Commentary/Dilip D'Souza

Tonic In The Hills

A young woman I know well, I'll call her Vinita, had a boil on her hip some time ago. This was no ordinary boil: the vile thing grew below her skin to a point where Vinita could not walk or sit without pain. She kept hoping that it would eventually subside, as less fierce boils do. But this one showed no signs of doing so. After days of pain, she was admitted to the hospital nearby late one night. The next morning, the surgeon gave her anaesthesia and actually dug it out, leaving a pit nearly two inches deep in her flesh.

When I took her flowers after the operation, Vinita was weeping softly with the pain. Luckily, the wound healed rapidly; she recovered and was back to her normal routine in days.

Just a few months later, Vinita found herself in the beautiful hills of southern Orissa. As it happened, I managed to tag along. Priya, a doctor we know, spends ten days a month tramping about in the various tribal villages in the area, bringing thousands of tribals there the only health care they ever get. We joined her on one of her trips.

It's through Priya and her husband Pravin, also a doctor, that I have got to know a little about the way the Saora tribals of that part of Orissa live. The two write regular letters which are always a strange mixture of hope and despair. In a recent one, Pravin mentions an immunisation programme against measles. Routinely laconic, Pravin does not say much else about it except that the programme will ''prevent a recurrence of last year's epidemic in which several hundred children died." Yes, in Orissa, measles murders children.

But in that letter and the next one, Pravin also describes what finally happened to Sushant, a boy from the hills he has been telling us about for some months. Sushant hurt his leg a while ago. With months of neglect at the hospital at the district headquarters, it turned gangrenous. It looked like there was no choice but to amputate the leg. If that depressed us, who knew Sushant only through letters, it must have been devastating to all who knew him in Orissa.

There was one option. An orthopaedic surgeon in Bhubaneswar offered to treat the boy, optimistic that he would be able to save the leg. The snag was, naturally, that his charges ran to tens of thousands of rupees. Sushant's family had nothing close to that kind of money. Eventually a benefactor from Bombay sent a donation that Pravin decided to use for Sushant.

I'll let Pravin's words describe what happened next: "I had a pleasant visit to Bhubaneswar on the 8th... [The surgeon] put a plaster cast on the leg to straighten the foot and will reapply it again next month. After a couple of months he plans to lengthen the Achilles tendon which has shortened. Then he expects the boy to start walking almost normally. This was a big relief to everyone."

It may not strike you, but I know. Those words, especially "pleasant" and "relief" are as close to an expression of exhilaration as we can ever expect from Pravin.

With stories of experiences like these at the back of our minds, we set off for the hills with Priya. Her days there are like their letters: that same strange mixture of hope and despair. Her efforts to train health workers and promote simple preventive health practices are beginning to pay off: the overall standards of health in the area are showing signs of improving.

But every visit has its share of sadness. The time Vinita and I joined her was no exception. A two-month-old boy died in one village because ... well, it happened like this. He had a high fever; as always, there was no doctor to examine him at the closest government primary health centre, a six-kilometre trudge away; a compounder there "prescribed" an expensive multi-vitamin tonic -- like everything else in the world of medicine, unavailable at the PHC; the boy's parents asked a friend to make the one-day hike into the plains to buy the tonic; the boy died before the friend could return. That was that.

Also that time we were there, Vinita had a curious reminder of her own hospital experience of some months before. News came of a teenaged girl in another village who was suffering from a boil on her hip too. It was clearly just as painful to the child as an earlier one, back in Bombay, had been. She, too, was walking and sitting with difficulty. Priya decided to bring her to her makeshift clinic to excise it. The journey, a jolting hour over terrible roads in the back of a jeep, was hard enough for the rest of us. We shrank from the thought of what it must have been like for the girl. But she bore it without a sound, with even an occasional smile.

At the clinic, here's how the operation went, as Vinita later related it to me. She and Sasikala, one of Priya's health workers, held the girl down on a cot. Priya picked up a knife and cut straight down into the flesh around the boil, two deep cuts forming a 'X'. Then she took a pair of scissors, slid it into the wound and separated the blades, tearing the inner flesh to widen the incision. When it was wide enough, she removed the infected tissue and bandaged up the wound. No, the girl was not anaesthesised: such frills of modern medicine have not yet made the ascent into the hills of tribal Orissa.

Forgive me for being so blunt. It was hard for me to even listen to this account, not much easier writing those last few lines here. Vinita tells me the girl whimpered every now and then, that's all. I marvelled at that: here I was, the hardened city type -- so I thought -- feeling faint just hearing about the operation second-hand. I marvelled also at the strength of Priya, who has to work in these conditions, deal with these situations, month after month, year after year.

Relating these small tales, I am trying to give you a flavour of the roller-coaster my emotions ride, the odd directions my thoughts take, when I hear from Orissa. Pravin's understated joy over Sushant rubs off on me, but I also think: I too hurt my leg as a child, but in Bombay, mine did not turn gangrenous. I think: I and nearly everyone I know had measles while growing up, but unlike many Oriya children last year, we all lived through it. I think: two nearly identical boils, but by the way they were treated, they might have been on two different planets.

Above all, the letters from Orissa reach out to that soft corner I have somewhere inside me for those hills. The fragrance of the air there, the silence that wells up mightily from the valley, the magnificent sight of the Milky Way rushing whitely across the starry night sky, the hope that shines through the despair: there's a quality to these memories that I will always savour. I have travelled to many and distant places, but none touched me as this one did.

For this hardened city type, there can be no better tonic than regular visits there. I have managed one.

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