Somewhere in 2004 I decided to leave medical college midway and see the villages ofIndia. Somehow the people at CRHSE Tirupattur (Centre for Rural Health and SocialEducation) got me to talk to the college about it. Anand Zachariah asked me to speak tohis father Dr P Zachariah and finally the college gave me permission to leave for 6months. Meanwhile I had spoken to many people and got a variety of ideas. Among themwas the suggestion by Dr Sharada L (now at Indian Institute of Science in Bangalore) thatI meet Dr Binayak and see the Shaheed Hospital. I had planned to spend a few months ineach of three or four places, but the short period granted by the Senate forced me torestrict myself to a month of travelling, followed by 4 months at CRHSE.I began with visit to Bangalore where I spent a week with Dr Ravi and Thelma Narayanwhile studying sociology under Fr Claude. Then I visited Mysore followed by week atCINI near Kolkata, a day at Santiniketan, and some time at St Lukes Hospital Hiranpurand in the districts of Sahebganj and Dumka, ending up at Palamau in western Jharkhand(now considered a strong hold of the Maoists).I finally arrived in Dalli Rajahara aroundthe middle of August When I first met Dr Binayak Sen in August 1984, he was examining a child in theverandah of the Shaheed Hospital (Dalli Rajahara, Chattisgarh). Just then the child passedstools. Binayak went and fetched a mop and cleaned up the mess. He told me that he wasas qualified as anybody else to handle a mop- so why not?This intrigued me. I waited for Binayak in the OPD that evening. A health worker sawthree patients and prescribed simple medicines for them. Then a patient with ten dayscough came and he asked me to see the patient. I didnt feel confident. But I wasimpressed at how he rationalised the decision to refer.The next day I think I had a loose stomach and rested at Binayaks home in the smalltown. I glanced at some of the books which Ilina had gathered for her research onworking women. She was away in JNU at the time. I went to the hospital in the eveningand spoke to Dr Saibal Jana and Dr Ashish and learnt about CMM and its struggle, aboutShankar Guha Neogy and a bit about the Gondi language and about Chattisgarhi.On August 15th Binayak took me again to Shaheed. He introduced me to the person whohoisted the flag that morning. He was a Gond tribal priest who proudly carried a CMMflag to show the jeeps when he travelled around. Then I met the health worker and askedhim why I had not seen him the previous day. He said, "I went to work". So I blurted out-"But you are a health worker.""No", he said, "I work in the mines. In my free time I come here to learn medical workand serve the patients".That I think was when Binayaks point sank in- a hospital for workers, of workers and BYworkers!In fact the committee that ran the hospital included all staff- sweepers, nurses, doctorsand so on- and all of them had equal rights. If a doctor had no children they earned lessmoney and the sweeper with a larger family earned more.At the end of 1984 I had a chance to join a medical relief team in Bhopal.I continued to meet the quiet and polite gentleman (Binayak) after 1984 nearly everywinter at Sewagram in the Medico Friends Circle meetings including the one on TB inBangalore at which Binayak was a leading personality.Suddenly after listening and participating for a day or two he would suddenly say, "I haveto go home today. It is time to harvest the rice. I am a farmer you know."
My first job in 1987-8 was in CRHSE again. Then I went to West Bengal to work with aPVOH (USAID sponsored) called Sidhu Kanhu Gram Unnayan Samiti. From there Iwent to Hiranpur to learn Santali. I hd first visited the Thompsons in Hiranpur during mystudent travels.In the 1990s I spent three years as a junior doctor in Hiranpur and another6 years in Santal Parganas in various other jobs. While I was at Hiranpur in 1990 a groupdid a study in Bhopal (on gas victims- it was to be part of a court proceedings). Binayak,Dr Rajiv Lochan Sharma and Dr Punya Gun were also in the team. Sathyamala, Sathyu,Mira Shiva and a large number of volunteers were involved. The bricks for Ramcontroversey was at its height and a riot almost occured at Bhopal.Later many of us from MFC also took part in translating for the International MedicalTribunal for Bhopal in 1994.Punya was writing health booklets in simple Hindi at Shaheed and he used to send theseto me. They were much appreciated in Santal Parganas. Binayak moved on to a missionhospital. He had a high BP I think. CMC could not give him a job in Pediatrics, but Dr PZachariah suggested this place at Tilda to him. Meanwhile Shankar Guha