All posts by drsusieblog

DGO in CMC

The DGO, the diploma in Gynaecology and Obsterics, was a two year program at CMCH with no holds barred.

Alice George , Muneema and I were in the same batch. I was going back to study after seven years.  To say that it was a challenge, would be putting it extremely mildly.  The Ladies Internes Quarters, the LIQ,  had several alumni who like me, had come back to do their postgraduate studies. Most of us were married and had come for our postgraduate training after the kids had grown up a little.

All of us had only one agenda, to finish the course as soon as possible and go home to our families. Nothing else mattered. We suffered the long hours that made no distinction between day or night and the indignity of being yelled at in public in middle age. Obs/Gyn is a hands on speciality and we learned, as we worked. The more we handled, the more we learned.   After those two years of rigorous training, excellent training on reflection, we were so tough, we could have handled and survived anything, anywhere.

The friendships we made in those two years were endearing and especially supportive. We would come back at the end of a long day with our tales of woe ,to gather in Gracy’s room, the largest room on the floor and throw ourselves with total abandon on her double bed. Exhausted beyond words , most of us would be fighting hot tears of anger as we repeated every humiliating anecdote to a sympathetic audience making soothing noises.
Guess what happened…..You could be sure that at least one person in the group would have been mauled every single day.  To cheer the group the humorous anecdotes would be recounted too , punctuated with appropriate audiovisuals, as some of us could mimic perfectly.

Events would be discussed and laughed at and dismissed as experience. I will never forget what Nirmala a microbiology postgraduate used to say. She would come back livid and say “Grace Koshi said this ……and I said that, mentally….
She said that ….and I said this mentally ….

The comfort phrase , I said this, mentally,  was a repartee that became a lifeline that helped us to fend off the humiliation and abuse hurled at us during our training. Technically we had spoken our minds and answered back.  Mentally.  It was off our chests. It saved our sanity and kept our sense of humour afloat, as we formed a protective band to help each other through the 730 days. Our only fear was the comfort phrase ….said mentally… , the lifesaving  repartee would tumble out of our mouths in a weak moment. That would have disastrous with uncomfortable consequences.

Sometimes the male Obs/Gyn bosses would crack really brilliant vulgar jokes that were hilariously funny and we would stare ahead with poker straight faces  suppressing every giggle that threatened to escape. If any one of us even smiled, we would be roasted alive when we got back to the LIQ.

Never Never respond to any of their vulgar jokes …was the dictum. Take them home and laugh all you want. Never in front of them. Never. Never. Never.  Bite your lips . Do whatever it takes…..but for goodness sake DO NOT LAUGH !!! This was difficult to follow as most of us were genetic gigglers, who needed very little to set us off.
We would start work at 7.30 am every morning , working either in the wards, the Theatre or the Outpatent Dept. At 4.30 pm we would , if we were on duty, pick up our bleeps and work through the night running like headless chicken between the Labour room,  Emergency Department,  Operation Theatre and answer calls from other wards if they sent us referrals. Most nights were unbelievably, crazy and busy.  We never saw our beds on duty nights.

At 7.30 am we would hand over the Bleep to whoever was on duty with a quick recap of what had happened during the night. Rushing to shower and change, we would report to the Theatre or OPD to work through till 5.30 pm, when we would crawl into bed and crash out, often missing dinner, to wake up in the wee hours of the morning to complete an assignment, or to study for a test the following day. . Leave was dirty word and NOBODY  encouraged palming off duties. Only death and disaster qualified as valid circumstances for swapping duties.

Sometimes one of the husbands would arrive to spend a weekend with his wife, with or without the kids in tow, at the YWCA Annexe. Saying goodbye was especially hard those days and everyone treated you like Dresdan china , marked fragile, when we returned to the LIQ. Settling back to the routine was enormously hard.

Sam was in the UK finishing his  Ph.D. My kids Rekha and Anish, were in Chennai with my Mum and Dad. I used to be miserable and quite reluctant to go back to Vellore after visiting them . All I wanted to do was to stay with my kids.  My mum would not hear of it and every Sunday night, she would send me packing, back to Vellore to finish the course. Whenever I threatened to discontinue my DGO in Vellore, Dr. Prabha Jairaj, one of the Professors in Ob/Gyn would persuade me to stay on.

Between my Mum and Dr. Prabha, I finished my DGO and returned to my kids in Chennai.  Sam arrived a couple of days later, to take us all back to the UK. Looking back, now that we are grandparents ourselves, we realise how difficult and how sad it must have for my Mum and Dad to say goodbye to the grandchildren they had looked after for two years , despite their advanced years.  Without sparing a thought for their loneliness, we just gathered our kids and ran off, without a backward glance.

We were just delighted to be together as a family again.

 

Rats in the Theatre

I would not have survived my DGO in CMC,  if it were not for Gracy, Joyce and Vanaja.

