A Doctor in a Rural Health Center.

                               

                                   P.K.Ghatak, MD
                            

                                   No 4.

 

Arun started, at the crack of dawn, from his home and took the first morning train to reach the main railway station then took another train to the next junction, changed train again to reach a railway station close to the rural hospital where he was assigned to work. At the rail station, he took a rickshaw and arrived at the hospital by then it was afternoon. The rickshaw puller dropped his luggage on the pavement and left. The office door was padlocked. Arun looked for the doctor he came to replace. But not a soul was there other than few patients in the female section of the hospital. Finally, he found one person; she said. “Doctor is on midday break; he will be back when the hot sun is down on the horizon.” She pointed to a chair in the corridor where he could wait. She was not even curious to know who he was or why he showed up in the hospital with his luggage.

Arun sat for a while; then paced the corridor; saw an empty room marked “Male Ward”. The room was crammed with broken and rusted hospital beds, metal benches, chairs and other pieces. He walked around the grounds. The health center was an H- shaped building; male and female beds were one on each side joined in the middle by the doctor’s office, outpatient clinic, pharmacy and an operating room. Behind the main building, there were two small buildings, one marked “Isolation Ward” the other “Kitchen” both were padlocked. One tubewell was on the ground. There were several small detached houses on the other side of the road. A little further away on a small barren earth mound, he could see the charred remains of a funeral pyre.

About 5 PM the doctor showed up. He said he did not know that he was coming to replace him and so he was not prepared to receive him. He was drinking a cup of tea while talking but he did not offer tea to Arun. After a discussion, they agreed that till further clarification came from the regional medical office, both of them will continue to work. Arun would look after the outpatient clinic and the other doctor would be in charge of administration and in-patients. He told Arun that there was no vacant building for him to move in but he would ask the janitor to vacate his apartment and then Arun could move in there. That would be a temporary arrangement till things were sorted out at a later time. He added that janitors were not entitled to housing, but the guy moved in because it was unoccupied. A cobra snake was spotted several times around that place and people were afraid to trespass into cobra territory.

The young janitor came and took Arun to his house. It was just a room built with brick and mortar, had a corrugated tin roof and had no ceiling. The door was functional; the windows had no shutters. There was no electricity or running water. He pointed to an outhouse at a distance near an old pipul tree. He cautioned Arun not to walk there in the dark because he said.” The snake lives there”. The janitor had next to nothing of his personal possession. He picked up his things, swept the floor clean and left.

In his bundle, Arun carried a blanket, a mosquito net, one pillow and a pair of bed sheets, and in his tin suitcase, he had a pair of paints and a few shirts and undershirts, a piece of linen as a bath towel and toiletries. He had no candles or oil lamp with him.

He sat on his suitcase and felt thirsty and hungry. He could see the sun was setting. He remembered his mother packed some snacks and sweets for him. He washed as best as he could, out in the open, drawing water from the tubewell and returned to his room. He ate snacks and sweets with utmost delight.

Sitting there in the dark he could hear in his head the welcome speech given to the entering class by his professor of Anatomy. The professor said. “I congratulate you for choosing to become a doctor, the most noble profession one can have. You will be asked to sacrifice, risk your lives but rewards will be plenty. You will be the first one to greet a new life in this world and you will be the last one to hold hands of a dying man giving him comfort and say goodbye”.
Arun thought about his mother, remembered her kindness to the poor and her faith in the goodness in mankind and her unwavering trust in him and her advice to him that by his own conduct he must prove his worth of his family name.

But there was a cobra in his vicinity. He knew snakes liked to stretch out on a cement floor in the evening. He had no way to separate himself from the snake; there was no bed and he had to sleep on the floor. Then mosquitoes began to bite him and added to his misery. He hung the mosquito net and got inside. He waited in the dark for a snake to crawl in. Nothing happened as long he was awake.

Very early in the morning, he was awakened by someone calling him.” Doctor are you still sleeping”. Arun opened his eyes and saw an old man standing outside by the window, almost touching his mosquito net. He was dressed only in a loincloth and carried a long strong bamboo walking stick in his hand. Arun realized he had no privacy; his privacy depended upon the goodwill of people not looking through the shutter-less window. His room stood next to the road and had no boundary wall. The man continued. “You are a government servant, you are paid to work, and you are on duty 24 hrs. a day, do not waste time lying in bed. Look, he continued," patients are waiting for you”. Arun looked in the direction of the health center, there was not enough daylight to see any building and he saw no one. The old man waited till Arun got up from the bed and folded the mosquito net and bed sheet and put them away. He asked Arun unceremoniously about his qualification, grade and honors and training he received at the university hospital since graduation, and at the end, he added,” If you are as good as you say why did they send you to a village”.
Arun pondered over the same question when he received his appointment letter from the State Health Department, directing him to go to the rural primary health center. He had the expectation to be placed in a teaching hospital on the basis of his academic achievements.

