I am brighter than you

She takes a lone walk,
the morning promises a fresh beginning,
she places her bare feet on the dew wet grass,
the grass-blades awakening her a little more.

The professional that she is,
hard-work is her mantra.
A go-getter in all she does,
at work she can be a nasty task master.

She softens by evening,
her sartorial elegance begins to show up,
she sashays down the club aisle,
she knows all eyes are on her.

She quietly takes a corner,
the corner suddenly becomes bright,
she sits for a while as the pianist plays a Beethoven,
but something else is tempting her from outside.

The moon is on its full,
she knows she can count the stars,
but tonight she wants to take on the celestial body,
proudly she tells the moon ,"I am brighter than you."

A personal battle

My grandfather was the first MBBS student of Manipur (those days people mostly studied only LMP). He joined the Calcutta Medical College after his ISc. at the Cotton College. But a few months into his course,he developed a debilitating carbuncle that made him come back home. On recovery,he found that the government had stopped his monthly stipend without which it was not possible for him to continue his studies. It's a different story that he later went on to occupy respectable positions in the government.

Years later,he sent his brother for studying LMP (Licensed Medical Practitioner) at the Berry White Medical College (presently Assam Medical College, Dibrugarh). However, during his internship,he contracted tuberculosis. Those days there were no Rifampicin,INH or Streptomycin. He coughed blood to his death.

Perhaps,my grandfather's dream of seeing a doctor in his brother crashed again. It has been decades since my grand-father passed away but today he has a family of 14 doctors.I have other family members who also had been affected by this disease, nosocomial,acquired from their work place.

Like me, if you look around in your family,relatives or neighborhood, you may find that someone or the other had been affected by this disease.

We need to wreck our vengeance and for that what we are doing now is not enough.

We can belong to a generation proud to say that we eradicated this 4000 year old disease but it's no cake walk....because I am not talking of vividly visible flies or mosquitoes here, I am talking of a very capricious microorganism that has been dodging all advances in health science.

TUBERCULOSIS-ITS JOURNEY IN THE LIVES OF MANKIND

The ancient Greek literature mentions of a disease called “Phthisis”. Hippocrates described the disease as the most common illness of his time, typically affecting young adults and nearly always fatal. While Hippocrates thought Phthisis to be hereditary in nature, Aristotle believed it was contagious.

Some authors described tuberculosis as the first disease known to mankind. It appears likely that Akhenaten, the Pharaoh of the Eight Dynasty of Egypt and his wife Nefertiti both died of tuberculosis. Evidence indicates that hospitals for tuberculosis existed in ancient Egypt as early as 1500 B.C.

The Old Testament mentions of a consumptive illness that would affect the Jewish people if they stray from God. It is listed in the section of curses given before they enter the land of Cannan.

The oldest of the Vedas, Rigveda called it Yaksma. The Atharvaveda called it Balasa.

Fransicus Sylvius, Dutch physician recognized that skin ulcers caused by scrofula resembled tubercles seen in phthisis and in his book ‘Opera Medica’ described phthisis as the ‘scrofula of the lungs’.

In the 17^th century, the tuberculosis epidemic hit Europe for 2 decades and it was known as the “Great White Plague”. It was seen as a romantic disease. Suffering from the disease was believed to bestow upon the sufferer heightened sensitivity. British poet Lord Byron wrote “I should like to die of consumption.” helping to popularize the disease as the disease of artists. George Sand described her lover Fredrick Chopin’s illness as “Chopin coughs with infinite grace.” Shakespeare also mentioned of a disease called “Consumption” in his play “Much Ado about nothing” and another called “Scrofula” in “Macbeth”.

Rene Laennec who invented stethoscope died of tuberculosis. He used the stethoscope to corroborate his auscultatory findings and respiratory symptoms with the autopsy findings of lung lesions of patients who died of TB.

 Robert Koch demonstrated that the disease was caused by an infectious agent, Mycobacterium Tuberculosis. He made this public at the Physiological Society of Berlin on 24 March 1882 in a famous letter entitled “Uber Tuberculose”. March 24 has ever since been known as the World Tuberculosis Day.

