All posts by drsusieblog

My Puppies on The Rainbow Bridge

I think I love dogs more than I love humans. I honestly do.

When Bouncy went missing in Bhutan, I never thought I would love another dog enough to go through the heart ache of losing them . I was so wrong.  When we went to Nepal , we got a pair of fawn and white Llasa Apsoos, a brother and sister. Pappoo, the girl grew up with us in Nepal and Tiny, the boy grew up with my Mum and Dad in Madras. They grew up in two neighbouring  SAARC countries, till we moved to Chennai when they were reunited.

I sat them down and explained to them that they were a consanguinous pair . Brother and sister I said. Unfortunately it fell on deaf ears. They thought they were husband and wife and would indulge in romantic spells periodically, when they would be off food and drink and mope around the house like a pair of lovestruck teenagers . It was a good job that Pappoo was spayed, so we did not inherit a bunch of incestous Lhasa Apsoos. Pappoo lived till she was 18. Tiny died when he was 22.

Papoo was the sweetest little puppy I have ever known. She loved me unconditionally and knew every nuance of my mood. She knew if I was sad. She knew if I was Happy. She knew if I was angry.  She just knew me inside out. When I came home, she would lift her little head and “puppytalk” to me, asking where I had gone and why I was so late coming back. She was my shadow and followed me everywhere. She would wait outside the bathroom with her nose pressed to the door till I came out and tripped all over her.  She never paid much attention to the visitors who came home. But, if she growled at someone, we stopped in our tracks and had a second look. She had a sixth sense and could “suss  out” who was okay and who was not. And her judgement was never wrong. Her brother Tiny was no judge of character. He barked indiscriminately at anyone who came through the door. No one paid any attention to his character assessment.

Pappoo developed Mammary tumours when she was 18. When I took her to the Vetinarary Hospital, I knew the diagnosis before they told me. It was malignant, something I did not want to hear and was hoping against hope that my gut feeling was wrong. When they told me that she may not live more than a few weeks , I broke down and howled like a wounded animal, in front of the hospital staff .  Pappoo lived for a few weeks after that fateful visit and I was with her when she finally went. I was sleeping with her on the floor in the bedroom and I must have dozed off, when she woke me with her feeble paw. I shot up straight and saw her looking at me with utter sadness in her eyes as she inched closer to me.

I watched helplessly as she slipped away from me after 18 glorious years together. Tiny who was also in the bedroom when she passed away, came and gave her a couple of  perfunctionary sniffs and went off silently to curl up under the bed. Evelyn Yogesvaran, my Bestie had flown in from Sydney and was  staying with us in Chennai when Pappoo died. She loves Dogs just as much as I  do . Together we wrapped her in her favourite blanket and put flowers in her wrap as we buried her in the garden. Evelyn shared my grief and knew exactly what I was going through. Only a Bestie would.

Tiny was as lost as I was after Pappoo left . My friends suggested that I take in another puppy to fill the void that Pappoo had left. I could not bear the thought. The milkman , the fish man and every other vendor who came to the house knew that I was bereft. The kind fish man, who used to cycle around the colony selling fish in a basket, stopped at the gateone day  with a fluff of white that wriggled in his arms. I said “ I am not looking ” and I looked. I said “ I am not touching ” and I touched . Before I knew it, a little white Pomeranian girl  had nestled into my arms and my heart and answered to Pappoo. Tiny who till then was sleeping, like death warmed up, under the bed, suddenly came alive and sniffed her all over, giving her a few licks and barks of approval.

Pappoo was a comfort to me when I was grieving. Many years later when my secretary, Mr. Bala,  was mourning the  death of their only son, I gave Pappoo , the Pom to him to mop their tears. Mr. Bala and Louisa were delighted to have Pappoo and looked after her like a baby, but Pappoo missed us and her pack. One day , when Mr Bala was getting ready for his bath, Pappoo darted out of the top floor flat they were staying in Choolaimedu and ran all the way down and onto the busy road, weaving through the traffic. Mr Bala, who was dressed only in his towel, ran and caught up with her and brought her back to their flat. When he brought her back to us Pappoo was limp and exhausted after her aborted escape and slept for days without moving, under our bed.

