Jan-Feb 1998
We've been in the RHC for 2 weeks and it's time for the Pulse Polio Programme. Held every year, this essentially consists of catching every under-5 kid and making them drink a few drops of hopefully properly cold-chained Oral Polio vaccines. This serves a very important purpose of course since in many parts of India, where shit mixes with the great outdoors, the ingested vaccine is also excreted. This is then transferred by whoever eats the food contaminated with this vaccinated shit and they get immunity in turn. This can be massive, reaching many villages and areas within a reasonable radius. This is called "herd immunity" and is a concept that has been drilled into us during the course.
Essentially, if you can't improve the sanitation, flood the shit with polio vaccine. Polio will be eradicated by eating shit-that's the national strategy- and judging from the results coming in from various surveys, it seems to be working remarkably well.
It's good fun and all for a great cause. Polio is usually a mild illness but of course it can turn lethal and cause paralysis. Over the course of two nationally designated days, camps are set up in schools and villages and Health Centres, kids are identified in buses, trains and in houses and are given these drops to swallow down. Many people, from us Interns to family physicians, GP's, nurses, Health workers and all and sundry are involved in this process and it's a huge co-ordinated attack on the polio virus. The drops themselves are tasteless, and since the virus, although live, has been weakened just enough to provide immunity but not an actual infection, are safe enough. It does provide excellent community immunity and is a much more cost effective way of doing things. There are logistical issues related to the transport of the vaccine since the drops have to be kept at a certain temperature throughout the whole process from manufacturing to administration and great care is (usually) taken to see that this happens.
As Community Medicine Interns, we are allotted a village each and one Sunday, we make our way to these places where we find a school or a camp set up. I bike down to Thondamanatham and spend a pleasant day chatting with the school and health staff, vaccinating huge lines of kids and getting a first hand experience of a National Immunization Programme in action. The only hitch in this whole affair is that it also happens to coincide with an India-Pakistan cricket match being played in Dhaka, Bangladesh and I hop onto the bike and zip down to the RHC every hour to catch the score. It's a day/night match so by the time the crowds are dwindling and the sun is setting, Pakistan have racked up an impressive 300+ score. This is depressing so I stay put in the school for a while putting 3-4 drops of the vaccine into small open mouths but around 730, when it's dark and the camp is readying for pack-up, I give up and whizz back.
India are rocking the chase. It's a tense affair. The other Interns are also back and some are standing on the table chewing their nails to bits, shouting the choicest abuses, going into fits of ecstasy at every four or six and sinking into doom and gloom at every dot ball or wicket. Everyone is an armchair cricketer. Beers are passed around, smokes are brought in from somewhere, Karunanidhi is sent to make more Chilly Chicken. Finally, when no one can shout anymore, Badrinath hits the winning runs.
The place goes crazy.
Just a typical India-Pak cricket match. But a very atypical Indian chase. Very satisfying.
A few days later, the Dept of PSM arrives in a van and informs us of a cholera outbreak in the vicinity. We need to identify the source of this problem and that will mean going from door to door in the neighbouring villages and asking the residents if they have passed rice water stool recently. Shyam and I team up and are sent to Kodapakkam, the village with the booze shop. There will be 2 other teams with us and we divide the village between ourselves.
Kodapakkam is not a big place and Shyam and I find that our particular area has a few pukka houses and stretches of empty space in the middle. And with most of the residents of these houses away on work it's a piece of cake. Our interviews take less than an hour and while the others are sweating it out, we chill out drinking Mazaa Mango under a tree, killing time and convincing ourselves we've done our bit. Sure enough, the source turns out to be a water pump in the same village and we feel proud to have contributed to the general health of this area. A job well done.
In the evenings, we often walk around the village and I usually wear a white kurta-pajama-my standard night dress. One evening, while walking on the road in front of the RHC, a few villagers spot us, snigger a bit and say "Payee Payee". I understand that this translates to "Ghost" although I am pretty sure real ghosts wear other colours also. There is a strong ghost belief running through here.
We are also invited to the village chief's house for Pongal and head out there with the whole PSM Dept in charge. The hosts are very gracious and the food is quite good. There is a pooja and some general banter, none of which I catch because it's all in colloquial Tamil.
Once every few days, I am on call. This is more of a pain than anything because I can't stray away from the RHC and have to attend to every patient who lands up after OPD Hours with any complaint whatsoever, at whatever time. Most of the time, it's cuts that need sutures or aches and pains that drag me from the Dorm to the OPD where I take a quick history, perform a quick check-up and spend a few minutes rummaging through the medicine cabinet for something suitable.
Suturing is fun. It actually feels like I'm doing something useful. It's a whole process of cleaning and draping, debriding the wound, opening appropriate sutures from their sterile packages and actually putting needle to numbed skin and forming loops around a needle holder and then finally knotting the suture neatly. The end results look OK and get better with every subsequent wound.