On April 20, 1882, Robert Koch demonstrated that Mycobacterium was the single cause of tuberculosis in all its forms. In 1890, Koch developed tuberculin, a purified protein derivative of the bacteria. In 1908, Charles Mantoux demonstrated it to be an effective intradermic test for diagnosing tuberculosis.

In 1895, Wilhelm Konrad Von Roentgen discovered X-ray which made doctors possible to observe the presence and the progress of the disease.

In 1902, the international conference on tuberculosis in Berlin proposed the ‘Cross of Lorraine’ to be the international symbol of the fight against tuberculosis. The Lorraine Cross was carried to the Crusades by the original Knight’s Templar, granted to them for their use by the Patriarch of Jerusalem. In the Catholic Church, an equal armed Lorraine Cross denotes the office of archbishop.

Albert Calmette and Camille Geurin discovered the BCG vaccine from attenuated bovine strains of tuberculosis. The vaccine was first used on humans in France in 1921.

Streptomycin discovered in 1944 became the first antibiotic effective against Mycobacterium Tuberculosis and its discovery marked the modern era of tuberculosis treatment. Soon after in 1952, Isoniazid was developed to become the first oral drug effective against Mycobacterium tuberculosis. Rifampicin followed in the 70s.

The possibility of the disease getting completely eliminated became visible on the horizon. However, the emergence of HIV, the development of resistance to drugs particularly Rifampicin and Isoniazid coupled with inadequate control programs let to resurgence of the disease.

60% of HIV +ve patients contract tuberculosis during their lifetime. Management requires therapy with both anti-tubercular as well as anti-retroviral drugs.

Multi-drug resistant TB (MDR-TB) and its more severe form extremely drug resistant TB (XDR-TB) is rocking the planet. Statistics on the quantum of drug resistance is still patchy but the trend is hard to refute. There are drugs that cure MDR-TB but it does not cure everybody. It takes a minimum of two years under the available regimen though trials are on, for shorter courses of treatment.

In a recent study published in the Lancet Respiratory Medicine journal, researchers said that more than half of 30 drug resistant TB patients treated with transfusion with their own bone-marrow stem cells were cured of drug resistant TB after 6 months. This may be another new ray of hope.

After a gap of 40 years, a new drug for treatment of tuberculosis was discovered. Bedaquiline, was approved under the accelerated approval programme of the FDA. The drug demonstrated the potential to fill an unmet medical need, has the potential to provide effective treatment where no satisfactory alternative therapy exist particularly in some cases of MDR and XDR tuberculosis. However, the drug also carries a “Black-box warning” of possible fatal cardiac arrhythmias.

Today, we are at the cross-road of elimination of this age-old disease during our life-time and million more TB deaths. The concept of “Universal Access” calls for all health-care professionals to deliver his maximum towards tuberculosis control.

The cost of inaction can be high, failure to roll out the tools that we have, can be disastrous.

Days have gone by,
months have passed away,
some memories have faded,
some refuse to go away...

