Thursday, June 6, 2019

Good To Me



I have had special visitors this last one week.
Dr Manoj and Manju were here all the way from Cochin.I was introduced to them long ago when I was in the second  year of my medical school.I had attended a conference in Gopal-pur-on-sea .They stood out as a young couple just married ,comitted to serving in Lamtaput as pioneering medical missionaries.Lamtaput then was a difficult place which ,as one of our managers put it ,even the Oriya people were afraid of venturing to, because of the fierce tribals there.Now a flourishing community serves there with a hospital as its focal point.
I was impressed by the quality of resource in the retreat and the testimonies and remember praying that I wanted to be among them because there seems to be so much one could learn from them.
God's meandering hands took me to Oddanchattram straight after my internship and I had the privellage to work and learn with these giants of faith .
The other couple was Andi and Bethsheba Eicher,my fellow sojourners whose visit was almost one year due.Sheba was also part of the EMFI conference from a different medical college but it was in Oddanchattram while we were doing our post-graduation that we became friends.They have ,as a couple accompanied me through my ups and downs eversince.
It was five days of praying,fellowshipping,journeying backwards as we shared our vulnerabilities,searching and comitting each other to Him who is always faithful.
Even as they travel onwards our prayers go with them as a fragrance ,carving out a destiny of friendships and bonds which are going to last them through eternity...
we will do what good our hands will find to do regardless of where God wants us to be,may He be glorified through each of our lives.

Sunday, May 12, 2019

Foxes in the vineyard..



I am trying to beat the Benaras heat with crayons,colour,psalms,gospels,song of Solomon,and Audrey Assad.
Song of Solomon 2:15 says,'Catch for us the foxes ,the little foxes that ruin the vineyards,our vineyards that are in bloom..'How often I have to go beyond the movenment of everyday living to commune with my King before I can detect the little foxes.How he yearns for us to come to him broken ,blind and bleeding to be shown these little foxes we would willingly give up for our Master.
Audrey Assad was introduced to me in a baptist church during my years's furlough.I remember one of the pastors sharing how she while walking alone up the Mount Everest base camp was helped by listening to this song even while she plodded up the hill which was cold,tough ,tiring and which at that time seemed scary and endless.A beautifully meditative track ,I say.
In my personal reading I have been struck by a phrase from the book of Romans which says '...We do not support the root but the root supports us...'
May we be rooted and grounded in Christ ,the solid ground ,always and more everyday.


