World No Tobacco Day- 31 May, 2020

TOBACCO

I was fifteen.

Whorls of smoke rose from father’s lips

But my first smoke felt like lung whips.

Routine. Ritual. Habit, it became

And life would never be the same.

I continued.

They the heroes took the puff

And I bought it on the cuff.

It seemed cool

Till I knew I was made a fool.

I smoked.

I was twenty.

Colleagues with teeth stained red.

Try it, they said.

Red stains. Pan and gutka stains. Tobacco stains.

And Alas, it brought all these pains.

I chewed.

Bitter it tasted

And my money was wasted

Yet, I spat out red

Until the day I spat out blood.

I bled.

I realized.

 Importance of life’s most

 Is realised not till it’s lost.

People. Time. Money.  Love. Air.

No, this isn’t fair.

I gasped.

Every breath a struggle

Machines giving all oxygen they could smuggle.

Now it is too late

To create a new slate

I knew.

I left.

A warning note

To my son I wrote.

Slow death. Painful death. Breathless death

This tobacco steals your breath.

I cried.

Little packets of lies

Your pocket it dries.

To life I bow

Thanks to tobacco.

I died.

Women

Saturday, March 07,2020

That clacking of heels stood out despite the cacophony in the OPD room. I glanced up to see the source and the grimace (that sometimes involuntarily jumps onto my face while trying to scold a non-compliant patient) ebbed into a smile. She was the next patient. Standing tall at a little more than four feet, she walked in with a confident smile and wished me good afternoon. She looked like a twelve year old gifted with more maturity than her childish eyes could contain. She was accompanied by an older girl who was around twenty years old. They were tailed by a young lad with a squint who was busy playing with the OPD door. Yes, even a normal door can fascinate a young child.

I inquired of my young patient as to what brought her to me. “I am having weakness…” she said in a sing-song manner. I tried my best not to smile too much. By then the older girl had taken over and narrated a story that would pull my heartstrings ( and hence find a place here). The young girl and the little boy were her neighbors. Their mother had passed away few years back. Their father had remarried and their step mother had given birth to a baby boy few days back. So our little lady was now taking care of the household. “So, does she not go to school?”, I had to interrupt. Apparently, she does. She wakes up early in the morning, cleans the house, cooks food and then goes to school. After returning, she has to do the laundry and prepare food. “So ma’am, please do write some tonic to improve her strength,” the older girl requested. One part of me wanted to yell at her that a twelve year old will not have the strength to do so much, no matter what magic potion I prescribe. But that would not change anything. “Is there no one else to help her?” , I asked rubbing my forehead. I was having a headache by now( or was that a heartache?). “No, not really”, the older girl was the one still replying. The little lady still stood as poised as ever. And the young lad’s latest fascination was the blood pressure monitoring apparatus.

I gave her a prescription and made her promise she will not stop going to school no matter what. “No ma’am, I will not. I love going to school. I want to become a teacher when I grow up”, her confident voice was reassuring. More reassuring than what I could imagine would happen to her. Probably that was all the reassurance I would have about this meeting. She thanked me and her heels clacked away. I sat still till that sound faded. She was the strongest woman I had met today. Yes, sometimes, age is just a number. Some of us are blessed to retain our childishness forever. But some like that little lady are forced to grow up faster and adorn roles beyond their age. This women’s day, as I think of all the women that have inspired me, this little one also makes it to the list. She will never know that though.

Sunday, March 08,2020

“Ma’am, I am getting discharged today. What about my medications?”, a thin hand was waving a prescription slip at me. It was her third post natal day and she was taking her little one home today. An older man was standing next to her. “Is this your first baby?”, I asked her. Looking down, she replied, “No, its my fourth child”. “So you will be coming back for sterilization right?”, I asked. “No”, the lady and the old man answered in unison. “How many kids do you want? Do you know having another baby will not be good for your health?”. “But it is a girl this time too…”, came the most logical explanation from the older man. “So??”, my tone had definitely become harsh by now. The man grumbled something and left the room. The woman looked at me helplessly. “How old are you?” “Twenty four”. Wow. Twenty four and four kids. Since this was not too uncommon in this setting, I had taught myself not to be too shocked.

“Ma’am, I do not really want another baby. I will talk to my husband and plan about sterilization.” The absence of the older man in the room had installed a new confidence in the lady. I wrote her medications and counselled her on breastfeeding and vaccinations. “Make sure you come back……”, with that I handed her the prescription. I really hoped she would come back…but not come back pregnant. Despite all the talk on women empowerment these days, the quest for the boy child still continues. She was just one of the many. One of the many woman who survive one child birth after the other to gift their family with a male heir.I hoped this lady would have the courage to stand up for herself and her four girls. If only her family realized that these four girls were blessings and strove to bring out their maximum potential….I opened Whats app and replied to all the “Happy Women’s Day” messages with a pang. How many women out there are really blessed to be happy? Worth a thought.

