Monday, September 5, 2022

Thoughts on drinking tomato soup

 To my friend who sent over tomato soup yesterday when she heard I had a bad cold. 

The tomato soup was tasty and thick,
Just what you need when you are sick.
And as I drank it nice and hot,
I sat back in my chair and thought
Of bonds that go back 40 years;
Of friends and foes and dreams and fears;
Of our women's hostel days-
Of chai and rasam, our joys and tears;
Of co-op, common-room, hostel days;
and our sometimes errant ways;
Of Ma Idiks, mess thambis, appam & stew -
See what tomato soup can do?

and a post - script:

And now this is no idle boast-
I'm well and having tea and toast.


Wednesday, August 10, 2022

Pathalgaon, 1992

Pathalgaon in March. Home is a small room attached to St Anne’s Convent, half a kilometer off the main road. It has place in it for a small string cot, a table and a bookshelf. A small bathroom cum toilet is attached. We have learnt to live with the minimum number of possessions, as there is no space for more, but we managed to keep our books. This is the only place we could find after leaving the hospital, which allowed us also to continue our work with RAHA. Dawn, and the drawing up of water from the well nearby, for washing, cooking and bathing. It is only March and already the water level is too low for it to be pumped out. Things will be much worse in summer.

A bath, a quick breakfast of upma and we hurry away to work. Ravi and I walk three kilometres down the road towards Ambikapur, to Asha Deep where RAHA has its training centre. It is 7.30 in the morning and the sun is already hot on our backs. Today we begin training a new batch of village health promotors (VHPs).

RAHA is a co-ordinating centre for over 80 dispensaries and health centres of Raigarh and Surguja districts of Madhya Pradesh. We work with RAHA as resource persons and at present we are training health workers as well as holding refresher trainings for them.

We meet the VHPs, thirty in all, including twelve women. All but one of the women have a toddler with them, and this woman has two young children with her. They will be living at Asha Deep for the next ten days, and group of us will be training them. They will then return after six months for the second training camp.

Introductions take up part of the morning. All of them are Oraon, though fortunately they speak Hindi too. The women have made time to come away from home: the older children will take care of the home and the fowls.

I take the first session in a large hall where we sit in circle on the floor. I tell them the story of Lakshmi, a young unmarried girl who dies of tetanus after a thorn prick. Her parents are too poor to take her to a good hospital. We then discuss all the possible reasons for her death. Everyone participates animatedly, and people recount their own experience of finding health care too expensive; of having to go into debt for treatment; of difficulty in finding transportation to reach a health care facility when someone falls sick. They recount how their own children are unimmunized because the Government health worker is so irregular in her visits. They compare conditions in towns and in their own villages. And finally conclude that the cause of ill health and death is much more than only a “disease”. That social, economic and political factors play a vital role in health too. I am glad they arrive at these conclusions: they are beginning to see that as health workers, they will be involved in much more than just “treating” patients.

We break for lunch. It is past noon and very warm. The toddlers have all already been either breastfed or taken out and given a meal. The hot rice, daal and potatoes makes us sweat even more in the heat. We take a two hour break as the trainees use this time to bathe and wash in a stream nearby.

Back for the afternoon session, which Ravi and I conduct jointly. The trainees sit in two circles and each is provided with a paper and pencil. They are asked to draw the picture of a man or a woman and to label the body parts. Laughter and protests that they cannot draw. Giggles from the women. Meanwhile, one toddler has chewed up his mother’s sheet of paper and she is provided with another one. With some encouragement, all of them concentrate on their drawing. We are doing this so that we have an idea how each of them views the human body and its organs before we teach them body anatomy.

After they finish, a volunteer comes and draws the outline of the body on the blackboard. Each trainee then comes up and marks one body part. There is unanimity in the opinion that all body parts - heart, lungs, liver, stomach, uterus and intestines lie in the midline inside the body. Some body parts are not represented at all.

We stop at this juncture for the day. Ravi and I have to go back and prepare the next day’s anatomy lesson based on their perceptions and what they already know.

