Medico in Green Pastures

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I am pleased to be here and to see you all. I have come to live among you, as rhizobium lives with legumes as a symbiont and not as a parasite”, with these words I started my job as Medical Officer at the Faculty of Agriculture in Wadura, Sopore, Kashmir nearly 60 miles to the north of Srinagar. It was a happy coincidence that on that same day, the students were celebrating their fresher’s day and by addressing them thus, I was given the opportunity to share my emotions about the enormity of the task facing me. While acknowledging their applause, I was acutely aware of the lack of medical facilities at my disposal. For years the faculty had had no Medical Officer, and I could feel the weight of my responsibilities on my shoulders.

“Doc! You are most welcome”, said the tall, well-built senior pharmacist Mr. Bashir Ahmad Nanda, as he took me around the College’s medical unit, which is situated on one corner of the lush green campus of the College. I made a quick assessment of available medical facilities, and together we started compiling a list of essential missing medicines, instruments etc. which would be needed for the unit. That very week I was allotted accommodation in the staff quarters, which came together with a young boy, Mr. Ghulam Nabi Bhat from a village near Kupwara, who was to look after me. The faculty apartments were in the heart of a pear orchard. Although there was more staff housing available on that lush green campus, only two units were occupied, one by the late Dr. Nirmal Singh, the Dean, and another where I had started to live. Invariably, we would meet in the evenings after our day’s work. Dr. Nirmal Singh was a very dynamic administrator and he had a very good sense of humor. During the spring season one could take very pleasant walks amongst the soothing white flowers. The Faculty is situated in more than 250 acres with beautiful lawns, and a large variety of flowers and fruit trees all providing a unique fragrance to the passerby. The Hurmukh2 range of mountains seem to safeguard the serenity of the campus. A small river called the Phoru flows calmly along the exterior boundaries of the campus, and a population of a few thousands souls lives happily on its banks.

Well dear reader, from a hectic doctor -patient -doctor relationship, I had chosen a place where as a doctor I had very little or no work at all to do. However, with the passage of time I started realizing that being a doctor does not mean being a prescribing machine only. I therefore, in addition to my official assignments, extended the remit of my services to this adjacent Wadura village. I would often come to collect posts from the administrative section of the college from Mr. Ghualm Mohamad dar, Qibla, as I would often call him, as that used to be the only way I remained connected in that internet-less era. One day I met the late Prof J.D. Safaya while collecting the post and he took me to his office. He lit a cigarette and in between puffs he went on talking to me “Doc! This is a transit in your medical career. As long as you are here you should try to contribute as much as you can, and remember what Alexander Pope said hundreds of years ago, “Honor and shame doth no condition arise, act well your part there all the honor lies”. I patiently listened to his peerless advice like any disciple should, and my only negative thought was that his smoking habit was both worrying and annoying me a lot. I felt it was too premature to counsel him directly at that juncture but I made up my mind to do so, albeit indirectly; consequently I undertook my first study on high risk smokers4 and associated risk factors of atherosclerosis on the campus. A series of lectures on preventive medicine followed.

One day a young boy was brought to our clinic with pain in his abdomen. He was writhing with pain, and a clinical examination displayed the possibility of a worm colic, a very common problem in Kashmir. “Doc,” his mother asked me innocently, “he has not taken anything since yesterday morning. Will it be possible for you to give him glucose (IV-fluids)?”. Her innocent request made us start thinking harder about upgrading our medical unit. “Doc! Why don’t we deworm all children in the village”, the senior pharmacist suggested. “To the best of my knowledge, worm infestation is quite prevalent here. You probably know most children miss some of their classes due to pain in the abdomen caused by worms,” he went on. The senior pharmacist who came from Baramulla5 had been living in the Wadura village for years together, and would visit his home on weekends. The loud sounds of his old Yazidi motor bicycle every Monday morning would mark his arrival back at the faculty. He had very good experience of the clinical problems found in the village, as he would practice there after hours. I found him a very co-operative team member during my tenure in the faculty. Finally, one fine day we conducted a mass deworming program in one of the schools of the village. Tab. Pyrantal Pamote was given on the spot to all the school children, followed by health education, with an emphasis on personal hygiene. The drug was well tolerated by all and we did not observe any untoward side effects in any of the children who received it. Intestinal helminth infections are prevalent in most developing communities, and school age children harbor some of the most serious infections, which can produce adverse effects on health, growth, and school performance. A while later, a smiling senior pharmacist told me “Doc! This morning on my way to college I met the principal of another school. They too have requested a camp like this in their school.” He was feeling satisfied with the results of the previous camp. Consequently, under the auspices of the National Service Scheme (NSS), all local schools were finally included, and the late Prof G.M. Wani, who was the Director Extension Education of Sheri Kashmir University of Agriculture Sciences & Technology (SKAUST), was crucially helpful. Our medical unit carried out a series of medical camps in Wadura village and also in Bomai, another village, again under the auspices of the NSS. It set a trend among the local population.

