August 06, 2005

Death in the dispensary

AV Ramani, a doctor I know, got her MD in Community Health from the Christian Medical College in Vellore. She has spent about 15 years working in rural MP and Orissa. She wrote up some of her experiences in a number of articles that published a few years ago. I'll post them here once in a while. From what she tells me, she continues having similar experiences even now. I hope this will prod her into writing them up. Ramani, are you listening?


Subhashi died quetly and without a fuss. This 30 year old woman from Tinighoria village in the Kerandimal hills of southern Orissa had been coughing for six months before she was brought to our little dispensary. Too ill to walk, weakened by anaemia which caused her feet to swell up, she had an air of calm acceptance about her. As if to say, I'm ready for whatever life has in store for me.

A jeep was returning to Mohuda from a field trip. Her husband and daughter brought Subhashi to us in it. She was only skin and bone and obviously very ill. Examination showed that her lungs were extensively damaged, probably by tuberculosis. Her sputum showed numerous acid-fast bacilli, the deadly mycobacterium that causes TB.

We started her on the appropriate drugs. We also explained to her husband that she needed blood and oxygen, both of which we did not have. They were only available at the large medical college and hospital in Berhampur, about 10 km away. But he was adamant: he did not want to take her there. He seemed to feel that he had wasted enough time and effort already, bringing her to Mohuda. "I would not have brought her if the villagers had not forced me to," he grumbled.

Subhashi was extremely cold, and spent most of the next day in the sun. I got somebody to take her photograph, sure that she would not recognize herself even two months later. Anti-TB drugs act almost miraculously on a patient. She said nothing when the picture was taken, but I could see that she was pleased.

At 10:30 that night, Subhashi woke up to go to the toilet. Since her husband and daughter were asleep, she walked by herself to the bathroom. By the time she returned, she was out of breath. We had gone to check on her just then, so we put her back in bed and propped her up. Once again, we asked her husband to allow us to take her to Berhampur. Once more, he refused. He said she was going to die anyway, so there was no use worrying about her or wasting any more time and money on her. Her daughter fast asleep beside her, Subhashi lay there and listened to both of us. I was
arguing and getting angrier; the husband remained indifferent and quite immovable in his opinion.

Suddenly, Subhashi stopped breathing. We tried to resuscitate her, but I knew it was futile. Anaemia and the TB had defeated her. Or was it something else which made her give up her will to live?

Even in death, Subhashi's face wore that same look of calm acceptance. I wondered then and still -- how did she remain so? I do not feel calm when I think of her. Nor can I accept her needless, lonely death. Is there a lesson I must learn from Subhashi?

1 comment:

Anonymous said...

I finished my Masters in Anthropology recently here in the US and am now thinking of applying for a Phd. I didnt know what I wanted to do my phd in but one day it hit me- what about public health? Anthropology and health are two fields that go really well together ( a good example being Paul Farmer's work). I think now that I would like to work on women and health in India, particularly specialize in the social determinants of health. But when I read stories like this it makes me wonder- am I not being naive and idealistic......what makes me think that I can do anything at all to help even one person. At the same time stories like this also tell me that I am on the right path!