Neogy wasmurdered. In his last testament (he recorded these on audio tapes) he asked CMM to getBinayak back to guide their health work.By this time I suppose Rupantar had been formed and Binayak started commutingbetween Raipur, Bagrum Nala and Dalli Rajahara.Later on the Bilaspur group started work and Binayak supported them. I know thatBinayak trained health workers and later Mitanins for the government. In 2000 bothChattisgarh and Jharkhand became new states. Binayak was involved in the Right toHealth movement. Both our states held a common hearing at Ranchi. I was able to sendthree or four patients from Godda to present testimonies. Binayak was at the hearing bythe NHRC. He was very disappointed that I could not go. Since I knew of many KalaAzar patients and their problems he thought that I might accompany some of them.More about my work nowadays- see the notes at http://karnajora.blogspot.com for 2009and http://prabirkc.blogspot.com for 2008. Other than that my work since 2000 hasmostly been in Polio Surveillance and Routine Immunization- which is rather differentfrom what Binayak has been doing.…........14 years on.................15th January 20088am I got off at Raipur Station. It cost me Rs 10 by auto to the bus stand. Bus Stand at Raipur
Another Rs 40 took me by a Sleeper Coach Bus to Dhamtari town. I reached at 10am.The Christian Hospital is just opposite the bus stand. Prahlad picked me up at the busstand and took me to the Rupantar office. I met his family, who stay there and at 11amwe set out by motorcycle for Bagrum. We passed Kukrel and two Primary Health centreson the way. Paschim Keregaon actually starts at the 10 km mark from Dhamtari. Another18km down the road is Keregaon (28 km from Dhamtari) junction where we had tea anda tuber called Khesar Khond. We bumped into Jaffar Ahmed, a former Rupantar staffwho now works for ASTHA at Nagari (the block town of Nagari is 37 km away fromKeregaon). Then we left the Nagari road and turned down the Ghattasilli road. This roadcontinues to Bhopalpatnam on the Andhra or Orissa border. We travelled about 6kmdown this road and then took a moram road (in 2009 this was in the process of beingconverted to aPradhan Mantri Gram Sarak). 2km later we were at Bagrum Nala. Here we met shanthiand Ghasia.Ghasia at the Bagrum ClinicThe earlier laboratory technician Puroshottam Yadav has left to set up a private lab.There were many malaria cases here around 2000. There were also many patients withTB. The first recorded patient was in 1995 and many in 1997 and onwards. Patient cardswere started in 1999. Now there are over 2500 patients recorded.The anganwadi and the primary school were open. But the panchayat was closed.Possibly owing to the large distances, panchayats here cover only a small population. Thelocal sub centre (which has 2600 population) includes 3 panchayats (250 people live inBagrum and 300 in Bindrapani). A male health worker arrived on a moped with a vaccinecarrier. Tuesday is immunization day in Chattisgarh. The expected births every year arearound 60. The health worker had OPV, DPT, TT and Measles vaccines. He had areconstitution syringe and a used auto-disable syringe. He had given one child measles
here in Bagrum. According to him the vaccine could be used up to one hour afterreconstitution. He also had two unused AD syringes.The ANM has gone to Dhamtari to withdraw funds to send the Mitanins for a rally atwhich the new Rice for Rs 3 scheme will be inaugrated tomorrow. There are 400 oddMitanins in Nagari block. There are a smaller number in Magarlod Block, which is alsosupervised by Rupantar.She usually visits each of 4 Anganwadis in rotation onTuesdays.On one Tuesday she attends the sub-centre. Keregaon sub-centre is attached toa larger Primary Health Centre. There was no doctor there apparently in 2008 or 2009.Other staff are also said to be irregular.Electricity first reached this area around 1995. Now there is regular supply of electricity.1 km behind the village is the reservoir of a dam. In fact there are 4 dams on the upperMahanadi. The first is just outside Dhamtari town. The road that we had traveled on inthe morning crosses the main feeder canal of this dam just after we left the Rupantaroffice.View of the river Mahanadi just below a dam at Dhamtari- a rich town with 40 ricemills.Now there are 2 crops of rice a year. Remember that Chattisgarh and Madhya Pradesh arehome to many ancient varieties of rice. The rice plant seems to have been cultivated hereearlier than in other parts of India.We had local organic rice and dal for lunch. It is machine-milled rice however. Ghasiashowed me the old records. We agreed to meet on Friday.
