Sunday, January 21, 2024

My friend Nazakat

Nazakat was my tailor in all the years I lived in Bhopal. A gaunt man, unfailingly polite and cheerful, he had his shop in Manisha Market in Shahpura. He had no assistants and did all the work himself, producing neatly tailored salwar-kameez sets. His wife sometimes accompanied him to the shop and would sit stitching on buttons or hooks if required. His customers included women in the Bharatnagar slum as well as from the middle-class Shahpura colony. He lived in a village outside Bhopal and would cycle to and from work each day. Festival times were busy and happy times, and one had to wait many days to get clothes stitched. Completed outfits would be hung neatly on hangers on a rod to a side of the store.

Demonetization was the first blow. Suddenly money was tight, the number of customers dropped sharply. People lost jobs in the informal sector by the thousands. (The hotel near my house that employed eight men shut down as the owner could not pay the wages - he had to choose between paying the workers full wages or purchasing provisions with the small amount of money he could withdraw each day). Women from the slum stopped getting new clothes stitched. Only a few completed outfits would be hanging up, and festival time did not bring a rush of orders.

After a couple of years, business started looking up again though it never picked up to the pre-demonetization level. Nazakat diversified into readymade garments - nighties, underwear and socks. These were in great demand and he was getting back to being cheerful again. 

Then came the lockdowns during Covid, and Nazakat's business never recovered from the blow. Apart from the days the shop had to be kept locked, very few people came to purchase anything even after it reopened. Not even the underwear got sold (remember the men's underwear index?). He was also competing with cheap, synthetic ready-made clothes that are mass-produced and were now freely available. I rarely had to wait for my clothes to be stitched.

By 2021, Nazakat was not earning enough to pay the rent of his shop, and had decided to give it up and to move back to his village. Several days he had only one customer the whole day - someone who would make a small purchase He was no longer cheerful. He was desperate to finish selling the stock already purchased and ended up selling it cheap to someone so that he could recover at least a part of the money. He left for his village and I missed seeing him at his sewing machine in his shop. Soon after, my husband and I moved to Bangalore. 

I kept sending material to him through people going to Bhopal and he would send the tailored clothes back.

I met him last August in Bhopal - and was shocked at his appearance. He was even more gaunt than before, and was breathless. He said he could no longer cycle and could walk only a little bit before becoming breathless. I was not sure whether it was his heart or his lungs that was the source of the problem. He needed work, he said, and I gave him several sets of clothes to be stitched. (When they were returned, I could make out that Nazakat was not well: the cut was not as precise as before, the stitching a bit eccentric).

It turned out that he had had tuberculosis that had destroyed large parts of his lungs. He had what is known as COPD - chronic obstructive pulmonary disease. And that had led to heart failure. A bronchodilator helped him to some extent but not much. He was also severely malnourished. Had the loss of earnings worsened his illness and his COPD? Had he and his family been eating enough to stay well-nourished?

We kept in touch over the phone, and I would call him every few weeks. Sometimes he would say he was doing ok, with no breathlessness, sometimes he would say he had no appetite. I urged him to eat eggs every day and meat whenever he could afford it. He refused my offer of monetary help, saying his son was earning now. But how well he earned, and whether they were eating well, I could not say. He would always thank me for enquiring about his health. "Aapka aur mera ek vishesh hi rishta hai" he told me in his weak voice. You and I have a special relationship.

Last month when I called him there was no answer. A week later, the cellphone service said the number was no longer in use. 

This evening I got a phone call from Bhopal telling me that Nazakat had passed away last month. 

I mourn the loss of a friend, a gentleman. What really killed him, though?

Tuesday, January 16, 2024

Winter hazards

On a field visit last week I was called to see a woman who had fever and swollen legs. No other information was available and so I went to see her. 

Deep in the Achanakmar forest, Dharmin Baiga lives in Dabripara, a part of Bindawal village. She lives with her husband, son and daughter-in-law. A small square of land to grow crops, a cow, a few possessions, and a two roomed, mud plastered hut is what they own collectively. Among the Baigas they are among the better-off ones.

When the cold increased this year, they did what they always do- sleep around a fire inside the house. Last week, Dharmin's husband found an extra big log to put in the fire so that he need not wake up in the middle of the night to put on another log. But their room is very small, and one end of the log extended under the cot that Dharmin slept on. During the night the log burnt along its length, including the part under the cot. The cot was made of nylon tapes that caught fire, burnt the blanket on top and burnt Dharmin's legs. Luckily she was not injured more severely. 

They applied some herbal preparation on the burns, and thought no more about it. However, in four days, both legs were swollen and the burn wounds oozed pus. Dharmin had fever and severe pain. 

When I saw her she was sitting in front of her hut in the sun, in obvious pain. She had badly infected burn wounds with cellulitis. She did not say a word about herself and I spoke to the husband about the need to get her to hospital. He was reluctant at first  - the crops needed tending, the cow had to be looked after. The son did not help them much, he said. But he agreed to come to hospital in our vehicle. 

Dharmin is undergoing treatment now and I am happy to say she is recovering. Sadly, hers is not an isolated case. Burn wounds in winter are a common feature seen in forest, rural and poor communities. Where warm clothing is insufficient or the hut lets in cold air, sleeping around a fire in winter is the norm rather than the exception. It is a hazard of poverty.

Dharmin outside her house in Dabripara

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.