Of dark ages . . .

Recently, we’ve had quite a lot of debates about propriety of having a mission to Mars when quite a large part of the country is so backward and in dire poverty. Of course, the Mangalyan program is commendable and we all are proud of it. However, I strongly feel that stories of neglect and backwardness of our great nation have to be shared. The major reason being the fact that a widening gap between the rich and the poor is something which could hamper the progress of the nation.

So, stories of 2 families in this series .  . . The first one . . .

BB, a 3 week old child was brought by his parents more than a week back. It was so obvious that BB was very very sick. He was not crying and only had a blank stare on his face. Of course, he was not feeding. BB has been sick since the previous day afternoon. BB was brought to the clinic where I sit twice a week the previous evening. However, since I was away, the nurses had referred him to a higher centre.

BB’s parents were very poor. They had taken him to a wizard and he told them that he needs some costly procedures to be done. They had no money to take the baby to a higher centre or to pay the wizard.

We had no choice but to admit the child. By God’s grace, he responded well to antibiotics. However, as soon as the baby was active, the parents wanted to take him home. Later, we came to know that a grandparent had suggested that he be also shown to the wizard so that the disease is completely cured and therefore the urgency to go home.

The parents left with the baby with a promise that he would be brought twice a day for his intravenous antibiotics. They kept their promise. However, the next day, the parents were very anxious to meet me. They narrated to us that the witch doctor has taken out a dozen pieces of bones from the baby’s stomach which was causing all the disease.

They were very confident that the baby will be totally alright now. One of colleagues was quite flabbergasted at their story. He gave them a good piece of his mind.

However, it was quite obvious that they very much believed what the witch doctor has told them.

Occult in its various forms are quite common in our country. However, the poor suffer from it the most. BB’s parents told me that the cost of ‘taking out the stones’ was couple of country chicken which costs a minimum of 600 INR.

We commonly hear about worse forms of occult practice. Elderly women, mostly widows are branded as witches when something untoward happens to someone. These women are hounded, beaten up and in many instances mercilessly killed. One police officer told me of an incident where a widow was decapitated and the head was brought to the police station by the entire village, and nobody could do anything about it. Even, FIRs (first information report) are filed against suspected witches for ill-happenings. And the police are at a loss to do anything.

I wish that witch-craft is something that needs to be dealt with in rural communities of the country. It is not easy. It would need quite a lot of advocacy among the community and its leaders and the success in eradicating it would need community support. However, the benefits would be quite a lot.

The second story in my next post . . . 

The Occult . . . The Paradoxes of Indian Healthcare - Part 3

India has always been associated with the occult. And you may be surprised that the myriad religions, the thousands of gods and goddesses Indian culture is associated with has nothing to do with this. Irrespective of religion, caste, economic status . . . people depend on the occult for healthcare . . . 

Today, I came across 3 patients who tried it out . . . and it's usually the case for the conditions involved. 

The first was a young boy who had an acute episode of seizures in the morning. The relatives brought him straightaway to hospital. After the seizures was controlled, the brought in one of the local exponents of black magic to throw out the evil spirit from the boy. Our staff had quite a tough time dealing with the relatives as they were quite well off. 

The second patient was not that lucky. Bitten by a cobra early morning today, the family had been subjecting him to all mumble jumble till about afternoon when they realised that he may do better in a hospital. He arrived at around 5 pm at NJH. There was no respiratory effort. There was a faint heartbeat. From our previous experiences with cobra bites, Titus commenced CPCR . . . then he realised that it may not of any use. The pupils were already dilated. 

The third patient was also a snake bite victim, a young girl with viper bite, who came in more than a day after the bite with a very bad compartment syndrome. Dr Nandamani did a fasciotomy only to find out that one part of the leg was already badly gangrenous. 

We were sure that the chances of her going into a below knee amputation was quite high. We referred the girl. 

Unfortunately, the parents were too poor to take the girl elsewhere. However, I did not want to manage a potential high risk surgical condition without the surgeon around. They promised to take the patient elsewhere next day. Sometime later that evening, I found out there was a commotion in the Acute Care where the girl was admitted. 

It seemed that the family had arranged for a 'witch-doctor' to come and do sorcery on her. I chased them out. Later, I found out that couple of my staff were also involved in arranging the witch-doctor. I called them and asked for an explanation. However, they denied any involvement. I did not have any evidence. However, later, I found out that they had initiated a discussion with few other staff on the reasons why I should have allowed them to do the sorcery. 'The doctors are anyway referring, so what is the big thing about the relatives trying out jaad-phook (black magic) for their daughter'. . . that was the justification. 

It was shocking . . . unfortunate, but true. 

The worst aspect of the use of occult is that  most of the diseases where the populace invokes the witch-doctors are clinical conditions which merit immediate medical attention . . . SNAKE BITES, SEIZURES, ECLAMPSIA . . .the major ones we're concerned about. One more disease for which the witch-doctor is consulted is HEPATITIS. However, since it is not an acute condition, we do not hear much about it. 

The amount of money that these witch-doctors make is enormous. 

