Do no harm…….

Dear countrymen !

Let’s light a diya on April 5^th at 9 pm for 9 minutes…

It was the PM Modi on national television , appealing the nation to show solidarity during the most intrigue situation of our lifetime! This was 12^th day of countrywide lockdown, imposed on 25^th March 2020 as a preventive measure to break the spread of a very recent but virulent virus nCOVID-19.  

Immediately the social media was swarmed with messages of varied emotions.

I’m a citizen of the Republic of India and not a clown to perform to the tune of the ringmaster…..

Lighting diyas on 5^th April at 9 pm for 9 minutes is astrologically backed up as the number 9 represents Mars or Mangal and this double 9 increases its strength…it’s a master stroke by Modiji….

I have always been sitting on the fence when it comes to be with or against Modi (ji). I can decipher his moves more objectively ….as some may lable me , I am his bhakt  but not andh bhakt.

Earlier on 22^nd March, he appealed the nation to express its indebtedness to those who are working relentlessly to keep us safe from this health calamity. The task was simple that we have to clap, chime bells, blow conch, beat utensils for 5 minutes at 5 pm. Both the appeals looked like tasks given in the house of Big Boss.  Big boss chahte hain ki sab gharwale……

Modi (ji) is a hardcore politician who knows his job as back of his hand. When it comes to his charisma he is in the left upper quadrant of Johari window where his quality is not only known to him but to others as well. While the government machinery was deep into combating spread of the infection , he took the task of motivating people to follow the lockdown righteously but without being aware that they are being pushed to do so.

This country can unite only on two emotions….first cricket and second patriotism…in that order. The year when Kargil  was won, maximum people sacrificed picnic with the family and went for flag hoisting on the subsequent Independence day !! He knows how to emotionally exploit people ….this time the charm was used for a better cause.

There have been tremendous response on both the occasions. Its amazing to see a nation of 130 crore population following unanimously …well almost…illustrating solidarity. Everyone had their own reasons to agree (or not to ) to accept both the appeals. Reasons varied from….

 Modiji ne kaha hai to karna hi hai

Modiji ke liye kuchh bhi

Arrey kuchh to karen…bore ho gaye ghar me padey padey

Agar maine nahi kiya to paaswale Sharmaji ko mauka mil jayega mujhe bolane ka

Ham sab kitty wale safed pahan kar karenge …theek hai !

Chiming bells and lighting diyas wont help, there is no PPE for health staff.

We need more testing facilities,everything cannot be turned into an event.

I had a totally different reason to follow the request….and without any scientific reason, even remotely. In medicine we are taught the principle of  do no harm . While managing a patient utmost care must be taken not to aggravate the morbidity. It’s a known fact that morbidity or illness is affected by the social, mental and spiritual status of a person other than the physical.

By following the two appeals of Modi (ji) , I was following the same principle.

It reminded me of 1996 when I was pregnant with my triplets. My parents being doctors, I was in the best hands and we were in a better position to handle the situation as all of us knew all the pros and cons of it. My mother lined up all her contemporaries to be available during any emergency if it arises. I was getting the best possible and timely medical facility by best clinicians in the city, courtesy my mother. But she was my mom first…being an obstetrician made it more difficult to keep her calm as she knew all the possible prognosis in this situation!

In addition,we went to a Vaidya who asked me to boil a herb in black cow’s milk and drink it every morning. We went around searching a black cow and then made arrangements to get the milk delivered every morning. I was also made to wear (obviously by my mother) a silver ring in my right little finger with the embedded cat’s eye stone touching my skin. I wore white dress every Saturday and lit a diya under a peepul tree at the twilight. I don’t know whether it was helping the foetus or me to be healthier….but one thing was sure, it was not doing any harm.  

