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Showing posts from 2010


The Gene X-pert was apparently developed by the department of defense after the events of September 11th when biological threats became a national priority in America.It was used to analyse the DNA in potential toxins in pieces of mails.In 2008,funding from Bill and Mellinda Gates Foundation ,FIND and NIH began to assess the machine's effectiveness in diagnosing tuberculosis. Gene X-pert as per a study published in the 'Journal' identified 98 percent of active infections because the tests look for the bacterium itself,latent infections are ruled out. Detection of latent infections would have no significance in the indian scenario because tuberculosis is so rampant in india. Treating latent infections could be potentially dangerous and could promote drug resistance because only twenty percent of the population harbouring the infection could manifest the disease. Inroduction of GeneXpert technology in the national health programme would pose two-fold challenges in india.

Let me heal in His hands.....I have not had the time!!

Someone asked me how was last christmas?...For the last four years I have been away from my family during christmas.I remember last christmas like the back of my hand.Infact for the past three years or so I have spent the christmas nights resuscitating patients back to life by the grace of God.It has invariably happened that the patient and myself ,we walk out of the ACU in the morning.They blessing me and I ,thanking the Lord for the Gift of life given for Christmas.However,last christmas was unusual indeed and will not I guess, go away from my memory too soon in the future. My cousin was struggling for life in Jaipur,the family had all but given up on him..Mr Ram Narayan Sahu(name changed),from Satbarwa,who had just had a bypass surgery ,who also had diabetes mellitus with stage four nephropathy came in with acute on chronic renal failure with gross fluid retention ,huffing ,puffing and frothing out blood and could not go for dialysis till the day-break.That was enough to keep me by

There it is !!

Sadoli block has been bothering me for the past two days.Today ,I shot a letter to the CMO,ACMO and the medical officer incharge of the block.Mukesh is planning a mela for Hep B awareness,immunisation and testing in the area.He called up a panchayat head in the village and was told that another person near his house had just died of jaundice a few days back. Got talking with one of the patient's bystanders from the area and he was sharing how the previous day when he went to a visiting RMO?Quack ?from Dehradun to administer a pain injection for his old man, he observed that the so called Dr was using the old man's used syringe and needle for a little baby and another patient who came in after that. When he reprimended him ,I believe he said,-'they cannot afford a fresh one ,so never mind!'. Waiting to see how the government goes about investigating the issue and taking some measures.


Five of a family from Sadoli block presented with severe jaundice with cholestatic features,ages ranging all the way from five to fifty five.They turned out to be hepatites B positive and negative for Hep C and HIV.I had just about started getting perplexed and getting the point person from the Sadoli block mobilised, another young fellow from the same block but different village altogether came in with the same picture and turned out to be Hep B positive again. Sadoli is a block in Saharanpur district in Uttar Pradesh.Our man is making a fleeting visit through the block to actively look out for more cases.These are the cases which have landed at our hospital.Are we looking at some epidemic of some sort, I wonder.Will try to intimate the CMO tomorrow after we get more details,I sincerely hope the government takes note and swoops down to the root of it all.

Being Thoughtful!

Ango was with me for less than a month preparing for her DNB exams.She has always been for me a little sister ,brought my way ,I believe,by the Holy spirit.I have stopped wearing a watch for the past five years and have all but given up on my phone for the last one year.I carry the latter around more for incase,but never felt the urgency to charge it.People have a way of reaching out to you in this highly sophisticated world of advanced communication. Coming back to Ango,she would be up and alert at five or so in the morning.I would hear her rustling around her room,having her quiet time,studying,etc and invariably I would be calling out to her in the other room asking her for the time. It went on everyday for the rest of the days she was with me. Time plays an important role in the mornings for me.It's a precious part of the day and I normally push in the best part of my day's schedule for then.It is perhaps the most important time of the day. Ango presented me with a love

Human rights issues in TB control.

I remember trying to convince Phoolmati Devi(name changed) to continue with her DOTS.She was an alcoholic lady in her forties with a family of twelve or more ,clustered in a two bed-room house,unwilling,uncaring and careless.After a series of visit from our boys and the doctors in turns she continued to be a potential source of infection in the middle of the village in Satbarwa.I was totally frustrated.I asked a series of experts on tuberculosis whether some way one could legally presurise her to take the medicines....everyone quoted human right issues..sounded a little confusing ...the knife could cut either ways.I got my answer in the meeting yesterday.

Why is the doctor so irrational??

The New yorker apparently carried a story about tuberculosis on the streets of Darbangha in Bihar recently. If there was a strong message to be carried from the sympossium,it was the message to ban the use of serological tests for diagnosis of tuberculosis.WHO is ,for the first time in it's history ,putting forward a negative recommendation. We stopped using serology for TB diagnosis five years ago,but never mind-it's better late than never. The article I believe,goes on to highlight how the doctors in Darbangha continue to order this expensive test for diagnosis of tuberculosis.The cost of the test runs up to 25 dollars.The patient is a labourer who earns around 2 dollars per day and the profit made from the twenty five dollars received ,is shared between the doctor who prescribes it,the person who imports it and the french company which produces it. So our poor rickshawpullers on the street ,who contract tuberculosis, are making these dubious companies in Europe rich!One

The important ..and the very important!!

I remembered Nirmal Bhuiya yesterday while attending the international sympossium for TB in Delhi.Nirmaljee was our DOTS provider.He volunteered to become one after his daughter who had tuberculosis was cured under the programme in Satbarwa.As I rave about it often,the DOTS providers in Satbarwa were one of the wonders of the world.Their dedication and perseverence and commitment to the cause of DOTS was phenomenal.That was before the government renumeration made it a paid service.These simple villagers pursued the cause of DOTS at considerable costs to their livelihood...paying at times out of their pocket for the transport and things and the government renumeration was not even forthcoming. Nirmalji contracted tuberculosis one day.He had quietly come into the clinic,had enrolled in and was about to go home when one of the TB workers up-dated me about things.I sat and talked to Nirmaljee for a while,some words of encouragement and promised to visit him at his house. We made a trip t

Tuberculosis-GenXpert /MDR/Rif.............right to life!!

