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siblings at a day-care centre in rural Bilaspur district, Chhattisgarh.

six weeks

six weeks today after the surgery, and i am almost back to "normal". my left arm has regained much of its power. my voice is now much stronger too, though not completely back to normal. the numbness in my fingers and arm persists, but that will take time, i am told. the physiotherapy continues.

it is amazing how the human body can heal itself.

my family has been with me through all this, taking care of me through the pain, the surgery and after. i am fortunate to have them around me. it is lucky we don't keep score within a family, for their love and care is a debt i cannot repay.

many of my friends - from school, college and later - called, visited, sent SMS and email. they lifted my spirits and reminded me again how lucky i am to have them in my life.

as for the team at CMC, vellore : the neurosurgeons, the anaesthetists, the nurses, the physiotherapists - all of who contributed to making me pain-free again, and started me on the path to healing - they have my eternal gratitude.

pause

so what happens when the brakes are suddenly applied on a life apparently going full steam ahead? i guess one pauses and takes stock. that is what i am doing now.

six weeks ago i suddenly developed excruciating pain in my left arm with numbness, discovered i had a prolapsed cervical disc, and needed surgery. after three weeks of 'wait and see' that is the normal practice (many such pains resolve themselves with rest and pain killers), i was operated on at vellore last month, just over three weeks ago.
the pain is gone, and i am eternally grateful for that. my left arm is weak with numbness persisting, and i go for physiotherapy daily, and i am glad to say that the strength in my arm is returning gradually.
one of the complications of neck surgery is nerve damage - a small percentage, but i was one of them. now one of my vocal cords is paralysed. my speech is soft - i cannot talk loudly, my voice sounds different, i have difficulty in coughing. after talking for a short while the volume becomes much lower and i have difficulty making myself understood. i am also undergoing speech therapy, and my voice is stronger than before, but i am told it will take months to really improve.

so it is off bad and bumpy roads for me for some months at least, which rules out field visits for now. my other work - that of training - has also to be put on hold for some time, and when i do resume, it has to be with a microphone always.

why did the disc prolapse happen? no one knows for sure why some people get it. twenty years of traveling on bad roads or no roads may have contributed, said my surgeon.

time to take stock.

an antenatal clinic

the monthly antenatal clinic at semariya is always a busy one.

today it is light due to the large number of weddings taking place, with 58 women attending. tiharin bai, the health worker at karhikachar calls up to say there are 12 women waiting there: the bus has not come today as it has been leased out to a wedding party. we send our jeep to fetch them.

it is baking hot in the clinic, well over the 46 deg C that bilaspur and its environs has been maintaining the past few days. it is painful putting the hot earpieces of the stethoscope into my ears each time to examine a woman, and i keep drinking gulps of warm water to fight the heat and thirst.

but that is a minor discomfort. most of the women who attend the clinic today have not gained any weight in the past month, and some have lost weight. all of them have been working in this hot sun under the NREGS. i tell them they need to rest, and not do hard physical labour. they need the money, they say, and cannot remain at home.

the NREGS can guarantee employment, but not their health.

difficult choices.

hydrilla and frog

a young medical student who spent ten days at our campus in Ganiyari earlier this month took some beautiful photographs.

this one of a resident frog keeping cool in one of the ponds on campus, is my favourite.

may

a sudden dust storm and drizzle has brought welcome relief from the searing heat here at bamhni in the achanakmar sanctuary. it also covered everything in the clinic with dust, and brought a man who had a split scalp when the branch of a tree fell on his head. and another man with a split scalp whose drunken father beat him unconscious with a bamboo pole when he challenged his drinking. fearing his son was dead, the man ran off into the forest and is missing as of now.

i am here again for the monthly health workers' meeting. it is past 8 at night and we are working by the dim light of two solar powered lamps: the battery is running down, since i have used up much of it for the lamp in the clinic to stitch up the scalps of the two men.

the health workers say they have seen few patients this month as they were also busy working in the NREGS programme. munni suddenly protests: "i go everyday for the work, but my name is not put on the muster rolls since i am a widow. i am told that i get a widow's pension of rs 200 a month, so i am not eligible for work under this scheme. can anyone survive on this money? the sarpanch has told me that these are the instructions of the lady officer who came for a public meeting last week. all the widows in all the villages in this area are now being told they cannot work in this scheme. i still go everyday and fight to work".

another says,"my parents are over 60 and fit and are willing to work, but they are also now being told that since they are eligible for old age pension of rs 300 pm, they will not be given work under the rozgaar guarantee programme." why cant they get work?"

"younger women abandoned by their husbands who get a pension of rs.200 too are not eligible."