Suddenly, all parents were de-worming their children every six months without any fear of untoward side effects of the deworming tablet. We didn’t study any impact of de-worming, but the number of students coming to us for treatment with worm colics decreased drastically following the mass deworming programs in the locality. Well-designed studies treating school-age children with anti-helminthic drugs have shown that mass deworming results in improved growth and nutritional status. There is enough data to suggest that after deworming the children also have higher scores in tests of cognitive function as well.

Our next milestone was the establishment of a small clinical laboratory, as the whole area was devoid of any laboratory facility, and patients needed to go miles away in order to get a simple investigation done. There were the myriad administrative hurdles found anywhere in cases like these, for instance, the creation of a post for a new technician, purchase of lab equipment, etc. While the proposal was under the blanket of red tape, awaiting official sanction, I suddenly had an idea. “Why don’t you learn basic lab investigations?”, I suggested to the senior pharmacist. He happily agreed and he was duly officially deputed to the sub-district hospital in Sopore where he was taught to do basic lab investigations. No sooner was his laboratory training complete, than we were able to start the budding clinical laboratory in the medical unit. Basic investigations such as hemograms, urine examinations, ESR, etc. were all done free of cost to students and on a”No Profit No Loss” basis for Faculty employees and local villagers. In this way, our laboratory was soon paying for itself, without any financial burden on the Faculty. The influx of patients from the nearby village increased rapidly, and soon our medical unit felt like a small busy hospital.

There is an increasing emphasis all over the world nowadays on preventive medicine programs, because such programs are cost effective and have been shown to yield better results. For instance, a Tetanus toxoid immunization program has been recommended by American College of Surgeons for agricultural workers and researchers, because their close contact with soil that harbors tetanus spores makes them particularly vulnerable to tetanus. We decided to undertake a mass tetanus immunization program on the campus. Trying to immunize healthy students against tetanus was an uphill task. “Doc, I am really afraid no one will attend our program” one of the staff members in the medical unit said. We decided to organize an orientation program, and during my “chalk talk” I emphasized the importance of preventive medicine in the form of vaccination.

“Friends, if you wish to participate, tell us more about your health in the past, whether you have any allergies or any chronic illnesses, complete this pro forma and submit it to the medical unit tomorrow.” “We’ll have a fun fair later,” I went on. “You can make cartoons, play musical chairs, sing, etc. tomorrow, and have some fun.” “But,” I cautioned, “you can make any cartoon of me, but please refrain from making cartoons about your teachers and your colleagues.” Soon after the orientation program had ended, all the students were seen boarding the college bus and leaving the campus. “No one will come tomorrow, Doc. They all have left,” said another employee of the medical unit gloomily.

“Well,” I said, “we will wait from 9am to 2pm for them and that is all we can and must do.” The next day the weather was very nice and I came out quite early in the morning from my accommodation in the staff quarters. It was a pleasant walk through the pear orchard, and even more pleasant listening to the chirping and singing of the birds. At 9am, to our great surprise, we saw the students thronging in great numbers in their green coats, their official uniform, to the medical unit. They started showing us the most wonderful cartoons. Our idea of drawing and displaying cartoons had certainly unleashed their creativity! It became clear to all of us why the students had boarded the bus the day before. Yes, you guessed it – it was to get material from the local market in Sopore, as no such market was available on the campus or in the nearby village. It was amazing to see how the students had depicted their problems concerning campus water, electricity, boring hostel life, etc. in a very creative manner. The funniest cartoons were about me, and with their permission I have preserved them for the last so many years now. I still feel that those were the best gifts depicting his patient-doctor relationships that any doctor could ever receive. The funfair cum vaccination and blood grouping program went very nicely, and no efforts were required to inject students with the further two doses required in order to complete the program. Data from those proformas formed the basis of a useful database, as they revealed that there were 18 students who were allergic to sulfa drugs, a number to penicillin and that some had family histories of diabetes etc.