I did all these things only for one reason….it kept my mother’s pacing heart and thoughts in control and her quietude kept me going. I don’t know finally what resulted in the uncomplicated birth , though quite premature, of my triplets. What helped in their growth as normal kids without any physical or mental (touch wood) shortcoming…Whether it was the clinical care that I received ….or due to my above acts something happened in the cosmos which gave us a wanted outcome…..

In the same frame

It was a hot and humid Saturday afternoon. We have been hearing news about rainfall in different parts of the country. But here in Patna  it was all dry and dusty. The day is going to be boring… I speculated. There was nothing exciting to do this afternoon…with lots of uproar on the newly released films Article 15 and Kabir Singh, it was not wise to go to watch any of these. The world cup match between Sri Lanka and India was just an eyewash. Half of the quota of Indian adrenaline rush was over with the two matches….first India –Pakistan where the latter was defeated and second India-England where latter won and had a tangential effect on our neighbour’s chances to remain in the race . So today’s match with Sri Lanka was not allocated with any adrenaline quota nationally. Now the rest half is reserved for semi final and final matches. With this analysis at hand, best option would be to go out for lunch somewhere… but what is the best option for a lone visitor? I decided to go to a small and decent place called Basant Vihar in Maurya Lok. This is one of the very few eateries which serve authentic south indian cuisine.

The place was filled families, office groups out for luncheon, and lone eaters like me. I was ushered towards the only available 4-seater table. The waiters were casually bringing ordered food to the tables, it was a cosy place with decent gentry and delicious mixed flavor of sambhar and coconut chutney . I was about to have a much awaited gastronomical experience. Suddenly the place went black-and-white. Commandoes clad in black were followed by few seemingly-authoritative men clad in starched white kurta pajama. This aura is only when you have a politician around. They requested people who occupied the two long tables at the wall to shift to another one. Everyone present was wondering who would enter next . And there came the most talked-about congress person Mr Rahul Gandhi ! As he passed by me, the followers tried to show him the direction to the table, he requested to go to the wash room. Few minutes later he settled to the corner table with around 20 other party members seated around. 8 commandoes and 10 odd local party juniors were trying to keep back the crowd…lunch to kar lene dijiye, selfie baad mein le lijiye….I somehow managed to take one by the time his food was awaited. He was in the city to appear for a hearing in the Civil court. He had defamation charge for his statement of  sab Modi chor hain during the election campaign.

I heard him order a dosa with diet coke…diet coke nahi hoga to lime soda de dijiye…he requested his party(wo)men. I offered the vacant seats at my table to the party members standing around. Next to me sat a young, fair and handsome chap looking all starry –eyed towards the recently-stepped-down- party president. He happened to be the joint ( or something similar) secretary of the state youth congress. Out of curiosity I asked the young man how and who decided that a person of Rahul Gandhi’s strature (he has one, we accept it or not) goes to such a regular eatery. “ Its his decision. He is a simple person, the janta should understand this. People are at loss by not recognizing this” I was impressed by the commitment he had in his voice. I asked him…may be what you say is right, but people will believe in what you show them. If he is a simple person, let him be a simple person…why everybody is trying to project him as an extraordinary one !  I shared my views on not being a fan of the party, to which he immediately asked …and why so? I dismissed him by saying that its personal perspective and he should not try to convert me into a supporter. He sheepishly smiled and again fixed his admiring gaze on Rahul.

 The whole evening I was thinking about this remote, impersonal acquaintance. He seemed to be very comfortable sitting in that regular eatery surrounded by general public. He had no aura and used the wash room (hello.....I don’t use it ). He may be stepped up on the pedestal where he doesn’t belong or don’t want to be …but once there , you have to rise to the occasion.  In the selfie we were in the same frame…literally and metaphorically…where I have stepped up  while he has not even started trying.

