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May 31, 1997


he cool, clean sheets pulled up almost to his chin, he lay motionless on the bed, his powerless arms crossed tightly over an emaciated chest. Under the white linen, a narrow tube punctured his abdomen and entered the left kidney to drain urine as it collected.

Occasionally, the head would move slightly and the eyes would snap open. A wasted right arm would emerge from under and hook on to an overhanging strap. He would put weight on it and try to lift himself slowly. The lean face would screw up with the effort and then, inch by painful inch, the paralysed torso would move... just enough to shift his upper body a couple of inches this side or that.

This is how it has been for Antony this past 17 years.

It has been 17 years since he last walked. Seventeen years since he held a rifle. Seventeen years since he ate with own hands, bathed himself, combed his hair or shaved himself.

It has been 17 years since he ceased to be the soldier he was, 17 years since he became a physical vegetable, a tetraplegic. Now he is another inmate at the Army's Paraplegic Rehabilitation Centre in Pune, its 23rd.

On hot afternoons like this when the whole centre sleeps, he would lie on the bed and, between catnaps, think. About the fluke accident on the army basketball court which rendered him immobile from neck down, about his family and about the kidney surgery -- his sixth in the past seven years -- he has to have two months from now.

He was thinking about it when the door to the huge room which he shared with three others swung open and Muralidharan Nair, another inmate, wheeled in.

"Asleep, Antony?'' he called. "You have a visitor."

The tired eyes snapped open, the head bobbed in greeting and the right arm attempted to wave his guest to a chair.

"Sit down, please," he said in Tamil. The words, coming through parched lips, were painfully thin.

"The catheter," he nodded to his abdomen, "will have to come out soon."

Antony's right kidney is gone. Dead, like the rest of his body from neck down. So is two-third of the left kidney. Severe urinary infection -- the curse of all paraplegics -- which blocked his bladder and urinary passage had crept up. Now he has to rely on the catheter.

In the morning, Antony had been to the hospital. After his morning bath, the attendant had carefully lifted him into a wheelchair and wheeled the seven kilometers to the private hospital. No auto-rickshaws or taxis for Antony -- for him every paisa counts.

After his accident in 1980 -- which shattered the fifth and sixth cervical segments of his spine -- Antony spent the next two years at the Military hospital. Then he moved to the PRC next door, and has been there ever since.

Urinary trouble plagued him right from the beginning. First it was infection, then two enormous staghorn calculi (stones) had to be surgically removed from his kidney. By 1994, his urinary passage was completely blocked, and the kidneys were functioning badly. His blood urea count had shot up to twice the normal (it is still stuck there). The doctors tried to drain his kidney by inserting a catheter through the urinary passage, but it did not work. Finally, they decided to drain it directly from the kidney.

But there was a problem. The military hospital didn't have the computerised equipment needed for inserting the catheter then and Antony was forced to approach a private hospital. Which meant he had to pay from his own pocket for the treatment. The foreign catheter itself is costly; and then there is the hospitalisation charges for three days.

"Since they know about my case, I get some reduction. But, even then, it comes to at least Rs 15,000 every time," he said. "The catheter needs to be changed every eight months. Then I need about Rs 500 worth of antibiotics and tablets each month."

So, for eight months, Antony diligently saves every paisa of his Rs 2,400 disability pension to hand over for his treatment. Now the facility is available at the MH too, but the Indian-manufactured catheters being used there need to be changed every month.

"Besides, I have been seeing the same doctor. It's not good to change doctors in between," Antony said. "Anyway, I would rather it was changed less frequently."

Now, it is time for another change. In the first week of August, Antony would exchange his hard-saved pension of eight months for a new, German-made, silicone-coated catheter. Then he wouldn't have to worry till next April.

The familiar white-coated figure moved briskly along the corridor, past 'A' block towards his office. The mosaic corridor was wide (with space for three wheelchairs to pass comfortably) and glowing clean. Flower pots lined the sides.

"Namaste, Doctorsaab," said an inmate as the figure approached.

"Namaste," he responded absently, without breaking his step. A little down the corridor, he turned left and stopped by the first room. Above the closed doors, a board proclaimed his identity: Lt Col (Dr) S P Jyoti, medical director, Paraplegic Rehabilitation Centre.

