Miscarriage

A curtain of rain separates
My verandah from the hospital.
On any other day a hundred
Silent patients would pass through
The OP clinic. Each of them
Allowing us doctors to listen
Feel, touch and question them.
The warmth of their fever would
Make us uncomfortably hot.

Today the air is chilled downpour wet.
Water roars in the stony river.
Five nurses, Gi and I sloshed
Through muddy puddles to witness
Our stream in full spate.
Only one desperate couple managed
To make it on the early bus.
Wanting an abortion.

Kutti Thambi Chinna Doctor

He died five hours ago.
A small boy of three.
Looked so still and limp.
His family wailed.

His house is a few fields away.
His aunt works in our hospital.
He was born here.
He died at home.

He had a fever.
He vomited for three days.
His mother took him to a
Local traditional practitioner.

Our ambulance was called.
He stopped breathing before it came.
Tha held the mother.
And both were disconsolate.

His name is not tomorrow.

Poem in a car

Imagine if this poem was fashionable.
And was found in a book of fashionable poems.
Read by fashionable people in fashionable cars.

Then the name of this fashion will be
Fair fashion. And it will be fashionable to be fair.

To be fair one would need to look at the paper
On which this fashionable poem was written.
And wonder whether the paper is fair as it is
fashionable.

Who cut the tree to create a fashionable poem's paper?
Whose tree was it anyway? Does she read
fashionable poems?

Who sat in the car in which the fashionable poem was read?
Should we wonder whether the car is fashionable as it is fair?

Who mined the earth to create a fashionable car's body?
Whose earth was it anyway? Was he ever in a fashionable car?

Blood toads

We deliver babies here
In a spew of blood and amniotic fluid
That splashes on our feet
Seeps into our cuts and crevices
And does daily battle with immunoglobulins
Yet the worry of contracting Hep B or HIV
Does not seem to worry the blood toads
Fat amphibians of the labour cot drain hole
Whose eyes shine at the most recent surge
Of human fluid.

Will today bring a rare gush of O Negative blood?
Will it send them scampering over the floor?
Student nurses in vain set after them
Scattering carefully stacked urine sample bottles
And a patient’s husband rushes to Salem
To buy injections that cost him two months earnings.

At night the new mother dreams
Expensive Anti D Ig courses her veins
Tiny lips suckle her breast
A multitude of pale green toads
Spawn nourished on her blood
Invade the ward hungry for more
A fresh red river flows from her uterus
Which is lax in terror.
She awakes screaming.

The junior night duty nurse runs
She awakens a thin tired doctor
The patient is shifted to the labour cot
Methergine soon flows into her veins
The now contracting uterus
Pushes out a kidney tray full of blood
Half a litre of gelatinous clots
More nourishment for the blood toads.

communityhealth.in

The link has been sitting demurely on the right side of this blog for quite a while but I realise that I have never actually written about communityhealth.in so far. In short, communityhealth.in is an experiment in creating an online resource on community health in India, something that is very close to my heart. Starting this January I hope to be doing a lot of talking about this project and I have created chdotin.wordpress.com for the same purpose. Do check it out.

Stone River Hospital

Occasionally I write poetry. There, I finally said it. Most of it is terribly personal, vulnerable and badly written. Over the last two months however I have occasionally written something that I feel comfortable about. Both the poems below are based on my experiences here and meticulously portray life as it really is.

A short note on the label of this blog post. 'Stone River Hospital' is a literal translation of Kal Aath Aspatre as we are locally known. Below is a photo of the river which runs about 200 feet away from my room. If someone had to literally translate what I am known as in the area it will be' Stony River Little Doctor' :-)

M's Betrayal

When the skin on the bottom of your feet
Burns. Burns really red hot.
It becomes hard and black. Like
Old cracked leather.
It makes a 'tok tok tok'
Noise like a coconut shell. Dry.

Inside creamy pus waits patiently.
The doctor will soon quit tapping
the skin with his pen.
He will mumble instructions in Tamil.
Nurses will scurry. The woman will
Starve to avoid vomiting with the anaesthesia.

In the evening Dhanam Akka will
Crack open a beautiful glass ampoule.
With the deftness of experience she will
Pull ketamine into a plastic syringe.
M lies on the steel operating table
Softly moaning under her green blindfold.

Soon cold steel clasped in latex
clad fingers will pare through
dead skin. Patient pus will burst
forth and dribble into a plastic
kidney shaped tray. Raw red
flesh will make a shy debut.

