Saturday, October 31, 2009


i had written in an earlier blog about kiran baiga who was anaemic and hypertensive and was awaiting her first baby. she had it during the rains, when she could not cross the rivers in the forest to reach the hospital. it was a low birth weight baby boy, who died of pneumonia when he was five days old. kiran is better, but i could not meet her yesterday when i went to her village - she had gone to collect firewood.

the boy in the tuesday clinic who we thought had a brain tumour turned out to have a degenerative brain disease. he will worsen progressively and not survive very long. there is not much that can be done for him.

the NREGS wages, i am sorry to say, have still not been paid. the villagers now have to open post office accounts into which the payment cheques will be deposited. apparently this is to circumvent the corruption in direct cash payment of the wages. but many of the men have already migrated so are not available to open their accounts. meanwhile people here continue to eat more poorly than before.

Thursday, October 29, 2009

a sick clinic

tuesday this week was another busy clinic at bamhni. i was supposed to be training the birth attendants this week, but did not get much time to sit with them. several patients sick with malaria were seen. then the vehicle was requested to bring a patient from surhi 6 km away: a man breathless with pneumonia, not getting enough oxygen into his system. i started him on antibiotics and oxygen and the saturation slowly crept up but not good enough. by evening he was worse, the left side of his chest completely dull, the breath bubbling in his chest. he probably had empyema (pus in his pleural cavity - the space around the lungs) and he was in heart failure.

meanwhile, more malaria patients later came a young woman who seemed at first to be hysterical, shying away from anyone touching her. but i found she had an acute abdomen - an emergency. the junior doctor who had accompanied me to bamhni was anxious about getting back and handling these emergencies himself, so i walked to the bend in the cc (cement concrete) road in the village - the only place where one can get a mobile network signal if the wind is right, and called raman, the surgeon at ganiyari to inform him about the patients i was sending back. he assured me that he would wait, however long it took.

back to the clinic, started antibiotics for the woman with the surgical emergency, and sent her and the patient with empyema to our base clinic, which is an hour and a half away by road from bamhni. i learnt yesterday that he was taken straight to the OT and had a litre and a half of pus removed from his pleural cavity. when i saw him last evening after returning from bamhni, he was much better. the woman had an appendicular abscess and had been operated on, and was smiling - no longer in pain, no longer seemingly hysterical. my colleague had been in the hospital till after 10 pm the previous night, attending to them.

meanwhile i kept behind at bamhni a 12 year old boy weighing 27 kg who i suspected had tuberculosis, and perhaps something more serious. also at the clinic that night was a pregnant woman with malaria and a child with malaria who was severely anaemic, both under observation to see that they did not worsen.

4 am yesterday morning i was woken up: a 10 year old girl from a hostel in jakadbandha was complaining of chest pain for a few hours. turned out it was another pneumonia. we started her on antibiotics, kept her at the centre, and sent the warden back to inform her parents who live in a remote village. i huddled back into my sleeping bag after seeing her but could not get back to sleep due to the cold. i could hear her brassy cough in the hall next door where she was sleeping.

both the children - the one with TB and the child with pneumonia were sent to ganiyari the next morning and are admitted there now. the patients with malaria were better and went home.

the dai training went on too, meanwhile.

Sunday, October 4, 2009

working and travelling in northern madhya pradesh was very educational, especially after 11 years in orissa. the feudal system, for example, is not so evident in orissa as here. caste plays a big role in everything in these districts of morena, tikamgarh, shivpuri and sheopur. in 2005 i remember a sub-collector at the collectorate in one of these districts, who was a dalit: he was given a separate pot and glass tumbler to drink water from. when we were going to investigate a measles outbreak, no one wanted to travel in his jeep. i heard later that after he was posted elsewhere, a "shuddhikaran' was done of his room. no doubt his pot and tumbler were broken.

i remember too, an ANM who would not touch lower caste women, not even to give the tetanus toxoid injections necessary in pregnancy. there was of course no question of measuring their blood pressure or of doing an abdominal examination.

a group of women who had a lease on several tanks in tikamgarh and ran a successful business in fish were unable to get their anganwadi functioning. they were reluctant to talk about it, but after some weeks opened up enough to confess that the anganwadi worker belonged to the thakur family in the village. since it had not rained the past two years, and the two handpumps in the village were dry, the only source of water for the group (lower caste women) was the thakur's pump that was put on each morning to water his fields. if we protest, even this source of water will be denied to us, they said. also, they would beat up our men, and maybe even kill them.

the anganwadi remained closed, the rations sold or consumed by someone else.

morena and bhind were different: the deep ravines and the stark landscape disquieting. in bhind, no upper caste man worth his name will go around without his rifle. it is a persuasive weapon for all purposes including once for insisting that i attend immediately to see a child who had been brought to me. i was in a school building setting up a temporary centre to manage an outbreak of cholera, and surrounded by many patients, but i left everything and went to attend to the child, who it turned out, was severely dehydrated.

the ravines provide a safe hideout for the various gangs of dacoits who roam freely between uttar pradesh and madhya pradesh. one notable one is the gadariya gang: he being known for his respect for women and for not touching them. one of the reasons, i am told, that he is tolerated in the area by the locals.