A chance encounter

 

A chance encounter

His voice was droning, almost as if it was attempting to keep pace with the fans on the ceiling; and his eyes, although not very deep mocked us, listening to his story. Mr. Kameswaran (name changed) spoke to us for almost thirty minutes that day, thirty minutes that I would spend many days reflecting on. I met him on the first day of my community medicine postings, a rotation which I should say is quite different from the others, since the subject challenges us to engage with patients in a deeper manner - drawing from both humanities and statistics – to explain the genesis of health and disease, in the form of a clinico-social case.  After an introductory session, our teacher asked us to split up and engage with patients in our institution’s wards along the lines of our discussion, along with a warning – “Do not write as you converse”. Only three of us found ourselves going to the internal medicine ward, which is the farthest from the college building, the largest and the least fancy. When we told the intern posted there of our purpose, he asked us to talk to Mr. Kameswaran, the man in the first bed of the ward, perhaps in hurry, or perhaps as agent of providence – that which drives us to higher truths.

We introduced ourselves to him, and asked for his consent, something which we are much accustomed to, I must note here that never have I found myself being turned down, something which makes me ask if our asking for consent really affords a degree of choice to an individual, or whether it is lip service – asking knowing we won’t be turned down. The routine medical case proforma is something we are much used to, even in the absence of our notebooks, it didn’t escape our memory. With his tepid approval, we asked about his complaints – an episode of constipation and a bloated abdomen which had now resolved; however, he was asked to stay for further evaluation. He did show some reluctance in discussing his condition, he kept insisting that it has resolved, however, instigated by the chains of ‘format’, we probed further and further. I must admit, that I did not understand his disease or why he was admitted. He did tell us that he suffers from diabetes and hypertension, pointing to strips of tablets on the table, almost as if he were a captive, pointing to the keys of release. He then told us that he doesn’t usually take his tablets on time, despite knowing that he must, I now regret not asking him why. Here, we found ourselves falling prey to the prangs of temptation – his case sheet. A single glance revealed he suffers from many ailments, renal failure and heart disease just to name a few. This was quite interesting, as he had denied suffering from most of these diseases when we had asked him earlier. Empowered by our new-found knowledge, we asked him again, and this time with some success. He did admit to suffering from a small ‘kidney-problem’.

In a routine case taking exercise, we would have moved on to clinical examination, however we enquired into his socio-economic background, under the aegis of community medicine. Being the first time, we were immersing ourselves in a clinico-social case, we found some difficulty with recalling the proforma. However, the spirit of the clinico-social endeavor guided us, we started with his home, he told us that he lives with his wife and daughters, in a small apartment in T. Nagar. He works as a watchman and his wife as a domestic help, while his daughters are in college. Without our asking he told us that he spends almost twelve hours a day, standing and sleeping as time allows him to, whereas his wife works in three different houses, travelling by bus from place to place. When he totaled their monthly income and looked at the BG Prasad Scale, we found, to our astonishment, that he comes under the upper-class category; whether this means the scale is fallacious or that I simply don’t know what true poverty is, is something I find myself scared to ask. While we did not go into the intricate details of his house, it was easy to realize that it was less than ideal. There was only one room – serving as a hall, living room, dining room and bed-room all rolled into one, a single rack served as a kitchen and there was a shelf, for pujas. There was a solitary small window, allowing what light and air it could in, and the house was perpetually noisy, with trucks and bikes honking outside. There was a single bathroom in the apartment-complex, dedicated to the six families, living there. By now he had warmed up to us, he spoke more slowly and allowed more details to be divulged. He hails from a town in central Tamil Nadu, some 200 kilometers from Chennai, a town where he shares large plots of cultivable land and a big house with his brothers. His family had moved to Chennai five years ago, hoping to provide a better education for their daughters. The costs that city life imposes on a family meant they had to take up employment, and live rather meagre lives. I couldn’t help but notice how he traversed the seas of human emotion – the dullest notes for the city, and the highest for the home of his heart, that in his village. Yet he was firm and unapologetic in his presence, his daughters need education and it is his duty to provide them. Interjecting, I asked when he found out he had diabetes, and he replied after a brief pause, “Two years ago, when I had a heart attack”. These words hit me, I could not help but link his disease to his migration. But before I could fully process what he said, he expressed his desire to move back to his village, “In a few years”, he said, “I will arrange the marriage of my children, and move back to rest” – as if the city was the land of unhappy promises. After saying this, he laid and dreamt a few moments before asking us if we need anything else from him. When our eyes went the clock on the wall, we politely turned him down, thanked him for his engagement and ran back to class.

After the discussions of class, I couldn’t help but recollect the words of Phatik, the Calcutta retuned schoolboy in Rabindranath Tagore’s story, the Homecoming - "Mother, the holidays have come." These words were the cry of the oppressed boy for hope, freedom from the colonial education of the British to the healthy air of the countryside.  However, I didn’t want to stop there – Mr. Kameswaran was staying in the city despite his obvious problems with it as it allowed him to move his family further, in the tier of society; he did express a desire to return after what he perceived to be his duties? Is the urban life then a necessary evil? Gandhi famously said, “The future of India lies in its villages”. For him, the village is central to the idea of India, urban life with all its impersonalism is fundamentally against the Indian. Rural life for him, meant all of what the Indian endeavour meant – simplicity, honesty, self-sufficiency and freedom from materialism, but with the idea of the divine in mind. In distinction, Ambedkar said “What is a Village but a Sink of Localism, a Den of Ignorance and Narrow Mindedness”. For him, a village is reinforcing those social hierarchies that marginalise people, and urbanisation is an anathema to those hierarches. Today, a large portion of India’s population still lives in villages, but many migrate to cities, in search of opportunities and freedom from the vagaries and rigidity of village life. I find it difficult to judge them for doing so – firstly, it is not my place to, and secondly, India is much poorer today than she was for most of her history, endeavours of higher nature, come after primary needs are met.

Yet there is a question departed from this dichotomy – what is the role of a health care professional here? India’s largely rural masses are served by CHWs- Community Health Workers; unlike the cities and towns where specialist doctors are in abundance. Are we trying to promote urbanization through this policy of health allocation? Or is this simply a reflection of the reluctance of trained professionals to move to villages, simply because they reflect the hierarchies and lack of resources discussed above. My opinion is that, in an era when many Indians are moving to villages, searching for their roots, this question is more relevant than ever before.