Akka, will you promise not to tell
Anyone. Promise on your heart.
Promise on your head. Promise. Promise.
I didn't fall into a cooking fire
because I fainted being two months pregnant.

I took some tablets because I didn't
Want a second child right now.
Ten pills from the local doctor. They
They knocked me out and then
Then my husband came home drunk.

Promise you won't tell anyone. Promise.
On your heart. Promise on your head.
He was in a murderous rage. He.
He tied me up and then he.
He stuffed a cloth in my mouth.

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You might be tempted to ask why this has been the best year of my life. Here's why ....

A Rural Practitioner's Happiness

Tiny hands. Big eyes.
The cutest damn expression in the world.
That's my reward. That's happiness.

Then I walk out of the labour ward.
I can see hills all around. Green.
That's my reward. That's happiness.

My cottage sits on the edge of the forest.
Full of books, art films and insects.
That's my reward. That's happiness.

The local women who work at our hospital
Call me 'Anna'.
That's my reward. That's happiness.

An old therakoote vadiyar
Is grateful I was with him during his second MI.
That's my reward. That's happiness.

When death comes. Despair.
Loneliness and gastritis.
I think of my rewards. I try happiness.

communityhealth.in posters

I had spent the whole of yesterday in the OP clinic seeing patients. Occasionally I would nip back to my room for a break and to read a little more of Helping Health Workers Learn, a book that is slowly revolutionising the way I understand community health. Inspiration struck at 1 am after reading the passage which I subsequently used in the first poster. The pictures are from my travels over the last year.

Click on the poster to enlarge.

The second poster is more personal. It was a sort of artistic representation of what being a community health activist at 1 am at night feels like. It uses a lots of ideas about art that I have been slowly developing such as where the artist situates himself, the progression of time between the pictures (look at the guava) and creating different messages depending on the distance between the viewer and the poster among others. I don't expect it to be popular or even be printed at all but it is my personal favourite. Poetry, art and community health :-)

Click on the poster to enlarge.

Lousy T design idea

Understanding Health For All

There seems to be so much confusion regarding terminology within People's Health Movement. We hear talk of 'upper-case People's Health Movement' and 'lower-case people's health movement'. 'Health For All' seems to be the buzz word used by everybody today, from private insurance companies and corporate hospitals to Right to Health lobbyists and community health workers.

Here is Dr. Halfdan Mahler, the grand old man of the Health For All movement breaking it down in the simplest of terms. According to him the concept of Health For All is a value system/ spiritual belief. It requires a leap of faith. You have to believe that everyone is entitled to try and live in perfect health. You have to believe that any attempt to take away this freedom is wrong. Then you act.

Taking it from there, People's Health Movement is then the largest network of Health For All believers. It is the most visible face of such a belief. Using new technologies such as the internet and cheap air travel it unites individuals, organisations and networks to work towards Health For All at all levels. Its core manifesto is the People's Charter for Health, an action plan to achieve the world it believes in.

So People Health Movement is not a movement after all. It is the biggest network within the Health For All movement. If it was called the Network Of People Believing In Health For All And Then Deciding To Do Something About It then half the confusion would be cleared away. But there is no denying that PHM rolls of the tongue more easily than NOPBIHFAATDTOSAI.

If you dont believe that everybody, I mean everybody, has the right to try and live a life in perfect health then you cant use 'Health For All' in its profound, genuine sense. In the world we live in everyone suffers from some curtailment of this freedom. The poor, the sick suffer more. However such curtailment can never be morally right. While forcing people to live in unhealthy environments, preventing their access to the best possible medical care, allowing them to be subject to humiliation and hate may sometimes be temporarily unavoidable it can never be morally condoned.

An individual or institution who then uses the 'Health For All' term to promote itself but condones even the temporary infringement on people's Right to Health is then merely 'HFA washing' or 'hfasing'. Similar to pink washing, the phenomenon of corporate houses using breast cancer awareness and charity as an excuse to market their products. See Think Before You Pink for more.

To sum it up. The idealistic concept of Health For All finds practical expression in the lives of thousands of individuals and institutions who constitute the Health For All movement. The largest network of such believers is the People's Health Movement. However there seems to be others who use the 'Health For All' term carelessly and sometimes for selfish purposes.

Trust Me Ts design idea

Click on the images to enlarge.