India: ‘Our patients’ grief, their joy pushed us to try harder’

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Dr. Gayatri’s first assignment with Doctors Without Borders/Médecins Sans Frontières (MSF) was in Bijapur, Chhattisgarh. Below she writes about her work as a medical doctor there and how it helped her find hope in an otherwise grim situation.

At MSF’s Mother and Child Healthcare Centre (MCHC) we were once approached by a pregnant lady. She was seven months into her pregnancy and was convulsing repeatedly. We delivered her baby in the middle of a convulsion with little hope of the child’s survival. We focused on saving the mother’s life. On delivery, a tiny little boy, weighing about 800 gms, wailed loudly as the convulsions of the mother faded away. The baby stayed with us for almost two months taking shaky steps towards a normal weight and no signs of infection. Everyday, his parents and I watched carefully, always on tenterhooks, celebrating every few grams of weight he gained.

Fortunately, as the parents came back regularly for the baby’s immunisation, we could track his weight as it increased to 2 kgs. Days after I left the project, I got a call from them telling me that the infant now weighs almost 3 kgs and has finally been christened.

Connections like this is what we MSF staff survive on; each success encouraging us to pay attention to detail in the patients’ history, making us push ourselves even moreto provide the medical care that the population has a right to.

Where malaria snatches lives

Patient numbers in the OPD would often rise to a mad crescendo towards the latter part of the year due to the number of malaria cases. Little boys with sunbrowned complexions and clothes held up by pieces of string tied around their waists would walk up and chat with us in Telugu, Gondhi, Halbhi and what I suspect was a version of Marathi. Toothy smiles, curious questions, narrations of grief and joy and relieved mothers made my time fly.

I recollect seeing a mother with a child perched on her hip, her teenage daughter holding a toddler and two other kids in the grandmother’s lap. All of them had malaria, discovered only incidentally through a blood test. The forests in Chhattisgarh have a population living in exceptional circumstances – amid conflict and an onslaught of malaria made worse by what seems like longstanding and severe anaemia and gross nutritional inadequacy.

Being part of MSF

The MSF team is therefore treating anaemia, skin diseases, pneumonia and pregnancy-related diseases in this area. Antenatal care and immunisation is emphasised. At the mobile clinic level, resourcefulness and shrewd decision-making are the most valued skills. Well-timed referrals to the MCHC at Bijapur or to a more specialised centre five hours away can drastically change the outcome.

One has other unforgettable experiences in the process. The feeling of the smooth rocks beneath my bare soles as we waded across a river as part of a mobile clinic team; swatting away insects as we trudged through tortuous trails in dense forests; tying intravenous fluid bottles to bamboo-stick bedposts at places with inadequate medical facilities, are memories that will stay with me forever.

A learning curve around the bend

My term in Bijapur has therefore catalysed an exponential learning curve for me, both in terms of technical knowledge and human relationships. For example,the limited resources available to us as medical care providers on our mobile clinics made us rely heavily on our clinical skills. I tried to visualise what the X-ray would look like in a TB patient by listening to the sound of the chest. Prioritising and recognising my limits as a doctor were other huge lessons that caused shifts in the way I look at medicine and life. The happy simplicity of life in the field has also brought with it profound changes in my perspective.

The right to health is basic and essential irrespective of social or economic status, caste, creed, religion or geographical location.  As a doctor, I recognise the power of simple measures. A wound dressed promptly and with simple sterile precautions, can save a limb. Recognition of signs of shock or dehydration is fairly elementary but timely treatment can save a life.

I feel that this knowledge both empowers and places a responsibility. I cannot ignore the fact that everyone deserves at the very least, this basic care, that requires little else other than simple initiative. MSF has helped me translate this belief into action and allowed me to be part of something much bigger than myself. It is because of this that I hope to be back on assignment soon!

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