Stigma

A frail hand held out the OPD card towards me. One look at her and I prayed she was not pregnant. When you are posted in the OBGyn OPD in a Primary Health Centre, it is not uncommon to find such frail figures coming for their fourth or fifth delivery. On probing her complaints, she looked down, covered her mouth with the edge of her saree and said “cough”. Sometimes, certain images get pasted in our minds. There is often no specific reason for it. But your eyes would have captured an image and your crazy brain just gets fascinated by it and decides to store it in a folder titled, “Worth a Thought”. That frail lady. Her yellow saree. The way she looked down. The swift movement of her hands as she covered her face. All of it got imprinted in my head. And there was just one caption that could be given- Stigma.

Cough for two months. Productive. Considering her malnourished appearance, the obvious thought in my head was Tuberculosis. “Have you had your Sputum tested?”, I probed. She bowed her head even lower, turned around to see if anybody was listening, and then whispered, “Yes. And I was told it shows TB. I have been sent here to get my blood sugar and other tests done”. After getting the rest of her history and examining her, I wrote the slip for the necessary investigations and referred her back to the RNTCP DOTS centre for initiation of treatment. But my conscience told me, there was something more I had to deal with here. Stigma.

The time that you regret a language barrier at work place is when you really want to try and counsel someone. I made the best effort to tell her that Tuberculosis is curable if treatment is followed properly. After two minutes, she was in tears. And she poured out her fears. The main demon in her eyes was not the disease. It was the stigma. What would people say now? She was standing at the edge of a dark pit. One push and she might succumb. Succumb to stigma.

India has come a long way in management of Tuberculosis. As a matter of fact, we are trying to achieve the sustainable development goal of ending TB by 2025, five years ahead of the global targets. Our National programme, Revised National Tuberculosis Control Programme (RNTCP)has been recently renamed as National Tuberculosis Elimination programme (NTEP). We have more efficient and feasible methods of diagnosis and better chemotherapy. The mycobacterium can now be detected easily and terminated. But none of these drugs can deal with the fear I saw in that lady’s eyes. A fear called Stigma.

We definitely have a long way to go. To tell people that falling sick is not a mistake. That it could have been anyone, including ourselves. Compliance is important and the cure will be just around the corner. Tell them how to prevent disease from spreading. Tell them what to do. Tell them what not to do. Tell them stigma is just the reflection of people’s ignorance.Tell them it is OK. Tell them there is hope.

We have reached the point of eliminating TB. Laudable beyond doubt. Next stop might just about be eradication. But as we try to give the best treatment to our patients, lets not forget the small (yet significant) issue of stigma. This is the social evil that could turn that yellow saree into a loop for the poor woman to end her life. Yes, we have a long way to go. Miles more. Like Robert Frost penned,

“The woods are lovely, dark and deep,   
But I have promises to keep,   
And miles to go before I sleep,   
And miles to go before I sleep.”

Yes, we have miles to go before we can outrun stigma. But at least lets start by trying. I wondered how much of my broken Hindi the lady had understood. But as she was leaving the room, she no longer had the saree over her face. Her eyes were no longer downcast. There was some light in them. Stay strong and fight, I wished her in my head. She sure has a long way. But at least she will try and cut the Gordian knot of stigma. Hopefully.

Tiny Heartbeats

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Her expression was blank as she carefully placed her hands over an obviously pregnant tummy. She was the first patient I was to see at the Primary Health Center that day. Taking her outpatient slip, I inquired of her complaints. “I have not been able to appreciate my baby’s movements since last two days.” I went through her previous records. She was 37 weeks pregnant and this was to be her first baby. Her eyes reflected fear and I felt her silently pleading me to tell her all was fine. Two days!!!Why didn’t you come earlier? I had to ask her. She gave some vague response as she positioned herself for examination.

Lord Jesus, please let this baby be alive. I prayed silently as I approached to examine her. My heart was honestly troubled and I hoped I didn’t have to tell her that she had lost her precious little one . With that prayer in my heart, I placed my hands on her abdomen. And the very second, the little life inside her budged! I looked at the mother’s face. She was beaming. Phew. Praise God!! Next I tried desperately to listen for the heartbeat using my stethoscope. But my ears failed to pick up the sound I yearned to hear. So I got the Doppler Fetoscope out to auscultate. After few failed attempts, a beautiful sound filled the room- Lub Dub Lub Dub…The tiny heartbeat was a solace to the mother’s ears and unknown to her, mine too. Sometimes, certain sights or sounds can simply make your day. It seems more beautiful than anything else around. And such moments always manage to draw out a song of praise from our hearts. Thank God for such beautiful reminders of grace!