Sunday, May 5, 2019

April


April has been an eventful month.I got to meet most of the family.My father celebrated his eighty-eight birthday,my sister and my brother-in-law was home for the holidays which was nice and I got to meet the greater family ,and my immediate family thanks to the elections which comes around once every four years and just being home..Most of my greater family memories are entwined around the cardomom harvesting season.....which is becoming rarer by dozen.We spent a considerable part of our holidays painting the fences at home in between the rain and shine,I managed to paint my book-rack,apparently ages old,talking of antiques...one of the copper containers were actually from the sixteen hundreds.My mother continues to use my grandfather's aluminium bowl from his Sreerampore theological seminary as a rice measuring bowl.She makes sure all of us keep it filled each time we measure out the rice to be cooked for the day.We do not understand the logic but I do believe that blessings come from the top.My grandfather was a giant.
Coming back to the current,Maisie the mongrel was the only one which survived the dog flu which took her sister,Coal 1 and Coal 2.Masie was the weakling in the group but she turned out to be the strongest.Thanks to aie Noz and Colin ,it has a shining coat and a sackful of dog supplements to eat beside the usual food.
I also performed my duties as a citizen and cast my votes for candidates I do not know personally nor have taken into account anytime in my life.Therefore i guess i have not performed my citizen's duty to the hilt.It was a mixed bag with each individual casting their franchise as per their own interpretation of what is right,often members of the same family splitting their votes three ways.I just realised that in the local context the bigger picture of the country is so irrelevant.We are more concerned about who will make our town cleaner,build our hospitals and run them better,manage our sewage better ,make our place safer for the future generation than worry about who builds a mandir or a masjid...etc.Even our parliamentary candidates were more in anticipation of better candidate who could potentially represent the state better ofcourse we do not compromise on idealogies but this year we had a wide choice,which was nice.
Sikkim is also giving us an array of young entreprenuars who impress with their ability and enterprise.Many youngsters have entered fields like farming with the entire gamut of packaging and marketting in their hands.They seem to be doing a good job.As I was leaving Sikkim ,My sister-in-law handed me a couple of packet of first flush from her nieces'tea-garden which was so smartly packaged.
I think Sikkim is slowly but surely coming of age with no dearth of talent and brains amongst the youngsters.A few decades ago my late cousin PG was the only person to clear the UPSC and become an IAS in Sikkim.I am not sure there are too many of them around still but the youngsters seem to be scoring nineties by the dozen in their boards from prestigious institutions all over India and abroad,thanks to the chief minister's scheme where the government toppers are selected and sent to these schools on a state scholarship.I cannot for sure say how many of these children are going to make a success of their lives,I will leave that to one's defination of success.
Back in the hospital we are labouring on, hopefully not in vain,I was hit by an onslaught of very sick patients which is slowly filtering down to acute gastroeneterites by hordes.My colleagues say,a flush of rain will bring forth a variety of patients,I am confused as to what I want.It would sure make the weather cooler.
First two days I was taken unawares by the heat and by mid-morning I was walking around like a zombie,forgetting names of the people.Thankfully by now I practise medicine almost by instinct.The very first day I did the foolish thing which wiser people from around here do not do.I went to the market in the mid-morning and found it deserted.I cleaned the house the best I could single-handedly and cooked meal for fifteen people.One of my junior doctors was leaving after her bond completion.It was nice to have every one over for a meal.
The following day whilst at work I realised I was functioning only 20 % ,was immensely drowsy and unable to take in what my colleagues were trying to communicate .Hence I started to prepare for work in the morning like one prepares for a war.I armed myself with a bottle of ice-cold water with flavour of tang,a box of grapes to mull on in between patients.This I realised made a whale of a difference.I was my own person by the end of the day.However I was a little taken aback when I started giving one of the ladies' a lecture on 'how one should drink adequate water and not go out in the son without a head covering preferably a cotton one'when I realised that an old lady was giving me an indulgent smile...I had forgotten that they have seen sixty odd summers which was going to get hotter in that place.I was the baby ,taking baby steps into the Benaras heat.
The election rhetorics are getiing louder and louder,they are also getting baser by day.The new low was when the PM called Rajiv Gandhi 'brastachar number 1'.I remember sitting in the OPD a few months ago,when suddenly this youngster bounced into my room ,dressed in sports clothes,smart but I could make out he was from one of the humbler backgrounds.He had a minor ailment but wanted it looked into before he went back to the archery camp,he said.He was under training in a camp in Bangalore,he said.I got started talking to him and he told me that Rajiv Gandhi had started these schools in several places where children with certain talents were picked up and groomed and he was one such kid.I remember feeling a sense of joy and admiration at Rajiv's far-sightedness and most importantly concern for the country's youth.Where are such leaders today?Will God have mercy on our country and give us leaders which will take India towards that light or push us into an abyss of darkness and confusion.We need to pray.We do not know who it should be one way or the other but we want the Lord's mercy on our land.
I have been reading Harper Lee's,'Go.set a watchman'.Her,'To kill a mocking bird 'was one of my favourite novels.I enjoyed the book.It seems to be relevant to the times and a fitting tribute to a society which is multi-layered ,it's choices,it's living,it's causes coloured by factors which are beyond human control,sometimes hijaked by stronger few,heavily corrupted with personal agendas where people like Jean Louis are considered naive.Naive they are,thay have lived in their personal heaven but when reality of the situation hits one in the face it can be devastating.Ask me,I have been through it.During such times I remember talking to one of my colleagues and he told me,'We are not in heaven as yet'.I repeated it dully with an ache in my heart then,but it took supernatural to take me to a place of healing.God has to do it otherwise all of us will be walking around with festering wounds hidden just below the surface, in communities,forever rubbing each other to pain.
The Lord will heal us if we let Him.

Thursday, March 28, 2019

Thoughts...just thoughts...