Was on and off for the sympossium conducted by the Bill and Melinda Gates foundation and FIND on tuberculosis in ICGEB in Delhi.It was on diagnostics and with the current onslaught of GenXpertMDR/RIF being endorsed by WHO the mood in the TB world is upbeat no doubt.However,in one of the presentations on ethics some points were highlighted which were rather disturbing.I,being a clinician working in a relatively rural set-up where MDR is rampant would naturally have a single question in my mind and that would be-how is it going to effect my patients with MDR?I came back totally discouraged by a few points put forward by a speaker who was discussing the ethical aspects of the tests in hand. He was putting forward the options that lay before the government of India.I thought the cost of the infrastructure would be a case in point but what was on discussion was the dramatic increase in case load,without a back-up of proportionate treatment facility which could have moral and legal implicat

Meanderings of the mind!!

Sometimes it so happens that you just want to let your mind wander and keep hasn't happened to me for sometime but I can see all the traits of a workoholic developing in me.I do my share of duty and more normally ,I do it because there is a need .I enjoy the work that I do but I don't necessarily drag myself around my work twenty four hours a day.I stuff in a lot of other things within that schedule but the last but one week I am beginning to observe myself staying longer hours at work....I leave the workplace by seven or later which is not normal for me....I need a lot of time to myself and I am quite possesive about it. The other day my sister was having a spell of dizziness and the doctors were at it trying to get to the bottom of it and now she has a MRI in her hand which reads a 'small six into six millimetre patch in the left parietal lobe ,may be demyelination!'. She is a non- medico and was on the phone asking me about it's implication.I kept

What Mathew shared today…..!

Mathew for one always surprises me with his faultless hindi. He gave the sermon in the church and it was a powerful sermon. Few things that I remember … We are here on a Sunday because of the Cross and not because of Christmas. When Mary said ‘so shall it be with me !’ to the angel ,she was fearful in the circumstances that surrounded her where the punishment for adultery was being stoned to death and being a social out-caste. When she agreed to the virgin birth she also agreed to a lifetime of pain. God put the burden of the salvation of the World on two young shoulders ,who went through periods of uncertainity,displacement…during this very season…. Christianity is a lifetime of intense pain which brings us to the experience of exceeding joy amidst it and is not a chocolate candy solution for everything there is. He challenged the youth in the church ,amidst the activities of the christmas to read through the four gospels. He cautioned us against institutionalizing

Disadvantaged or advantaged..??

A fifty year old lady came to the out-patient accompanied by a fiesty husband with a history of having been through the DOTS-1 and DOTS-2 in the local PHC with continuing symptoms and with added features of florid peripheral neuropathy.The lady was having a tough time standing straight the first time I saw her.They were poor ,refused admission.Came back with the investigations which made my heart heavier.She had a suspicious mass in the right upper zone in the X-ray and her sugars were touching 400mg%. She needed a CT,but that would put them back straight by two grands where they were counting the pennies for the immediate treatment.It was a saturday afternoon and it was well past the out-patient time.While the out-patient staff patiently waited,I struggled through my words to convey the news.The man looked a little indecisive and wanted his wife's opinion.The wife took the matter in her hand and very calmly made some very practical decision taking the matter and the responsibilit

It happens sometimes...!

This has been a mad week end indeed! With all the students and the consultants away for the examination week ,I was supposed to be the lone doctor managing the medical out-patient which has an average of eighty to ninety patients,I actually ended up seeing my usual thirty patients (don't ask me how ? we have not solved the mystery as yet),second call for the emergencies in medicine ,as well as consultant incharge of the wards and the acute care unit with another resident doing the hands on. Yesterday evening,a patient with a broncho-pleural fistula went into an acute episode of traumatic pneumothorax following a tube block-he was a hefty man to boot who already had a chronic kidney disease,it was a frightening three hours with us almost losing him but somehow we got the better of the pneumothorax with my heart in my throat even as we flailed around with the patient.Thanks to the few colleagues around who were such a rock I thought I would collapse on the spot.Just as the calm was

Tuberculosis and HCH!

Started organising the TB work in HCH. It's a mammoth work with hordes of multi-drug resistant tuberculosis patients.Trying hard not to think too hard about the challenges that are going to come my way once I get started.It's amazing just how much of involvement each of these individual would need.Have roped in Mukesh from CH to help me out.He already has an extensive field experience in tuberculosis. Started off with preparing my colleagues and getting a register started with the patient details.Have segregated a room in the out-patients that is going to serve as the clinic on wednesdays.We will need a lot of grace from the Lord even as we get deeper into the work.Today I met a patient who was well into the third year of the drug,having lost his family to the disease,being supported by the hospital entirely. There are a lot of patients who are potential MDRs. A huge number of cases are from the adjacent Saharanpur district of UP. A month back,one of the patients walked in

'Fazal tera hum par prabhu..raham tera hum par....'

One of our seniors was visiting from abroad. While speaking in one of the devotions,he was reminding us how fortunate we were to start off a day's work with the morning prayer.He asked us if we were aware of it. Having worked in a mission hospital for most of my adult life it is a norm but for me every day,a good time of corporate worship with devotion before the work starts off continues to be precious.I remember during my post-grad days running to the chapel early in the morning to sit on the cold cement ground of the ODC chapel to listen to the nursing students singing those melodiously beautiful Malyali and Tamil songs ,not that I understood too much of it ,but it used to be ethereal.Even now in HCH,the OPD staffs lead the worship to some out of world worship songs accompanied by beautiful indian and western instruments.Songs like 'Fazal tera hum par prabhu,reham tera hum par' typically folkish and heavenly ,has the ability to export us to another world alltogeth

Can you give me a minute please!

The day before yesterday ,a little before midnight ,a couple was brought to the casualty.They were both dead-long gone and cold by the time they were wheeled in.It was a case of deliberate self harm.Under the normal circumstances ,the doctor would have examined the patients clinically ,declared them and would have continued with her work.This time however,something made her take a long second look at the couple .They looked familiar...The doctor on call was doing a thesis on DSM and had a set of questionnairres she had to go through with each of the patients with the diagnosis.She could not put a finger to the identity so she put down the numbers mentally making a note to take the chart out the next day to see what the earlier visits had been for. All cases of DSM ,before discharge, go through an evaluation and counselling at various grades ...starting from the doctor incharge, to the consultant and if not a staff ,the pastor.If they need help they are sent for specialist consultatio

Give it a thought!