 

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The next milestone for the medical unit was the establishment of a Well Baby Clinic cum Vaccination Centre to cater for the needs of the populations of adjacent villages. Universal immunization vaccines were made available on the campus in collaboration with the Health Department of Kashmir. Most of the local people were completely ignorant about these vaccination programs. Accordingly, a campaign in the form of posters displayed all over the area was launched, and prominent citizens, religious leaders, school teachers etc. were mobilized to increase the awareness of vaccination programs among residents in these villages. The Government of India launched the Pulse Polio Immunization (PPI) campaign, with the first National Immunization Day (NID) observed in December 1995. Since then, a drastic reduction in the number of polio cases has been observed in the country as a whole. India accounts for more than 50% of cases of Poliomyelitis reported globally, but the strategy of conducting successive rounds of NIDs and sub-NIDs over the years has brought India close to achieving the complete elimination of polio. A campaign was launched to make the vaccination drive successful. The medical unit of the Faculty distributed posters, and lectures were delivered in religious places by the senior pharmacist so that this national program, including our part in it, became a great success. We ourselves observed encouraging results and hundreds of babies (aged 0-5 years) hailing from different villages were vaccinated in the faculty medical unit.

Another winter had set in and now I tried to analyze the annual data on the various health-related problems of the Faculty students, and quickly observed a high frequency of gastrointestinal upsets and pharyngitis. These could possibly be due to the unhygienic conditions of the mess. That very day I had a meeting with the Dean of the college, the late Dr. Nirmal Singh and presented him with our data. “Sir, it appears that hygienic conditions of the hostel mess need to be improved,” I explained to the dean. “Fine, Doc. Please give me a written proposal as to how we can encourage the development of better facilities,” the dean said. This way, a six-point program for improving hostel hygiene came into existence and under the chairmanship of Prof S. D. Masoodi recommendations were implemented. Mr. Peer Sharief ud din and student’s welfare officer Dr. Saifuddin played a very crucial role in improving the hostel life of students. Another interesting observation emerging from my study of our data was that a good number of students would come to us with psychosomatic symptoms like fatigue, insomnia, headaches, etc. to the medical unit. It seemed to me that a lack of interesting recreational facilities for students on the campus could possibly be responsible for such symptoms.

The campus, though very beautiful, was located far from the main town, had minimal transport facilities and very limited recreational facilities. I proposed that active research-oriented activities, cultural programs, seminars, workshops, etc. be organized so that students would start liking the place. Accordingly, the medical unit organized a seminar on
organophosphorus poisoning and medical management which was sponsored by Rallis India (Agriculture division) and was possible due to wonderful efforts of Mr Bashir Ahmad Janwari & Mr. Mohd. Ashraf Janwari, both graced the occasion. The programme was attended by progressive farmers, students and various other district officials. The students showed a lot of enthusiasm for this project, and Prof Z.A. Baba, Prof B. A Khanday Prof. Ali Mohammad Wani, Prof Ahangar and other speakers actively participated in the program. Coming back to my earlier observation, it was interesting to note that the frequency of runny nose (rhinitis) and excessive sneezing appeared to have a linear relationship with the spring season, possibly due to pollen allergies, as the campus was lavishly planted with flowers. On the subject of campus water supplies, I said to the Dean one day, “Sir, I think we should analyze the water supply. It doesn’t sound good to me but without testing it, I really cannot be sure about this”. “Well Doc,” he replied, “I will be travelling to Srinagar this coming week. We could go together, taking along with us a water sample. We could then get it investigated properly while we are there”. Early one morning during the next week we collected the sample from the tank and headed towards the S.P. College Hydrobiology Laboratory in Srinagar.