Anish was watching Tiny and Pappoo settle in, with hope, as he wanted  more dogs. When I was not looking, he ran and got a Dalmation puppy, a gorgeous boy we named Snoopy, who honestly  thought that I was his mother. He was an unruly, lovable rogue who never obeyed commands or did as he was told. When he was scolded, he would run and hide in my saree petticoat with his rear end sticking out and his tail wagging to thump on the floor. The silly dope thought that if he stuck his head in my saree petticoat, he was safe and invisible. He was getting so naughty, we decided to get him a trainer when we moved to the Uthandi beach house on the East Coast Road. A police constable was found to train  Snoopy. Whenever he heard the trainer open the gate, Snoopy would rush in and hide in my petticoat and had to be dragged out on all fours for his training sessions.

One day Sam took Snoopy on a walk round the Defence Colony. He was well behaved till a point several roads away from our house, when he suddenly stopped, siffed purposefully , perked up his ears and made a dash for it leaving an astounded Sam holding onto a puppyless leash. I do not know how Snoopy knew that I had come home and he ran all the way home to greet me.  When Sam came home looking for Snoopy he found him peeping from under my saree petticoat. Snoopy developed a renal condition when he was 9 years and died in the Uthandi Beach House on the ECR . How many times can a heart break I wondered ?

When Anish brought Snoopy home , he slipped in another surprise,  a beautiful black beauty of mixed pedigree with a docked tail that Gopinath Gopalan, Uncle Gopi to the kids, had given Anish from his last litter. Christened Tootsie, she had a Doberman Mum and a German Shepherd Dad. Her fierce demeanour belied her sweet and loving nature she showed only the family. To the rest of the world, she was the protector, the guard and the one who kept all the unwanteds away. One Tootsie was all it took to keep the robbers away.

Meanwhile , the gardener who came once a week to “do” the garden brought us a green eyed beauty, a chocolate Labrador we named Tiny, in memory of Tiny the Elder , the 22 year old Lhasa Pup who had crossed over and reached the Rainbow Bridge. Tiny the Lab had the sweetest temperament I have ever seen in a dog.  She never made a fuss, never misbehaved , always did as she was told and was the gentlest of the lot, green eyes and all.

Snoopy the Dalmation fell for Tiny the Labs charms and she had a beautiful litter of 6 puppies that we could not classify or categorise. When she went into Labour, I separated her from her curious companions and took her up to the terrace and  sat up with her as delivered the litter. My training in Obs/ Gyn did not make me any less nervous as this was the first whelping I was witness to and this was the first set of puppies that Tiny was having. She was absolutely marvellous for a first time Mum and did everything by herself, as her maternal instincts kicked in .

The puppies were  all anterior presentations and came head first. During the passage, the sacs broke as they slipped out and she licked the puppies clean stimulating them to take their first breath.  I watched her eat the after birth with every birth and I  was enormously relieved  that we homospiens did not share that trait, as the visuals that flashed through my head were quite gross.

I fed Tiny milk and eggs after each birth and moved her puppies with their eyes shut, to a cardboiard whelping box lined with newspaper where they wriggled and wiggled to huddle in a heap, close to the warmth of the other. When she was done, I was crying as I cleaned her up.  It was an epiphany moment for me when Tiny and I bonded. I was  overawed with the whole wonder of the whelping process I had just witnessed.  I was overwhelmed with her absolute trust in me, as she looked up at me with her beautiful green eyes when I sat next to her and stroked her brown coat to encourage her. Exhausted, Tiny climbed into the whelping box and lay there passively, as the little wiggly sausages found their way , blind ,to nestle close to her and find her breasts to suckle.

They were a good looking brood who found loving homes easily. Not one of them had Snoopy’s spots. They were all chocolate with white socks and mittens and a splash of white on the chest like a waist coat, that made them look like liveried Butlers . Even the runt was good looking. Smaller, yes, but just as good looking. What on earth do you call a cross between a Dalmation and a Labrador ?  Dalradors ? Labmations ? Tiny the Lab was the only girl who carried Snoopy’s Pups. None of the other girls, Tootsie or Pappoo had Snoopy’s pups. Tootsie was spayed . Pappoo always snapped at Snoopy, when he went sniffing. She took her virginity very seriously.