When I went back to CMC to do my DGO, Joyce Ponnaiya was doing her MD Path at the same time,  Gracy Thomas was doing her MD Obs and Gyn and Vanaja Verghese her DCh. In fact there were a whole bunch of us who had come to do our post graduate training, after marriage and babies. We supported each other, mopped each others tears and jollied each other along . Mercifully none of us were miserable together at the same time. Or for too long.

Whenever we could, we ran off to the Movie Theatres to  spend 3 make-believe hours, totally immersed in every improbable scene that flashed  across the screen. We never missed a single movie that came to town. It did not matter if the Movie was English, Tamil,  Hindi or Telegu. Somebody in the group would translate.  Sometimes the running commentary was more hilarious than the movie itself. Sometimes we slept off, exhausted, lulled to sleep by the aircon and the darkened Theatre and had to be nudged awake when the movie ended.It did not matter if the movie was a hit or a flop. It just gave us a chance to forget the day’s woes for a few hours.

Meet you at the steps of the LIQ at 9pm.
It’s a new release
Kamal Hassan and Rajnikanth are both in it

Leaving the day behind with its ups and downs, all of us waiting at the LIQ steps at 9 pm,  would pile into open-top cycle rickshaws and laugh all the way to the Theatre in total abandon. Riding out of the gates of the hospital gave us a heady sense of release, a  phenomenon we thoroughly enjoyed. In the Theatre, we sometimes occupied  the entire row, with very few empty seats around us.

On one occasion there were a group of Roadside Romeos sitting behind our  row of seats. As the projector whirred on , it became increasingly evident that the boys were more interested in the ladies in front of them, than they were in the picture. They kept smacking their lips and passing lewd  comments. Some leaned forward breathing lecherously down our necks, bent on being obnoxious. One uncouth youth actually slid his sweaty paw between the seats and pinched one of our seniors, right in the exposed midriff of her sari clad figure.

The poor unsuspecting guy had no clue that you NEVER mess with the likes of this particular Senior, who shall remain nameless, unless you were prepared for Jhansi Rani to rise up from the ashes.  She is a beautiful spunky girl, with a spirit to match. Absolutely fearless, she stood up in the Movie Theatre, whipped around with her slipper in hand and whacked him smack across his unsuspecting and surprised face.

How dare you …she hissed as she flailed him with stinging slaps.
Take this…
And take that…

The stunned youth was mortified. Beads of sweat gleamed on his  pale face.  He was used to eve-teasing timid girls who would have suffered it all in silence. Or moved to another part of the Theatre. He had obviously taunted many girls before, but none of them had ever turned around to attack him. He was caught completely off guard and his jaw dropped in shock and horror.

In an attempt to regain his dignity and composure he squeaked,
It’s a rat …..Its a Rat….A rat must have bitten you…Rat…Rat…as he bent down pretending to look for the Rat.
This incensed the lady  further, who whacked him some more as she yelled,
Rat ?
Did you say Rat?
You are the Rat!   Nee thaan Da perichali !   You’re the big fat Bandicoot !

The back row emptied itself in a matter of minutes, while the rest of us cheered. I suspect it would be many moons before that particular Roadside Romeo eve-teased any body, in any Theatre.

 

An Artificial Limb

A prosthetic limb when fitted on a Leprosy patient after an amputation can sometimes be more than an appliance that helps him walk.

When we joined Anandaban we were blessed to have Sharan Prasad Ruchal join the Staff. He was a highly skilled paramedic from Tansen who doubled up as an anaesthetic technician administering spinal anaesthesia when needed in Theatre. He had been trained in Prosthetics with the famous Jaipur Foot and the  Prosthetic Limb Centre at Anandaban was opened under his guidance.

A man of few words, who lived by example, Ruchal was a invaluable assistant when I worked in Anandaban. I could depend on him with my eyes closed. I admired his integrity, his quiet dignity, his proficiency at work and the way he switched effortlessly from one role to another, be it in Theatre, in the wards , crafting a limb or leading the worship for the community at prayers as their beloved Ruchal Dai.

When we fitted Ram Bahadur with the Jaipur Foot after his below knee, BK amputation, we presumed that the  limb would help him move from point A to point B giving him the independence that he so needed and is so vital after losing a limb. It did get Ram Bahadur from point A to Point B . But it got him much more than mobility.

After he was discharged he disappeared for a few years. When he came back we did not recognise the new avatar of the simple amputee  who had shuffled away gratefully. He walked with a swagger, dangled many chains from his neck, flashed many rings on every finger and had a shiny watch to boot. He was apparently very flush.

After a few days at the hospital and a few pegs of the local hooch ,he bragged about how he had made it big. Nepal shares a long and  porous border with India and the dedicated check posts placed at strategic points  do not curb the illegal traffic of humans and drugs in and out of either country.  Ram Bahadur had found a novel use for his hollow Jaipur foot.

