Doctor in Village 2

Doctor in village 2

In the days when my father started practising House Calls were an important duty of the general practitioner. For the new generation let me explain that this was when the doctor went to the house of the patient and examined him or her. There were no ambulances then in rural areas and bed ridden patients used to get care by these House Calls. For the new practitioner this also represented an opportunity at better payment because house calls were always better paid. The caregivers who wanted house calls always waited with a taxi till the last patient in the doctors queue was seen. These visits also strengthened the bond between the doctor and the people. Often this meant wading through dirt and walking through fields but at the end it gave a satisfaction that's difficult to recreate in the current scenario . The essential equipments for this visit like stethoscope, BP apparatus and some medicines were always kept ready in a small briefcase earmarked for this purpose. What I about to talk about is an interesting incident in one of these house visits. My father used to be called frequently to see an octogenarian grandmother. Let's call her Mary for convenience. She was the typical devout Christian lady always clad in the chatta and mundu. While as family doctor my father was familiar with most families it was near impossible to be in the know of everything . So house visits were one opportunity to banter about the events in the family like marriages . So it happened that one evening he was called in again to  see Mrs. Mary at her house. After finishing his examination and prescribing medicines he started some chat to humour the old lady.
" So,how is your elder daughter doing? " he asked " she's in Irinjalakkuda,no ? "
Mrs. Mary looked at him and nonchalantly asked
" So you did not know it doctor ? "
My father was perplexed since he did not know what he was supposed to know.
He nodded " No".
" She died two months back doctor "the octogenarian replied stoically.
My father was shocked and said
" I am so sorry to hear that, " he said " you must be feeling terrible "
Her reply was instantaneous.
" Oh no,was she not old doctor? She was past sixty "she replied and went back to her rosary counting ..

Doctor in Village - 1

Doctor in Village 1

Movies always begin with acknowledgements ,so let me also start by acknowledging that these write ups have been prompted by writings of my friend Srinivasa Raghavan about his legal career. But I had written some of these earlier but it did not occur to me to post it in FB. Some of this is my own,but most experiences are my father's and shared with us when he was alive.

My father Dr Rajagopal moved into Ollur then a sleepy village near a sleepier town,Trichur ,Kerala in 1970,the year I was born. He was then in his late twenties ,full of zest and the aspiration to succeed. He joined the ESI dispensary in Ollur as its Medical Officer in charge . For the uninitiated,ESI stands for Employees State Insurance , a government entity providing health services to the organised labour class. Although he was a fresh hand ,my father was given charge specially by the then Director of ESI Dr. Chitran Nambudirippad apparently to end bickering between two existing doctors. When he landed up in the village ,he was provided a quarter behind the dispensary. Years later I joined government service in the very same dispensary. I went around the quarter where I had probably crawled around. It was by then a dilapidated wreck.
Anyhow even then the quarter had its share of surprises,commonest of which were poisonous snakes! But this is not about any of those crawling creatures!
This story is about the two doctors who were then practising. I shall refrain from naming them correctly since one is very much alive. They lived and practised on two nearby streets. They were the only doctors then and competition was tough. Fees were minimal at two or five rupees ,so your survival depended on the number of patients .
The way they tried to maximise their clientele was rather stunning. They kept two youngsters at the start of the streets where they practised. Let's call them Dr Samuel and Dr John. When a family start walking towards Dr Johns clinic cum house,the youngster employed by his rival will come  forward
" Hey you are going to Dr John? Do you know he gives all the wrong medicines ? You will get cured only slowly. Turn back and go to Dr Samuel. Now, there is a fine doctor."
At this if they turn back ,at the corner,the other youngster will accost them,pretending to be an innocent passer by.
" Going to see Samuel Dr,?...do you really value the life of your child or......"
Imagine the plight of the poor family ! There were also smarter ones who escaped paying fees with one doctor by pouring abuse on the other.
When my dad started  to practise,first thing he did was to befriend one of his competitors. The other one had already left.
They remained friends till my fathers death in 2012. Their camaraderie despite competition was legendary and locals found it initially difficult to believe. Indeed many of my friends in school believed they were adversarial. To this day i remember the support given by this " adversary" when my father was unwell due to any reason.Such were the times ......