Dr. Sumeeta Antonysamy was the Vet who took care of our Puppies. A beautiful and compassionate human being, she had a way with our Puppies.The minute she entered the gate, the Puppies would surround her, clamouring for her attention and  knocking her dimunitive frame to the ground. After an enthusiastic welcome, they would settle down around her, while she examined them one by one in great detail , whispering sweet nothings in their ears that they seemed to understand perfectly. She was quite intrigued with Tiny, our Lhasa Apsoo  and admitted that she had never had a patient as old as our Tiny was at 22 years. She was patient and extremely kind to the Puppies by answering our calls promptly, sparing them pain and discomfort with her early and correct diagnosis and by treating the Puppies appropriately. An absolute gem, committed and caring,  Dr. Sumeeta  was someone we respected immensely

And that is how we came to have an odd assortment of Puppies who ran before us and around us, filling our days with unparalleled love and joy. A far cry from my Puppy-less life in the retirement community., Anandam.  Sometimes I feel an empty ache , a dull physical void without a Puppy in my arms and I threaten the Psalm that I am going to get a Puppy one of these days.

A glazed look comes over his eyes and he looks as if he has switched to deaf and dumb mode. A  well practised deaf and dumb trance. He is petrified  that one these days, he will come back from the HIV/AIDS CARE Centre he runs in Nammakkal and the Kolli Hills, to find a puppy, or maybe two,  sleeping on his side of the bed. He remembers too well the days we used to sleep like the alphabet H.

Sam and I lying longitudinally  at either end of the mattress, with all the puppies stretched out horizontally between us !

 

 

 

Ash-Adi, the Twins next door.

We have always had the best of neighbours . Well almost always.

We bought 208 Defence Colony, when we returned from England and had no clue about Feng Shui or Vaasthu, the rules and principles that governed the Real Estate Market of Chennai. . We loved the peace and orderly layout of the Defence Colony and we loved the shady canopy of the  Mango tree in the back yard.

We had no idea that the front gate of the house should not face a road. No one in their right  Fengshui -Vaasthu mind would ever buy a house that faced a road. If they did , they would install a statue of the Lord Ganesha at the gate to reflect any bad luck that came down the road into their house. Since we were Christians that was not an option. We made some modifications in the interiors and moved in with our dogs .

Our neighbours on western side of the house were the Bhats ,  a Saraswat Brahmin family from Mangalore. Mr and Mrs Bhat lived next door with their youngest son Prakash , his wife Sahana and their twins Ashlesh and Aditya. The twins were around 6 months when I first them and fell promptly in love with them.

Ash-Adi as they came to known, were my friends and we used to talk across the fence between the houses. Once when I was watering the garden, I heard a conversation between Ash-Adi and someone else. I thought their cousins had come for the holidays and called out to ask them if Swastik , Sahana’s nephew had come over for the holidays. The twins peeped through the well developed gap in the fence and said that they were playing.

Intrigued,  I asked them who it was that they were talking to. “Thats  Gopu , Susie Aunty, “. they said in unison. I had never heard of a Gopu in their family and stepped up onto the parapet and looked into their garden.  There was no third child there . Only Ashu and Adi, the twins.  Alarmed I looked around. “Who’s Gopu ? ” I asked. “Gopu is our friend, ” they said. ” He comes over to play with us every day”.   They then introduced me to Gopu, their imaginary friend. Not wishing to sound stupid, I played along and asked Gopu how he was doing and the twins replied. When I asked what Gopu had eaten for breakfast, the twins gave a detailed menu. I quickly realised that this was serious and that Gopu had come to stay. After that for a couple of months, most of the conversations with the twins over the fence always included Gopu, till they outgrew Gopu.

It was a pleasure watching them grow up next door and turn a year older on the 10th of every September. They were beautiful babies, bright and ever so intelligent. Every morning when Prakash sat on the verandah, drinking his coffee and reading his paper, Ashu would sit in a chair next to him, cross his legs exactly the same way that Prakash did and read the headlines from the supplement. He never understood a word of what he read, but he could read every line before he was two.

Adi was the brave one . One day he had a fall and cut himself quite badly and was taken to Malar Hospital for suturing. Ashu cried buckets seeing the blood run down his twin’s face. Adi never cried and they did not need to give him a local anaesthetic for the sutures as he slept through it all. Though they were not identical twins they had a bond that kept them close. They were alike in so many ways and yet unique and different in so many ways

They were the pivot and soul of all my Xmases in Defence Colony. Ash-Adi decided when the Xmas Tree should be taken out and dusted to be decorated. They put up the trimmings and they switched the Xmas tree lights on , a operation they fought over. I  confess that I have always needed more  than 30 days in a year  for Xmas. My Xmas tree would find its way into our living room around the end of October, to be taken down at Epiphany on the 6th of January.  Ash-Adi  knew exactly which trinket went where on the tree. My Xmases revolved around the Bhat twins. Sahana found a set of Santa costumes for the twins and she used to dress them up with a white beard and they would go around to their friends in the lane to share the Xmas cookies and biscuits.