India Shining

A way to monitor the efficacy of the existing health system in a district is to interview a sample of patients by method of home-visit.In one such exercise,I reached a village in West Khasi Hills District of Meghalaya.
As the SUV manoeuvred through the road(one can't actually call it a road),top-less, bare-footed kids pulled the back-bumper,some jumped on it.Most could have run faster than the jeep but all chose to follow.
The village had not seen an outsider for long.In no time,I was surrounded by a huge crowd.Some looked curious;most seemed happy.
Poverty at it's worst,torn dress and shattered looks were more than I could see.
As I began talking to them through a local interpreter,some smarter ones tried to speak of the bad road,some asked for a school and a few others for electricity.
Little did they understand that I had come just to take interview of a patient..and their problems were far beyond what I could address.
Roads for one,I knew would never happen,why should the government invest on the track where no vehicle plies...where no one will ever own one.School and electricity though were remote possibilities.
After I talked to the patient,I clicked a few photographs and showed to them on my laptop.They all surrounded the screen searching for themselves in the picture..all of them definitely quite amazed with the gadget.
One of them told me that the last time a visitor had come to the village was around 5 months ago and he had something to do with the soil.
Perhaps he had come to conduct a survey on the Uranium reserves in this place.He probably had to do with what was underneath and had no business with who and what was above the soil.
Patricia,a renowned journalist had once called the two Lok sabha M.Ps of the state as 'Uranium ministers' when they were given ministerial berths at the centre when the rest of the M.Ps of the 5 smaller states of the North-East were denied the same.
The people were agitating against Uranium mining,then and their positions carried the rider of convincing the people. Today, we see no more agitation...the mouth of the agitating leaders have perhaps been stuffed to silence.
I have read somewhere that fusion is the ultimate source of energy and Uranium the fuel.I have also come across that the 'Nuclear deal' that was signed by the country banked largely on the limited Uranium reserves,one of which is in this part of Meghalaya.
Why is there so much darkness in the lives of people whose land will be lighting the rest of the country?
West Khasi Hills has been giving the nation tonnes and tonnes of coal every year for decades..the administration is unpardonable for the lack of development in this district.It's not about asking for quid pro quo but it's criminal to keep people in such abject poverty and deprivation when we are boasting that we are a global power,an emerging economy.
Is India truly shining? Are we merely talking of the glittering street lights of the towns and the cities? Are we only counting on the hypermarkets and condos that signify urban India today?
As I bade good-bye to these people, knowing fully well that I will never be back to this place again, I saw a beam of hope in their eyes. They must be thinking that I will be bringing something good for them.
Six months after..as hopes decline, they will be talking among themselves that a man came,said he was a doctor,talked to a patient and went away...nothing changes anyway.