"why dont they hold back the pension for the three months that the rozgar guarantee work is going on? then we can work and earn more."

several of them sign a petition to the CEO of the block, asking to be allowed to work (that is the letter that is scanned and posted at the start of this note).

the talk veers to payment received: some have received no payment for seven months of work - two months this year, five months of last year. many have received cheques, but the post-office in surhi shuts its counters when many of them go together to deposit and withdraw the money as it is too much work. some are waiting to deposit their cheques for over a month: "the postmaster even refused to come from his house to the post-office when he saw us."
they dont have much choice, as there are designated days for each village in the panchayat to collect their money from the post-office.
in bamhni there is a rozgaar sahayak who goes to surhi and deposits their cheques and collects their money, apparently so far not asking for a cut. other villages don't seem to have this person in place.

how much do they get? "we were told it was rs. 102 per person per day, but we get only rs 100 per day, a cheque of rs.1200 for two weeks of work. so where are the rs 24 going?" i dont know what the current rate is, and i cannot answer.

i also have no answers for abandoned women, widows and older citizens not being allowed to work. i have to find out. anyone knows anything about this?

rabies then, rabies now.

this was written for rediff about a patient i saw in 1992, nearly 20 years ago. nothing much has changed, it seems, apart from the fact that sarguja district is now in Chhattisgarh instead of in Madhya Pradesh.
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Bitten By Dog, Bitten By Man

One evening in March, Somaru was brought to the dispensary in Bhainswar, in the western part of Surguja district in Madhya Pradesh. As was usual among the Gonds in this area of MP, Somaru had married early and at 17 was the father of a six-month-old baby. A gentle, well-built lad, he had been learning irrigation techniques from Father Alex who lived opposite the dispensary.

Now, he was quite unrecognisable: a wide-eyed, desperate boy, babbling incoherently, clutching at Father Alex's arm and asking repeatedly for water to quench his thirst.

Five months ago, on Diwali night, Somaru was bitten by a dog on his right ankle. The wound took weeks to heal. As the dog had been stoned to death immediately, there was no way of telling whether or not it was rabid. Somaru paid no heed to our pleas to get vaccinated against rabies at the Primary Health Centre in Sonhat. We worried too much, he said. Besides, he did not want to cycle 13 km through the forest to the PHC for any injections.

As the wound healed, Somaru resumed work, tending his field. Exciting things were happening in Bhainswar. For the first time, the villagers were growing a winter crop of wheat, thanks to the irrigation system they had devised which lifted water from the river that flowed past the village. Somaru had no time to worry about his ankle.

All of a sudden, he had begun to feel feverish and could not swallow water.

The evening wore on. I watched over him in the fading light with a feeling of helplessness. I knew Somaru had contracted rabies. He was, quite literally, beyond help. Nothing anyone could do would save him.

Somaru talked incessantly, begging Father Alex to save him, crying out in fear that he did not want to die. Again and again he asked for water and when we did give him some, he spat it out and turned violent.

Father Alex and I explained to Somaru's relatives that he had a serious disease and would probably die within a few days. We advised them to take him home and keep him quiet, warning them that he could turn violent. They could not accept this. How could a five-month-old dog bite cause this madness? Besides, the wound had healed completely, and he had been perfectly well till just two days ago. "He is possessed by spirits," they said.

While two of the younger men borrowed the dispensary jeep and drove 80 km into the jungles to fetch a vaid (traditional healer), Somaru's family carried him home and kept an all night vigil, chanting and praying while he tossed in his tragic delirium. By morning, Somaru's in-laws and other relatives from the surrounding villages had arrived and joined in the prayers. Then the vaid came in, took one look at poor Somaru and declared that this was not a devil he could exorcise.

Somaru died late that evening, 24 hours after he had been brought to the dispensary, in an agony of fear and thirst. When we heard the news, a wave of relief washed over me. No one should ever die such a death, and at least it was over for Somaru.

Just then, his uncle and father rushed into the dispensary, fear writ large on their faces. Somaru was very violent just before he died and when they tried to restrain him, he had bitten them both. His father and uncle, I realised, were also possibly infected.

Father Alex and I went to Sonhat to get the rabies vaccine from the PHC and bring it to Bhainswar where the nurse could administer it to the two men. This would save them from having to find a place to stay in Sonhat until they completed the course of vaccination. The vaccine available in the market cost nearly Rs 300 a dose, and the villagers could not afford that. Only the subsidised vaccine from the PHC was within their reach.

There was no vaccine available at the Sonhat PHC, so we drove a further 40 km to Baikunthpur, a large mining town. Here we were informed that the only anti-rabies serum available was at the district headquarters, Ambikapur.

Three hours and 120 km later, we were at Ambikapur. There, the district hospital authorities told us that they had no vaccine and it had to be obtained from Indore, nearly 750 km away!

In despair, we went to see the collector. Not that he could do anything, but we wanted to tell him what had happened. He was extremely sympathetic, got in touch with the hospital authorities and asked them to send someone to Indore right away to get the vaccine. He also told them to hand it over to Father Alex for transportation to Bhainswar. If the vaccine did not arrive in a few days, he told us, he would sanction funds to buy it in the market.

Over the next ten days, Father Alex returned three times to Ambikapur, to the district hospital. Each time, there was no vaccine. Finally, he went back to the collector only to find that he had been transferred out of the district. Eventually, we spent nearly Rs 1,800 each on Somaru's father and uncle for a full course of the rabies vaccine. I am happy and relieved to report that both are well.

Some weeks later, Father Alex happened to be at the Sonhat PHC and found it stocked with the rabies vaccine, supplied from the district headquarters.

"It is always available at Ambikapur," he was told. "But how did you hope to get it without bribing someone at the hospital?"