He used to pack Hashish in plastic bags at the bottom of the hollow of the prosthetic limb. Over the potential loot of weed , he would pack raw meat that he allowed to decay with a horrendous stench. When the stench had reached a swooning score on an invisible scale,  he would strap the artificial limb back and hobble across to the check post.  Smelling him approach well before they saw him , the guards would pinch their noses and wave him across presuming that the stench came from his decaying Leprosy foot.  Safely across the border and out of earshot he would empty the contents of his artificial limb, clean out his hollow artificial limb and proceed to peddle his wares making him an extremely  rich and happy entrepreneur.

There are artificial limbs …and there are artificial limbs.

 

 

The Devanesans

I had heard about Dr. Chandran Devanesan from Sam all my life. He adored CD, as he was affectionately called.

When Sam was sent to the Madras Christian College after he finished school in Hyderabad, his Dad put him on a train bound for Madras with a tin trunk that held his clothes and belongings. The shy young boy landed in MCC a day before the College started when none of the Halls were open.

Dr. MacPhail the principal was not prepared for students arriving ahead of time.  He told Sam to sleep on the floor outside the office of the Selaiyur Hall.  When he went to sleep, Sam was alone. When he woke up there were 2 Seniors from Ceylon, Stephen Aseervatham and Wesley Ariarajah  sleeping on either side of him. They had arrived in the early hours of the morning and were waiting to rag him.

It was a big change for Sam. The language was different. The food was different.  He switched from schoolboy to adult, from kakhi shorts to bell bottom trousers,  trading the regimentation of the boarding of the Wesley Boys School for the loosely knit freedom of a Hall system at Selaiyur Hall. One person who helped Sam make this transition was Dr. Chandran Devanesan, the first Indian Principal who took over from Dr. Macphail. His beloved CD who kept a kind eye on him throughout his stay in MCC.

CD as he was affectionately called, was the mentor who guided Sam into the Student Christian Movement, a fellowship that had a deep impact on Sam’s personal and spiritual growth. CD encouraged Sam to volunteer at the Pammal Leprosy Clinic. During the weekly visits to the Clinic the students used to clean and dress the ulcers on the anaesthetic feet of the Leprosy patients, paving the interest for a career when Sam started Medicine at CMC, Vellore.

When we were posted in Nepal, Sam heard that Dr. Chandran Devanesan was attending the UMN Board meeting in Kathmandu . Sam was so excited, he wrote and invited CD to make a detour and visit us at the Anandaban Leprosy Hospital after the meeting. To our delight , CD agreed and he spent 3 glorious days with us in our home.

CD was very proud of Sam as he was of all the Alumni. He went on rounds with Sam all over the hospital and met the Staff and Patients in the wards. He preached at  a service over the Diwali weekend and spoke of the Light of World and the conquest of good over evil, seamlessly entwining doctrines in a simplistic way that everyone could understand. He did not have any notes to read from. He spoke extempore with a Nepali interpreter translating it for the patients and staff who had gathered to hear the Doctorsahib’s Principal speak.

CD was a charming house guest who fitted in effortlessly with the family. He romped on the floor with Rekha and Anish who loved him from the start and climbed all over him, while he played referee during their squabbles. They would wait impatiently outside his room for him to get up in the mornings . He was the Grandpa figure that they missed in Nepal. I heard him ask them Why are you both complimenting each other so early in the morning ? during one of their verbal spats.  A line I borrowed and frequently used after he left.

He was appreciative of anything that I cooked for him and he left promising to bring Mrs. Savithri  Devanesan with him the next time he came to Kathmandu. Sadly  that was not to be, as he passed away shortly after, leaving us sad,  but filled with happy memories of a brilliant human being with simplicity and humility as endearing qualities that left an unforgettable impact on everyone he came in touch with.  I for one will never forget CD and the happiness he brought into our home when he visited us.

RIP dear dear CD.

I met Mrs Savithri Devanesan when I was a second year medical student in CMC.  Sivalingam, a Malaysian  student from  MCC was referred to CMC with a diagnosis of a malignant tumour in the Gall bladder.  He was sick and sinking. His mother had come from home to be with him in the last few days. All of who were from Singapore and Malaysia used to visit them in the wards.  One morning when we went in to visit, we saw an extremely beautiful, elegantly dressed lady sitting on the bed comforting Siva’s Mum.

She was crying as she held Siva’s Mum in her arms. Rocking her back and forth she kept comforting her, as only another mother could. I will never forget my first impression of Aunty Savithri as she came to be known .  A loving and compassionate human being. Beautiful on the outside and beautiful on the inside.

Siva was just one of hundreds of students from MCC.  Dr. Chandran Devanesan  was the Principal and as the Principal’s wife, she had made the effort to drive all the way from Tambaram to Vellore to comfort the mother of  one their students who was dying among strangers, far from his home and relatives.  She won my heart that day, in a ward in CMC.