One Night in a hotel room

A nine hour long journey had tired me out,it was 7:00P.M. already dark for over an hour on a winter night.
No.316 was a big,well designed room;moonlight hitting on the bed producing murky shadow of the glass wall that stood between the room and the verandah.The verandah overlooked the lake that seemed to be all around it as if the room had been constructed on a peninsular land that insinuates into the lake.Inside the room,I saw a wooden staircase leading to a glass cubicle where there was a bunk bed,a television set and a small carousel,where the children could do their "LAKDI KI KATI".
A perfect honeymoon destination;a perfect place for a family holiday too,I was enthralled by the extravagance of this room...I was seduced by the ambience of the surroundings.I wished my kids were around me,even as I well knew I could not afford this room on a private holiday.There must be others more pocket-friendly,the room would not have been as exquisite,the lake could have been as placid,the moonlight could have been more soothing.I took a quick hot water shower,put on warm clothes, arranged a hot-air radiator and decided to spend the evening on the verandah.I ordered for a glass of "PINA COLADA" and nursed it for three long hours on tiny sips.
I remembered my daughter telling me,"Papa,though you are the real head of the family,mama is the real head".She used the word 'real'on both occasions but I understood what she meant.I wasn't the one running around footing bills,attending parent-teacher meetings,buying vegetables,getting electrical connections repaired,calling in the plumber or helping her in her home-works.I wasn't the one taking her to dentists or to doctors even for minor ailments when her dad was one.
I could neither make it on her birthday nor on her brother's first birthday. She knew her mom had planned a grand evening on her 10th wedding anniversary which had to be reversed in the last hour when I failed to turn up.
For no fault of mine,I was feeling wrong.I hugged her as tight as I could as if I could squeeze part of my guilt away and in a self defence tone,I said,"Think about the children who do not have any of the parents".The reality was that I was not there when they needed me.To them,I mattered,not what I do...I said to myself,she is too young to understand what is "Touching lives as you travel miles".I thought of ringing them up to say where I had reached. With my rapid shuttling of places,it had ceased to matter to them where I was...what mattered was,I wasn't at home.I changed my mind to ring up the next morning.
Though I loved picking up my meal from the buffet,by first judging the food with my eyes,I was getting too fond of this room to even part for an hour.I scrolled through the 'A la carte' and ordered for something I could barely pronounce,the food that came in was beyond my understanding,I would have preferred the PARANTHA at the road-side Dhaba.
I thought of Morrie,a character in a book "TUESDAYS WITH MORRIE".I thought of how the Lou Gehrig's disease was stealthily taking everything away from him and how he took it all...SMILING.I liked the lines that he wanted on his tombstone," A TEACHER TILL THE LAST".Morrie reminded me that teachers were people who could be so tender yet so strong,when the situation demands.I had seen it in my wife,I had seen a glimpse of it in my friend. He made me admire them all the more and for that...I loved him.
I remembered me not being me,I looked back to see how foolhardy I was.I knew the weakness was on my mind and that's where the real battle needed to be fought.Chaos,confusion,pain...but amidst all that hoopla,my inner strength was growing in leaps and bounds.I felt a sense of victory...a win over my own self.My heart was heading for a silent oath...the bow was to bear.And the final big lesson," You can't be rough with the petal of a rose...it shrivels".
I played my favourite number 'AGAINST ALL ODDS' by Phil Collins over and over again.I knew I could write a poem...William Wordsworth would have created another' Daffodils'..I wrote simple lines.I saw a simmering light in the horizon..a small boat...FISHERMEN OF THE NIGHT.
What do I say about this place...'AN OASIS OF SERENITY'..nay..beauty was beyond words.I wished the night never ends but the temperature was plummeting,the cold..disabling.
I changed the music to Kishore Kumar's no." Mere Liye Soona Soona",it was on this song that I last danced..that was a good 10 years ago.On this song, I could not stop myself...I danced again.The music had the rhythm,my dance was not matching it...it didn't match 10 years back too.
I lay on the bed humbly acknowledging,"All good things come to an end".I curled on like a baby,the music was now changed..it was 'Kenny G' playing me the lullaby.In my dream,in the darkness of the night,I was boating alone in the lake. A woman in a white saree walked on the water away from me as if the surface tension of the water was able to withstand her body weight.She never looked back,I never saw her face.
My mobile rang,I looked at my watch,it was 3:15 A.M.,which meant I had slept for three hours.I picked up the phone,there was no reply..I rang the no.back and the IVR replied "This number does not exist". 'So weird'I thought and slept again.The mobile rang again,it was 3:30 A.M.,again no reply.I rang back and again the same reply " This number does not exist".Phone calls at odd hours make you worry;small children in one town,ageing parents in another...my sleep was disturbed.I considered ringing them up but thought it was not right to disturb at such odd hour.
I must have dozed off for a while when the crimson rays of the rising sun penetrated the glass wall to hit my eyes.It was 6:00 A.M.,I hurriedly got myself ready. I was almost leaving the room..that was when I looked out for my mobile,I couldn't find it.In a fit of rage,I called in the waiter,"Who the hell is playing the prank with me?"I shouted.
"Any problem sir" he replied.
"Where is my mobile phone" I sneered at him "I was receiving calls on it last night".
He calmly replied,"How do I know,sir?Wasn't your room locked from inside?"
"Yes,it was locked but you must have opened it from outside with the master key and taken the phone away while I was asleep.I am talking to the Manager" saying this I walked out.
My driver was there in the lobby of the hotel.He said,"Sir,I found your mobile inside the car". I got even more irritated,"So,you are also part of this whole joke"I said to the driver who stood astonished.I snatched the mobile from him saying how can it be in the car when I was receiving calls on it last night.
I immediately checked the "Call Log",the last call I received was the previous day afternoon 3:00 P.M.,there was no call thereafter.
The waiter perhaps reported the matter to the Manager who came up to appease me.She called me to her chamber and offered me a glass of water.
"Dr Singh,you are the first one to occupy this room" she said.
"How's that so? Isn't your hotel supposed to be eight years old"I replied.
"That room was locked for 5 months..when it reopened you are the first one to occupy" she said calmly.
" Why..why was it locked?"I replied angrily.
" Inquest..forensic grounds" she said.
She continued," A honey moon couple came 5 months ago..the next morning the woman was found dead..her throat slit..the man missing,we need to perform some HAWAN".
I got onto my car...my next destination was four hours away.

A Humble Prayer

When the soul is weary,
and the heart is tired.

When you have that failing feeling,
that says " I can't take any more".

When you don't have the strength to lick your wound
and live to fight another day.

When there is no one to understand you
and you know you have lost them all.

When you are just about to give it up,
as your heart breaks into unrecognisable fragments.

That is when you go back to God,
Once again muttering your child-like prayer.

That is when the kneeling soul learns
that the listening Lord is there.