Managing the hospital was not the best thing I have done in my lifetime.Three years of administration in Satbarwa I guess, was a growing but a painful time ! By the last but one year I had become almost numb to the pressures of the administration from within the campus but from without,it was a different story altogether.The very fact that I could actually sit behind a desk and listen to the endless chatters of the local touts was an achievement indeed.One day I even ventured to the court amidst pan-chewing lawyers to get into a discussion about a medicolegal case concerning the hospital.I mentally patted myself on my back the day I returned from the lawyer's office wondering how my father would react if I told him about it.Ofcourse,I never did. I was trained to be a doctor,aspired to be a missionary,called to be a christian. The last ten years of my life has been a roller coaster journey moving into very different roles as time and situation demands...... What really set this

Reading and reminiscing!!

I have been reading 'Things can only get better 'by John O'Farrel ,an ardent labour supporter surviving the eighteen years of conservative rule under Thatcher.I have no idea who is to be given the credit for collecting these books in the library but I bless the soul.This is the second book in a row from the HCH library which is had me in splits..I cannot wait to get my hands on the next one. John O'Farrel is born a labour supporter on the wrong side of the social scale...who has had to survive eighteen years of Thatcherism...all the time hating her guts..!! Here is a man earnestly trying to fit into the labour he describes...'Every definate opinion I attempted to make petered out halfway through as I realised I ought to consider the other side of the argument ,until the end of my sentence ended up contradicting the beginning'. The book traces out the life of an active labour supporter through the period when the very existance of the labour party

The little but important joys!

Was not keeping too well because of my ears...anyways made the trip to Mirzapur.Came back and felt extremely neighbourhood twins had their first birthday prayer meeting.After the OPD my eyes would just not keep open.I made myself comfortable on the couch felt like I had put my head on the pillow for fifteen minutes and I started dreaming.I dreamt that the stairway leading away from the twins place towards my house upstairs was covered with a snow-white sheet and decorated with tiny flowers...I was trying to make my way to my place through the decoration but it was pinned through and through.The room to their house had a certain glow and deep within was an inner voice telling me the prayer was about to start..I woke up from my slumber then and the meeting but started.What a strange dream ,so apt.My lazy self made my way to the meeting only after a phonecall from the parents..but this was a refreshed me! I have had this dream on my mind for sometime. The sunday follo

Reading through the fortnight!

Read two books over the fortnight. 'Like a dandelion dust'-on a possible adoption revocation. 'Handle with care'-about a child with Osteogenesis Imperfecta. Both the stories surprisingly are stories which depict sensitively the struggle a parent will go through to do the very best,as they perceive, for their children....the struggle....the dependance on Egypt....near fall ......and restoration on one count and rather sad conclusions on the other. Both the stories are supposedly fictions built on research..but it could easily be your story and mine.... It struck me how hard it is for us fallen men and women to let go and let God.... We forget time and again how great our God is....Elohe Tzevaot,the Lord of Hosts!!

Beyond the Mirzapur..!

It was Mirzapur again this morning.The morning clinic brings in a steady stream of women in all shapes and sizes...The call for prayer in the mosque is followed by a spectrum of pretty little ladies pouring out from the madrassas in green dresses and white scarves...very curious to see me sitting in the clinic,they peep in through the netted window with broad smiles.Some of them greet me with a salaamalequm! to which I immediately respond walequm salaam! and am rewarded by giggles..Near the door, the whole morning, a dignified elderly gentleman has been watching the proceedings in the clinic and Mukesh introduces him as the patriach of the family and the head of the village....he serves us lovely tea towards mid-morning in decent china...By the way ,his son has won the municiple elections I believe. My colleagues tell me there has never been a communal violence in the area.Mind you ,there is not one ANC patient in the clinic.The NRHM actually has made it's presence felt here,they


Standing pert on my kitchen counter are two pretty mugs..printed in beige.Each time I see those mugs brings me joy..It was a gift from a friend who remembered me...and remembers me through most times of my life....with it was a note from her little one with painted hearts and the biblical verse..'Love the lord your God with all your heart.....' I received another post from my sister today,she is ten years my senior,a beautiful mother and a great women of God as well.It was a post about a message by a Louie Giglio,where he talks about the structure of Laminin-described in the wikipedia as 'Laminins are a family of proteins that are an integral part of the structural scaffolding of basement membranes in almost every animal tissue' It is the cell adhesion molecule and what literally holds us together.He refers to the verse in Colosians 1:15-17 .(Referance to the picture of Laminin in my blogspot).It's indeed amazing to discover in parts how God has so wonderfully


Was in Mirzapur for the village clinic.The clinic space was a private house ,a space in an extended room with three charpoys.It belonged to the municiple candidate who's election results were expected the next day.Mirzapur is a muslim settlement and that is it!I had never been to a purely muslim settlement as such, so it was a little surreal for me.The houses had a typical muslim architecture with a mosque right in the middle of the chowk.The village was peaceful,prosperous and at their daily living.....farming,weaving ,praying,children going to school.One could hear the cry of Allah...o...Akbar...from the mosque in the quiet of the afternoon.The house owner himself laid out a table and a chair for me. We had the regulars coming in for their quota of medicines.Some of them followups from HCH happy to see a familiar face...... Something that one of our seniors left behind a few days ago has been hovering around in my mind.While taking a lecture on ethics,there were a few words tha

Going out for a clinic!

I went to the Bathshaibagh clinic with the CH team today.It's an hour's drive from the hospital.It's a lovely drive and the clinic is situated within the campus shared in common by the Central industrial Security Force and the Hydel project. A few things struck me even as I attended to the patients in the clinic. 1)The people who wait for doctors to reach the clinic are the old,debilitated and those who are unable to access health facilities at a distance.If we were not there they would have been over-looked.Hence it seems extremely essential for the doctors in our hospital to move out to the fields from time to time if we really want to reach out to the marginalised. 2)This year whichever part of the country I have been to, there seems to be a surge of malaria epidemic,I do not know what the government stats say. 3)A central security force like CISF does not seem to have any accessible health facility anywhere in the campus,not even a dispensary.Felt extremely sad.Were

Thank you Lord......!