This fortnight has been different from any other.I am anticipating a tough summer but I am sailing in by the grace of God.I have developed a new interest in eating fish with whiskers fried just right and as have been advising the patients thus far,I hope my haemoglobin takes a kickstart.I already feel so much better.
In the work front ,it is getting busier,more interesting and after a laboratory and x-ray closure imposed on us has been lifted I am enjoying medicine as I should
.We had a freak viper bite come in with local swelling,AKI and a prolonged CT.He is on the road to recovery.The last I saw a viper bite was fifteen years ago.
A day earlier another lady was pushed into the casualty with a history of having consumed insecticide.We asked them to show us the pictuere of the poison and the son had a picture of Cypermethrin in his mobile.Apart from the smell which was strong enough to give me a headache her saturation was in the seventies but she was bright and awake scolding her relatives.We tried giving her O2 witha reservoir mask but her saturation would not budge.We decided to intubate her but decided against it since she was too awake.I asked a junior to take an arterial blood gas,she drew what looked like a venous blood twice although she did feel the second time round the syringe had filled up easily.I had a go with the needle and came up with another dark sample but decided to run it nevertheless.The dark blood had normal gas inspite of the low saturation.This was a mystery .One of our juniors barged into the casualty and exclaimed,'Mam,this is not cypermethrin...it does not smell like this...so we caught hold of the son and enquired if she could have eaten something else?It was then that he decided to tell us that the patient .had mixed it with 'glitter',sodium benzoate to be precise.
Thus the mystery was solved,she had methaemoglobinemia and inspite of the high flow oxygen and normal gas she was rapidly desaturating.Her O2 dissociation curve was shifting to the right.She needed urgent methylene blue infusion and we did not have it so we packed her up with the high flow oxygen to BHU.
In one of the rooms,V ,all of fourteen years is awaiting death with his entire family in attendance.His osteosarcoma has metastasized to the lungs.Every day we enter his room with a sense of dread,this is something even years of dealing with never makes it easy.Everytime we go in he picks his head up from his pillow and looks at me with some kind of expectation..al I can do is wordlessly pat his hair.My colleagues have shared the gospel with him but only the Holy spirit can convict him.So far the mother was dead against letting the child know the truth so he would demand a lot of things from us but today it was different.We can see visibly that he is losing his fat but he looked at peace.Like he does everytime when we enter he lifted his head from the pillow and he sat up and asked me 'Can you do something to help me with my breathing problem?'We have been tapping his pleural effusion every other day,it being haemorhagic it is quite traumatic for the person doing the procedure so we started him on steroids as well,hoping it will make his symptoms tolerable.We don't have morphine and so every breath is a struggle but one can feel his intelligence as he participates in the conversation for his well-being.Today his two younger brothers four and seven and his sister who must be twelve were sitting by his bedside along with his parents and his granny.I asked them if they were vegetareans,they said naught.I asked them why they were not feeding him non-veg food and V quietly informed me they were having fish that evening.He had also expressed a desire to have gajar ka halwa which had been given to him.V looked so much more open to us and so much more comfortable mentally.He had expressed a desire to go back to his village for a day,our palliative care team has offered to make the arrangement with an oxygen cylinder tomorrow.
We walked out a lot light hearted then usual when the father came running behind us and said with a defeated expression,V knows that he is dying ,we told him.While we felt relieved he looked more cast down.Having this child with us to care for ,sobers us down every day.
The two younger kids had come to see the fair in the market but I saw a shadow of sadness in the eye of the youngest.
Just one more day before I catch the flight home for easter...leaving behind this scenario of sadness,grace,suffering,healing ,God's goodness in good measure, riches one would never find in world's greatest pastures.
To Christ alone be all Honour and Glory.

Friday, March 15, 2019

The walk diaries,


I enjoy watching the swan paddle and swim in the water in front of the hospital.Today I realised why?The ducks and the swans everywhere around the world look the same,regal,dignified and beautiful and go about their daily activity sublime and oblivious of all the dirt and cacophony that surrounds them and yet manage to mantain their graceful demeanour.

Today was a strange day to say the least.Our day started with Parwati getting extremely restless on the moderate amount of oxygen which was available.We finally had to opt for intubation and bagging to get her going.By the middle of the afternoon we had got her insurance in order and so was able to cart her to a bigger unit for the much needed HRCT/CTPA and a good ICU care.Vikash offered to accompany her and Vijay went along for the paper works that would be required.She belongs to the Musahir community which is a community of rat-eaters.She has been safely transferred to a tertiary care centre by God's grace,her care covered by the insurance.Parwati was not happy to leave our hospital so I had to invite her back to visit us with her new-born once she was well.Her father the old man almost shizophrenic in his response to all the trouble we were taking 'did not sound grateful for all the help we were meting out which left some of the staffs bewildered ,especially the ones who were with her through night and day knowing that they would not be able to give anything back.We all had become used to his responses and used to take it with a pinch of salt but it struck me that we often forget that this is exactly where our riches lie and what Christ has called us to.

After the drama of the morning,I walked to the OPD with extra calm that can only come by the grace of God ,grateful for the commitment of the colleagues who are willing to walk the extra mile.
In the OPD I had the patients new and old,some I thought had just registered to pour their heart out and so I listened to their life stories of pain ,loss and somatisation- expressed as sighs ,tears and sometimes just hopelessnes.You counsel,you pray ,you try and understand the best you can.
I have been seeing a few army jawans who are immediately distinguished by their sense of discipline and the way they present themselves.One such jawan came with a skin lesion on the face,so I took a picture of the lesion to get an opinion from Dr Molly,a good friend and a dermatologist.I took his number.Dr Molly was quick with her opinion but the man's phone is always out of range.He was supposed to go to either Jharkhand or Srinagar the next day.