When Sam’s younger brother Prem went to MCC , he too landed early before the hostels were ready and before the Hall rooms were allotted, making one wonder if this was a genetic trait the brothers shared. Sam, on the Campus settling Prem in ,was flooded with nostalgic memories of his arrival at MCC several years ago. Mrs Devenesen  met them on her walk and heard about Prem’s predicament. Without batting an eyelid, she invited Prem to join the many other students who were camping on the verandah of the Devanesen Home, waiting for a room in various Halls.

Mrs.Savithri Devenesan’s legendary hospitality extended beyond the verandah of her home to all the kids who entered the gates of the 100 acre Campus of MCC. She was a Mother figure to many, often sending them food from her home when they were admitted to the Infirmary, a loving and tender touch to many youngsters far from home. I am sure she would never remember every random act of kindness she ever did as second nature, but there are a host of grown men, all the world, who remember her affectionately, with fond memories.

RIP dear dear Aunty Savithri.

Sometimes Life hands you a beautiful human being you can never forget. Sometimes Life hands you two beautiful human beings as a couple you can never forget . An extraordinary couple who complemented each other.  A couple who lived by example. A couple who opened out their home and hearth to youngsters far from home, shaping formative mind, as role models.

CD and Aunty Savithri……

 

The morning after the wedding

Our wedding was in Christ Church Singapore, on Saturday , the 27th of November 1971.  After all the festivities were over, we crawled into my bed in my room in the parsonage in the wee hours of the morning.

No sooner had we shut our eyes when we were woken up as the sun came up.  We were taken to Christ Church for the Tamil service at 8 am. After the 8am Tamil service at Christ Church , my Dad drove us to the 11 am Tamil service in the Epiphany Church that he had built in the Naval Base , Sembawang.

When the 11 am service was over, we drove home where the entire family of parents, uncles, aunts and cousins were waiting to finish the wedding Biriani stored in the fridge over lunch. Somewhere between the Biriani and the Ice cream, Sam’s Dad a Telegu Methodist Pastor, announced that he had not understood a word of the Tamil services we attended in the morning.

He wanted to know if there was an English service he could attend in the evening. Before we knew it, we were taken to the English Evensong at the St. Andrew’s Cathedral at 6 pm. Sam by then, was beginning to look a bit blue around the gills and he muttered under his breath to me. Thank God there are no services anywhere else in Singapore after this.

When  we returned to India we went to Dudgoan, where Sam’s Dad had a special service where we were blessed all over again and met all of Sam’s family and friends. Between the Anglican Canon and the Methodist Pastor they made sure that we were blessed and sanctified by every congregation they could get their hands  after the wedding.

Signed, sealed and blessed on multiple occasions by various congregations , we returned to CMC , Vellore as Man and Wife..

.

 

 

The Class Reps of the ’64 Batch

No one believed that the Class Reps of the Disintegrated Batch of ’64 of CMC , would or could ever fall in love .

Sam and I were the class representatives of the Batch of ‘64 in CMC, during our undergraduate medical studies. We represented two volatile gender  factions, who seemed to be at war with each other all the time.  We were a batch of highly intelligent individuals with opinions that matched our perspicacious personalities. We could never finish a class meeting without a fight and someone walking out in a huff, swearing that they were going to resign from the class, never to return. There was a great divide between the girls on one side and the boys on the other.

The class of ’64,  had an amazing quota of brilliant finishers who went on to make a mark in the world, chasing  stellar careers in both academia and in the remotest ends of need across the world. When we met for our 50 th reunion in 2014, a record number of 49 classmates met.  We had aged and mellowed. A bunch of mature medical care givers who had grown to respect each other over 45 years apart, actually went rushing to greet each other with fond memories.

Sam had joined medicine after his BSc at the Madras Christian College and was four years older than I. He stepped into my life and assumed charge. He looked after me and protected me from the word go.  When I wrote and told my Mum and Dad about Sam in our first year they had a mega-fit. They had not packed any hormones in the green trunk and falling in love was not in the cards. They felt that I was not old enough to decide.

Whenever I went to Singapore on holidays they would try and talk me into giving Sam up. We would have been incommunicado if Preima Doraisamy  our college friend who was also from Singapore and usually home for the same holidays that I was, had not smuggled Sam’s letters in, right under my unsuspecting Mum’s nose.  Sam would post his love letters to her address and she would come to visit me and give me Sam’s letters. Years later when we were married, I told my mum about Preima playing Cupid Courier and she had a good laugh.

The debate lasted six years. When I threatened to stay single the rest of my life, they gave in. The thought of me as a stubborn old maid on their hands must have been the deciding factor in their change of heart.

We were married in Christ Church Singapore on November 27th 1971 and Sam became the son they never had.

 

Newlyweds in the MIQ

The only piece of advice that my Dad gave us when we got married was…. Never to go to bed angry with each other.

This was an old fashioned recipe to stay friends and to keep a marriage together. Certainly one that helped us make the adjustments as we started our lives together as a married couple. When we returned to Vellore, we stayed in a single room on the ground floor in the Mens Internes Quarters, the MIQ at CMC.