When Diwali came around ,the Twins shared their crackers and the sweets that Sahana made at home with us. This was a routine we all settled into with perfect ease. It was such a comfort knowing they were next door, with only a flimsy fence of sorts between us. We had a huge library with all the books our kids and I had collected. Ash- Adi were extremely disciplined when they came over to borrow the books and they returned it with entries that Sahana kept.

I really enjoyed the baby and toddler years I was blessed to share with the Bhat twins. After their grandparents passed away, the house was sold and they had to move to Mangalore after their exams. They were looking for a house for just a couple of months. Broken hearted, that they were moving , we offered them the ‘Upstairs ” of our house, as it was empty as both our kids Rekha and Anish were away at college. The Bhats moved in thinking that we had done them a great favour. What they did not realise was that they had done us a big favour. A huge favour.

The house came alive with the twins. Sahana took over the kitchen and would have a hot meal on the table ready for us when we reached home after a hard day at work.  There was someone waiting for us when we got home. There was someone to bake brownies and biscuits for. Ash-Adi’s favourite dinner was “macaroni and cheese” and I loved making it for them. Someone to read to and tell stories to. Someone who said  “Yes, me me ”  enthusiastically and raced you to the car , when we asked “Who wants Ice-cream? “.  Someone to spoil.

The months whizzed past and soon it was time for them to move to Mangalore. I watched them drive away with a piece of my heart and went upstairs and looked around the hollow emptiness, the sound their absence made and cried my eyes out.

I could never look across the fence after that and soon we decided to put the house up for sale and we moved to the East Coast Road with our dogs.

Uncle Sampath Raj of the BRTF

Mr Sampath Raj worked with the BRTF , the Border Road Task Force of Bhutan and ended up being Uncle Sampath Raj to us and the kids.

Whenever we travelled with the kids in Bhutan it seemed nothing less than an expedition. The Land Rover would be packed with pickaxes, shovels, a kerosene stove, Kerosene in a jerry can, basic rations, blankets  and all sorts of bric-s-brac in addition to our clothes ,  diapers ,etc. This was purely because the conditions on the roads were unpredictable and we could be stuck with landslides , snow or a treefall for hours on end.

Dotted along the roads of Bhutan at set intervals were the stations of the Border Roads Task Force which were ministering angels when we were marooned  on the roads.  They were manned by kind paramilitary personnel who maintained the roads. If we were lucky to be stuck near one of these stations we had nothing to worry about. We would welcomed and given a room with a heater and a hot wholesome meal with rice, dhal and potato.

It was on of these road blocks that we met Uncle Sampath Raj who adopted us and kept in touch with our adventures on the road and pointed us to the nearest BRTF post, whenever we had a road block. The staff at the nearest post took over and looked after us till the block was cleared. Uncle Sampath Raj would stop by on his travels when we would a piping hot meal for him with sambhar, as he missed his south indian food.

When Uncle Sampath Raj retired and left Bhutan we lost touch with him and he became a fond ,pleasant and distant memory. Twenty years later, I was traveling in England. I was looking at a train time-table in Victoria Station in London when I noticed an elderly Asian man and a young boy from the corner of my eye. They seemed to be walking around me trying to get my attention. I turned away, as I honestly could not recollect having seen them before. A little later, I heard this voice behind me.
“Excuse me,”
“Are you Dr. Susie by any chance?

Embarrassed, I turned around and smiled at the old man who was peering up at me. I thought he was a patient that I had treated. Sometimes, it is difficult to answer when patients comes up to you in a crowd and ask you if you remember them and you truly wish you could. Sometimes you remember some part of the patient’s anatomy better than the name or the face.

“Yes “I said hesitantly, waiting for him to continue.
“Don’t you remember me, Dr Susie?” he asked.
For the life of me I could not.
“I am so sorry; please could you jog my memory?” I asked awkwardly.
He let me stew, for a bit, in my discomfiture.
“Bhutan….BRTF….Uncle Sampath Raj” he finally said to my relief and great delight.