The walk back home is pleasanter than the one in the morning. It is 5.30 pm and the sun has set, but daylight lingers on. Back home to a cup of tea, then to relax for a while, then to draw water, prepare the evening meal of chapatis and daal, trying to finish before the inevitable power failure at 6.30 pm. As it gets darker, the mosquitoes buzz around and bite viciously.

I can hear the children singing their evening prayers at the large wooden cross outside our window. These 30 girls live in a hostel attached to the convent and attend school in Pathalgaon. Their ages range from 6 to 12. My interaction with them has been limited to greetings and smiles when we meet occasionally. Fortunately they are healthy and do not require medical intervention often.

The power goes off at 6.30 pm and I light the two kerosene lamps in the room. Tomorrow’s lesson is to be prepared, a letter to be written. After these are done, we go out and sit at the base of the cross in the cool breeze of the evening – the mosquitoes are not as bad here.

The village is very quiet, and the stars in the sky are numerous and I feel I can reach out and touch them. We are cut off from the outside world – no newspapers and what we do get are a few days old. If we are still awake when the power is restored and if the voltage is good enough, we may be able to listen to the radio. I realize I am exhausted.

Am I wasting my time? I wonder. Was three years of hard work for an MD in community medicine meant to prepare me for this life? Did my prepare me for this sense of loneliness I sometimes feel? How do I reconcile Chi-square tests and Poisson distribution and systems analysis with hauling water from a well and teaching village workers about scabies and malaria; and with coping with life in a village in rural MP? I know one day it will all fall in place….

Reflections are interrupted by dinner and more preparation and we go to sleep at 11.30 pm, still by lamplight. The mosquitoes are worse now and as I crawl into bed under the mosquito net and stretch myself out, I realise I am looking forward to another day.

Saturday, July 2, 2022

Ganiyari, June 2022

I returned to this part of Chhattisgarh after a nine-year gap. Having worked in the community programme of Jan Swasthya Sahyog for five years, my husband Ravi and I had moved back to Bhopal where I worked freelance. Last year I returned as a consultant / mentor to the community programme, spending a week here each month, and another few days from Bhopal (and now from Bangalore) for tasks that can be done offline.

When I am here I try to visit the villages as often as I can, supporting the field staff and reviewing their work. When I first returned after the long gap, it was with a sense of homecoming, though the campus of the base hospital at Ganiyari was unrecognizable due to so much construction: most of the empty spaces that made it so attractive were gone, covered with buildings: a larger lab, a larger inpatient ward, more outpatient buildings, a very large nurses' hostel, etc. And many more people on campus. The patient load seemed to have increased too, though there are more surgical patients than other cases, I understand. 

Patients waiting outside the gates of the JSS base clinic, Ganiyari


The subcentres in the field have expanded too, especially the ones at Bahmni and Shivterai. The one is Semariya was falling apart and I am happy to say it is now being reconstructed almost from scratch, hopefully with more space. This centre is used a lot, with many more pregnant women and outpatients compared to the other two. Bahmni, where the clinic used to be overwhelmed with patients each Tuesday, has far fewer patients than before - attributed partly to the fact that the Government health centres in Surhi and Lormi (from where many patients would come to the clinic) are functioning better than before. That was good to hear.

The villages do not seem to have changed substantially compared to a decade ago. A few villages have some more pucca houses, some have individual standposts for water at each house. But apart from that, the roads between the villages are as bad as ever, the poverty seems the same, especially in the Baiga villages. The forest department is as refractory as ever about building a culvert across the Maniyari so we continue to wade across the river in the rainy season. 

Women of Rajak village, waiting for a village meeting
 

There is more migration to more distant places - Tamil Nadu, Bombay, Delhi. And after the lockdown, many among those who have gone back have gone on a motorcyle. Their experience in 2019 has been a bitter one and they do not want a face a situation where they have to walk back from their place of work to their village in Chhattisgarh.