A few days later I showed him the report. “Good, Doc!” he said. Please now prepare a report as to how the campus water can be improved”. Unlike our modern “connected” times, when everything is available at the touch of a button or the click of a mouse, I hurriedly rushed to my college library, then consulted one of my professors, and together we drafted a plan for the improvement of the campus water. Based on our plan, all the overhead tanks were cleaned, a lot of mud was removed and a filtration motor was installed. The mud was so copious that it filled nearly eight trucks. The campus water became markedly better. “Please regularly and adequately use bleaching powder. The water coming to my apartment must smell of chlorine,” I instructed the officers working with the water treatment plant on the campus. They meticulously heeded my instructions, and the water supplies soon became better which led to great satisfaction on everybody’s part. The quality of life of the students living on improved, as did everyone’s general mood.
Invariably, in the month of July, we would often head toward Gulmarg8 for a picnic. The campus had a wonderful dairy farm, and there were a lot of cows. We would get excellent quality creamy yellow colored milk flowing thickly from the container, owing to its superior quality, at a discounted price. However, from time to time, employees from the dairy farm would come to the medical unit with vague complaints like low back ache, fatigue, etc. “Could they be harboring zoonotic diseases (diseases that are primarily present in animals and are contracted by humans), or perhaps even tuberculosis?” my heart whispered. I prepared a proposal for screening all elderly and symptomatic employees
of the faculty for tuberculosis, and selected groups for Brucellosis, in collaboration with the Health Department of the Valley. Dr. Nadroo, chief of the Diary division proved very helpful in the screening process. Two cases turned out to be positive for tuberculosis, one was working as a cook in the boys’ hostel and another was in another section. Based on my recommendations, the next morning Mr. Mohd Sayed Usmani, the Sectional Officer in the Dean’s office was seen dictating the transfer order to his junior clerk, who was typing it on an old-fashioned typewriter and the cook was transferred to a different section. Invariably the sound of their typewriter used to be clearly audible in the corridor, yards away from their office. In the end, the cook successfully completed his tuberculosis treatment course, but of course while working away from the hostel mess. Three other employees working on the dairy farm turned out to be positive for brucellosis and they, too, improved remarkably after treatment.

One day, an old farmer came to our medical unit, having walked through heavy rain to reach us. “Doc,” he complained, “my foot is hurting me badly.” He had come from a nearby village. His foot was causing him so much pain that he had made the effort to come to us, despite the rain. When I examined him, I was confronted with an angry-looking abscess. We had no facilities to drain it safely, and regretfully we referred him to the higher center in that torrential rain. “Next time we should be able to tackle such cases, Doc”, said the senior pharmacist. And indeed, a few months later we finally succeeded in establishing a minor operation theatre facility in the medical unit. One room of the medical unit was utilized for proper sterilization like autoclaving, and adequate instruments, dressing materials, etc. were procured. Patients from local villages were treated under all aseptic precautions free of cost. Small procedures like abscess drainage, wound dressings, removal of cysts or ganglions, the management of burns etc. were carried out in our basic operating theatre. It was not possible to carry out major procedures there, but even doing simple procedures would give us all immense satisfaction. Pain relief is one of the most important duties of a doctor. All our efforts should be focused in providing tender loving care to our patients and taking virtue as its own reward. With the passage of time we realized that short term ailments like diarrhea, gastritis, colic, profuse vomiting etc. needed an in-patient service, so with this idea in mind we developed a two-bed short stay facility on the campus so that patients could be shifted to tertiary care hospitals after proper stabilization. One-day the Dean’s driver came to the medical unit. He was complaining of abnormal movements of his limbs. I examined him and it looked possible to me that he was suffering from Myoclonic jerks9 and needed a specialist opinion. The nature of his illness and his driving job demanded that he be transferred to different duties. I humbly explained to him that while driving, your involuntary movements can lead to an accident hence it is important to work in a different unit of the faculty. I referred him to the Sheri Kashmir Institute of Medical Sciences (SKIMS) Hospital in Srinagar for a neurological consultation. I was forced to divulge this professional secret in my heart as the person could potentially endanger the lives of both students and staff, hence I informed the Dean of my suspicions about his condition. “Please explain to me what could happen while he is driving, due to his illness Doc,” he asked. “Sir, it is possible that he could suddenly apply the brake or inadvertently press the accelerator, either of which could prove fatal while he is doing his job on a driver’s seat”.

The Dean kept his hand on my shoulder and said: “That’s interesting, Doc, because one day, as we were travelling together in the jeep, he suddenly applied the brakes. I thought it was simply a narrow escape. I need your written proposal, and I will post him to a different section,” he said. The next morning, I brought the letter, and he was posted in a different section. Unfortunately, he had only been working on a temporary contract in the Faculty and one of the officers in the administration questioned his fitness to continue his employment there. Next thing, the driver came to speak to me. “Doc! Help me! My employment is in danger”, he said as he burst into tears. I felt terribly sad and I immediately rushed to the Dean’s office.

“Sir,” I explained, very concerned, “I never intended to harm him, but simply intended getting him moved to work on a different section which did not involve driving and where his myoclonic jerks wouldn’t endanger anyone.” Finally, Mr. Bashir Ahmad Bhat, our capable Assistant Registrar, observed the spirit of the rules and changed the order. I was very relieved when I spotted the erstwhile driver working happily in another section of the faculty a few days later. It was the month of June, dawn was still breaking and the campus was yet to come out of the blanket of dark night. Mr. Ghulam Nabi, my attendant knocked at my door. “Doc! Come quickly! There is noise outside, and bright lights are flashing,” he called. I quickly put on a jacket, took out my employee identity card, and left my quarters. The “bright lights” at the distant end of the campus were caused by a fire in the main college building. The whole village had gathered together near faculty quarters. The flames were very high. I felt very sad that the great institution was being burnt down by an unfortunate fire.