Notes on a TB patient in Dr Sens handwriting at BagrumIn the evening we went to Dhamtari Christian Hospital. I found Dr Vaibhav Londhe, whohad done his internship in CHAD when I was doing my MD there. He was quitesurprised to see me. His mother in law knew Binayak. She appears to be a niece ofBishop NM Bagh, who was CNI Bishop of Patna when I was in Hiranpur. She had alsobeen to the recent CMAI meeting in Shillong. Vaibhav’s daughter was fast asleep. Hiswife Dipti came down a little later and for a minute mistook me for Binayak! She thoughtI looked familiar but didn’t remember me from her student day Community orientationProgrammes when we had taken their class to the villages. Vaibhav is an MD inObstetrics. His elder sister Megha is also an MD in Obstetrics and now works at the EHAHospital in Herbertpur. Vaibhav suggested an ante-natal clinic a Bagrum Nala. FirstSaturday sounded like a good day to him. He told me to talk to Pappu Bhaiya (PKMartin) about this. We heard that Anil Henry and his wife Teresa (nee Martin) are atmungeli (between Bilaspur and Ganiyari). Sachid Das has moved to a hospital near seoniin Madhya Pradesh. Dr PD Deshmukh, whose mother had received the Paul Harrisonaward, is now at Tilda. Renu Jogi is apparently looking after her husband and his work.She is probably related to Dipti too. Dipti’s father was the Secretary of the EasternRegional Board of Health Services of CNI for many years. Vaibhav rememberedRakhal’s visit to Dhamtari. Rakhal had done an evaluation of Mitanins. The Dhamtariblock Mitanins came out top. Dr Netam of Dhamtari CH had been one of their trainers..Iheard that here is a Panchakarma (AYUSH) clinic in the Dhamtari Christian Hospital.P K Martin looked much older than when I last saw him with a backpack in 1981. He stilldrops in at Men’s Hostel where his son Aditya is now a fixture. Grandpa Martin was inthe clinic when I arrived Martin’s father retired as Superintendent of Dhamtari CH manyyears ago and they now have their own 30 bedded private hospital. PK (aka Pappu
Bhaiyya) told us that “Cherry” (Thomas Cherian who works for WHO in Geneva) wassurprised that he still stayed at the hostel when he was in Vellore and he (Martin) hadsaid, “That’s where all the men stay, yaar!”JP (one time Principal) had phoned PK as soon as Binayak was arrested. The Martinsknow the local police well. In the 1980s PK was an amateur shikari on a motorcycle(“poacher”). He knew where to get a donga (makeshift boat) and shoot ducks at the dam.And to be sure the best boar in the area was found near Bagrum Nala. We confirmed thelocation on the map in the clinic. PK agreed that the panthers who attacked the dogs attheir mango orchard west of Dhamtari might not trouble the people at Bagrum. The SP ofpolice had recently asked Pappu Bhaiyya whether he would help them hunt Naxalites.Nobody knows the backwoods like Pappu Martin, ex-poacher and now surgeon to thepoor and the rich of Dhamtari. We met his Jeevodaya (local Catholic dispensary Ibelieve) patients and heard about his patients from the Mandir Trust. We met HarmeetSingh who was born in Dhamtari and trained in Raipur as an orthopaedic surgeon. Heworks for the ESI and uses the Martin Hospital operation theatre. PK told Harmeet howhe amputated the legs of a supporter of Shankar Guha Neogi who had been subjected toroller torture. I watched a video in the evening of a meeting of Mitanins at Kukrel in2006. Chandrika sang in Chattisgarhi. There was a discussion on NREGA and on thehealth system. They say Johar here, just like in Jharkhand.Anganwadi/ government creche children at Bagrum16th is Makkar Sankranti- day of the Rs 3 rice rally- the mitanins travel to the rally wasfunded by the untied fund for the sub-centre. The newspapers say that Ram Vilas Paswanstarted an NFP scheme in Dantewada today. Bailadila II B was started too.See this film-
Keregaon Tea Shop with PrahladKeregaon and Bagrum are in Nagari Sihwan block. Bagrum road branches off the way toGattasilli after 8 km Tribal children around the fire near BagrumForest Jhum is the Slash and Burn agriculture practiced when there is low pressure on theland. Many communities practise this for subsistence (to get food) while doing othertrades to earn some money• See videos of Lagni Kamars mother, a basket weaver. Basket weaving is theirtraditional trade• Chamar Singh who excelled in his exams is a Kamar first generation learner from aRupantar hostel Chamar Singh of Amapara