Dr Jyoti is a short, burly orthopaedic surgeon in his sixties who has been specialising in spinal cord injuries for over a quarter century. He had been the medical superintendent at the Military Hospital, Khadki. After retirement, he had taken charge at the PRC, whose inmates (or 'boys', as he prefers to call them), all of them, had been his patients.

The PRC, meant for the 100 per cent disabled personnel of the three defence forces, has now been in existence for nearly 23 years. On June 27, 1973, the then chief of army staff had laid the foundation stone. Next year, on July 7, the centre started functioning when it took in its first batch of inmates -- 11 paraplegics who were discharged from the MH. Then, the centre had a capacity of just 24 single beds.

In 1980, the facilities were increased to accommodate 65 inmates which included 57 single beds and family quarters for eight. Today -- spread over 10.3 acres, the building consists of four identical parallel blocks connected by a massive corridor which cuts through its centre -- the PRC is the largest of its kind in south-east Asia. It now houses 75 inmates.

In the 10 years he has been at the centre, Dr Jyoti has seen the organisation grow -- if not much in the number of inmates, certainly in stature. The 'D' block was added after he took over -- the Rs 5.5 million building with 30 beds have taken up the accommodation capacity to 109. However, even four years after it became functional, the block is yet to house even a single inmate, thanks to the severe fund crunch plaguing the centre.

"We have 30 disabled on our active list and there are hundreds who have returned home after they were discharged from the MH,'' Dr Jyoti, now seated in his spacious office, was saying. "But as things stand today, we cannot take care of even one more person."

Since 1968, over 2,000 disabled ex-servicemen have been discharged after they reached the finality of treatment at the MH (For an officer, this is one year and for a soldier, two). Many would like to come back.

"These people are completely dependant on attendants for almost everything. They need lifelong care... lifelong specialised care," says Dr Jyoti.

Both para and tetraplegics (or quadriplegics) have no bladder or bowel movements. "Their injury is on the spinal cord, the part of the brain which continues down through the backbone. See the nerves which begin at various levels from it?" Dr Jyoti pointed to a medical chart. "They serve different functions. Your movement, your sensation, your equilibrium, your bladder and bowel control, your sexual urge, everything is controlled by the brain through the spinal cord. It is comparable to a main electricity line serving many smaller units. What happens if the line is cut in between? The area beyond the break would be in complete darkness. The same thing happens when you permanently injure your spinal cord -- higher up the spine the injury is, the greater the disability."

Thus, persons who sustain injuries to the first eight cervical segments of the spinal cord would become tetraplegics; those with injuries after the eighth segment -- in the thoracic, lumbar, or sacral regions -- would end as paraplegics.

In India, however, only those who sustain injuries below the third segment will survive. "If the injury is at the third cervical, his breathing stops. In European countries he may survive, but not here," Dr Jyoti explained. The option of neuro-muscular simulation (neuron transplant to the injured area) is available to the paraplegics abroad.

"Experts abroad are willing to operate on our inmates for free. But the inmates will need highly expensive follow-up treatment when they get back -- and we do not have the needed infrastructure for that," said Dr Jyoti.

They are extremely vulnerable to bedsores, pneumonia and urinary infections which, in many cases (as in Antony's), leads to kidney failure. Normally, a paraplegic would pick up kidney trouble within the first five years. The bladder muscles being paralysed, the urine has to be drained by external pressure. The paraplegics drain it themselves; the tetraplegics need an attendant's help. This operation, however, wouldn't empty the bladder completely -- hence the risk of urinary infection.

Similarly, they are vulnerable to pneumonia -- a common cold, if not cared for properly, would lead to serious complications. "A tetraplegic cannot cough. The discharges need to be removed from the lungs if there is infection. Or it will develop into pneumonia," Dr Jyoti said. ''Bedsores, too, could develop into septicemia and be life-threatening for them."

Almost all the inmates at the centre have been admitted to the military hospital at some point of time for treating bedsores -- however careful you are, this, like the urinary trouble, is one thing which a paraplegic cannot escape.