The ground floor was reserved for married couples. Sam had the narrow single bed extended with a plank of wood that had its temperamental days. Sometimes it behaved and stayed up with its hinges and sometimes it did not. When it dropped down, it threw whoever was sleeping at the edge off the bed, without warning, onto the floor.

The person sleeping at the edge had two definite disadvantages. Firstly, you could be thrown off unceremoniously onto the floor unannounced. Secondly, if you slept on the edge, you would have to get up when the milkman knocked on the door at some unearthly hour. And wash the milk pan. Very quickly I worked out that I was better off sleeping near the wall and I don’t think Sam found out for a long time why I opted to sleeping near the wall.

The room was tiny and had a bed, a table and a single built-in cupboard which housed all of Sam’s belongings. When we landed Sam was astonished that I needed to share his cupboard and table. He was delighted that we were married and were going to play Housie -Housie, but he had not worked out the logistics of married bliss and sharing shelves in confined spaces.

We used to get our meals in a yellow enamel floral tiffin-carrier one of the wedding presents we had brought from Singapore. It had 5 compartments held together by a metal frame clipped at the top. It used to hold rice, a curry usually a sambhar or rasam , a vegetable and some curd. It was not much but we always managed to share it with our friends who came to visit.

On Sundays we were treated to 4 pieces of meat that lay in a thin film of gravy .  Sometimes we would squeal in delight at the smell of the 2 pieces of fried fish that wafted out when we opened the tiffin carrier. On a salary of Rupees 120/- that was all we could afford.   We were poor but we were deliriously happy .

Sam’s friends used to drop by and visit us and I was shocked at all the classified information they had on the girls. When men gossiped they call it Update. I found out more about some of my hostel mates in MIQ, than I did in all the years that I lived in Womens Hostel, before I got married.

When one of the wives in MIQ became pregnant and started morning sickness in the early months, the retching and vomiting would be transferred  the occupants in the rooms above and below their room. People who lived around the couple would get to know that lady was pregnant, before the parents did. Pregnancy was a passport to move to one of the houses on the hospital campus with a tiny living room, a tiny bedroom, a tiny bathroom and a tiny kitchen. An actual Tiny home.

Its funny how your first home and your last home are so similar in space and function. We downsized to move into Anandam, a retirement community at the foothills of Kodaikanal after we retired.  It reminds me so much of our early beginnings as a couple in CMC.

Compact living. A stainless tiffin carrierwith 5 compartments that brings us our meals on wheels from the Cafeteria. No vast plinth area to clean. A chatty milkman who rings the bell at some unearthly hour. Squeals of delight when something from the ordinary surprises us when we open the vegetarian tiffin carrier.

The only difference is that I insisted on 2 bathrooms in the 1000 sq feet retirement cottage when the plans were drawn. Banging on a bathroom door in the morning, cross-legged with a full bladder is good way to ruin a good marriage that started in a single room in the Mens Internes Quarters , CMC, Vellore and survived the journey that followed.

 

Bhutan’s first eye camp

Bhutan in the early 70s had an elderly population who were sight challenged because of cataracts.

Responding to a need to address the ophthalmic challenges that were prevalent in great numbers at that time, Sam wrote to  Professor, Dr. Anna Thomas the Ophthalmic Surgeon at The Schell Eye Hospital of the Christian Medical College and Hospital, Vellore. As students, we had attended eye camps that she conducted in the villages with her team, restoring sight to the villagers with minimum fuss and bother.

The team would start work in the evening using the darkness of the night to do the ophthal screening they would normally have done in a dark room. Patients would be prepped for Surgery in the morning. Sister Soshamma who had worked with Dr. Thomas for years knew her every move and placed the correct instrument in Dr. Thomas’ outstretched hand during the operations every time. As did Somu , the Paramedic, their Man Friday, who accompanied them everywhere.

If Sister Soshamma was Dr. Anna Thomas’ right hand, Somu was her left. They would set up multiple operating beds and Dr. Anna Thomas would move from table to table while Sister Soshamma and Somu bandaged and dressed the cases she operated on. There were no untoward incidences in the camp cases and no infections either, as the cases  were  chosen carefully and operated on under stringent sterile conditions.

Letters took a long time to go from Bhutan to India and back. When we did not hear from her, we assumed that she was not coming. One morning  the post man brought a letter from Dr. Anna Thomas. She had accepted our invitation. She was coming to conduct an Eye Camp in Gida Kom Hospital. The Eye Camp team, she said, would arrive in 2 weeks. We were delighted.

Sam ran around and got all the sanctions and paper work done. The night Dr. Anna Thomas and her team arrived there was an unprecedented upheaval, like never seen before in Gidakom. 12 labourers , all male, of different age groups ,were brought in with the deadly alcohol and berry poisoning. This was the highest number of poisoning cases that we had ever seen in a single night.  Leaving Dr. Thomas to rest, we ran down to the OPD.