Hazaron Nalaon aur Ek Hi Nagari could be the name of the story of Sail Bahara villageThe Jharia or pools of the drying brook (brook is called Nala) used to be the main sourceof water in Sail Bahara.In 1990s Rupantar advocated a well. The well prevented the outbreaks of diarrhoea whichplagued this Kamar basket weaver settlement in the past.See the preview videos athttp://prabirkc.blogspot.comhttp://www.youtube.com/profile?user=cprabir&view=videoshttp://cid-06aa90f278b5c9e9.skydrive.live.com/browse.aspx/BagrumnalaSee these films• Story of Sail Bahara- Pilku Ram and son of a villager• Jhari(a)- dried Nala/ stream• The Well• Water Arrives in Bagrum Nala• School Pump in BagrumLawyer Sudha Bhadwaj of Bhilai discusses with Medha and Gabriele of NAPM
Binayak and Ilinas daughters Pranhita and sister Aparajita at the jailIlina and Aparajita at home speaking to PUCLs Raju Sail after we met Binayakthat day
Prahlad and family in 2009 (the elder son is at the computer). Prahlad is a staff ofRupantar and was my guide on my trips to Dhamtari2009...another year has passed. …. Binayak is still in jail. I visited Bagrum again.Mainas son and his father seem contented. They are at grannys place -a tiny tribalMainas son and his father
settlement in the forest. Maina arrived at her mothers home by motorcycle late in theevening with her family. The next morning the doctor visited them before returning to thecapital city of Raipur (100kms away). I used the same MP4 player-cum-camera to takethis snap and to take a lttle video of raised pulsations in Mainas neck veins. We sent thisby email to the consultant internist at Bilaspur (who travels all of 6 hours each way for afortnightly clinic) with a little note on Mainas condition. He in turn phoned instructionsfor her treatment to Ghasia the village health worker, on the WLL (wireless in LocalLoop) telephone which was recently installed in the remote tribal village.Little changes- electricity, motorcycles, roads, WLL phones and cheap digital camerasthat bring the benefits of specialist doctors advice to the remote jungles of central India.This is about Maina Bai (25/F), who probably had RHD with a ? diastolic murmur on theleft sternal border (am I correct in guessing tricuspid regurgitation?)She complains of cough for 2 weeks.Saw her on 6th February morning. She is the ex-Pradhans daughter and an old patient atthe Bagrum clinic. She was advised an operation, but has married 3 years ago and has a 2year old son. They live in Bathina.She was on Enalpril 2.5mg, Frusemide 20mg and Folic Acid since 2003 at least. She hadstopped Penicillin G (oral daily doses).She now has a pulse of 66/min which appears regular and BP 120/60mm Hg.Her JVP is raised (see video clip)? diastolic murmur on the left sternal borderHer respiratory system seems to have no creps or rhonchi, but she has incessant coughingand possibly throat congestion. There might be a patch of increased vocal resonance atthe left posteriorly.Her LMP was 20 days ago. She has regular menses.For now I have advised her to increase Frusemide to 40mg (watch out- the prescriptiondoes not mention whether she misses weekend doses) and restart Penicillin if it isavailable (Prahlad is trying).Her mother wants her to have Sputum testing as she has lost weight. This will be done.A brother of hers had congenital heart disease and was operated. He has used Rotahalercaps in the past and they want to try it for her. Sounds unlikely to help- have notforbidden it.There is a WLL phone at Ghasis place 07841 298225- so you can easily contact andmake the needed corrections. Maina will be there for the 13th clinic.PrabirDear prabir,…............ and all the technology employed.
The first time ever that i have seen a JVP on the internet!The JVP isindeed raised, and there are prominent cv complexes possibly becauseof tricuspid regurgitation. With a diastolic murmur and her gender, iwould think she has mitral stenosis as the root cause and thetricuspid regurgitation is due to pulmonary arterial hypertension. Infuture, you might consider one of the new Littman electronic stetho,whcih can give you a phono recording immediately!the cough is likely to be due to pulmonary venous congestion with herCHF, although there could be an intercurrent LRTI as well. Apart fromthe raising of the frusemide dose, and advising some bananas on adaily basis for the potassium/oral potchlor, i would advise a courseof amoxicillin/doxycycline ( if the 2 year old is not feeding ). shealso seems to be in atrial fibrillation, and should be on digoxin 5ug/kg/day to control what appears to a very rapid rate.( 66 per min isnot what her JVP seems to announce)5% of people on enalapril can also develop dry cough as an adverse effect.She can be considered for intervention at AIIMS. Recently we sent 5women together with our escort to AIIMS and they have come back, withwide smiles and widened mitral valves.i shall ring up ghasia tomorrow and follow this up.with best wishes,anurag(then at JSS Ganiyari and currently on the faculty at Mc Gill University)