From the Middle of Nowhere

Even though renowned as the land of reformers such as Chanakya , Buddha and like, Bihar is undoubtedly the most under developed State in India. Be it by the rampant political anarchy or by the curse of incessant floods, Bihar raises eye brows at those who seek a tad of development there. Dr.Santhosh Rajagopal depicts the vignette of one of Bihar’s remote village where he had a mission as a delegate from W.H.O.
First written 2006
The Baghmathi river was flowing surreptitiously quiet, as she had never been in spate, as if the fog that enveloped her early in the morning was perhaps the only thing dangerous about her. Her vast fertile banks, enveloping villages of Chandauli, Ganeshpur and numerous other hamlets teeming with people were separated from her fury by just a sand bund. It was about 7 in the morning and fog was omnipresent. The temperature was near freezing and no amount of warm clothes would prevent even the bravest from shivering. A convoy of vehicles appeared out of the fog. They have traveled atop the bund taking dangerous turns and swerves that sent the occupants on a macabre roller coaster ride. I was riding the first vehicle whose driver seemed to take a sadistic pleasure in rocketing through the most improbable of roads.
On a mission
We were in Bihar to help out in the Polio Eradication Drive, then hopefully in its last legs. The officer sitting behind me had been there for barely two months, but seemed to have taken in even the local dialect. The driver informed us that when the river was in spate, kilometers of water would be the only sight there. The bund then became a Noah’s ark, keeping the villagers alive till the river spent out her fury completely.
The vehicles drew up at the depot where the vaccines were then ready for distribution. One by one, the vaccinator teams took delivery of their quota of the Oral Polio Vaccine and set off on their rounds ,on foot, deep into the riverine wilderness.
A touch and go
Some hours passed and it was time to monitor the activity of the teams. We were eight doctors and an equal number of Volunteers. My area was a bit in the interior, informed my guide. I hitched a ride on a bike of one of the volunteers. As it meandered its way up the slope of the bund, one bike preceding us got caught in the quick sand and crashed-, luckily ,no injury. We traveled on the bund which was roughly twenty feet wide. In many places people were living on it, which made it even narrower. Their buffaloes mowed and bleated as we played trapeze between them and the waiting river.
We asked around for directions, occasionally consulting the map ,and the gospel of the eradication Drive – the Micro plan. The microplan lists all human habitations in a given area.While in Bihar it is as good as a Google map.
The bike jumped down from hedges, and raced through slush, as I held on for precious life. Most of the time after descending the bund, we were traveling through backyards and fields. Roads, on which the toughest of off -roaders would have a fit, were made every year, my Volunteer informed me. Every year around June, the river makes mincemeat of them. The numerous islands of treacherous river sand on the roads testified to the correctness of his statement. After about 8 kms of that ride ,we came to a small school. We parked the bike and began hunting for the vaccinator teams.
We passed a few houses covered by them already and checked their work. There were no electric poles, no telephone lines, the only link with civilization as we know it were the three bands on my cell phone which told me the nation’s oldest telecom operator was around.(Thank God for that).
We met Arvind, a supervisor. He was about 50 and lightly built, that morning he had set out on a cycle with a vaccine carrier in search of his teams, and bumped into the babus. (us).He wanted to learn from how we worked, he informed us cheerfully. We wanted to see his teams, which were working about 4 km away. The path had water bodies and slushy areas, so walking was the only option. After a bumpy bone rattling ride, I was only too eager to accept that .We waded through the fields and walked atop bridges made solely of decaying vegetation. All around were the hinterland of our great country and I was benumbed by the primitiveness of it all. I took out my cell and called home. I cheerfully informed my wife that I was calling from the middle of nowhere.
Heart of India
We met a team made up of an elderly gentleman and a kid barely out of his teens. The lad was holding geru (a type of ink), to mark the visited houses; the senior was going about giving drops to children. Children were everywhere, dressed in nothing more than rags, eating out of full but flea infested plates, crowding into single room huts set one within the other, riding the omnipresent buffaloes. I remembered a remark of one of my colleagues about a place “swarming with kids”. The team was vaccinating the kids, marking their fingers and houses as well as managing formats, which had increased in number that time around. I watched ,as the old gentleman, obviously semi-literate, fumbled with the papers. We went around colonies of what the supervisor calls the lowest caste in Bihar. These are the Mushahars- literally, ones who eat rats. Later I learnt that the female literacy among them was 0.1%.There should be no castes, I meekly suggested, he agreed readily but went on about why they were the underdogs.