A week's shopping was due-was literally out of the permutations and combinations in my diet.The doctor had advised me morning walks for my ears-have been faithfully walking ever since.I have no idea when the transition to a good patient happened.Today was sunday so I thought I would postpone my walk for the evening and club it with shopping.I took the path through the tea estate.The jungle was a delightful spectrum of colours and could have passed off for a bird sanctuary...a cow and a calf was at it munching off the tea bushes...I walked on taking in ,delighting in the restfulness of it all.A kilometre away I was in Vikashnagar vegetable monger's drooling over all the fresh vegetables, a sure sign of winter coming in. By the time I had decided what I wanted and needed, the plastic bags were breaking to the seams so I demanded a stronger bag off the man.Apologetically he fished out a plastic sack and asked me if that would do.It looked pretty convenient albeit a little awkward

The teacher and the taught!

'Mam,the words in Park and Park are beginning to make sense....they are popping out of the book at me like it hasn't ever before..'-this is how one of the youngsters described the classes Jebu(Dr Jacob John) has been taking for our DNB trainees. Public health has been a big struggle for them.It was so very kind of Jebu to take time out of his schedule ,to come all the way from CMC to Herbertpur to give the students a brush up. These words from the student brought back to memory the same line used to describe a bible study taken by Dr Kuruvilla Varkey. The words were actually uttered by Dr course of a conversation....during his visit to Satbarwa where I was based. It is indeed heartening to know that the legacy of a good teacher and the taught goes on.......

Getting to know my ears!

I have been getting these episodic vertigos in spring for the past five years .October saw me travelling.I developed it again.Quite a few people in the paraphenalia were spinning as well so I took a labhrynthine sedative and pushed it to the back of my mind.After a week when I started developing tinnitus as well my alarm bells started ringing so I visited the ENT surgeon.Saurav after having examined my ear told me'Mam,you have Menniere's disease '.I discovered something else that day.My ability to feel shocked or upset had also taken a bouncer. The only emotion I felt was an intense curiosity!Suddenly I was very eager to get to know my ears.I was in no discomfort whatsoever but my head had started ticking overtime trying to discern different aspects of my hearing and tinnitus.As was expected,comprehension to low frequency sounds were a bit muzzled so was the ability to discern words against a noisy background.Grand!I go for my audiometry this saturday. I turn thirty-nine

Isaiah 11:6

It's a saturday and I have an afternoon off and the luxury to sit on the computers for sometime.Nandu and Ango were with me for a week,they have left for JKD.It's always nice to have my juniors around. There is something extremely fresh,naive and heart-warming about these youngsters who immediately take it in themselves to be your gaurdian of sorts.One person I had the privelage to meet while in Chattarpur was Anjali,a fresh junior doctor from Ludhiana doing her bond with EHA.I had gone there to replace one of the senior doctors.She was looking after the medical patients in the hospital. I was taken aback and very warmly amused to observe how she took me under her wings while I was there.She had a ready answer and a solution for almost all the queries and concerns I had.She made sure I had all my meals,I had a stethoscope,a pen to write with,a book to read,tea in the mornings,water in my room,dosa for breakfast..and even a chocolate cake because I happened to have the craving

Do I listen enough?

Developed an acute ear infection and got a taste of tinnitus and vertigo yesterday.My Rinne's and Weber's are haywire.The ENT surgeon thinks I might be getting Menniere's,I hope not. In the mean time I had to take the chapel.Ango was sweet enough to translate for me.Not that I don't have a hold over hindi but I found the whole process of mentally translating my meditation to hindi as I spoke,too tedious. Four aspects of our call came through in the meditation. 1)Call to interpret the sign of times. 2)Call to convert in response to the interpretation. 3) Call to touch God.(Ref-Luke 7,vs36-50;Mark 12,28-44;Mark 5,28. Imagine God telling you 'You have done a beautiful thing!'. 4)Call to connect to God. 'Disconnected Moses only managed to bring trouble to himself and his family but connected the might of Egypt could not stand before him.'

TUBERCULOSIS-a need for an honest appraisel

India is supposedly home to one fifth of the tuberculosis cases in the world.According to the WHO reports nearly two million people contract the disease every year,while 2.8% of these are supposed to be drug-resistant.As per the government statistics the coverage of RNTCP is supposed to be one hundred percent with a success rate of 86%.With two million cases coming in every year, even if the programme were to be as successful as it seems to suggest,we have a major public health problem at hand. The WHO objective for tuberculosis management suggests a case detection rate of more than 70% which according to the reports have been achieved in most places and the RNTCP is I hear, looking towards a target of one hundred percent.Is it a feasable target in the current ground scenario? Is there a need to put into place some radical legislations before we can even think of getting somewhere. Does the government of India need to have an honest appraisel of the current ground situation at all

CWG ,a lesson!

I always end up creating a ruckus with my loud laughter when I am around Jamela aka. Today she was narrating the whole Commonwealth games ruckus from the eyes of a Delhite commuting past the area to the office everyday.We have already been hearing a lot about the drive on the part of the CWG authorities to hide the slums of Delhi behind corrugated sheets put hastily on the side of the roads with huge banners to hide the slums.She was narrating how on the first day after that, they noticed a small hole cut out from the sheet from where people were commuting in and out to the open road.It stayed that way for a few days more but after a week some ingenious fellow had brought out a whole bed through the gap and a whole lot of the slum-dwellers were generally using it as a chowk,to sit on and talk. I laughed my guts out in the central office when I heard this but on the retrospect I was just thinking what a great illustration of a hidden sin it was!

Delhi,CWG and a poorman's bread!

Travelled to Delhi. The only referance to the Ayodhya verdict I heard on the way was from some of the bearers in the train who were arguing with a passenger.Delhi seemed ready for the commonwealth games.A sleepless night had ensured that I be behind in energy ,steadiness and patience.The normally 45 minutes drive from Nizamuddin to Dwarka took three hours straight.Thanks to the CWG lane the government had segregated, the cars in a row crawled in the traffic while one half of the road looked empty un-used and superfluos. Delhi did not look one bit like one of the economic superpowers holding an international event of repute. Had already heard so much about the mud-slinging that was going on in the television channels ,I did not want to add to it,but I did feel bad for the auto-rickshawpuller who had to make do with a single sawari when he could have done three in the time. I do after all, agree with Mani Shankar Aiyar to an extent I think!-but I do want the games to do well.