Remember Who You Are!!!

Disney movies have been a weakness for me. Not sure if it is the child in me finding deeper meaning to familiar childhood stories or the adult trying to relieve a wonderful lost phase of life. Nevertheless, I am always more than happy to watch a Disney remake even though we know the story inside out. So one can imagine my excitement when Lion King movie was released. “Hakuna matata”…I started humming by reflex. It was one of my personal favorite animated movies and I was more than happy to watch a more realistic remake. And the movie did not disappoint. The animation was mind blowing with such care for details. We couldn’t help sing out loud with Simba, Timon and Pumbaa, as they danced away . But my favorite moment in this story has always been the scene where Simba talks to Mufasa’s ghost. But this time, as a twenty-six year old young lady trying to sort out her life, that scene had a different impact on me. As Mufasa’s ghost told Simba, “Remember who you are”, I felt a shiver down my spine. I tried to attribute the goosebumps to the air conditioning. But I knew there was more to it. In that cinema hall in Lucknow, I felt the small prompt voice of the Holy Spirit remind me who I am- the daughter of the Heavenly King.

“Remember who you are”. Why was this so startling? Was it because I was living a life forgetting who I am? Was this a much needed reality check for me? Was I not living as per the standards of my Heavenly Father? Why did I forget my duties and rights as a child of the living God? When did I start drifting away? The answers to all these questions were not reassuring. I wished I could just tell myself,”Hakuna matata”. There was no running away from this. I did try though. But then I went to church last Sunday and guess what message the Pastor had for the congregation!! “Remember who you are. Remember whose you are. Because our thoughts and actions are deeply linked to our identities. So make sure you know your identity. Your identity is in the Lord Jesus!” When you run from a lesson by the Holy Spirit at the movie, He will definitely catch you in Church, I guess!

But it was lesson I needed at this point in life. There were lots of areas in my life where I was almost ready to compromise my faith and the teachings of the Bible. I had forgotten who was in control over my life and was struggling to navigate it. I had tuned out from the whispers of the Holy spirit. I was the prodigal. I really needed to remind myself who I am and whose I am. And then I decided to run. Run into the open hands of my loving heavenly Father, always waiting to receive His prodigal.

The Barefoot Father

The blazing sun forced me to gaze down and walk. And sometimes, you find many a worthy sight when you look down . I noticed that the person walking in front of me was barefoot. He had a bag of clothes. The tilt in his walk indicated that the bag was heavy. Next to him was a young boy of around 10 years and a woman in pink sari. Probably his wife and son. It struck me that they were wearing slippers. As I was about to pass past this family, a little boy who was walking a little ahead turned and started talking to the man of our story. And then I found the missing slippers!The little lad was wearing an adult man’s sandals. His father would have given his slippers to protect his son’s tiny feet from the sun kissed dirty roads. A father’s simple gesture of love.

As I hurried past them, I thought of my father, the sacrifices he had made for us and the extent to which he is willing to go for us. True, fathers don’t get to claim the benefits of “I carried you for nine months” slogan of every mother. Their love and sufferings are of a different hue.They are simply there for you. Mostly as our unsung heroes. This also reminded me of my Heavenly father who is the epitome of love and affection. I guess even a walk in the afternoon sun can reveal thoughtful sights…if you keep your eyes and heart open. With these thoughts, I walked into the shades of the Outpatient hospital block.

Photo by Juan Pablo Arenas on Pexels.com

The Buffalo Rider

One finds many an interesting face during a morning walk through the village. And this definitely was one! Mounted on a buffalo with absolute poise and ease, he did look a little intimidating. Not to mention that the whole scenario reminded me of the Hindu mythological god of death, Yamraj who rides a buffalo. I hesitated for a few minutes before asking him for a picture.

And did he pose! Like a king seated on his throne, he smiled at my camera. The serious look on his face was replaced by a beautiful smile that was reflected in his eyes. And on he went after that. To find the best pastures for his buffaloes.It is normal for the villagers to take their animals grazing early in the morning. After all, these animals are their main source of income. I doubt if our old man himself had had his breakfast.

Meenu

Unkempt.. This was the only word that came to my mind when I saw her. Her clothing was shabby- a green top and brown pants, colors having faded less than the dullness of poverty around her. I wondered when she had last brushed her hair, if she ever did. She was lean and one would say around eight years old. But then there was this enigma about her face. She looked slightly older than that. A little lost?Disconnected?Expressionless?