As walked along he cautioned me on dangers of walking in the fields, and I politely informed him that I too came from a village and was no stranger to walking on fields and narrow bridges made of felled coconut tree trunks back home. He insisted no village can be as backward as his, and I reluctantly agreed. It was 4 PM and I suggested we could have a tea. Arvind promptly disappeared into a rather better looking house and reappeared with ginger tea of the best quality. He was the local Compounder, he informed me and the respect showered on him as we passed made it clear that he was more close to being a doctor in the locality. I had no illusions about any one  of my professional brethren setting foot there, in what the Mahatma would have called the heart of India. Somehow during my entire stay I kept remembering the Mahatma, might be because Champaran, where he began his “career” of Satyagrahas was close by.
Back through the dark

It was about 5 PM and time to wind up. Tired from the long walk, Arvind offered us seats in another courtyard. As we settled down he waxed eloquent on how things could never change there. I strongly disagreed, and said it can be changed, provided we aspired to. Which suddenly made me think, what were all those kids aspiring to? They seemed to be contented with riding buffaloes into the fields, hang around with gur made from sugarcane, and tearing up and playing with posters of the just concluded elections. No entrance exams for them, no scholarships, no pencils or sharpeners, no schoolbags either. – Just the predictable grind of a rural farming life, with the most primitive of implements.
We were offered Dahi,(curd) and I accepted. I refused the big cup, settling for half as much, only to regret later. I remembered we had skipped lunch, which explained the nectar like taste of home-made dahi.
As the sun was quickly disappearing into the enveloping fog, we made haste and I dreaded the prospect of return through the route. Luckily we could find an alternate, slightly less dangerous path. As we came in, the rest of the team was getting a bit worried about us. As I approached, my local colleague asked me how the activity was. The dahi was elixir like, I told him as we bundled on to the waiting 4 wheel drives on our way back.
As we rode into the darkness, I remembered an argument I had with my brother-in-law working for software major in Bangalore; on how much time India would take to become a developed nation. Ten, he had said. Fifty, I had wagered, fresh from a similar trip to rural UP. I called him up on my cell. “I have changed my mind on that”, I informed him. It would be hundred years…..” .The connection broke off, as if to reinforce the statement.
POST SCRIPT:
After several rounds of deployment to the capital Patna and the national capital,I finally revisited rural Bihar in 2010.By this time the government had changed .The first sign of better tidings as I entered  a rural Primary Health Centre in Madhubani district was the drone of a generator that was ensuring 24 hour electricity supply.I was in for yet another surprise- at 7 PM a delivery was happening in the PHC! This was unthinkable in Bihar where some PHCs resembled cattle sheds once.I was told by a visibly irritated doctor that the villagers have given up home delivery since the “money” came. He was referring to the Janani Suraksha Yojana which gave a sum of money for hospital deliveries .I told him we should be happy since they can have safe deliveries. He looked at me and made a statement that has me speechless. ”Sir, if some complications happen at home and the mother dies, at least we doctors will not get the blame. Now we get blamed for everything.”
We are so happy to blame politicians for everything that goes wrong. As I returned to my place of residence- a PWD guest house still with no electricity or water- I reflected on this statement .Nothing came to my mind except the proverb-“You can take a horse to water…….”