A night in the station

The Ayodhya verdict was scheduled on the 30th of September 2010.I was to leave Chattarpur the same night at nine.A sudden phone call from my sister urged me to leave the hospital a day earlier on the 29th and it had to be at midnight to catch an on-going train to Delhi from Harpalpur.We were in the borders of UP,I had no access to television news so was unaware of the umpteen number of SPGs and the border closing measures the government had undertaken.Pappu,the sardar drove us through the night to a sleepy station past the mid-night.Rev Prakash who was travelling with me had a 'Frontline' which I managed to skim through in between slapping several mosquitoes that were having a field day sucking blood off the passengers in deep slumber inside the waiting room.I decided to move out to the benches for some fresh air. An old villager lay on the bench stretched out to his full length covered by a thin chaddar.When he saw me approach the bench.He apologetically got up and attributed

India of the Risen Christ!

Glory of the Lord being manifest in the lives of Shadrachs,Mesachs and Abednegos from the North.. Moses' from the East and the West moving with the Hand of God upon them. Joshuas from the South claiming every land they put their foot on for Christ. And Davids from the core of and women after God's very own heart worshipping and loving him like the shepherd king. AMEN.

India of the crucified Christ!

There was a prayer call for all churches in Chattarpur. The only issue to be uplifted was the country. While praying for India,I started painting a picture of Christ crucified in India. It looked something like this. The crown of thorns lay on Kashmir...the nailed hand bleeding on either side lay on Gujarat on one side and Orissa and the eastern states on the other.The foot of the Christ was in the south nailed to the cross again ,it seems. The heart....the weeping..agonising...beating heart of Christ lay in central India.... but WAIT!... there is something more... THE CROSS IS EMPTY... CHRIST IS ALREADY RISEN.... THE PRICE HAS BEEN PAID..... but the reality of the risen christ continues to ellude the billions in the land! Where is Mary Magdalene today?? ('How will they know unless they are told...?')


It's last but one week of September.In UP and the border districts of MP,all eyes are on Ayodhya.It's fascinating to note how every common man's decision about the week seems to be bordered around the verdict.People wanting early discharges,wanting more medicine,wanting to avoid travel. The ward that admits the medical patients in the hospital here is a potpouri of socioeconomic mix.It is a large hall meant to house eye patients during season but is at the moment converted into a medical ward. In the first bed ,next to the nursing station ,an endearing old man in his sixties with Alzheimer's who has developed a scrotal ulcer is bedded.His two sons and his wife attend to his needs and seem to be devoted enough.He is a bundled up mass of silver hair,looks almost like Einstein and wears a blank expression on most days.His every nuances and discomfort are well interpreted by his folks and brought to our notice.Twice a day,i make it a point to walk up to his bed and make c

An unreasonable man who is courageously wise and wonderful!

I read three books during my fortnight's stint in Chattarpur.The diary of an unreasonable man-by Madhav Mathur published by Penguins could pass of for a bollywood pot-boiler.'The cure 'by Geeta Anand,a senior writer with the wall street journal captured my fancy quite a bit.It deals with three of my favourite topics of medicine,research and sheer grit in the face of adversity.It's a true story about the Crowleys, whose two children are diagnosed with pompe's disease.The father fights his way through the difficult circumstances to save his children.It takes us into the world of research and the dynamics involved in the search for 'cure'.It has inspired a movie'Extraordinary measures'starring Brendon Fraser and Harrison Ford.I am yet to see the movie. The third book I am glad I lay my hands on was James Herriot's novel'All things wise and wonderful'.A wacky,warm and well-written as only an english man can write english.I found myself chuck

At it!

It’s been a hectic two days.Sort of getting started with the DNB classes-with exams just three months away ,we have two students from family medicine ,two from rural surgery and two from OBG appearing in December.By God’s grace help has been forthcoming from various sources-taking classes,helping with their course work,helping start a family medicine forum every Tuesday from three to four where the students sit together by themselves to discuss some prepared topics and share the schedule for the next week.One of them keeps the minutes and the non- exam going batch do some research on various topics given for the add-on.It’s just a way to encourage a dialogue ,discussion and a feeling of camadarrie amongst the students ,each one helping each other out in what ways one can.They had their first sitting yesterday amidst visitors from South Africa who were heavily into the system in the hospital.Had an average biryani and an excellent salad with strawberry ice-cream with the visitors in a r

Walking with myself,with friends and with Jesus!

It is almost a fortnight since I joined goes on. Was overjoyed to receive a brand new bronchoscope from a visitor in America. Was faced with a spate of interpersonal problem issues from friends,from the one question during the day was why can't people get along? I have started carrying a small book of meditation by Selwyn Hughes in my apron pocket.Sitting in the OPD ,I found myself having a constant desire in between the patients to get back to the Word.I couldn't find a Bible that would fit into my pocket,so next best thing that fit was this book.I like Selwyn Hughes' meditations.All through my growing up years our parents subscribed to 'Every day with Jesus'and we loved every issue of it often waiting for the new issue to come ,expectantly wondering what theme it would hold. During my school days there was one more daily reading which we loved and spoke to us.It was called 'Spring in the Valley' and became mine courtesy my

A day of dissapointments!

I am sitting in front of the PC not exactly sure where I am getting.It has not been too good a day.Apart from a few dissapointments which I dealt with on my knees.I keep recieving strange notices off and on -notices to put my signature on-and I wonder to myself ,I thought I was trying to get away from all this. I keep surprising myself with my own reactions.I have to literally talk to myself and say 'it is allright to be dissapointed'. I remember one of my seniors in one of the sessions suggesting we talk to our soul as often as possible, as David did.Sounds amazing!but that wouldn't be possible if we ran the world . The more I look at myself ,more fervently I find myself praying - 'Lord hide me behind your cross!


Today my neice who had come to be with her father for the last three months flies back to the US sans the assurance of having the earthly father,I cannot begin to understand her pain.Walking up the hill for the last rites,she was heard commenting 'appa is so mean!He is making us walk so much!'I could almost visualise my cousin winking. The other day there was an article in the newspaper sent all the way from the UN where an IPS officer from the backwater is posted .It was a tribute to a senior colleague who had been his district collector when he was posted afresh as a young police officer in the God's own country. I received another letter from a lovely lady from Bangalore who had been in school with him and had read his book.I thought it was a lovely gesture of grace ,especially since I did not know her. For the past two days the pastor has been blessing us with this lovely words-'The Lord remembers!'. What a beautiful assurance and what a beautiful truth!We,w

Something of the yore and something new!

