As a part of mandatory 3 months rural posting during Internship, we were posted at Chiraigaon, Varanasi. The hospital was a rundown building in the middle of a vast expanse of agricultural land. There was poor sanitation, bad health care infrastructure, shabby dormitories for medicos, erratic electricity supply, pathetic roads, no tap water, lots of mosquitoes and frequent sighting of snakes. For obvious reasons, almost all interns would go back to college after few days of forced Rural Picnic! My first exposure to the reality of primary health care in India was quite disheartening. After having spent 5 years of my life in the grueling MBBS program, I found it difficult to overcome the feelings of regret, disillusionment and frustration. I had dreamt of a respectable career in a fancy hospital but now I was exposed to harsh realities that doctors have to face and those were not what I envisioned for myself. I started to think of changing my career by writing the Civil Service examination like some of my friends. By end of the second day, all my colleagues went back to BHU but I decided to stay for few more days to enjoy the rural setting. On 3rd day of the posting, I came to know that PHC needed to send a doctor for a school health program. Bored and lonely, I volunteered to go to the SOS Village. It was a hot and humid day and my only aim was to quickly finish the assigned job. Realizing my impatience and complete lack of interest, the Director of the SOS village cut short his welcome tea session in his office and accompanied me to the dispensary. As I entered the waiting area of the dispensary, I saw few sick looking young kids accompanied by couple of young women. The Director introduced me to those waiting kids and their subsequent reaction was quite startling. Despite being visibly weak and sick, they all rushed to me and hugged me from all sides. I could gauge that they all had very high fever and some were even shivering. Those little souls welcomed me as a hero who would relieve them of their sufferings. I had absolutely no experience of treating kids whatsoever. I panicked realizing what was expected out of me. The hopes in the eyes of those kids were unnerving. I started thinking of various possible excuses to run away because I was afraid of cheating them and exposing my incompetence. As I nervously sat in the doctor’s chair, the first child entered accompanied by a young nurse. She was a 6 years old child who was shivering with high fever. With great sense of uneasiness, I started taking history, the only thing I was good at. I did not know brand names of pediatric drugs. I did not know their dosage. I did not know the proper diagnostic algorithm for management of fever. I had morbid fear of the drug induced side effects. To act like an accomplished doctor, I started to examine the kid’s chest with a stethoscope. To be honest, what I could hear in the stethoscope was my own loud heart beat.
In order to keep the child comfortable while examining her, I asked about her family and why her mother did not accompany her? What she told me and how she reacted to that innocuous question changed my life forever. Simmy explained how she witnessed her bleeding parents die in a car crash one year back. Her maternal aunt, who already had 3 kids, was ready to take care of her. However, she was sent to the orphanage by her uncle who considered her an unwanted burden. At this point, the otherwise calm child burst out sobbing and clung to me in a tight embrace. I was overwhelmed by the thought of holding a small child who was suffering from great mental and physical agony! We both cried together hugging each other for several seconds till the nurse began to explain me about the SOS village. The village aims to bring together destitute women and orphan kids in a family model. The destitute women serve as the mother and several kids are allocated to her as if in a typical family. They all live in a proper house provided by the community and the mother receives monthly salary for her family’s expenditure. Simmy’s fever was very high, she was shivering violently now. My terrified mind was struggling to make a diagnosis and possible treatment. Then suddenly, the nurse turned out to be my savior. The nurse had worked with a Pediatrician for 6 years! She knew the names of drugs and even their dosage. Buoyed by the competence of the nurse, I gained my composure and confidence. In next 30 minutes, I saw seven small kids who were running high fever, body ache, vomiting etc due to Measles. Each kid had their own story of how they ended up being orphaned and brought into SOS village. Everything that happened in that one hour in that clinic is still etched in my memory. I was being treated as a messiah who would relieve the kids of their illness. My inner voice urged me to take up the challenge and not run away!
By end of the day, the number of kids with fever grew from 7 to 17. I realized I was dealing with an outbreak. With a competent nurse, I took charge of converting a play room into a temporary ward with 20 mattresses on floor. I knew that Measles is a self limiting viral fever where the only thing one has to do is to control fever. The nurse and I gave medication, monitored temperature, massaged heads, and consoled the sick children throughout the night. By midnight, 5 more kids were brought into our makeshift ward. From a nervous medical student, I was transformed into a confident organizer and probably a compassionate physician. No one questioned my ability and no one suspected my prescription. I was being showered with gratitude that I did not deserve.
I was told that I was running a huge risk of contracting Measles myself that is known to have serious consequences in adults. However, I was infected with something more serious. I had fallen in love with those innocent souls.
Though, the outbreak settled in two weeks, none of the kids wanted me to leave the campus. I realized that, for those kids, I was the only male in that gated campus who matched their father’s age. After one month, I decided that it was time to go back and a small farewell was organized in the community hall. As soon as it was announced to the unsuspecting kids about my departure, all the kids rushed and clung to me. Their teary eyes and sad faces made me feel as if I was deserting them. Overwhelmed by their sudden and spontaneous reaction, I decided to extend my stay. The bonding was getting deeper every day. Time passed swiftly and I completed 3 months in the village and it was mandatory to return to my college. I dreaded facing another farewell party. I had no strength to witness those gloomy eyes. One night, controlling my tears, I informed the Director that I am leaving! I requested him to tell the kids that I will return after attending an emergency in the hospital. I was sure that kids will forget me and perhaps forgive me.
With a heavy heart, as I stepped out of the gate of the SOS village, I could feel that I was a different person. I was convinced that I was in one of the noblest profession. No amount of power or salary that other professionals may enjoy can compare with the gratification of alleviating suffering. What makes you a good doctor is not your attribute but your attitude. It is not the prescription but the compassion that heals most ailments.
Dr Pankaj Chaturvedi
Tata Memorial Hospital