I finished my morning OPD well after one and was walking to my quarters for lunch when I noticed a cart with a baby lying on it and a gentleman was standing by the side.I asked after the patient and was told that he was asked to wait since the OPD had closed for the morning.I said not and immeidately carted him to the casualty which was when I realised I was looking down at a face of a fully grown man of around forty or so and better part of his structure was the face.the trunk was stuck to the face ,the chest almost non existant ,the pelvis was missing and his groin was a maze,no feet.Hands were two coiled wires on either side with a few fingers jutting out.Phocomelia perhaps.
He had presented to the OPD with urinary retention.He brought my attention to the fact that his bladder was almost touching his chest.As I got talking to him,he shed a tear and expressed his difficulty in eating food because he had lost all his teeth due to medicines.I made a note to myself to talk to my dentist colleagues about making dentures for him.I kept his phone number and the address.
Once catheterised his companion took him home.This is a patient registered under our disability programme and our colleagues minister to these patients in various forms.

We see wretchedness,poverty,pain,bondage ,all around but we see the hand of God and his ever present help at different times.
We see heart breaking corruption,backbreaking religion which does not value ethics within it's realm...our hearts ache with pain for our fellow brethren but more so for our beloved country.
We ask ,'How can they not have the fear of God in them?'
That is when the answer resounds,'but they do not know God,'
The ball is still in our court.



Thursday, March 7, 2019

Just a thought.


The burden of rabies in India is supposed to be 18,000 to 20,000 deaths per year as per the WHO figures.In my little over a six month period in eastern UP I have seen more dog-bites and rabid patients than I have seen in other parts of India.I saw young children,adolescents,older persons, a strapping sixteen year old with full blown features.Every other day we get patients with dog-bites,mongoose bites and the list goes on.Today I saw a five month old baby with a wild animal bite.You just walk out of the campus and one sees variety of stray dogs roaming around the country-side.
Everytime a person with a dog-bite walks in I give them a small lecture about awareness and the need to vocalise and demand vaccination of the stray dogs in the villages.Everyone gives me a blank stare and smiles happy to shell out the cost of the vaccine which must be taking a portion out of their daily earnings.
We even tried to bring it to the notice of one of the officers in the government.He coolly shrugged off the responsibility to another department.Humans may be affected but it is animals to blame!I was talking to one of the vetinary doctors who tell me that immunisation of thirty percent of the stray dogs would ensure herd immunisation and the rate of rabies would come down dramatically but in this mad world who will listen?
People from eastern UP are made up of sterner stuff.They will have a florid MI and will be wincing with pain but thrombolysis over and after 24 hours one of them asked me sardonically,'Will I keep sitting here or what?It is tough explaining the disease process to a patient who seems to have embraced the symptoms.
You dig a little deeper and you will see how they have embraced the hardships of life as normal.I have been left with my mouth wide open everyday of my life when I have taken the trouble to dig a little deeper.I met a man who had just bid farewell to his teenage son who had got burnt in a battery factory in Mumbai,he seems to have got a compensation of 2 lakhs.I met an old man whose daughter-in-law had comitted suicide a fortnight ago as a result of which both his sons were behind bars.I met a lady whose ancestral house she is living in has already been sold by her brother-in-law to a third party.Every now and then she comes to the out-patient with palpitations.I have seen a young father lying face down on a bed and bawling away next to a twelve year old son ranting on the next bed,rabid and the stories go on.....
Seventy years after independance my countrymen still think this is normal.Are we truly free,I wonder?
...but all these signs of utter poverty are nothing compared to the poverty of the human soul which does not see beyond themselves and theirs.

Wednesday, February 20, 2019

Reminiscing on the journey...and looking forward...

My spring onions have sprung up and thrived much to my delight in a flower pot.The garlic has also sprouted but is not as good.I had put in some coriander seeds and chilly,some greens are growing from one of the pots but it does not exactly look like anything I have planted so I catch all and sundry who walk by ,to identify the plant and so far I have not had a satisfactory reply so I am just letting it grow.Each time I walk out and walk into my house I give my plants a good look over.It brings me great joy.