Somu and Sister Soshamma were brilliant. Rolling up their sleeves they pitched in. In no time,  multiple units of gastric lavage was set up . Somu is tall, lanky and loose limbed. He looks a bit like Nagesh, the yester-years comedian of the Tamil screen.  We were in splits seeing him sit purposefully astride the cowering labourer, urging them to relax while he passed the tubes. He spoke no Hindi  and the Labour spoke no Tamil.

Undeterred,  Somu  exhorted them in colloquial Tamil to relax while he passed the tubes down.   Dai, vaai thora da, Dai, Dai, Dai…Pallu kadikathe Da. ..Dai, Dai. Soon inebriated men were retching and gagging all over the place, emptying the poisonous contents of their stomachs and limping to recovery. Trudging down the hill later that night,  the exhilarated duo , Sister Soshamma and Somu, both agreed that they had not had such excitement in a long long time.

The eye camp was inaugurated the next day by Lyonpo Dawa Tshering the Honourable Foreign Minister of Bhutan. The first eye camp in Bhutan, was dedicated to the memory of the late Third King of the Druk Kingdom, His Majesty Jigme Dorji Wangchuk, the benevolent Monarch who had died in Nairobi on a visit.

There were no dark room facilities to examine the patients. All the patients were examined at night and posted for surgery in the morning. As this was the first Eye Camp conducted in Bhutan, the Government had publicised the event extensively and many elderly were carried to Gida Kom over the week old camp.

Some patients were carried strapped to the back of a younger relative. Others were carried in baskets that the young held in place with a broad cord over their foreheads. Some had trekked for miles with their elderly in hope and they returned home to a new life, sighted and aware of their surroundings with new glasses free of cost after cataract surgery.

This helped in demystifying the stigma of Leprosy and a Leprosy Hospital. Word soon spread that Gidakom Leprosy Hospital looked after general patients too. It was not just another Leprosy Hospital.

It was not such a bad place after all.

Climb to Catheterise

A retained placenta can be an Obstetric nightmare.

Many women in rural Nepal in the early 70s, hesitated to have their babies in the hospital. There were many reasons for this. Firstly they were on alien turf among strangers. Secondly it was more expensive than a home delivery. I discovered a third reason quite late into my stay in Nepal.

We had a hospital dinner for which the staff and their families had been invited. One of the drivers Sathya was like a family member. He drove the kids up and down to school and looked after Rekha and Anish like his own.  He was as loyal as you make them. During the dinner I noticed that Sathya’s wife was missing. I asked him if she was unwell and he replied sheepishly that they had just had a baby a couple of days ago and the placenta had not fallen off yet.

I nearly choked on my food. Whaaat , I said . What are you talking about , Sathya ?  I asked incredulously. That was the night I found out another old Nepali custom.

Many  Nepali mothers who delivered at home, did not cut the cord after the baby was born for cultural reasons . The baby and the placenta remained attached and the placenta was kept in a mud container alongside the infant, till the cord shriveled and dropped off with the dry placenta. Only when the placenta and cord fell off was the woman considered Cleansed . Only then could she move out of the house.

This tradition had a flip side. The incidence of neonatal tetanus and cord sepsis was low in Nepal, because no unsterile instruments were ever used to cut the cord. This was the third reason many Nepali women hesitated to have their deliveries in hospitals. In the Hospital, we cut the cord and threw the placenta out in a bucket,, without so much as a please.

When they delivered at home, many of them would have a prolonged 3rd stage of labour with a retained placenta. Normally the placenta is expelled within 30 minutes of delivering the baby.  In retention of the placenta this time is prolonged and often requires manual removal, ideally under anaesthesia.

The most common cause for retention of the placenta is a full bladder. The bladder, the uterus and the rectum lie in front of each other linked by slings holding them in place. Dysfunction of one of the these organs disturbs the normal function of the others.

In the busyness of dilating her cervix and delivering the baby the mother forgets to void her bladder.  A full bladder in turn causes  retention of the placenta. This is potentially dangerous because it increases the chances of postpartum haemorrhage and infection from all the manipulations that are tried, often unsuccessfully, to deliver the placenta manually.

I used to be called for a house visit, when a lady had a retained placenta in the villages near by. The first few times when they told me that the house was just here , I believed them and walked miles to reach the patient.  Subsequently I got smart and I knew that their Just here was anything but that.  Just here could be several million steps on a pedometer I did not possess.

The first time I set off with the ward boys, the paramedics and the patients relatives, we drove to the nearest point on the road and then took to walking down a mud path which seemed to go on forever. Finally we reached a three storied house set in a wooded cluster. The ground floor housed the animals that the family owned. The goats, the cows and the dogs lay around, perfectly at peace with the kids who played a short distance away . The family lived on the first floor and the grain was stored in the second floor.