Kumud,Sandhya,Pradhan and Ajay were here for a day.They had an extra day at hand.They were on their way to attend the MUC,they arrived a day earlier and they came away straight to Herbertpur.It gladdened my heart to see them. Spent a lovely evening with them.It was like having one's family visit. Prayed for Satbarwa together. It's two weeks exactly since I joined H'pur and the women's group met at my place today to get ready for the all night prayer at the church.We have the women leading the worship from ten to eleven.Lyn is leading us in worship and the lovely ladies are all supporting her in spirit.It's such a joy to meet up with a group of ladies who are ready and open for the lord to work in their lives.I am excited,I don't remember a time ever when I have waited on the lord for a whole night... The DNB students had their internal evaluation today.Geogy is here for the same.He spends his time diligently with the student,working on them so as to make sur

He came from heaven to earth to show the way!

Was reading from the epistles for the morning quiet time.Enjoyed Philipians .I had my chapel turn .Was looking to the Lord for some guidance .While praying,I was suddenly singing in the spirit...the leading was to speak about Christ's I had to turn back to the Gospels...and it was the gospel of John that I turned to. Certain aspects of jesus' ministry came through. 1)He was 'sent'. 2)His purpose was clear and he moved with His head towards Jerusalem...towards the purpose. 3)His priorities were He teaches his disciples to pray.. Oh Lord our father, who ought in Heaven , Hallowed be thy name.., Thy Kingdom come... 4)He came to reconcile and restore men not to condemn them. 5)His most intimate burden which he shares with His father in His prayer were- -that they have eternal life and this is eternal life that they know you and jesus Christ whom you have sent. -that they may be one as we are one . -That they may be sanctified by truth an

As you do it!

'As you do 'by Richard Hammond is a travel adventure narrative written by one of the crews of Top Gear-the BBC serial .It is a delightful read anyday with the author taking you on a trip to the Arctic on a dog sledge to a drive across the heart of Africa with all it's varied struggles and babboonry.Born in 1969,he has a hilarious take on the struggles and fiascos behind the scene of filming TV serials on adventure.Loved his language and found myself chuckling all tomyself even as I finished one half of the book on a saturday night.It's amazing how recording one's experiences through everything that happens in life can be such a fascinating read for another person.I liked the person that came through in the book.

Something due......

My cousin PG who passed away recently was an exceptional person.Almost a decade older than I ,reckless as can be ,did everything one could possibly do in his lifetime.Was an achiever who broke rules every step of the way and always had the last laugh most times. I remember him being picked out in school for getting into a gang fight of sorts-I also remember him being a rebel in school and topping the boards-I remember him bearded and into martial arts.......hearing stories about his hindu days...he was once telling me how he burnt all his furnitures in the lawn of his college on the last but one day....he topped his college as well.I remember his father changing drivers gallore because he was found perpetually in their company 'guitaring' away and generally jamming around.I remember my uncle taking my two cousins in turn for sessions of lecture which lasted half an hour or so but both the boys were in complete awe of the father. He went on at the age of 22 to fields of the IA

I understand perfectly what you mean!!

Difference in the way we understand and comprehend people was something I have ,I must confess, rarely entertained.I still remember once after an impassioned interpretation of some passage, one of my juniors softly reminded me,-'mam,we are men,we understand and comprehend things differently from the way women do'.I am still trying to comprehend what he meant! Working in a rural set-up of Jharkhand for better part of nine years,we take a lot of things for granted.I shifted to Herbertpur in the beginning of this month and thanked my stars that, for a change ,I wouldn't have to learn my alphabets from the scratch,it was Hindi in JKD and it remains hindi in Uttarakhand allright.I hadn't quite taken into consideration the local nuances that remain so much a part of India. For instance while examining the abdomen of a patient in JKD ,when we ask a patient to bend the leg to relax the abdomen,there is one and only one way it is understood and that is what they do .In Uttarak

These days...!

HCH feels hazy and like a dream.It is that time in my life when everything seems a little surreal.Have just lost a cousin who was such an important part of our lives,everything seems so temporary!Was driving through to the Himachal border to Ponta for dinner with friends,the scenery around was really quite out of the world.The river flowing ,the hills,the endless forests...and then ofcourse the man-made place of worship...hindu,sikh or muslims...,I wondered aloud..why does man immediately build a place of worship wherever they find an out of the world place?It is that deep longing to connect with the creator of the beauty I suppose!! I have not really settled down in Herbertpur the way I thought I would-the deep restlessness is still there.It is just the second week,I suppose there is enough time.I have a deep peace about what I have left behind,but oh lord,I still do need clarity about the steps ahead.


Chapters in life keep opening and closing-very often it is for a time and sometimes it is quite final.You learn each time but the learning comes with the reality which hits you off and on...even as you move on...a pain somewhere which hopefully time will heal.You watch,you live....God gives you an oppurtunity to see things from a point of view one may never have been sensitive about earlier.....we learn the hard way most times. Being in a medical profession ,we see death so often that we often shut ourselves to it.There comes a time when it hits you on the face....and then the very experience .....helps you grow. Loneliness of the dying has been very much a part of my meditation in the recent week.As I was sharing my experience a friend seemed to be very quiet and she suddenly asked me,if it was possible for believers to be lonely when they are dying?Difficult question to answer and when I asked her why?-she told me that her father breathed his last even as he asked her mother to pra

He is the rock of my salvation!

The last ten days have been a time of soul-searching indeed. It started with Shalom seeing Jesus in the mess-it was young Jonathan with his beard,et al.It intrigiued me no less to know that the little boy has this fascinating talent of personifying different people from a different plane altogether.It would be absolutely normal for him to identify you as a fruit,an animal or a character in the cartoon net-work.I wondered aloud to Jeevan as to whether he was a great cartoonist in the making!Not bad at all for a two and a half year old child. In the midst of the transition hulla-bulla,felt a strange spiritual pressure to make a quick trip home to meet up with a dear uncle,visiting from abroad and a brother who is dearly sick.It was a precious time at home with the family. I met my cousin for the first time since he has been diagnosed and that was eleven months back.He has been a fighter all his life.Eleven months had brought a sea of change in him.Everytime we met we would have discus

Nine years of my life!