Considering that modern medical facilities are very much far away in terms of accessibility, availability and affordability, it would take quite a lot of effort to turn away the common man from these money mongers. Talking about money mongers, the sadder aspect is that modern clinical practice is also very much in danger of reducing it's practitioners to money mongers . . . which is not much different from our 'witch-doctors'. More about that in my next post on the Paradoxes of Indian Healthcare . . . 

Snake Bites and the Occult . . .

The morning of the day I entrained to Delhi, we had a very young man being wheeled in. He was already dead and cold. Bitten by a snake the previous night, he was being managed using black-magic (jhad phook). Sometime early morning, the family realized that it may be better to give a try with the doctors. He reached the nearest district hospital only to realize that there were only a total of 2 vials of Anti-Snake Venom in town. PD, who had come few days back was from the same district - he could manage 5 ASVs. 

Even PD had accessed a witch-doctor before reaching the district hospital and later NJH. The worst part was that when PD was on the ventilator, the relatives had arranged for a local witch-doctor to come into the Acute Care Unit in the garb of a relative and perform witch-craft. I had the opportunity to witness the tamasha. Unfortunately, it did not cross my mind about taking a snap.

Later, after I had started off to Delhi, we got one more patient with a snake bite. He also had spent time with the 'jhad phook'. He is on the ventilator. We hope that he'll do well. 

It is unfortunate that even after quite a lot of awareness among the community about the success rates that patients with snake bites have with NJH, most of them do not turn up to the hospital fast. Of course, the dependency on the occult is not only limited to snake bites.  Hope you remember that MD, the patient with post-partum eclampsia had also come after a session with the witch-doctor.

I'm looking at the possibility of printing pamphlets about prevention and management of snake bites in the community. Please do send suggestions . . .

The Occult . . . And Worse . . .

Below, is a clip of a news item published in our vernacular daily last week.

The translation is as follows -

It has been reported that a certain Mr. Mukhan Ram (55 years), a resident of Dharuwa village under Kanti Police Station was paraded in the village after having his hair tonsured. Mr. Mukhan Ram is a witch doctor by profession since the last 10 years.

The Panchayat had decided that Mr Mukhan should be punished in social, economic and psychological terms. In relation to the incident, villagers reported that the wedding of the daughter of a certain Umesh Ram took place on 23rd April. Mr. Mukhan had done a certain ritual during the wedding. After the ceremony, when the girl was leaving her house to her husband’s place, she had become unconscious. The girl’s father, Mr. Umesh Ram brought a new witch doctor for further ceremonies from Belchampa, Palamu. The new witch doctor proved by his magic powers that Mr. Mukhan Ram was responsible for the girl becoming unconscious after the wedding ceremony.

Mr. Mukhan Ram’s wife got into a fight with the family of the girl after hearing this. Mr. Umesh has demanded that Mr. Mukhan Ram pay up 25,000 INR which he had to spend towards getting his daughter alright after she had swooned during after the wedding ceremony. The Panchayat has given a time frame to Mr. Mukhan to pay up this amount.

Amazing, for two reasons -

1. First and foremost – the newspaper deciding to put this into print.

2. Second – to note that we continue to incidents like these in our country. Most probably, the girl would have too tired and probably hypoglycemic after the ‘long Indian wedding’ – and that was enough for a witch doctor to extract 25,000 INR from the family towards healing her . . .

My countrymen, we can only weep for our fellow brothers and sisters who are caught up in this mire of ignorance and sorcery . . . 

The Occult

SK's parents had a very peculiar request about 4 days back. Initially, they told that they wanted to take her to Ranchi. I knew that this was not going to happen as couple of her neighbours had informed me quite early that the family was too poor to even pay the medical bills at NJH.

I called the father separately. I asked him about the request to take to Ranchi. He told me that the family was planning to take SK home to die. But, he was also going to try out some black magic – called ‘jhad phuk’ in local terms by the witchdoctor called ‘ojha’.

It was unbelievable. But, true in rural areas in third world countries. After much persuasion, he agreed to allow us to try to save his daughter.

It is not uncommon to see new amulets being tied around patient’s wrists or put along with a necklace while they are still admitted in hospital.

Couple of photographs of patients with things tied around their bodies.

IK, who was clinically diagnosed to have encephalitis - he was too sick to be even taken elsewhere. He made a remarkable recovery. If you look carefully you can see one blue colored and a white colored thing tied over his left shoulder. IK's father had quite a lot of faith on the treatment we were giving him. Then, I asked him about the reason for the extra things which used to change almost every alternate day. IK's father would only giggle in reply.

I found this tied on AS's arm couple of hours after I had admitted him. I am sure that it was not there when he had come in. Unlike what I had expected, AS was taken to the nearest medical college hospital the next day morning. But, he passed away the very next day.

It is quite rare that we see patients especially with medical complaints who does not have one of these amulets tied around their neck or wrist. Many a time, especially with snake bites, they perform quite elaborate rituals before they bring the patients for treatment.

I'm not sure of having seen such practices in any other place to such an extent as I've been seeing here. I don't know about practices in other parts of the world.