To get to the first floor one had to use the wooden ladder that leaned on the side. Did I just say leaned  ? No correct that to, we had to climb up a wooden ladder that was screwed in vertically at ninety degrees to the building. I was in a sari which is not the best attire to climb anything.  Kicking off my slippers, I nonchalantly tucked my saree between my legs and held on to the ladder and climbed as far as I could, with my eyes  shut tight. If I closed my eyes I could shut out the perpendicular ladder which brushed against my nose with every rung I climbed.

When I threatened to slip and fall all the way down,  two of the ward boys pushed me up apologetically from my behind and two male relatives standing on the floor above, at the top of the ladder, took hold of my arms and pulled up and I landed unceremoniously with a thud onto the mud floor.

I was totally unprepared for the stench that hit me as I surfaced to take stock of my surroundings. I had landed myself in a dark and dank room that smelt foul. It smelt of stale blood, stale urine and stale human excreta.  Gagging I got up . My eyes had accommodated to the poor light by then and in the far corner I saw a low bed which seemed to have someone sleeping on it.  Gingerly, I inched closer and I got the shock of my life.

Lying on it was a lady , stark naked , covered with a sheet of flies flying over her. She was lying propped up against the head of the bed and she was swatting the flies around her listlessly with a vacant stare. She looked tired and dehydrated. Between her legs in a pool of clotted blood, lay something long and twisted that looked like an umbilical cord that had stopped pulsating hours ago. There was a dirty cloth ball tied to the cord . They must have tried to pull at the cord using the cloth ball.  There was no sign or cry of any baby in the room.

The ward boys had climbed up and reached the room by then.  They positioned her flat on the bed and brought her near the edge of the bed. On examination , her vitals appeared normal . Her bladder seemed distended and needed to be catherised.  Forgetting  the unsterile conditions we faced, I put on a pair of gloves and catheterised her, letting the urine collect into a plastic bag the ward boy held out.

No sooner had we done that, I saw her wince as if she was having a contraction.   I pushed the contracted uterus gently  away from her suprapubic region with my left hand and wound the fingers of my right hand around the cord  to give it a gentle tug. To my utter and unmitigated relief,  it came out freely, bringing the culprit placenta with it , followed by a surge of blood that squirted everywhere.

We sponged her down with some cotton, got her dressed and padded , bundled her up in blankets and put her in a cloth sling stretcher, tied like the ones the proverbial storks brought babies in.  They lowered the sling stretcher down  carefully,  navigated  by a crowd of spectators who had gathered below. When  she had reached the ground floor safely,  I slid  and  slithered  down the perpendicular ladder and landed on the same behind, that had been pushed up the perpendicular wooden staircase, barely an hour earlier.  Dusting myself I got up with the giggles, which helped ease a tense and embarrassing situation all around.

Somewhere in the weary entourage that headed back, I heard a baby cry. One of the ward boys was carrying the baby who on examination had appeared to be fine and none the worse for wear.  Mother and Baby were in safe hands and were on their way to the Anandaban Leprosy Hospital. We walked back to the Landrover, settled her in and drove to the hospital where the staff were waiting for us.

The Nursing team took complete charge. They wheeled her away,  mopped and sponged the patient, started a drip , added the antibiotics , checked the cord, cleaned the baby and settled the exhausted mother and child in a warm bed and clean sheets with a hot meal. The Staff at Anandaban were wonderful. They stepped in when needed and followed their instinct and training, rising admirably to the occasion. We would have been utterly lost without them.

I was cross eyed when I reached home. Shedding everything outside the bathroom, I had the longest bath ever, rubbing off layers of grime and dirt before I crashed out, wondering what Dr. Paranjothy or Dr. Kunders or Dr. Prabha, for that matter, would have had to say about my first encounter with a retained placenta in Nepal ?

Sam had an amused expression when I recounted all that had happened. And this is the lady who lived in high heels, hated using the stairs and went from one floor to another in a lift, wherever and whenever possible, he said with a quiet laugh.

 

 

Obstetrics , Genuflexed

Leprosy hospitals were always built in isolated places far from civilisation.

When we started work in Bhutan in 1973, Gidakom Hospital was just another sleepy Leprosy Home on a hill in Khasadrapchu. Since it was the only hospital for hills around, we started a general clinic to treat the patients that came from the villages nearby. Word soon spread and people from the surrounding villages made tentative tracks to the hospital, seeking medical aid.

With time the stigma associated with a Leprosy Hospital dimmed and the villagers knew that they would be helped, if they came to us. What we could not handle, we bundled in a vehicle and sent to Dr and Dr. (Mrs) Norbu who looked after The Thimpu General Hospital with a team of experts and a full fledged operation theatre.

Our greatest joy was the birth of the first normal baby at the Gida Kom Leprosy hospital. The baby’s father was the teacher at the Tibetan school in the village above the hospital. His wife was a young Tibetan girl barely out of her teens, who was too far gone in labour to be shifted anywhere.  We had no choice but to deliver the baby In Gidakom.