Her mother was busy preparing breakfast for us. “Meenu, wash the vegetables”,the daughter was told in the local Mythili language. Meenu immediately obeyed without any objections. On finding out that Meenu is around 14 years old, I was more curious. Yes. “Around” fourteen. Because sometimes people don’t know their age. How do you know your age? Because your parents know your date of birth? Because you have official documents to prove it? Now imagine. Your parents are illiterate. They have too many kids than they can remember or handle…too many that they start to forget..forget when they were born. How old they are. Add a little bit of poverty and the disadvantage of being a girl child. And top it up with low mental capacity and differential ability.Now, is there a wonder why Meenu’s age was a confusion to her mother?!

“Why don’t you comb your hair? Tie it up and it will look pretty”, I suggested in broken Hindi which I hoped they would figure out. Meenu just smiled and ran away. Her mother gave me a nod for the answer. Next day Meenu looked different. Her hair was neatly combed and tied up. I complimented her new look. Again the reaction was the same. A small smile and she ran to hide away. Barefoot.

“Does she go to school?”, I enquired of her mother. She looked at me beaming and shook her head. No. Meenu has never been to school. Meenu can’t study. Meenu can’t understand things. Meenu is a little slow to learning. Meenu is good only for household chores. Meenu will stay here and help her family with work. Meenu is a poor disadvantaged girl in a small village in Bihar. Meenu is unlucky. And Meenu has no choice about it.

Unfair? Definitely! What if this child was born in a family with better conditions? Meenu would have better clothes. Her hair would be combed daily. She would get to go to school. Someone would spend time with her, assess her and help her improve her differential abilities. She would have more choices in life. Yes. Circumstances define your choices.

But for now, Meenu is happy. She grabbed the biscuits I offered her and ran away. She is content with her current scenerio. She has a roof over her head. They have food to eat. There is the large natural playground of the village. She can run around and play happily. She has no clue about the life she could have had if she was born into better conditions. Ignorance can too often be a bliss. But is that not a boon for now? I erased “unkempt” from my brain as my tag for Meenu and replaced it with “Content sans choice”. “Can I take a photo Meenu?”. Meenu looked at me and gave a sly smile. And for once, did not run away. She posed. Her tiny body, barefeet and torn clothes appeared on the screen of my phone. But the camera couldn’t capture her smile. I wonder why.

An Apologia

Photo by Du01b0u01a1ng Nhu00e2n on Pexels.com

Am I delirious?
Or this a thought spurious?
You seem so distant.
So distant, I seek thee from a distance. 
When did you leave?
I heard not the door shut.
Why did you leave?
Knowing the gamut
Of my feelings demented.

Was it so piteous?
Could you not forgive my insipience?
You seem so far.
So far, I seek thee from afar.
When did you leave?
I felt not the distance.
Why did you leave?
I may have lacked persistence
But you could have resisted.

Am I mistaken?
Why is my solace taken?
You seem so new.
So new, I need to know you anew.
When did you leave?
It feels like an abyss around.
Why did you leave?
Too lost to be found.
Bashing my spirit to the ground.

When did you leave?
Why did you leave?
Oh!When did you leave?
Oh!Why did you leave?
Oh! Precious poetry!
Why can’t I write thee?
Won’t you come back to me?








The unchanged

When I first came to Lucknow, I tried to look for the new things. New perspectives. New lifestyle. New traditions. I tried to imbibe the best of the newness around me while fleeing from the worst. But over time, I have learned to appreciate something else- the things that do not change. Those sights, thoughts, feelings and actions that have a universal undertone.

The innocence of a child. That sparkle of affection in the eyes of lovers. A pregnant woman’s careful placement of hands over her abdomen. The shy smile of a bride. That lustful look of a man. The hungry cry of a baby. Taste of cold water on a hot summer morning. The wagging tail of a friendly dog. A charming smile. Fluttering leaves. Flapping wings of a bird. The blissful morning breeze. Petrichor. The beauty of a butterfly. The magnificence of the full moon. Stench of poverty. The tone of wailing at the loss of a loved one. Anger. Hue of blood. Fear. Stench of urine. Road rage. Wilting flowers. Coldness of death. Thirst. Pain. Stickiness of sweat. The cool shower. Darkness. Hunger pangs. Saltiness of tears. Blaring horns. Snoring. Wrinkles. Peace.

There is a universality amidst all the diversity of life. A common thread which binds us in an oblivious way .Somehow we manage to neglect all of this and try to divide ourselves. We place barriers of all sorts- region, religion, sect, caste, colour, race, age, qualifications and what not. If only we could forget all these and live just like humans. Humans- without any prefix or suffix.