Most of these patients also require a Tetanus Shot since no one can recall when they last got a booster. The TT (Tetanus Toxoid) vials are kept in a fridge in one of the rooms and each room in this OPD Block has a separate key. This means that when one is called to the OPD to attend a patient, there is a bunch of keys to contend with. One night, I suture a wound and open a few rooms to get to the fridge and the vial. I find a syringe and a needle and take the 0.5 cc needed. I replace the vial in the fridge but after I finish, send the patient off and am ready to lock up and get back to sleep, I discover that the keys are missing. It's 2 AM and this is extremely irritating. I then spend the next 15 minutes hunting for the stupid keys and finally locate them inside the fridge.
There is a lot of debate amongst us Interns as to which sequence of postings in Internship is the best in terms of opportunities to study. Alas, passing Final Year and slogging one's balls off in Internship is no excuse for the protracted, painful drama of PG Entrance Exams still to come. We have started with PSM, inarguably the posting with the most free time and will move on to Medicine, Surgery and OG in that order-each very busy postings with killer night duties and hard taskmasters. Batch A, which starts with Medicine and will get to Community Medicine only in September think they have it good because all that free time will arrive just in time when they really get serious about the Exams.
Frankly, I don't care. I'm still basking in the glory of passing Final Year. But even though these exams are a year away, they are completely unavoidable and will decide what one does for the rest of one's career. Each exam is taken by about 5000 aspirants, all fighting for a grand total of 50 PG seats on offer. The catch is that, for any given individual, only 5-6 seats will be of real interest. I know of seniors who got great ranks in the exams but did not get a seat and subject of their choice. It can take more than a few attempts to get it right.
I thought Final Year was the end. It's not even close.
We've been in the RHC for 2 weeks and it's time for the Pulse Polio Programme. Held every year, this essentially consists of catching every under-5 kid and making them drink a few drops of hopefully properly cold-chained Oral Polio vaccines. This serves a very important purpose of course since in many parts of India, where shit mixes with the great outdoors, the ingested vaccine is also excreted. This is then transferred by whoever eats the food contaminated with this vaccinated shit and they get immunity in turn. This can be massive, reaching many villages and areas within a reasonable radius. This is called "herd immunity" and is a concept that has been drilled into us during the course.
Essentially, if you can't improve the sanitation, flood the shit with polio vaccine. Polio will be eradicated by eating shit-that's the national strategy- and judging from the results coming in from various surveys, it seems to be working remarkably well.
It's good fun and all for a great cause. Polio is usually a mild illness but of course it can turn lethal and cause paralysis. Over the course of two nationally designated days, camps are set up in schools and villages and Health Centres, kids are identified in buses, trains and in houses and are given these drops to swallow down. Many people, from us Interns to family physicians, GP's, nurses, Health workers and all and sundry are involved in this process and it's a huge co-ordinated attack on the polio virus. The drops themselves are tasteless, and since the virus, although live, has been weakened just enough to provide immunity but not an actual infection, are safe enough. It does provide excellent community immunity and is a much more cost effective way of doing things. There are logistical issues related to the transport of the vaccine since the drops have to be kept at a certain temperature throughout the whole process from manufacturing to administration and great care is (usually) taken to see that this happens.
As Community Medicine Interns, we are allotted a village each and one Sunday, we make our way to these places where we find a school or a camp set up. I bike down to Thondamanatham and spend a pleasant day chatting with the school and health staff, vaccinating huge lines of kids and getting a first hand experience of a National Immunization Programme in action. The only hitch in this whole affair is that it also happens to coincide with an India-Pakistan cricket match being played in Dhaka, Bangladesh and I hop onto the bike and zip down to the RHC every hour to catch the score. It's a day/night match so by the time the crowds are dwindling and the sun is setting, Pakistan have racked up an impressive 300+ score. This is depressing so I stay put in the school for a while putting 3-4 drops of the vaccine into small open mouths but around 730, when it's dark and the camp is readying for pack-up, I give up and whizz back.
India are rocking the chase. It's a tense affair. The other Interns are also back and some are standing on the table chewing their nails to bits, shouting the choicest abuses, going into fits of ecstasy at every four or six and sinking into doom and gloom at every dot ball or wicket. Everyone is an armchair cricketer. Beers are passed around, smokes are brought in from somewhere, Karunanidhi is sent to make more Chilly Chicken. Finally, when no one can shout anymore, Badrinath hits the winning runs.
The place goes crazy.
Just a typical India-Pak cricket match. But a very atypical Indian chase. Very satisfying.
A few days later, the Dept of PSM arrives in a van and informs us of a cholera outbreak in the vicinity. We need to identify the source of this problem and that will mean going from door to door in the neighbouring villages and asking the residents if they have passed rice water stool recently. Shyam and I team up and are sent to Kodapakkam, the village with the booze shop. There will be 2 other teams with us and we divide the village between ourselves.