Inside outside

“You should try ascabiol lotion once you get back home” While going back to Gwalior I was watching Pachauri- my research assistant who was constantly scratching at odd places. He had developed this for 2 days now. I was feeling hungry after the days work but was holding back myself to bring out the munchies from my bag. With no antiseptic solution at hand, I cannot afford him to eat from the same packet. It was 4 hours journey and I had to divert myself from the urge of eating something. Instead I diverted the attention by giving him details of how to apply the lotion, what personal hygiene he should be following and some simple rules of restricting the infection. He was craning his neck to listen to the instructions and repeat them wherever necessary.( I had asked him to sit in the front with the driver).

I was in a relieved mood after completing a 12 day long research assignment. Going from one place to another, talking to people, gathering information, collecting recorded data, bringing out perceptions of people, understanding the undercurrent and dynamics had been a tiring experience for me. I was looking forward to get back home. Just before starting the travel I had called home to inform that I shall be reaching home (inshahallah) soon.

In my current assignment, I was given the task to assess efficiency within the government health system when provided external support. My parents are doctors and have been very sincere civil servants. I was witness to the glory that a doctor possesses in a hospital. I was also impressed by the ethics and dedication that my parents worked with. But what I did not know or could not understand the “red tapism” with which the whole system worked. When I finished MBBS and appeared for PSC, my father came down very strongly against joining the government job. In those days it was synonymous to the stability and security for life. Refusing a government job was equivalent to insanity. So although I was an “insider” to the system due to my parents, I was pronounced “outsider” with my father’s decision. Throughout my assignment, I was trying to make up my mind whether I would have been happy as an “insider” or I am happy as an “outsider”

It was almost dark outside with a little February-chill in the air. The driver was relaxed with the mere thought of hitting home after a long time. Relaxation sometimes makes you careless as well. We had just left the town and were 20 kms away when suddenly the roadside boulder disbalanced the jeep. I could feel myself whirling out of it and landing on a hard ground with a thud. Before I could gather my senses, a huge truck passed by brushing me. Oh my god! I am right in the middle of the highway. No no no…. don’t panic! Get up… right, look around…. Where is the jeep and driver and Pachauri? I started calling their names. After adjusting to the twilight, on my right 8 feet deep in a freshly dug trench, I could make out something like a jeep. But why I can see the wheels? It was upside down with Pachauri trapped in the front seat. I could not locate the driver anywhere. As the occupational standards go, he had fled.

I limped to the middle of the highway and started waving at the vehicles passing by. After sometime (which seemed to be ages) a passenger van stopped and tried to decipher what I was saying in a shocked status pointing at the trench. With some difficulty they could rescue Pachauri who was vomiting and dazed. Once in the van, I requested the driver to take us to the District Hospital.  Pachauri now started complaining of tingling and numbness in feet. Oh my god… he may have a head injury and a spinal concussion. “Be in one position - on your side” I instructed him. Mentally I had started making notes of what actions to be taken once I reach the hospital. He should be admitted and seen by specialists to assess the injury and rule out the dreaded possibility of head-injury and concussion. I need to contact the Chief Medical Officer who can coordinate everything.  A passenger was observing me intensely. He leaned forward and handed me over a handkerchief- take this, you will be needing it. I opened it and saw few hundred rupee notes. He said ‘ don’t thank me, first you have to take care of the  your colleague.’ He also agreed to accompany me to the hospital and then to the accident site to retrieve whatever  could be found.

Once in the hospital I was running around to organize admission, x-ray, emergency call to the Doctor-on-duty and then to the Specialists. Against my personality I had to throw a lot of weight and drop some heavy names to get things organised. However, to my surprise this worked at the higher level but the actual doers in the hospital were still unconcerned. They were facing such emergencies everyday and had grown insensitive towards it. Also they lacked professional attitude. I was given a private room which stinked, but my quilt dipped in diesel masked the smell. During the night I went many times to the general ward to see if my colleague was ok and confirm that his symptoms didn’t worsen. Now I was able to look at my self. I had bruised badly in many parts and clothes were torn. Some how our luggage was retrieved but not the money-purse and camera. My left hand was swollen which looked like a fracture. I had agreed to get a temporary plaster (I had to buy PoP) and decided to get a proper management under my father’s supervision who was a fine Orthopaedician, once I get home.