Please send our kids home!

Please send our kids home!

Meet Muruganandam, all of 13 years. He frequents my office with a stainless steel tumbler full of chundal –a healthy Tamil snack made of groundnut and coconut scrapings. He is good looking with a polite tongue that could be the envy of a diplomat. My office secretary used to buy from him sometimes because she was hungry and sometimes just because he was nice. I occasionally talked to him when he told me he is doing this to augment family income. His father was dead, mother was chronically sick and bed ridden. He had two elder sisters who stopped schooling in middle school and are now working in a beauty parlor .Today I had just returned from a lecture to doctors undergoing training in the Training Institute with which we share our office space. This was a good batch which interacted a lot and gave a polite applause at the end. So I was in a happy mood when I walked in and saw Muruganandam .I asked him how he was. He smiled and said he was okay. I could not see his Chundal and it was odd time –school hours. He smilingly informed me he had stopped attending regular school. He had also stopped the Chundal business. He had got a job in a factory making some mementoes. His mother and uncles had told him in no uncertain terms that he was expected to work and not waste time studying. He was in 8^th.Now his kindhearted teacher was taking a weekend special class for him and marking him present on all days. But his family was aghast that he should continue with his insistence on studying.

“But Anna, (honorific title -brother that we Maduraiites use for anybody including younger ones), I will study till 10^th.And then further if I get good marks. Or I will join Polytechnic college.” he said with a glint in his eye.

“Are you able to study with just a weekend class?” I asked him.

“I manage” he said sheepishly

The parent in me woke up.” How much did you score in the last annual exam?”. He had mentioned that he wrote only the annual exam last year.

“I got only 438 out of 500,’ he said” but this time I will get 450 plus”.

I was left speechless. I remembered me hugging my kids whenever they got even indifferent marks, just so that they felt happy.

“Do they teach well in school? What about your friends?” I asked.” Do they study well? --those who attend regularly?”

‘Oh, I have two friends who just play cricket day long and if the Head Mistress scolds him they abuse her. I tell them it is wrong, it is wrong, no, Anna? They do not care”

He then told me they got 150 marks and one of them was a Policeman’s son. I ask him what his salary is .A princely sum of 3000 Rupees. I am confused now. Can and should I offer him a monthly sum so that he can attend school? Will that mean having a conflict with the family, or worse, financial demands from a sick mother, poor uncles and so on?

His major worry now is that he should complete 9^th Std. Probably fearing pressure from his family his kind teacher has suggested a way out .He can directly go to Class 10.I do not know how that happens. He is equally flummoxed. But his reason for wanting to do Class 9 is different

“Only if I go through Class 9 can I understand Class 10 lessons well and score a good mark”-he tells me-accurate reasoning.

I think aloud, discuss with my staff and finally gave him my card with phone number.

“Thambi, (younger brother/small kid), you are gonna study’ I told him.” Give this card to your teacher. Whenever you have a problem in studies ask her to contact me”

I do not know if I did my dharma today. I am also wondering about his job. He is in a factory making ‘shields” and cups for winners. I could not help thinking with irony whether he would ever hold one in his so ever so deserving hands.

India is littered with the shreds of many such dreams of poor bright children shattered against the walls of parental apathy and state neglect. His class teacher is my and his, only hope. I pray to God to give strength to the hand of this unknown but I am sure, beautiful lady.

And we are “shocked” by Europeans' overbearing concern for our kids. Come on guys, we do not put neglected children in foster homes, we throw them into factories and the streets. So relax. Just send them to India. We need them in our factories.

(Name changed to protect identity)