Beyond the Steth: An unconventional medical prescription
By Nitin Ignatius
HOW IT ALL BEGAN
Education is a tool of empowerment. But in reality, I felt it was serving the exact opposite purpose. A person who completed 10th grade should ideally feel good about it, but I saw most feeling already insecure about their 12th admission and the same trend continued through MBBS MD Mch and so on till one’s grave. Many of the senior most faculties who were supposed to be role models didn’t seem content with life either. On the other hand, I had already met people who had no degrees and very few possessions feeling more blissful about life.
From all the moonlighting in local clinics for pocket money during college days I had understood that medicine as we are taught in a tertiary care setup was not resonating with the common ailments with which a person approaches his health care provider. It was common sense, empathy, and practicality that always prevailed over any gold standard drug, investigation, or treatment. So, I knew there was a gap in my training as a doctor that an academic institution was failing to fulfill.
I was always a traveler, first to tourist places, then to offbeat destinations, and then to no particular destination at all, and from each journey which lasted a few days or a couple of weeks or a month, I always came back more enriched. A couple of years to roam around the country was something that I always wanted to do and with an MBBS degree, I felt secure enough. The whole idea was to own a rucksack and a tent, start from a place nearby and go far, not to expect anything, and to go and experience whatever comes by with open eyes and an open mind embracing all the confusion that was bound to come along. Then I met a few amazing people who gave me more people and places to go to and spend time with, offered me a stipend for a year and camaraderie for life calling it a Travel fellowship. In retrospect, it is the best decision I have ever taken to date.
Articulating the experiences of crisscrossing the country for three years would never do justice to even a day out there. The time I spent living with rural and tribal communities in all four corners of India and the center of the country across mountains, deserts, forests, and plantations was an eye-opener to the realities of our diverse country. I heard countless languages and managed to pick up a few. I partook in countless feasts and festivities and danced to countless songs. I bathed in rivers, roamed in fields, caught crabs, and climbed hills with awe-inspiring nature around. I have felt the warmth of hospitality in places people perceived as hostile. People laughed more often, and life was more laid back. But not everything was as rosy as the romantic in me wanted it to be, rather I saw inequalities all around.
FACING REALITY
The same holy hill where we had danced the whole night was being leased out for mining and the people who fed and sheltered me with all love in the world were about to be displaced from their homes. The boy who showed me his village was about to migrate to the city as a manual laborer as his 33-year-old father was forced to retire from the same work because of ill health owing to 20 years of hard labor. Another boy wanted to learn to dress a bullet wound and was eager to teach me to fire a gun in return. An old man who hosted me in his home was hitting his daughter-in-law quite mercilessly and believed he had every right to do so because he had bought her with his money. In one place a Brahmin fasted on milk, fruits, and sago pearls while a recently Hinduised tribal fasted on a 5-rupee savory.
Hunger was the most dreadful side effect of anti-tuberculosis medicines. Leaving livestock unfed even for a night was never an option and was the biggest reason for reluctance in overnight hospital stays. No matter how severe the disease was, it was impossible to come to the hospital during sowing or harvesting seasons as it would mean food shortage for the entire year.
It was increasingly becoming clear that even the right to take care of one’s own health was a privilege only a few people enjoy.
PRICELESS LEARNINGS
Working in resource-limited secondary and primary care hospital settings, being part of community health movements, and even attempting to set up a primary care clinic in a remote village, my clinical acumen improved for sure. There was excellent mentorship and amazing colleagues all around and experiences were always hands-on. I was soon confident enough to diagnose, admit, treat, and discharge most patients and do minor operative and obstetric procedures independently. I could train and learn a lot from nurses, health workers, and other volunteers in different languages, and with each place, I had something new to learn. The more I spent with the community more I learned. I was also exposed to various social sector initiatives in education, livelihood, microfinance, governance, land rights, labour rights, peacebuilding, and forestry. This is where I began to understand everything is related to health in its broadest sense. The biggest learning was on how to customize care for an individual, family, or community. What works in one village may not work in the next. There was never a one-size-fits-all protocol. Every time, we had to adapt and improvise. And everyone was passionate about what they did.
It is very difficult to say how the travels have influenced me. I am definitely not the same person who started off. Doctors many a time are like horses with blinkers on, we see only diseases that are facing us in the eye and fail to see laterally - the person as a whole in his community with all social complexities. Having imbibed a bit of every place it is as if the blinkers have come off. I believe the whole idea of medicine is to attain the highest possible health and well-being for all the people. I feel more empowered knowing that there are many like-minded people around and the biggest gains for me from my travels are those people whom I befriended. It is as if I have many homes in many corners of the country where I can go anytime for any amount of time