Friday, October 1, 2021

Elephants at Luchki ghat

 

July 1987

Luchki ghat lies to the east of Ambikapur, the headquarters of Surguja district. The ghat road is 7 km long, winding between two high hills, and is the main route out from Ambikapur to the east.  The ghat has many scattered hamlets, and one small reservoir.

I first heard about the elephants in early July when I was on my way to a health worker training camp at Tongo-Ghagra which lay beyond the ghat. We had to take a 38 km detour over bad roads and were told the reason – the tribals has blocked the ghat road with a tree in protest against the Collector’s inaction regarding a herd   of wild elephants which had been menacing them for a week. The elephants had come there from further east – from around Jashpurnagar. They had smashed huts and destroyed crops and the authorities had not done anything about it so far. The tribals wanted permission to kill the elephants if necessary. It was a herd of seven – five adults and two calves. Subsequently the Collector had visited the area and had persuaded the villagers not to kill them – he would make arrangements to capture them.

Now, a week later, our hospital (Holy Cross Hospital, Ambikapur) had been requested to assist in delivering health care to the affected villagers, and a nurse and I went out to Luchki ghat. The hill to the north of the road had been fenced off with high voltage wire, and there were prominent signs put up urging people not to touch the wire, and not to attempt to graze cattle inside the fencing or to try and pick mushrooms on the hill. The plan was to isolate the elephants on that hill and then get tame elephants to help capture them.

We drove to Rai, and then walked four km to one of the affected hamlets. It rained all the while, and the nurse and I were wet by the time we reached it. A group of people had gathered near the primary school building as they had heard that we would be there. Several old people whose houses had been destroyed completely were housed in the school building – they had established themselves in separate groups under those areas of the roof that did not leak. Rain water which came in was being collected in what vessels they had in an attempt to keep the room dry, but it obviously had not done much good. William, a village elder, took me around the hamlet. It had a desolate look about it with no people around, the only sound being that of rain.

We went to William’s house which was a short way up the hillside and had been the first to be attacked by the elephant ten days ago. There was a large hole in the back wall where an elephant had smashed through and a corresponding hole in the front wall where it had exited. The corn crop had been trampled and destroyed, and the ragi that had been planted had been destroyed too. William and his family had rushed out in panic when they had heard the elephants approaching, and along with the rest of the villagers, had raced down to the reservoir and waded out into neck-deep water. They stood there all night, praying that the elephants would not follow them there. Parents carried little children on their shoulders all night as they stood there, and the incessant rain made matters worse. Fortunately the elephants (after having had their fill of corn) had retreated into the forest at dawn. From that night on, the men took turns to stay up at night, beating drums and making enough noise to keep them away. So now the menfolk were an exhausted lot.

What had the municipality done? They had been given money as compensation, William told me, to rebuild their huts, but now the mud was too wet to build with, and the families had spent a lot of the money buying seeds to plant their crops again. They families were out in open, most of them having rigged up a sheet of plastic between the trees and sheltering there. Till the rains let up in September and the sun was strong enough to dry the mud, they would be unable to build their homes. The elderly from among the families had been put in the school building.

Most of the people had fever, and several children had pneumonia. Malaria was rampant as usual.

I spoke to the primary school teacher and asked – didn’t the presence of the villagers living in the school building disturbed the routine of the children? Not at all, he replied – I have only five children attending this school. Seeing my surprise he explained. This school had upto 50 children coming here before the reservoir was built. After that, many families had to relocate. They could not move up here as this hill was already occupied by people, so they have moved away, I am not sure where they have gone. Only the families left on the upper slopes send their children here. And as there are so few children in this school, why should the Government spend money in maintaining this school building? The verandah is alright, so I teach there. The people inside do not disturb me not at all.

That was the first of many visits to Luchki ghat that season. The huts have been rebuilt now. The elephants have all been captured, except for one female elephant who when trying to escape, ran into the fence and got electrocuted to death. I am not sure where the elephants were escorted to and whether they returned in later years.

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.