Although the patient’s condition was stable, I had requested the CMO to refer the case to Gwalior Medical College. It being my alma-mater, I felt more confident to go around and seek medical care. The process of referral started early morning. Finally we could start after 6 hours of  clearing the confusion of who was the driver-on-duty, getting the ambulance tyre repaired, sanctioning the slip for POL, getting a referral slip, case-sheet and discharge ticket  from the casualty,  making the Radiologist write his comments on a bad quality X-ray,  requesting the CMO for an ambulance attendant and of course I replaced the nursing staff .

The 200 km journey to the Medical College was completed in 8 hours which was more painful and uncertain than the 2 labours that I had. When I handed over the patient to the Doctor-on-duty and then to his family members, I looked at myself to assess the damage I have undergone physically. I also reflected on my mental status. Being a doctor myself, I was able to coordinate quickly and get the best possible care I could. But looking at the attitude of the staff , insensitivity and apathy developed over the years of being in the system, I thanked my father for his strong reservation.

I had been sitting over the fence many times to analyse my feelings and to come to a conclusion once and for all. But still I find myself pondering on the issue of ‘whether I am happy as an outsider or would have been pleased to be an insider of the system’.      

Lalit’s Six Losses

The baby is lost.

This was third time that I was given the same news in last 2 years of my acquaintance with Lalit. He was support staff in the office. He would finish off the routine work long before we all came into the office. If he had a specific work with anyone of us, he would stay back and meet that particular person.

“Lalit please clean the toilet properly tomorrow. It’s stinking & the dustbin is almost full.” While entering my room, I tossed this instruction to him .He said ‘ji madam’ meekly & did a gesture which meant – can I speak to you? I was putting this face to name for the first time. He hesitated to speak in the open. Sheepishly he extended a medical report – “you are a doctor na? This is my wife’s report. She is pregnant but the doctor say there is no baby inside!” His expression conveyed the confusion and disbelief on the expert. I took the reports still looking at him and trying to hear the noise in his thoughts. Since my entrance to the medical school this was the second case of pseudo pregnancy I was coming across. (This is a rare condition where the woman experiences all the symptoms of pregnancy, except formation of a foetus in the womb. This is due to the strong desire of the woman to bear a child.) I read through the prescription. The couple had lost 3 babies; this fourth one was also a lost hope. He could not believe what I was explaining to him. How can this happen? Should he get one more ultrasound done from a different place? What would he tell his wife? I realized how incomplete my education was. Explaining a rare textbook condition in real life – no teacher empowered me to handle this!

Days passed and I remembered Lalit only with the site of a dirty washroom or a cobweb hanging on my head. On a hot summer day one of the drivers informed me “Lalit is on three days leave. His wife is not well. She had an abortion”. Again!! This time he had decided to conceal the news and avoided medical checkup. Instead the couple was a regular visitor to a mazaar every Tuesday. “You scold him for doing such a childish thing. Why should he avoid a medical checkup? See what the result is!” The driver had concern in his voice. Next day he came with his wife Sunita. A short and obese woman with a smile on her face. The smile was more for the husband to sustain hope . Both listened to my advice attentively- try to avoid pregnancy for next 3 months, go for a medical check up immediately after the pregnancy is confirmed, they can continue the weekly visits to the mazar along with it.

“I wish that you take care of Sunita this time.” He was waiting for me outside the office. His request made my heart skip a beat. This was the ultimate submission of the couple, whose hopes were rekindled for the sixth time. Craving for the child had made them courageous to stake their hopes. I asked him to bring his wife along. What was in her eyes- fear, apprehension, anxiety, faith? I explained the possibilities and risks associated. My limitations to provide the needed care were very well known to them. I was expected to agree to the bestowed role of a mentor for the coming days.

