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The Rediff Special/A V Ramani

A death in the dispensary

30 year old woman from Orissa Subhashi died quetly and without a fuss. This 30 year old woman from Tinighoria village in the Kerandimal hills of southern Orissa had been coughing for six months before she was brought to our little dispensary. Too ill to walk, weakened by anaemia which caused her feet to swell up, she had an air of calm acceptance about her. As if to say, I'm ready for whatever life has in store for me.

A jeep was returning to Mohuda from a field trip. Her husband and daughter brought Subhashi to us in it. She was only skin and bone and obviously very ill. Examination showed that her lungs were extensively damaged, probably by tuberculosis. Her sputum showed numerous acid-fast bacilli, the deadly mycobacterium that causes TB.

We started her on the appropriate drugs. We also explained to her husband that she needed blood and oxygen, both of which we did not have. They were only available at the large medical college and hospital in Berhampur, about 10 km away. But he was adamant: he did not want to take her there. He seemed to feel that he had wasted enough time and effort already, bringing her to Mohuda. "I would not have brought her if the villagers had not forced me to," he grumbled.

Subhashi was extremely cold, and spent most of the next day in the sun. I got somebody to take her photograph, sure that she would not recognise herself even two months later. Anti-TB drugs act almost miraculously on a patient. She said nothing when the picture was taken, but I could see that she was pleased.

At 10:30 that night, Subhashi woke up to go to the toilet. Since her husband and daughter were asleep, she walked by herself to the bathroom. By the time she returned, she was out of breath. We had gone to check on her just then, so we put her back in bed and propped her up. Once again, we asked her husband to allow us to take her to Berhampur. Once more, he refused. He said she was going to die anyway, so there was no use worrying about her or wasting any more time and money on her. Her daughter fast asleep beside her, Subhashi lay there and listened to both of us. I was arguing and getting angrier; the husband remained indifferent and quite immovable in his opinion.

Suddenly, Subhashi stopped breathing. We tried to resuscitate her, but I knew it was futile. Anaemia and the TB had defeated her. Or was it something else which made her give up her will to live?

Even in death, Subhashi's face wore that same look of calm acceptance. I wondered then and still -- how did she remain so? I do not feel calm when I think of her. Nor can I accept her needless, lonely death. Is there a lesson I must learn from Subhashi?

A V Ramani is a MD in Community Health from the Christian Medical College, Vellore. She works for Gram Vikas, a NGO in Mohuda, Orissa.

A doctor's heartwarming account of health care in Orissa...

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