I was completely floored. Fancy meeting Uncle Sampath Raj in Victoria Station after twenty years and fancy him recognising me. He had aged and he was in civilian clothes and not in his BRTF uniform and quite honestly I was not expecting to see him at Victoria Station of all places.

We spent a happy hour reminiscing over a cup of coffee. We talked about Baji , the faithful Nepali gentleman he had brought into our lives to care for us. Uncle Sampath Raj told me that he lived in England with his daughter’s family and introduced me to his grandson with great pride. I was delighted to see him again after all those years. Dear Uncle Sampath Raj. He brought back so many lovely memories of a warm friendship in Bhutan.

A kind and warm friendship .

My Mum the Royalist

My mum was an incurable royalist and she loved the Royal family of England.

When Prince Philip the Duke of Edinburgh visited the colonial island of Singapore, we were taken in droves from school to wave the Union Jack as he whizzed past us in an open vehicle. When I got back home that evening my mum wanted to know every itsy-bitsy detail.

What did he look like? she asked.
What did he wear? she went on.
Did he have his naval cap on ?
Was he smiling? she persisted.

I had seen the man in a blur for a flicker of a second as he whizzed past me in a car. I had no answers to the questions that she asked me.

When Edward the Eighth, abdicated the throne to marry Mrs Simpson, my mum followed the saga from the beginning to the end. Later when she came to stay with us in London she was delighted that they were airing the TV series Edward and Mrs Simpson .

The world stopped in our Kew garden flat, the evenings it came on air. We were most impressed that she could recall the events of the erstwhile romance in chronological order, even to the contents of their love letters. She knew them all verbatim.

Later when Singapore became a republic the national anthem Majulah Singapura was played continuously on the telephone at a particular number. My mum found the telephone hard as she could not hear very well.

Ring up and listen to the national anthem very carefully, she would tell me.
Learn it properly
You have teach it to me after you learn it.

Between the phone and her daughter, my mum learned the National Anthem of Singapore. We watched History unfurl as we were taken from school to hear Singapore’s first Prime Minister Mr. Lee Kuan Yew speak at the Radio Station. We watched a dynamic young man, a Raffles scholar no less, walk purposefully into the room with a spring in his step, smile and lift his right hand with the V-sign to start his speech Merdeka Singapura..

What was he like?
What did he say?

My mum was always waiting for pieces of second hand filtered information that most of us handed out in fitful reluctant spells, steeped with irritation.

The world is kind to the blind. The world is cruel and impatient with their deaf. Everyone trips over themselves to help a blind person cross the road. The same person will snort impatiently if called to repeat something to a deaf person.

Sad

My patients, my friends

In his travels Sam often crossed heights where no doctor had set foot before.

He was away for several days while the children and I stayed at the hospital with the staff and patients for company. Their devotion to our family was quite touching. They protected us with a love I cannot describe. If I was unwell and could not go down they would troop up to check on me with anxious faces pressed against my windowpane.

I learned many lessons from my patients, many valuable lessons that I do well to carry around with me. They taught me to look at life in perspective and to appreciate the couplet,
“I cried when I had no shoes,
Till I saw the man with no legs”

Nowhere else is this more poignantly true. I would be amazed at their cheerfulness in rejection, their fortitude in pain and their calm in disaster. Many of them would tell me about the early skin lesions that they found and ignored, sometimes out of ignorance and sometimes in denial desperately hoping that it was not leprosy. Many thought that the tell tale signs would disappear with time. Many were just sadly ignorant.

Mothers would be frightened to cuddle their babies fearful of spreading the disease.
“I can’t hold my baby, Doctor”
“How can I feed her?”
“What if she gets it from me?”

Ground glass bangles

We would get forensic cases of poisoning every month, each one more bizarre than the other.

When we did toxicology in College we studied about the antidotes for most of the poisonous and noxious substances. Or so I thought. There were no chapters in the book for what met me in Bhutan and Nepal. I certainly had no antidote for glass bangles.

One Sunday afternoon just before lunch, I was called to see a young, newly married girl in the hospital. She had attempted to commit suicide after a fight with her mother-in-law. In a fit of rage she had broken her new glass bangles, ground them and swallowed them. When I saw her she was bleeding from the mouth and gums and crying profusely in her mother-in-law’s arms.