Deepti and her sister , the hospital nurses, prepped the patient.  The Chief Nurse Mr. Modi Sangma and Rongong, the Paramedic got the treatment room next to the office in the main building ready. It was piercing cold and we were all bundled up in our woollies. It was going to be a cold ordeal for the patient who had to bare it all, without an electric heater and running hot water.  They placed a bukhari in the  centre of the room and got the hot water going. Mercifully, we did not have to waste too much time waiting. She delivered quickly. The baby was born in a bleak mid-winter when we were ill equipped to handle our first obstetric case.

More than the lack of facilities, the glow of the burning Bukhari in the centre of room, next to the patient’s bed, terrified me. We did not have electricity , only the temperamental light from the Hydel in the evenings for a few hours. We had no electric heaters. The rooms were heated by bukharis , metal cylinders with a chimney that took the smoke out through the roof.  Cut pieces of firewood fed into the metal cylinder through a small flap door, would burn to warm the cold room. This was dangerous as the emission of fumes of carbon monoxide, from the dying embers could reach lethal levels. CO is a poisonous heavy gas that sinks low in the room, endangering pets, animals and people sleeping on the floor.

I had been called down to the labour camps working on the Hydel project to certify death on a couple of occasions. Young boys who had left home to eke out a living in a far and distant land would be lying dead on the floor on thin mattresses and blankets. They would have gone to bed with the bukhari burning in the room with all the windows closed to keep the cold out. In the night the fire would have gone out and the embers would have given off Carbon Monoxide to do its worst.

On the night of our first delivery, I sprouted eyes all over my head, as Deepti, her sister and I kept vigil. When we were not checking for maternal haemorrhage, we were checking to see if the bukhari was active, or we were checking to see the baby I held close to my heart, was breathing right. None of us dared sleep that night.

Never were we more conscious of the grace of God than in Bhutan and Nepal when the nearest hospital was many hills away and where we had to take independent decisions and live through them and after them . We wrapped the baby in several blankets and took turns to sit up with the baby the whole night, amazed as always by the miracle of childbirth and the entry of a new baby into the world. The exhausted mother slept blissfully, glad for the rest.

This became a pattern both in Bhutan and Nepal as the stigma of Leprosy  diminished with time and  Obstetric cases were admitted freely to the Leprosy Hospitals.  The staff and the Leprosy patients , ringside and totally involved,  cheered as they rejoiced with the parents at the first cry of a normal baby  born in their Leprosy Hospital.

The delivery cases were admitted to a rather stark room with a  metal obstetric bed, stirrups in place and two wooden cots, one for the patient in labour and one for me. I would sleep in the same room with the patient, next to the patient, sharing every contraction with the patient, in mental genuflection, with one hand on her abdomen, too frightened to leave the patient. His presence was a constant third, a living presence in the Room.

The obstetric table was a cold sheet of metal with a thin plastic covered folding mattress., There was no running hot water to clean up after the delivery. I used to feel desperately sorry for the poor mother who lay there exhausted after her ordeal. The moment the baby was placed in her arms, the tiredness would fade and she would bond with her baby as she nestled the baby close to her breast, making the rest of us in the room feel like voyeurs intruding on their epic mother-child moment. The light in a mother’s eyes when she first meets her infant could light up an entire street and the Siberian Desert .

Years later, after I had moved completely to Dermatology, I delivered my grandson, Ashish Mathew Samuel, in similar conditions at the SDA hospital in Shimla on 5.5.01. It was a deja vu. I was the only doctor present at the birth.  The Obstetrician who was supposed to come,  was caught up in a case on the other side of the hill. I had no option but to step in. I had not delivered a baby in 30 odd years. Many things had changed in those years. My face had more lines, my hair more grey and my knees creaked like an orchestra with no conductor. I had not bellowed Push Push since the last time.  I had not cut any cord in a long time. It would be correct to say that I was a tad apprehensive.

Thankfully the miracle of birth had not changed in all those years and my training kicked in without a whimper. I never left her side, sharing every contraction with Vidhu, in mental genuflection as she gazed at me through eyes glazed with absolute faith and confidence, spurring me on. Eyes that reminded me of every patient I had delivered in Bhutan and Nepal.

Our second grandson  was born in Malar Hospital in Chennai on 14.3.05. I was delighted when Dr Jaishree Gajaraj the attending obstetrician let me deliver Rohan Mathew Samuel. The only difference was that this time, we were VIPs as I was the Dermatologist at Malar.  Vidhu, Anish and I were in a corporate and sterile air-conditioned room with a host of trained doctors and nurses.  There was an Operation Theatre on high alert in the background with a team of doctors trained to handle any emergency and a neonatologist, a friend and college mate from CMC, Vellore, Dr. Benny Benjamin, waiting to receive the newborn with open arms.

Some things had not changed. My total dependence on the Almighty, His Presence in the room and His abiding grace to all of us in the room . When I think of all the things that could have gone wrong in all the births I had attended in resource poor settings, I thank Him that nothing did and I thank Him for His mercy and faithfulness.

Always and Always.