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.


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