Kodapakkam is not a big place and Shyam and I find that our particular area has a few pukka houses and stretches of empty space in the middle. And with most of the residents of these houses away on work it's a piece of cake. Our interviews take less than an hour and while the others are sweating it out, we chill out drinking Mazaa Mango under a tree, killing time and convincing ourselves we've done our bit. Sure enough, the source turns out to be a water pump in the same village and we feel proud to have contributed to the general health of this area. A job well done.
In the evenings, we often walk around the village and I usually wear a white kurta-pajama-my standard night dress. One evening, while walking on the road in front of the RHC, a few villagers spot us, snigger a bit and say "Payee Payee". I understand that this translates to "Ghost" although I am pretty sure real ghosts wear other colours also. There is a strong ghost belief running through here.
We are also invited to the village chief's house for Pongal and head out there with the whole PSM Dept in charge. The hosts are very gracious and the food is quite good. There is a pooja and some general banter, none of which I catch because it's all in colloquial Tamil.
Once every few days, I am on call. This is more of a pain than anything because I can't stray away from the RHC and have to attend to every patient who lands up after OPD Hours with any complaint whatsoever, at whatever time. Most of the time, it's cuts that need sutures or aches and pains that drag me from the Dorm to the OPD where I take a quick history, perform a quick check-up and spend a few minutes rummaging through the medicine cabinet for something suitable.
Suturing is fun. It actually feels like I'm doing something useful. It's a whole process of cleaning and draping, debriding the wound, opening appropriate sutures from their sterile packages and actually putting needle to numbed skin and forming loops around a needle holder and then finally knotting the suture neatly. The end results look OK and get better with every subsequent wound.
Most of these patients also require a Tetanus Shot since no one can recall when they last got a booster. The TT (Tetanus Toxoid) vials are kept in a fridge in one of the rooms and each room in this OPD Block has a separate key. This means that when one is called to the OPD to attend a patient, there is a bunch of keys to contend with. One night, I suture a wound and open a few rooms to get to the fridge and the vial. I find a syringe and a needle and take the 0.5 cc needed. I replace the vial in the fridge but after I finish, send the patient off and am ready to lock up and get back to sleep, I discover that the keys are missing. It's 2 AM and this is extremely irritating. I then spend the next 15 minutes hunting for the stupid keys and finally locate them inside the fridge.
There is a lot of debate amongst us Interns as to which sequence of postings in Internship is the best in terms of opportunities to study. Alas, passing Final Year and slogging one's balls off in Internship is no excuse for the protracted, painful drama of PG Entrance Exams still to come. We have started with PSM, inarguably the posting with the most free time and will move on to Medicine, Surgery and OG in that order-each very busy postings with killer night duties and hard taskmasters. Batch A, which starts with Medicine and will get to Community Medicine only in September think they have it good because all that free time will arrive just in time when they really get serious about the Exams.
Frankly, I don't care. I'm still basking in the glory of passing Final Year. But even though these exams are a year away, they are completely unavoidable and will decide what one does for the rest of one's career. Each exam is taken by about 5000 aspirants, all fighting for a grand total of 50 PG seats on offer. The catch is that, for any given individual, only 5-6 seats will be of real interest. I know of seniors who got great ranks in the exams but did not get a seat and subject of their choice. It can take more than a few attempts to get it right.
I thought Final Year was the end. It's not even close.
ghosts wear other colours too?where did you discover that?
ReplyDeleteIt was kanitkar who hit the winning runs. We did not stay in dorm initially because extension people were filling the dorm. We were in cmo quarters.
ReplyDeleteAh, my bad. Thanks. Kanitkar then. But I was never in the CMO quarters. I spent my whole posting in the dorm. Never been inside the CMO quarters.
ReplyDeleteI'm a year senior and I remember doing a few days of "extension" due to attendance shortage with you guys. I had the pleasure of scaring the crap out of two of your class guys while they were studying in CMO quarters at night. A few of you guys were with me during the prank... I love your blog..
ReplyDeleteMost funny episode....I am laughing still. It was the VBRs.
DeleteHrishikesh Kanitkar, Asia Cup .... India chased down 217 to win if my memory serves me right. Memorable, because we laid the ghost of Sharjah to rest after nearly 20 years by beating Pakistan in a major final and not choking in a big run chase!!!
ReplyDeleteOops ... that should read 317!
ReplyDelete317 is right, but it was the Independence Cup in Dhaka. Not in Sharjah. We played the Sharjah matches later in the year when Sachin scored consecutive centuries against the Ozzies.
ReplyDeleteThe Sharjah match I was referring to was the Manoj Prabhakar - Javed Miandad last ball 6 that had seared itself into the consciousness of Indian cricketers for over a generation, resulting in us choking each time we met Pakistan, or played in a major Final!
ReplyDeleteDude....it was Chetan Sharma. How can you forget?
ReplyDelete