“Aiyee, look at what this foolish girl has done, Doctor Memsahib!” wailed the old lady.
“She has swallowed her glass bangles”
“Stupid girl….…what am I going to do?”
A stomach wash was out of the question as it could do more damage than good. A practical option was to feed her masses of soft boiled cold rice and wait. We force fed her and sat with her for 24 hours watching every bowel movement and keeping a close watch on her pulse and blood pressure, checking for signs of tenderness or guarding of the abdomen.

Mercifully, she recovered, unscathed and returned later with her mother-in-law to have her first baby with us.

Carbon monoxide poisoning was an occupational hazard with the immigrant labour recruited to work on the construction sites in Bhutan. They were usually young men from the neighbouring states of Nepal and India brought in as a task force by a contractor or baidhar. They would go to bed with the bukhari burning to keep warm. As the wood burned out carbon monoxide would be released and being a heavy gas it would settle low down and kill people fast asleep on their mats on the floor and animals huddled around them. In the morning they would be found dead with bright red froth coming out of their cold blue lips tragically ending many a dream of survival.

Leprosy

In 1971, as young medical graduates, Sam and I left Christian Medical College, Vellore, to work in what we thought was the most challenging of medical fields, Leprosy, now christened Hansen’s disease.

To many, it still meant tattered, huddled-up bundles of rags at roadsides that occasionally shuffled to beg. For several years we worked in leprosy hospitals in India, Bangladesh, Bhutan, Nepal and Africa.  As part of our training, we visited several leprosy hospitals the world over. The hospitals were different, the landscapes were different, the medical facilities variable. Only one thing was constant. The sad, betrayed, sometimes sightless, eyes of the patients we met.

Reconstructive surgery, face-lifts, prosthetic limbs, restoration of function and loving acceptance gave them a new lease of life. Only the sadness in their eyes remained. Away from the comfort zone of the hospital wards they were discarded remnants of the human race. Many refused to be discharged and to leave the hospital grounds. Some made their homes around the hospital campus in satellite settlements.

Leprosy, is a chronic disease caused by the Mycobacterium leprae, a cousin of the tubercle bacillus that causes tuberculosis. The tubercle bacillus has been grown in the lab and has been studied well enough to develop a vaccine to prevent the spread of the disease. The M. leprae unfortunately has not been grown in the Lab and therefore has not been studied well enough to develop a vaccine to prevent the spread of the disease. M. Leprae can be grown in animal models like the 9 banded armadillo, nude thymectomised mice and the chimpanzee.

Leprosy, is a disease of the peripheral nerves, with tell tale skin signs. The M. leprae, causes damage, both sensory and motor in the affected nerves. When it causes sensory damage the area supplied by the nerve becomes anaesthetic, with loss of sensation, leading to damage to the affected parts. Even if the limb passes through a fireball, it will not wince or pull away as there is no feeling. Even if rodents gnaw at the toes and fingers, the patient will sleep through it all as he cannot feel.

Sometimes, patients would tell me that when they went to sleep they had all ten toes. In the morning only some would be missing after the rodent had done its worst. Many of the patients had to wade across rivers to get to the hospital and they would swear that they had all their toes when they started off from one bank to the other. When they reached the other side, blood would be streaming from injuries, bites and gaps. With no sensation on the soles of their feet, they would sport ill fitting shoes, walking for hours to develop pressure sores on the soles of their feet. This would very often lead to florid infections, teeming with maggots.

When it affected the motor part of a nerve, the muscles supplied by the nerve would be paralysed. Every joint has two sets of muscles that pull in opposite directions. For example a joint would have a set of flexor muscles that flexed the joint and a set of extensor muscles that extended the joint. If the flexors ore paralysed, the extensors would act unopposed and vice versa. In leprosy the flexors of the fingers are paralysed and the extensors contract unopposed and cause the characteristic claw hand deformity. This interferes with all the fine movements of the hand including grip and writing.

With a claw hand, the palm is turned inside out and when the patient tries to pick up anything he actually pushes it away from him. Reconstructive hand surgery cleverly uses good muscles and inserts their tendons into paralysed muscles restoring movement.
In the early Seventies, sharing of experiences between the two hemispheres was lopsided. One had patients, the other had resources and both fumbled for knowledge, in an era, where communication was just another expensive and difficult word to spell and never boasted of speed. Research and development with this backdrop was difficult. There were no internet communications and no conference calls.

