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RURAL HEALTHCARE ORDEAL - A Gainful Experience By Dr. Suheir Khajuria
I was in my third year at Government Medical College, Amritsar, bubbling with the self-confidence of a young medical student and over-enthusiastic to sync the symptoms of cataracts and otitis media in people, to what I comprehended in the books. In addition to ophthalmology and otorhinolaryngology, I had Social and Preventive Medicine in my curriculum. This subject opened the window for me to care for the health needs of two rural families in Punjab- the heart of rural India, where two-thirds of the population resides in rural areas1. During that one year I had to educate them about their nutrition and hygiene. My job was to help them see a physician before any small illness became grave. The objective was to provide them with all the essential healthcare amenities. I was a little apprehensive at the commencement of the project because I was not acquainted with anyone in the family. I had never been to that village before. The first day our campus bus drove us to that village, and all I knew about the families was their home address. After marching through narrow streets with open drains in the village, I made my way to the houses. Both the houses allotted to me were located next to each other. My first encounter with the families started with a brief introduction. One of my families was a family of six, where a farmer lived with his wife, two children, brother and mother in a kutcha (made of loosely held bricks and mud) house that consisted of two rooms. The children had no access to education and were unaware of the existence of schools. Although the farmer’s younger son, “Bunty,” always had a penchant for my pens and notebooks. The second family comprised of a farmer in his mid-sixties, with his wife and four children, which included an adolescent girl, “Kulwinder”. They lived in a house with two rooms, one of which was used as a shed for the two buffaloes they owned. And now, these families were “my” families, for the next year. As I journeyed back to my school in the campus bus that first day, I was absorbed with how I was going to start when tutoring my families. I had never been so perplexed ever before. Everything in and around their houses was disorganized and chaotic. There was so much to instruct them about; they did not have sanitary dwelling and the surroundings too weren’t hygienic. Concepts of uncontaminated water supply and sanitation were alien to them. They didn’t have proper toilets to use and eventually went to open fields to ease themselves. Their small spaces were shared with animals. Flies landed on their food and there was no money to buy their medicines. That day I knew, I was facing one of the greatest challenges of my life. I jotted each problem down and was determined to hit upon some plausible measures to deal with them. I visited my families every Friday. The lesson progressed with the fundamentals to avoid spread of infectious diseases. I instructed them to boil water to make it safer for drinking as boiling water kills micro-organisms that could cause diarrhea or cramps. I trained them to cover the containers they used to store water and food. I advised them to keep their house clean and how it would avert the flies from coming in. For reasons unknown, Bunty’s elder brother liked the tang of the ORS solution that his mother learnt to make at home with salt and sugar2. I talked about family planning and use of oral contraceptives to the young couple. It was off limits to talk about sex education to adolescent girls as it is considered a threat to the cultural values in many parts of the country. Kulwinder’s mother asked all the men in the family to leave for the fields and made it very convenient for her daughter to approach me with any doubts. I checked the weight and vitals of my family members and accompanied them to the hospital if they needed to be seen by a doctor. The residents and professors guided us at every step in our project. They facilitated doctor’s appointments and provided us with multivitamins to be distributed to the families. I introduced my family to the daily energy requirements which vary depending upon age, sex, working conditions and activity following the recommendations made by the Indian Council of Medical Research3. Accordingly, I advised them to drink milk and grow green vegetables like spinach and mustard leaves in their farm which would suffice for their requisite diet. Spinach and mustard leaves are commonly used to prepare traditional Indian curry dish “saag,” eaten with bread like roti or naan4. As a child, I had never liked saag. I would choose to eat instant noodles, or a peanut butter sandwich, whenever my mother cooked saag at home. Amusingly, I had even forgotten the taste of saag. But I counseled my families on the nutritional value of saag, as spinach is an excellent source of vitamins, minerals and dietary fiber. This time, it was not about choices, it was about need. I had to consider ways to extract the utmost benefit out of the little possessions my underprivileged families had. I was intimidated at their aptitude to appreciate what I taught them. In spite of being uneducated, they were inquisitive and wanted to grasp the knowledge I shared with them. Thereafter, on my subsequent visits, every time I would see them in an improved condition from the last time, I felt triumphant. I felt swollen with pride for both my families and myself. There was one thing I knew within my heart; I could never do enough for them. Everything I did seemed too little from my perception. But for them, I was no less than a God. They would assemble on the floor and offer me their chair during our heart-to-heart talks for hours. My second family invited me to the younger brother’s wedding ceremony. I gave them gifts of new clothes and gave them money. But was it adequate for them? Could that have made any difference to the state of affairs they were in? These questions continued to trouble me. As all fine things come to an end, so did my venture. All third year students took their university exams and most passed with flying colors. We were looking forward to reading the clinical subjects of medicine like surgery, obstetrics, or orthopedics. It was time to pay my last visit to my families, before they were allotted to another third year student to care for them. I visited them on a Sunday; I remember Sunday being a special day for me. My mother would always make something out of the ordinary for dinner, like pizza or perhaps Chinese food. Sunday was special for them too, and one of my families had prepared saag and roti. When my family requested that I have dinner with them, I couldn’t have said no. My heart wouldn’t let me. I had no courage to express my dislike for saag because I did not want to disappoint them. After all, it was their special Sunday dish. As soon as I agreed to their invitation, the farmer sent his son to the market to buy butter with an expression of contentment on his face and respect in his eyes. The farmer’s wife made me sit on a chair in the corner of the room they used as a kitchen and served me saag, roti and butter. At that moment I realized that I loved the flavor of saag. The flavor of love and admiration the family had developed for me in that year. I could savor the hard work of the farmer that had gone into growing the leaves; the toil of the wife who was preparing it in barely lit corner of the room and the hard earned money that was spent on buying butter for the dish, prepared especially for me. And that minute qualified me for the supreme lesson of my life; it should never be about your choices as choices are always engineered and eventually altered by circumstances. Dr. Suheir Khajuria is an alumni of Government Medical College, Amritsar, India and is presently volunteering at Johns Hopkins Bayview Medical Center, Baltimore. She collaborated with the American Medical Student Association early this year. She was one of the participants of the AMSA sponsored Community Public Health Institute, 2009. She can be contacted at suheirkhajuria@gmail.com References: 1 Punjab population, downloaded from http://punjabgovt.nic.in/economy/HumanResource.htm 2 ICMR (1990). Recommended dietary intake for Indians, New Delhi. In Preventive and Social Medicine, K Park 2005, Pbl M/s Banarsidas Bhanot, Jabalpur, India, p. 458. 3 e-Doctor, Oral Rehydration Solution, Srivastava R. Downloaded from http://www.edoctor.co.in/#/oralrehydrationsol/4522488819 4 Saag, downloaded from http://en.wikipedia.org/wiki/Saag | ||||||||
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