"In Europe, in the early 1940s, 80 per cent of the paraplegics used to die within two years of their injury. But now, with new developments and medicines, they are sending 80 per cent back to work. From 80 per cent dead to 80 per cent to work -- that's progress they have achieved there. But in India, 80 per cent of the paraplegics in the villages still die," Dr Jyoti rued.

"Taking care of a paraplegic is expensive and the majority cannot afford it," he continued. "Every year, our own boys who come to the MH for treatment ask for space here. But..."

Away to the left of the 'A' block, adjacent to the wheelchair racing tracks which runs parallel to it (which is the first thing you notice coming in) is the PRC's basketball court. Here is where most of the 'able' paraplegics get together on "pleasant" (read not too hot) evenings to -- as they say -- "stay fit".

This being another of those pleasant summer evenings, they were warming up for a game. In trousers and basketball jerseys, the players roamed the court practising their shots, while an appreciative audience -- of inmates, attendants, and other regulars -- watched. The shots, though from wheelchairs, went in more often than not.

The two teams readied for the jump-ball. The referee tossed the ball between the players and blew the whistle. The game was on -- and off went the players. With amazing speed and dexterity -- highly unexpected from the 10 wheelchair-ridden men -- they raced down the court, skillfully braking and turning away from each other, passing fluently and scoring occasionally.

To most, the game was more than just a game -- it was a solace, one of the few pleasures they have left in life, a chance to pit themselves against opponents, a reminder of their fighting days... And as such, it was fought with an enthusiasm and spirit that would do any professional proud.

"Look at them, they always fight it out! No halfhearted efforts about my boys!" said Dr Jyoti proudly.

This, he said, was true in other cases too. For instance, at the sheltered workshop in the compound where a private company employs the men to assemble electronic connectors, they worked with a dedication seldom seen in normal workers.

"The default ratio of what my boys produce is less than that of the normal workmen," Dr Jyoti claimed. "These are the only few challenges they can take up and they give it the best they can."

This spirit, probably, is the reason why the centre boasts of so many Shiv Chhatrapati award winners (the Maharashtra government's prize for excellence in sports) -- 17 -- under its roof. Nine inmates participated in the para-Olympics, of whom three came back with medals.

Some three hours later, everyone had finished their dinner in the huge chairless dining hall and were out on the corridors, relaxing. "The first six months after the accident is the most difficult period in any paraplegic's life," said Muralidaran Nair. He, too, like Antony, was hurt in a fluke accident. While crossing a small bridge, he had fallen down and injured the thoracic segments of the spinal cord. He was then 24.

"Initially, I had the feeling this was not very serious, I would be able to join my regiment soon. I came to know I would never walk again only after two months. The initial reaction was to kill myself... but later, when I came in contact with others like myself, the feeling wore off. Here, I see many people like me, I am treated like a normal person..." he paused, thought for a moment and added, "I am not sure whether I would have survived so long if I was at home."

Dr Jyoti was to endorse the view next morning. "The first step in the rehabilitation process is to convince them that the paralysis is final. That is the most difficult part. Once the disabled has accepted that, the rest of the recovery is not very difficult."

Forty-four year old Hariram Kohli, a tetraplegic artist (he paints with a brush clenched between his teeth), has own explanation for this. "You see, there are four stages in a paraplegic's life -- non-acceptance, anger, bargain (with God) and acceptance. Most of us here have overcome the first three stages and are in the last state. That's why you find us happy and comfortable with ourselves."

"But are you really happy?"

"Yes. There is no point in being sad. What has happened has happened. And it is irreversible. So why be sad about it?"

Yet, beneath this mask of happiness which all inmates wear, beneath it which prompt them to dress smartly, speak cheerfully and laugh merrily, there lurks a soul-wringing pain. Which Radhakrishnan, a tetraplegic for the past 17 years, put into words:

"We talk and we laugh, yet none but us can understand what it is to be like this."

It has been 17 years since Antony walked.

Antony on his wheelchair

Outside the Paraplegic Rehabilitation Centre

The wide corridor allows three wheelchairs to pass comfortably

Relaxing in the corridor

Lt Col (Dr) S P Jyoti, medical superintendent, PRC

Playing basketball

The inmates in action on the basketball courts

The inmates in action on the basketball courts

Some of the inmates who participated in the para-Olympics

The enormous, chairless dining room

Hariram Kohli


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