Everything took time.

Sam’s travels on the terrain

Sam was the traveller in our lives.

He would set off with the paramedics and supplies to seek out the defaulters list of leprosy patients who never showed up for medication. This was no easy task as some patients gave false names and addresses making the entire exercise a waste of time in some parts of the mountainous country. It did however give Sam a chance to understand what the paramedics were up against in terms of terrain, travel and effort.

Some villages were miles and mountains apart and took several days of walking to reach. Sometimes they had to wade across rivers and in the rains the leeches were a bloody nuisance. Most of their clothes and socks were washed in salt to prevent the leeches from sucking on but every time they crossed a river the salt washed off a little more to provide virtually no protection at all. When he came back home he would shed most of his clothes and foot wear outside and came in for his bath. Sometimes it would be the first bath that he would have has in days.

He would come back with the most interesting stories of people and lifestyles untouched by time.

When he went to Bhumthang he met people who did not use money to trade but who bartered for salt and provisions. They had no use for the green stuff and managed to keep their threshold for stress high. Some parts of Bhutan were untouched by modern gadgets and gizzmos. It is joked that when the first automobile drove up the road for the first time the local villages brought fodder to feed it as they thought that it was an unfamiliar beast of burden.

He travelled and met a group of people with a polyandrous matriarchal system where woman managed to juggle very successfully, several husbands in one lifetime. The Bhutan of the early seventies was under populated with a high infant mortality rate and people were encouraged to have more children.

 

Bouncy

Bouncy was a white and tan Lhasa Apsoo who came to live with us in Gida kom.

She was a lively little Apsoo we loved dearly. When I left for work in the morning she used to sleep on the steps leading down to the hospital with a woebegone face. Baji used to say that she would not stir from the spot till I came home. When I returned she would stand at the top of the steps and welcome me back jumping up and down barking in delight. When I reached the top she would run around me in circles sniffing my ankles.

She knew when I was happy. She knew when I was sad. She was a loving companion up in the mountains of Bhutan. One day we had some visitors who came to the house after they had gone around the hospital. When they left in a jeep we found that Bouncy was missing. I was devastated. I could not imagine a world without my Bouncy. I kept thinking that it was a bad dream and I would wake up to find Bouncy curled up at the foot of my bed.

I scoured the whole campus shouting her name, tears streaming down my face. The patients and staff joined in the search for Bouncy, but it was in vain. There was no answer and there was no familiar bark. No Bouncy dancing around my ankles. No Bouncy tripping me as I walked home in the evening shadows. She was gone. I could not believe that I would never see her again. I had lost Bouncy for ever. She had given me no warning, no illness, no goodbyes. She had been simply snatched out of my life forever.

I don’t think that I will ever love another dog again” I cried to Sam that night.
“I don’t think I want anymore pets,
“Ever”
These were famous last words from a dog lover

Early days of monotherapy

In the early seventies leprosy was treated with a single drug, Dapsone.

Clofazamine was added later to treat the multi-bacillary patients who were AFB positive in skin smears. Neuritis and nerve palsy was a common occurrence for which oral steroids with all its known side effects were administered in tapered doses to prevent permanent nerve damage.

When we did rounds the patients used to cry in pain despite the analgesics, splints and steroids. It was heart rending to see grown men cry in pain. We had no Rifampicin , no Thalidomide and we had no multi-drug therapy to offer them as these came much later in the archives of leprosy. What we did have was Antimony Injections which mercifully are no longer used.

Foot care in Leprosy was difficult as the terrain was mountainous and walking in ill fitting footwear the only means of transport. This was a disastrous combination for anaesthetic feet which became infected and maggot riddled.  Amputations were the last option available , when it was done in stages compounding the deformity and the disability that changed their stance and gait with no option for customised prosthetic limbs.

Treatment  of Leprosy in the early 70s was far from satisfactory as research was an alien word and funding was not forthcoming except through the Charities. With time , Leprosy was integrated into Integral Health Plans of the States and Governments and slowly a glimmer of light appeared at the end of the tunnel, as Multidrug Therapy was introduced and Orthopaedic and Hand Surgeons took an active interest in correcting the tell tale deformities , like the claw hand with tendon transfers and physiotherapists taught them the use of the transplanted tendons to move their limbs.

No matter how much research and newere modalities of treatment appeared in the arena, Leprosy was always considered a stigma and patients and ostracised.