, which means that nearly half our children go to bed hungry every night. a national shame, if there was one.

seen here is shiva of chaparwa village, grinding garlic to make a gruel to give his younger brother vishnu who was crying with hunger. there is nothing else edible at home, and both parents have gone out to work. shiva, 5, is confident he can wait till the parents earn, buy some food, and come home in the evening. he hopes the garlic and water gruel will help vishnu, 2 years old, to stave off his hunger pangs for a while.

Bahoud

naresh baiga, 10 years old, with tuberculosis of the foot and leg bones, was unable to stand when he first was brought to our clinic at bamhni. fortunately he has responded well to treatment.
when we visited bahoud last week, i went to his house to see how he was doing. we found him in the street, playing in the dirt with his friends.

choitram baiga, 38, however, has not been so lucky. he has multi-drug resistant tuberculosis, and continues to be unwell in spite of over a year of treatment. he is being provided with what are called second-line anti-TB drugs, which are expensive, and need to be given for a longer period of time than the usual course of medication.
earlier this year he had sold his few his goats and pigs to raise Rs. 6000 in order to hire a tractor to help till the 5 acres of land he has been given here at new bahoud. in spite of that, the rice yield has been poor, and will last his family of 8 for three months. the BPL rice does not last the entire month for the family. the oldest son, 18, works and keeps enough money aside to buy a kilo of arhar daal every fortnight for his father.
choitram's main worry now is how his family will survive this coming year. he is now unable to walk and drags himself around on the ground once someone helps him off the bed.

tuberculosis continues to be a serious and widespread problem in rural india. this small village of bahoud has three patients with severe forms of tuberculosis. the risk of death due to TB increases as the body mass index of the patient reduces. that means that a malnourished person is more likely to die of tuberculosis than a well-nourished patient is.