“Doc, take care! The whole area has been cordoned off, so please don’t go there, it is risky,” the villagers insisted. But it was difficult to resist trying to help, even though there was nothing I could do actively. I therefore headed towards the main building which was enveloped in flames. As I approached, a torch shone on on my face, and I turned it a little. “Hands up!” yelled one of the ambushing security persons, whom I had not spotted in that darkness. “I am the campus doctor”, I explained, hands raised above my head. “Could you please take me to your office,” I humbly requested him. Having thoroughly frisked me, he messaged the officer and I was permitted to proceed. The building was burning fiercely and was completely engulfed in flames. Glassware in the laboratories could be heard bursting, as if children were playing with crackers. It was indeed very sad for me to witness the whole scene. Firemen and army personnel were trying their best to overcome the flames. “Sir, would you mind getting our Dean? He lives a few miles away,” I requested the commanding officer. While we were discussing this, one of the walls collapsed with a loud bang, and an army officer blew a whistle. Everyone present collected in front of the building, but two people were found to be missing. Minutes later the building had been carefully searched by the firemen and two security staff were carefully brought out. Unfortunately, neither could be resuscitated. Hours later firemen finally managed to extinguish the flames, but the main college building, including laboratories, etc. was completely destroyed. The campus looked sad for months until the renovations started to rebuild its charm, but it never returned to its full former charm. The smell of smoke would often remind everyone of that unfortunate fire and for a long time it would overpower even the fragrance of the roses on the campus. Months later, I needed to go to Srinagar for my personal work so I was away from the campus overnight. There had been a security search operation in the Faculty quarters. Unfortunately, an incident had taken place during the search operation and one of the employees who was on night duty in the medical unit, Mr. Bashir Ahmad Bhat, died in the crossfire between the militants and the security forces. I came back the next morning and it was hard to behold the faces of his old father, his small children and his sad wife. I am not sure what would have happened had I been that night within the campus. A few other employees advised me to commute to my work there, and not to live there anymore. In fact, it was very scary to stay on the campus, as all faculty quarters remained vacant in that huge space. I reluctantly stopped living there for a while. However, as the saying goes, time is the best healer and the fear slowly diminished and a few months later, the Dean of the faculty started to live there again and so did I. Months later there was an administrative reshuffle and Dr. Sunder Singh took over as the new dean of the faculty. He was also very cooperative with our medical unit activities. “The Students have to go on an educational tour to Ladakh, Doc. Could you accompany them?”, the Dr. Sunder Singh dean inquired one day. I immediately replied in the affirmative as I had never explored that region. Prof Bashir Ahmad Khanday and I were asked to accompany students to Leh. The month of August was in its youth and one morning early, we boarded the StateRoad Transport Corporation’s twenty- seater mini bus which set off from the Tourist Reception Center in Srinagar towards Kargil. I had packed up some essential drugs, first aid materials, etc. to take with me in order to be of help to the needy while travelling. The picturesque sights on both sides of the road were enchanting, and we had a very good lunch at Sonamarg. Soon our bus started to negotiate the twisting, rough hill road towards Kargil and we gained height progressively. Looking out of the bus window to the valley below was rather scary. The road happens to be very narrow and rough, and has no side walls. Only a few miles before Zojila11, it started to drizzle, and as the road became wetter, so our fear of slipping and sliding became greater. Thoughts of what could happen if the rain increased and rocks started sliding onto the road, perhaps even onto the bus itself, in the middle of the journey, were in everyone’s minds. When the driver was negotiating sharp turns, tremors would go down our spines, and at times everyone would scream with terror. The driver seemed to be quite experienced; he went on driving quite nonchalantly, and in between times, boosting our morale as well! After an hour or so the rain stopped and we all heaved a sigh of relief. After we had covered what seemed like only a few miles, some vehicles on the other side of the road came into sight. The driver of our minibus started reversing inch by inch under the guidance of the bus conductor, who had come down to guide his master on that muddy road. ( To be continued…)

Author is a MD. DM (Gastroenterology) FACP, FACG Consultant Gastroenterologist & Associate Professor at Yenepoya University, Mangalore. He can be reached at ibrahimmasoodi@yahoo.co.in

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