The couple kept me well informed of all the developments. Everything was going on in a smooth way except mid trimester hypertension. I did a regular BP monitoring and spent a lot of time talking to Sunita. It eased out her anxiety. She was admitted to the Medical College hospital due to constant high blood pressure. While supporting the move, I felt relieved in last six months. I had an unknown companion who will take care of Sunita and her baby. In the Teaching Hospital with skilled and experienced staff, Sunita’s known bad obstetric history and a preventable situation of borderline hypertension, she was in a safe haven. Atleast I thought so.

It was a lazy Saturday morning and I was trying to concentrate on a training manual for the health workers. The training is designed to enhance their skills to provide care during pregnancy and delivery. It has been a Herculean task to convince experts that through these skilled workers, safe delivery can be guaranteed to a rural woman in a remote area. Evidence shows that only few women will experience complications   and need sophisticated facilities. I remembered Sunita, her reflection in Lalit’s face which was getting fresher with excitement as the due date was nearing.

“They are putting Sunita on drugs to deliver the dead baby.” Lalit’s voice was so distant and calm over the phone. It took me a full minute and 3 questions to understand what he meant. Words ebbed and there was a killing pause. He finally said “that’s okay, sab mata ki marzi hai (it is destiny). I was ashamed of myself and my fraternity. The couple had given me full right to maneuver the course of action. Why did I rely on others? I should have taken a more active stand. But how could I suspect the experts in an apex institute! They never deviated from the technically correct procedure. I realized that they were running on the technically and scientifically correct path. But they hardly stopped at culverts where sensitivity, empathy, accountability exist.

I have neither spoken nor met Lalit & Sunita since then. It had been breach in faith on my part and I feel guilty to face them. Whom should I ask about how they are coping with the loss? What happened to the new baby’s clothes which they had bought? Is she continuing taking the tonics? How shall I console them when we meet? I do not have any answer. I can only say- “I am sorry, I failed.”

United we stand……..

In the winters of 2014, one of my friends’ shared that her housemaid was asked for money in the maternity wing of government hospital in the state capital. This was the time when the state government had declared Health Sewa Guarantee ensuring free treatment, drugs, diagnostics and diet to all who are admitted in the public health facilities. At national level, the state was being lauded for this initiative. By declaring pro-poor policies; the 1 year old government was trying to deepen  its roots to ensure victory in the consecutive fourth term in the future.

Having advantage of access to the higher officials in the department, I shared this incidence with them who were very disappointed and raged by it. In recent years, situation in the public health institutions have seen a stark change . Hospitals are much cleaner, with availability all the basic and essential resources. Suddenly hospitals were revived to its original functions.  They were swarming with people …..patients. The wards were full, medicines stocked at the counter, laboratory busy in taking samples and writing investigation reports. With fund flexibility in a national programme, human resource crisis was also addressed to some extent with contractual appointments and outsourcing of support services. Of course doctors were as scarce as ever…..

Stung by the act, the department ordered a probe to pin down the culprits and take an exemplary action for others not to repeat the same in future. Our organisation being outside the system, were asked to be part of the probe team and were expected to provide an unbiased angle to the whole situation. We were quiet satisfied that the administrators have taken cognizance to teach lesson to the involved . Its for later to decide who actually learnt a lesson in the process…….

One of my colleague was deputed to be part of the probe team. As per the government order he went to the hospital on the scheduled date and time. The other members who were from within the system didn’t turn up for the probe. Doubled with the sense of responsibility, my colleague decided to have a very casual discussion with the staff posted in the labour room. When asked , who were on duty during the reported episode, each one of them had a memory black-out…..He continued in a generalist manner without pinpointing anybody and started going through  the chronological sequence of events since the women was admitted till she was discharged after the childbirth. He also tried to tally the casesheet with the services provided to her. To his surprise, the case sheet was very sketchy with no protocols followed, which he discussed with the staff and left the hospital. No probe report was prepared as this session did not meet its purpose in want of absence of other team members.