In the morning both old and young people came to see the new doctor. Arun was given the task of taking care of the outpatient clinic. He worked diligently and by the time he saw the last patient, it was past midday. All employees left for lunch. Arun did not know where to go for food. He had nothing to eat in the morning and had snacks the night before. There was no restaurant within a 3-mile radius. He saw a rickshaw and asked the rickshaw puller to take him to a place where he could find food. He took him to a market and pointed out a restaurant. It was just a shack, cooking was done out in the open, and people sat on long benches and ate - one bench facing the street the other facing the back wall. He was shown to the backbench. He ate alone, facing a dirty wall which was only 6 inches from his nose. Later on, he learned the backbench was a preferred sitting because the dust from the dirt road kicked up by the passing vehicles landed on plates of people sitting on the front row.

After lunch he looked for transportation to get back, there was nothing available during the hot noon hours; people looked at shelters under shades and took a break from work. He began to walk back to the health center in the hot sun. The heat was intense, and the pavement was radiating heat and he felt his face was scorching and by the time he arrived at the hospital he was drenched in sweat. But he could not get inside his room because the room felt like a hot oven. He sat under the pipul tree but remained alert in case the snake showed up.
After sunset, a few hospital employees showed up at the center, but it was more of a social get together than any significant hospital work.
That was how the first day of work ended for Arun. He, however, did not know how and from where his next meal would come. He went back to his snake infested lodging to ponder over the whole situation and started to get hungry thinking about food. He found it difficult to fall asleep on an empty stomach.
That old man showed up every morning until one day he brought his grandson to Arun. That young man was losing weight, had a low-grade fever for 2 to 3 months and now had developed shortness of breath. Arun examined him and found fluid in his right chest. He inserted a needle in his chest and drained about a liter of pleural fluid and placed him on drugs for tuberculosis. His grandson got well in a short time. Then on the old man became Arun’s cheerleader. He bought Arun mangoes, coconuts and other produce from his field. He gradually opened up to him and told him the difficulties he had faced in getting government officials' approval to locate the health center in his village and securing a piece of land from villagers. When no one gave him the land, he took over this cremation ground. He endured all kinds of bureaucratic obstructions and foot-dragging, but he prevailed in the end.

Three months had gone by, but Arun did not receive his salary. His mother was sending him money to keep him going. When inquiries led him nowhere, Arun took a few days off and went to the state health department. After several attempts, he located his" joining letter" in the file cabinet of the head clerk. He took the letter and went straight to the chief medical officer, thinking the office would admonish the clerk, Instead, the doctor told him it was Arun's fault and stated, " young man do you not know how things run in a government office, you have to grease every wheel if you want anything done" He later learned that the grease was only Rs.2/. He took the document personally to the office of accounting and gave it to the clerk responsible to grant his pay slips. Arun thought sure this time he would receive his salary. But again- this time the accountant at the disbursement office demanded" Baksis" a coded term for a bribe. This time the grease was also RS 2/. (2/5th of a dollar at that time - the exchange rate).

On a very hot day in mid June Arun was lying underneath his bed, using the bed as a shield from radiating heat coming down from the tin roof. He poured water on the floor and wrapped himself in a wet cloth. At that moment two of his medical school classmates unexpectedly showed up. His friends were appalled finding him in that wretched condition. Arun smiled nervously and said it was not as bad as it looked. His friends told him that they were leaving for the USA and they came to say goodbye. They urged Arun to make plans to go to the USA and they promised to write to him regarding the medical training in America.

A letter arrived from his friends from Connecticut in due course. In the letter, they described the medical training they were receiving at the hospital and listed various medical conferences, grand rounds, and case presentations, etc.  “It is the opportunity of a lifetime. To be most useful to your people you have to be best educated and trained,” they concluded.

Arun decided to go home and talk it over with his mother.

Six months later Arun was sitting in the airport lounge of Air India, he had in his pocket a one-way ticket to Kennedy airport in New York via London; and then on to Detroit, Michigan by Eastern airlines.
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