Finished packing nine years of my life in two hours. Parcelled,taped and ready to be carted by GATI travels. Mostly books,a few electronic items and kit-kats I have set my heart on along the way,...a lamp-shade I picked up in Kolkotta,..a hand-woven basket for the flowers...the cushions which my sister picked up for me from manicure guitars and a synthesisor...things that kept me times. Now for a quick trip home to Mangan to say hello to my family and I start off with just a bag or two to worry about. Am I sad to leave Satbarwa?-strangely not.Just a deep sense of peace......I believe it is God's time! It is Herbertpur time.

My country,my people!

It's tenth of July already and it has not rained as it should in central India.We hear of floods in the north causing havoc.A fifty year old farmer from CHopan walks into the out-patient.It is hot,humid and uncomfortable.He has an abdominal pain and has travelled more than five hundred kilometers to the hospital.I attend to his ailment and then I strike a conversation with him.Is it raining in your place?I immediately connect.No rains in Chopan either,the rivers,ponds and the streams are all drying off.He says ,till now they have not even tilled the land!So what will you do this year ,I ask.He says he will plant maize and vegetables.That will happen after the rain comes ,if it comes at all because they have no other alternatives for irrigation. I ask him what happens if there is no rain at all this year and he says they will find a daily wage work where construction of building and roads are on and he is not getting a day younger! The next person to be wheeled into the emergency

Outisde our comfort zones!

With due respect to all my colleagues who work in the government departments and many of whom are beyond reproach,we, who work in the heart of rural India, have been for decades very cynical of the government machineries.Often all things government are synonymous for 'corruption' in these areas.They have been known to sit on files and make life difficult for people who actually want to do something. Over the last several years,I have been seeing a shift in the general trend-most of our units have opened up to the national programmes and are walking hand in hand with them towards the MDG. We have seen ourselves as people who have been called to stand in the gap for the rural population and in some areas also to make sure that the tax-paper's money percolates down to the lowest strata in the form of health facities........etc,etc....but I see a bigger role our faith-based health-care institutions have .It is to set a trend in the way these programmes are managed,the facili

A culture of scarcity-a culture of intense pain!

I don't really know if it is the same elsewhere. The government has influxed a huge amount of money at the hands of the stakeholders and yesterday some of our community health department boys were telling us how people are making money out of the systemn's loop-holes. There were two ways in particular they described. The people who do not have the BPL card go up to the sahiyas who find a suitable name with a BPL number in the list and plant it in the coupen as the ante-natal lady's husband and get money out of the systemn and perhaps takes a commission from the patient's family.How did the community health worker come to know about it?One innocent village lady asked if that was one way it could be done because the others were doing it. There were some other things the CH guys shared which my fading memory seems to have failed to capture. This ,as opposed to those faithful DOTS providers the team nurtured in the villages of Satbarwa!Simple village folks,altruistic a

Boot ka sattu!!

Nine year old Ashok Bhuiya was brought into the outpatient gasping for breath.There was a history of snake-bite and he was unconcious.As soon as he entered the ACU we intubated him and put him on the ventilator and then went on to treat his snake-bite symptoms.Normally snake-bite with neurotoxic features respond quite fast to rapid resuscitation,so much so that after the bolus doses of ASV and the support drugs they often get up instantly and throw off the endotracheal tubes-I have seen quite a few of these cases.Ashok Bhuiya however was an abberation.His vitals were holding ,he was delirious and his sats were not too good. Even after the full dose of ASV ,he continued to struggle for breath so we kept him on the ventilator,overnight.The next day in the morning i noticed his level of conciousness was good but he still did not have his breathing back.After disconnecting the ventilator for a while and encouraging him to breath on his own,after ten breaths or so he asked to be connected

I pray for you Palaumu!

Today the boys on their daily round of the blocks for tuberculosis work were narrating an incident of cold murder in bright daylight.Apparently an old score had to be settled and so a young man was tied up with a rope at all angles and dragged across the tough Manatu road behind a motor cycle-the man apparently died!I thought such things only happened in hindi movies.By the time they reached the place the area was infested with police personals. This is a tough world in tough times.This is Palaumu for you living up to it's reputation of being the 'bloodiest district in India'. Eight years ago when I was posted to Tumbagara that was how I had been introduced to my destination of work.That was the only information I had about the place peppered with heavy advices to decline the offer.Much to the chagrin of all involved my leading was clear.I don't regret my decision one bit even as I get ready to say adieu to the place and all the memories I have of the place. I would

Photographs and memories!

Grace,Vikram,Angel and joshua are here in the campus for a day. What a joy it is to have your old friends around. Everyone is as we were -more mature perhaps but exactly the same. We sat,we talked ,we bullied each other to high heavens and we did what we are best at 'just being friends!'

An awakening!!

Deep from the recesses of my mind I dig back fourteen years in the retrospect,a medico trying to make sense of a culture so foreign to the one I was brought up in.It was the days of intense heat,mosquitoes,ghugnis,rickshaws and manjula the maid who was forever on the tree-top.Sitting out on metal beds to get that whiff of a gale that frittered past ,watching,waiting,chatting,living a life so different and yet so enlightening. The smell of formalin reeking through the perspiration of the fifty heads poring over a dead body,pulling a muscle here,a nerve there,memorising,agonising over some nameless body parts. An illiac bone used as a sun-shade,femur a went never seemed to end.The day I could chuck the bones was the happiest day of my life and the night before the anatomy exams the most harrowing. What kept me going were those poetry sessions that could flourish where-else but bengal-it was a life-line indeed.Nothing was spared,not the mosquitoes,not the ricksha


i was just chatting on the net with my sister when she asked me what's with you these days! i found myself subconciously answering her-'nothing much!just relishing the last few days of 'intense Palaumu'!. Intense Palaumu!!-why did i write that? That has sure set me thinking.I need to mull over it a bit.


Went to visit a lawyer in the courts in Daltonganj-Layers and layers of papers and people -jampacked in a room where every other person can eaves-drop on what is discussed.The black-coated entities chatting,watching-beady eyed,chewing paan(I dread this!),writing the clerical languages in pile after pile of worn-out files. The case in hand was discussed ,even as I started dissecting the case and putting forward the relevant points,he kept butting in to say'that is what I am going to argue in court!' I wondered if I should fight the case myself! The case against the institution seemed extremely flimsy,the opponent hardly one,but a case nevertheless! Somewhere in the process of getting things clarified ,it struck me that three years in the administration had indeed changed me.Who would have thought i would be so comfortable discussing a case in a court-house with a room full of beady-eyed,pan chewing babus watching your every move ! My father would be surprised!