The campus seems to have perenial flowers and the winter was as colourful as I hope spring will be.The chill of the Varanasi cold did get to me but even as I put on my coat to attend a call this evening I actually started sweating.So the weather is slowly but surely changing.Spring will come to England with a startle.Overnight the daffodils will dance and the trees all around will bloom blood red,purple,snow-white,blue,lavender,yellow and every splash of colour taking one's breath away while my portion will be the Indian summer in the heart of India.This year I hope to be better prepared to face it.
The Indian summer is in my portion but I take heart because most importantly 'The Lord is my portion.'Everyday we see His hand of grace in our lives.He is to be praised.

I miss just sitting on a bench watching the world go by,reading books in those small gardens in the heart of the city,munching my sandwitches and hot-dogs with squirrels for company and discovering history accidentally...here I see humanity,endless sea of people in need,suffering ,struggling,fighting their inner demons,just struggling to survive,to be counted,to be heard and sometimes to just get by their daily lives.Does it fascinate me?I have seen too much of it in the greater part of my years on earth.

I happened to do my medicine degree from Bankura district which was enlisted as the poorest district in India at that time.People lived on puffed rice and water.I saw wretchedness poverty and large heartedness at close quarters as we watched the mohallas of servant quarters with Gayatris,Manjulas and unpteen number of mashis who used to cook,clean,drive the rickshaws..invite us into their mud-houses to share meals with them.
I started writing poetries in Bankura.What else can you do when the corpse that lies in the anatomy table is just bones and skin and yet nobody has taken the trouble to remove the armful of colourful bangles that adorns her?Things I saw then were endless...it would be in a diary somewhere.

Post graduation was in Tamil Nadu.There it was more comfortable kind of poverty with certain innocence.'Pattis'in the sixties would wait the whole day outside the OPD for their numbers to come just to have their amitryptaline repeated and would often put in bombastic english words right in the middle of the tamil monologue.The crusadors had clearer vision and they were well looked after.

My next stop straight after Tamil Nadu was Palaumu in Jharkhand.Now I had the privellage to not only see poverty at close quaters but Palaumu had another feather in it's cap.It was supposed to be one of the bloodiest districts in India.A fresh post-graduate from a protected environment of my post-graduate institute,being pushed into this area was an education in itself.I easily took a cool four years to find my footing there,the sheer magnitude of the disease burden of tropical diseases,poverty,bonded labour,naxalism,addictions like alcoholism,immaturity and the genuineness, bravery and aspirations of the poor taught us to look up even as we persevered to try and do our bit.We interacted with the community,got invited for weddings in the village,invited the villagers for annual functions and ate lunch out of leaf plates on the floor but most importantly worked with them even as we facilitated the various health programmes whether it be TB,RCH,HIV,Malaria,.....
At times we hopelessly looked on as the villagers carted in cobra-bite patients in respiratory distress with five hundred rupees in their hand.Everyone was catered to.Patients with falciparum malarias used to be brought in in droves,grunting,screaming ,bleeding.....Many lived,some died.Others with rupture uterus,mucked surgeries from other centres ,complicated obstetric cases used to be a common sight.In the last seven years or so ,in the centres I have been to it is not so common.
I wonder if the RSBY and the various insurances programme the government put in place made that crucial difference or have I moved to more affluent areas now, I wonder.
My sister always used to tell me that I am lucky in the sense I have had the privellage to sample the main beds of culture of India,namely Bengal,Tamil Nadu,MP,UK....and now I am in Benaras another place,with it's own set of bondages ,very different from the ones I have been exposed to before.

In all the journey around the country there has been a rock steady hand that has led me on and it is that hand which will safely see me home someday.
I have been going through the overview of the book of Ezekial in the old testament.It really astounded me as it did Ezekial himself that God of Israel chose to reveal himself to Ezekial in a vision by river Chebar in Babylon.It says the hand of the Lord was with him.
As was the question in Ezekial's mind ,Should not the God of Israel be in His temple in Israel?What was He doing in Babylon?Through the vision God continues to show Ezekial how the israellites had desicrated the temple,had built idols and had turned away from Him.Then God reveals to Ezekial great things about the things to come.
This prophet of God is in bondage to the foreigners physically but that lone man even as he grovelled by the river Chebar has been honoured by the great God of universe Himself who has shown him the present and the future of His people.
It brought to mind another man who God spoke face to face as though he was a friend of God.(Exodus 3 vs 11),the man Moses.Even at the end of his journey God takes him to the top of Mount Pisgah to show him the land God's people would inherit but he would have no part in.
To that end ,I hope we believers will aspire,to be a friend of God regardless of where we appear to be physically.
Our God is a relational God.