Higher officials issued order to shift the staff who was on duty during the reported incidence out of the labour room  with immediate effect for an year…… thus the case  came to a logical ending…. Or was it going to start in a more illogical way…….

After a week my colleague got a notice from a police station…..there had been a police complaint against him to harass a schedule caste woman, who happens to be posted in a government hospital as a staff nurse. This clearly was a case of atrocity against the ‘downtrodden’. He was accused of using racial words against her. Thankfully in such cases FIR is not written without having a dialogue with both the parties. Christmas and New Year were spent to put all the efforts jointly to avoid formal FIR. Strong sources were identified to gain access to Politicians, IG Police, couple of senior bureaucrats …even the Chief Secretary. The top officials were sure that the case doesn’t hold water, but it was not getting anywhere near to closing. We all were worried, but my colleague had lost his sleep with the mere thought of being an accused, he had yet to climb up many steps in his career.  

Finally we decided to seek the most indigenous and trusted path…..face-to-face discussion in an unofficial manner through a mediator. The mediator turned out to be the Steward of the hospital (brain behind the police complaint) who belonged to the ‘upper’ caste. Our background work revealed few of his soft spots which we hit in the most machiavellian way. First meeting was the bull’s eye where the ‘victim’ withdrew the complaint by formally informing the police in writing. Later the complainant leaked the fact that she was asked to write a complaint to teach my colleague a lesson not to get involved in such things in future. After all it could be a direct blow to the economy of the hospital staff  !!

After almost a month long ordeal I learnt that united we stand only for a common  interest…..and we can arm-twist the benefit of our diversities as well to gain it.  

On 26^th January  I felt mocked by the song ……Hindi hain hum watan hai Hindosatan hamara……

Kavita the Kutch cupid

Rann of Kutch has suddenly become prominent on the world map. Thanks to Amitabh Bachchan and Gujarat tourism. It’s a perfect example of a well thought advocacy campaign hitting soft spots in the brain. Kutch literally means something which intermittently becomes wet and dry. The same word is also used in the languages of Sanskrit origin for a tortoise. Our taxi driver was a native of Uttar Pradesh but considers Gujarat as his second home. Better infrastructure, basic amenities and quality of life (as compared to his home state) has made him a local brand ambassador.

It was time of Rannotsav …..a three month long festival to attract tourists. At Dhordo tent village, a huge space is created for the local craftsmen to display and sell their handicrafts. In the arid surrounding, this space was in riot of colours.  Mirror work, applique work, bead jewelry, hand embroidered artifacts, bandhani , mirror frames and mobile covers made out of camel skin…..it was a treat to look at.

Natives of this part are majorly Ahir, Jat, Agariya, Baloch tribes. Men are lean and thin with athletic body while women have chiseled features. In the barren land they can be easily spotted by their bright coloured clothes. Layers and layers of apparel save them from the dry heat. The natives are hardworking and simple people and have learnt to survive happily in limited resources.

In the handicraft market, I spotted a cheerful nymph displaying creative and colourful artifacts made with love and passion. Her stall had tit-bits like rug dolls, purses, mobile holders, door hangers, hair clips, ear rings. The conglomeration interested me but was not motivated enough to buy anything…. as the potential users of this stuff have moved out of my home and became busy with their more exciting campus life. I was watching extraordinary marketing skills of the 8 year old girl. In few minutes she had sold souvenirs to four tourists. Adorned in bright blue coloured dress, she was wearing all possible jewelry. Her rustic features and captive smile attracted many towards her small stall. She refused to tell her name or take a picture unless you buy something from her stall.

It’s interesting to see how human life adjusts and thrives upon in any circumstances. It was astonishing to see in the   dry, barren, arid western tip of the country there is life full of colour and vigor!!

After 100 rupees and a rug doll I could click a lively snap of this Kutch cupid- Kavita