The Rain.

The monsoons came two days too late this year. I looked up to the skies in desperation for that flurry of dark clouds that precede rain... There were patches every where-we would but gear up for the rains at night and a gale would blow it away. We started praying...and we looked up to the skies in expectation...the first day...the second day ,we the officers did a cooperate rains still....the third day we prevailed in prayer and left it to the lord...the rain came and oh it came....eversince there has been continuos mercy falling in the skies,trees,ground and our thirst parched souls.I actually cannot get enough of it.Even at the middle of the night I find myself cocking my ears to make sure that the sound I hear is that of the water on the roof...steadily hitting the roof,....falling ,falling,falling! I put my sleepy head back on the pillow satisfied that it is raining. Oh the simple joys of answered prayers!

It's hot ,it's dry.....and we haven't even prayed for rains.

It's touching 48degrees and there is no sign of rain.We saw the clouds gathering in the distance ,a gale came and blew it away-it rained cats and dogs an hour away in Latehar-Palaumu remains hot and dry to the hilt....we hear theories and more theories-even Delhi had cooled down to 26 degrees when I last left it.The cut off date normally is the 15th of June ,the thirteenth is over Muani was telling me how dizzy she felt in the church.I did too in my house,i did not dare venture out,not even to the church.I was feeling hot even as I poured cold water over myself...I tried to lull myself into sleep to tide over the day because there actually was nothing I could possibly do in that weather-the pillows were dripping wet with sweat-the floor immediately after a cold water swap was radiating heat at all angles-having pulled the curtains down,I couldn't put the lights on because that would have meant more heat! The congregation hasn't even prayed for the rains yet!str

Doctor,have you had a knife on your person ever?

I had never had a surgery in my life. I have done plenty of it inspite of my not choosing it for my speciality. I have enjoyed doing them.It gives clinicians a certain high-just the feel of.......being in control...having the ability to open up a patient and setting things right...and closing them and presto! they actually walk out of the hospital almost normal! This time God was kind enough to put me on the other side of the knife. I went through the entire procedure but somewhere along the time when I was moving towards full recuperation I felt a strange sense of humiliation-my grouche was-when God had made me perfect in his image,why was there a need for man to put a knife on my body?I never knew such a feeling even existed-it was a revelation,a step towards empathising better with my patients and understanding Isaiah 53:5 better. When one of my relatives had an attack of appendicites ,he hesistated a lot at the prospect of going under the knife I overheard him say'but I h

Lead me home...!

Its but a month more and I am out of this place called Tumbagara in Jharkhand-now the reality of it is beginning to strike me.I look at ordinary people I have worked with every day,people I have struggled with,people I have lived with every day of my life and I feel a strange sense of sadness ,their lives have cut into my life deeper than I actually thought possible.It's been nine years of actually growing up to the realities of life like responsibilities,work,struggles,joys,friendships,pain,faith,companionship,sickness,healing and even a surgical scar! I have connected to the people ,to the ministry of the place and yet I am certain I am to move on now-inspite of the pain I feel at the thought of leaving all the people I have, by God's grace, learnt to love- there is a strange sense of peace and a certainity that it is time... 'Precious Lord take my hand lead me home...'

The Check-list Manifesto!

Over the last few months,my mind has constantly dwelled on the quality of work we do. I find myself perpetually pressed, trying to barely manage or make do with the kind of work I have no interest or a knack for.For all practical purposes it works...things run and life goes on...most people are happy except me ,I find myself getting a bit restless. I find myself increasingly cautioning my juniors against cutting corners while doing procedures and things,because one fine day you wake up to realise that while doing so, we have compromised on quality as well.Classical example is making diagnosis in rural hospitals without relying on investigations being done in the laboratories,because for whatever reason we find the results are not reliable,the diagnosis is fine patients get better but the juniors who work with you begin to think that it is the norm. Atul Gawande's'The checklist Manifesto' comes as a breather. It talks about using checklist for the most simple medical pro

The language that I cry in!

Tehelka,where my brother-in-law edits the print had carried a story on a naga lady who is cut an album which went on to win a lot of accolades in the music scene.This is a lady based in new-york and the album has some lovely numbers which reek of home sickness.Apart from a number titled 'Kohima',there is a number called 'the language that I cry in' which has the naga traditional wailings for the prelude. My sister was just sharing with me about how when she gave birth to her litle one in Sydney,at the height of her birth pangs,she found that she had reverted to her mother tongue while expressing her distress. In all of us is an impending deep longing to find our way back home.The question is how many of us actually do?-for wasn't it St Augustine who said and I quote-'"God, you have made us for yourself, and our hearts are restless till they find their rest in you."

Hey -What's going on?

My brother-in law was in town.He made a trip to Lukhnow and La-Mart's.He has some good news.The school has been declared a world heritage site and heavy repairs are on in the campus.I am glad it is happening. Jammed up at a good friend of my sister's(Asenla Jamir) in Delhi yesterday night-felt strange-had seen her when I must have been around seven or so and she remembered every detail of those days-had a lovely dinner with the lovely lady-who sang to us a lovely rendition of 'hey what's going on'by Non-Blondes.They all seem so much in it although their whole batch is touching fifty in a couple of years time.So much for lasting friendships and beautiful people!-They are like good wine maturing and more priceless with age! In the mean time I still have not got over the Uttraula haze-People come and people go but they leave behind a portion of themselves with us -there is a trend with the Uttraula public.Everyone wants to conceive-God knows why?Couples pushing fifty

Human Failings and ministry of God!

I was taking the congregation through the life of Simon Peter and his relationship with Jesus.Throughout Christ's ministry on earth we see Simon Peter as a fallible human being showing streaks of genious,impetuos and blatantly short of most things expected of him.Yet when Jesus' appears to the disciples after the crucification he leaves the ministry of reconcilliation to Peter,firstly by reconciling him to himself and then to the greater ministry of God.He asks Peter the pertinant question -'Do you love me?'.When Peter says he does,he asks Peter to look after his sheep. He could have asked this question to Peter just before he was crucified,after all what is more important to man than his life . The fact that Christ had the question for Peter at that juncture, points towards the importance the events that were to follow after the crucification had for the Christ -the ministry was more important than anything that we as human beings deem important in our lives today.