August 31, 2005

Spitting Olympics

Something I wrote based on a trip I made a few years ago.


As I sit on a bench with Sekhar, a steady stream of young men approach the open courtyard in front of me. Never from closer than 6 feet away, each one snaps his head forward and -- powerfully and voluminously -- spits into the courtyard, rounding off initial releases with two or three supplementaries. Their prowess explains the even red tone of that corner of the courtyard.

Is this some surreal Olympics of spitting, the young men competitors? No, just another routine day at the medical college hospital in Berhampur, Orissa.

We have brought Sekhar, a tiny three year old suffering from suspected intestinal obstruction, here because the small dispensary his mother took him to didn't have facilities for surgery. I have to look down at Sekhar, or at his bottle of intravenous drip that I am holding, to remember this is a hospital. A teaching hospital, at that. I have been in this building only half an hour, and already I fear for Sekhar's life if we leave him here.

Outside, cows stand in pools of yellowish liquid that has oozed from blocked drains. As you enter the building, the aroma envelops you -- a fruity blend of human and bovine waste. The dingy corridors have not been swept or mopped ever, I'm sure. A pool of something -- vomit? urine? what? -- is a magnet for a horde of flies. I was angry because we were refused a stretcher for Sekhar -- "Why do you need a stretcher for a 11 kg boy?" -- but when I see the stretcher, I'm glad I carried him. It is blotched with large bloodstains. Spit stains too, for all I know. The bars of the window opposite, encrusted with years of spittle, are grown to twice their size.

But it isn't just the filth that makes me fear for Sekhar's life. I am on this bench watching spitters because we are waiting for the Casualty Medical Officer, who has to sign Sekhar's papers so he can get a bed. The CMO is on duty, yes. But he is not here, no. He strolls in after an hour. Before he gets to the papers, he munches a samosa thoughtfully. When he finally does sign, he won't let me take the papers and rush Sekhar to the ward. Only peons are allowed to carry the papers, he says thoughtfully, and there isn't one to be found. Sorry!

Finally in the ward, I do an agile sidestep as a nurse strolls past, the syringe she has just administered an injection with held in front of her like a lance. Sekhar's drip runs out; the same nurse has to restart it. It is an hour before she can spare a minute from lance duty to do it -- an hour that skinny, malnourished, hurting Sekhar is off his only source of vital fluids.

"You can talk to all of them, and they still make it so difficult," says Sekhar's mother. "How could I have managed on my own?"

I don't know. But a prominently displayed sign I see on the way out assures me that Sekhar will survive his stay at the Berhampur hospital. It's signed by Biju Patnaik, the late ex-CM of Orissa, and it says: Take care of your hospital. Keep it clean.


Amit said...

Dilip - I shudder at the thought of "general" or "public" anything ... hospitals, schools, urinals ...... The sanity is not maintained..

There was a wonderful article in IE by Sudheendra Kulkarni (was he the same man behind the Advani fiasco) on a similar topic...

But the issue needs to have a solution which comes from the inside and not outside...

Unless we understand that we are a part of the problem we cannot be a part of the solution.

Dilip D'Souza said...

Sriram, a small clarification. I did not ask you about the tragedy of the commons.

I'm not in the business of pronouncing one hospital or the other worse or better. But Berhampur was pretty damned awful.

I have no doubt about your last sentence.

Anonymous said...

What everyone seems to forget is that for something to be clean, the people around (ward-boys, nurses and yes, even doctors), need to have seen something clean. When everything around them is dirty, when everyone spits, when they come from houses which probably are near open drains or in slums, etc. how can you expect them to even know what cleanliness is? Even in the private hospitals and clinics that are spotlessly clean, can you imagine the effort it takes to educate the support staff into what constitutes cleanliness? To make them understand that the way they lead their own personal lives has to be forgotten? That toilets are meant to be dry at all times? That people aren't allowed to spit...with no exceptions, except in a sink? That floors have to be swabbed each time a person enters with dirty shoes and doesn't clean on the mat outside? That they have to wash their hands all the time, clip their nails, keep their hair tied?

If you've never flown, you would never know that the windows of an airplane cannot be opened!

Being dirty is what is natural to us and therefore we make everything around us dirty, unless someone forces us to unnaturally be clean.

PK said...

I dont agree with last statement of sriram.We blame everyone, politician,bureaucrat,service provider-Doctors,hospital staff in this case.hello!! who are contestant in this spitting olympics? COMMON PEOPLE who come to hospital for treatment or as attendent or visitor.Yes, Let 'us' keep the place clean and pleeeze dont give stupid excuses.

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