Category Archives: free healthcare

The Poverty Vow

(c) Dr. Rajas Deshpande

Long day. Came home. Ritual steamy hot bath to wash away the hospital feel, followed by steaming hot dinner. Switched on jazz, and I picked up the pasta. Heaven descended upon my tongue.

“How perfect this moment is!” I thought, and that’s where I was wrong. The phone rang.

“Sir, 18 year old buy, had fever since a day, took some tablets, became unconscious, now comatose. Vitals are stable, although he is coughing occasionally. No past history significant. Poor family, cannot afford treatment. Father is a labourer. What should I do?”

“Get him into the ICU, intubate if required and stabilise. Arrange for an MRI”

“OK Sir, but Sir they don’t even have a deposit. They had first gone to the government hospital, but as they were not happy there they have come here”. (c) Dr. Rajas Deshpande

“We will work something out. I am on my way” I replied.

In an hour, after examining the boy and seeing his MRI and other tests, we concluded that he had viral encephalitis. The standard medicines were started.

The boy’s father, an obvious poor slum dweller, was in a state of shock. The mother, sobbing, told me the history. I reassured them. When I explained the diagnosis and treatment they asked some questions.

“We don’t understand anything, we are illiterate and poor. Do anything Sir, Just save my son, Sir” the father folded his hands together. Private hospitals have a quota for free patients, but usually it is always overloaded. I requested the hospital management to please make this a free case, they accepted.

The next day, the child opened his eyes. On the third day he started responding. I was quite elated to have his mother speak with him. However, his respiration was still shallow, and blood presure very low. His heart rate was fluctuating due to the effect of viral infection. He was still critical. I spoke to his parents twice every day, specifically reassuring them. Poor patients must never feel that they are not equally cared for. (c) Dr. Rajas Deshpande

That evening, as I attended my patients in the OPD, the patient’s father came in, requested that he wanted to have a word. He came in with six other people. None of them could possibly be poor, given their get ups.

“Yes?”I asked.

The patient’s father looked at the giant next to him. “You ask” he said to the giant.

The giant, chewing his gutkha, askked me “What’s wrong with his son?”

“I have explained them thrice”I replied, “he has viral infection of the brain. There’s a lot of swelling upon his brain”.

“How come he is not improving? His BP was normal when he came. He did not have any heart problems. Now you tell us his heart is not functioning well” asked another medical superstar with white linen and gold teeth. (c) Dr. Rajas Deshpande

“Yes, this happens commonly with viral infections” I replied, feeling hopeless. How to teach complicated medicine to this pure- muscular class? I wondered.

“But you said he had infection in the brain. How come now he has it in the heart? Is the treatment wrong?” Asked someone similar among them, in a tone nastier than medical examiners.

I looked at the patient’s father. He was looking at the ceiling, deliberately avoiding eye contact with me.

“Listen, Sir”, I told them, “Your patient has viral infection, it has primarily affected the brain, but involvement or dysfunction of other organs is well known with such infections, this is not something new to us. We are on guard, dealing with the situation. Nothing is wrong about the treatment, in fact his brain swelling has improved, and he is conscious now. Ask his mother” I looked at her.

“I don’t know” she said, “we don’t find any improvement in my child. Nobody tells us anything”.

“Haven’t I explained you and his father patient’s condition every day?” I asked. They did not reply.

The white linen gold teeth spoke again: “We want a report. We want to show the case to another doctor”

That was a relief. I gladly wrote them a report. They went doctor-shopping all day. They returned next day. Almost everyone had asked them to continue the same treatment that we had advised, except some desperate non-specialist telling them to shift the patient immediately for a surgery at his hospital. Even our gold-toothed medical superstar understood that it was wrong! (c) Dr. Rajas Deshpande

“We will continue treatment here only. But our patient must survive” came an open threat.

”I will do my best, but I cannot guarantee you anything. You may please transfer the patient under the care of any doctor of your choice” I told them.

“No no, you continue to treat him.But if anything goes wrong, we will file a police complaint. We will ruin this hospital”said one of them.

I am allergic to threats. I don’t allow them twice from the same source in my life. How could any doctor guarantee that there could be no complications? How could I say that the patient could not react to any medicine in such a critical condition? If every patient could have guaranteed improvement, what’s the need for a doctor?

“I am sorry, I am planning for a leave next few days. I won’t be able to see your patient. I have requested our management to transfer your case to another doctor” I told them.

There was a movie “Teesri Kasam”in which the lead character, at the end of the movie, vows never to help the character of the lead actress in the movie, because the very wish and effort to help her has shattered his life, caused him regret. Most Doctors are now being forced to take such a vow. Urban Poverty is not so simple and innocent in a hospital as it appears to the media and society. Whether it is the roadside rowdiness of slum dwellers who roam around with weapons or a maid’s drunkard husband in civilised society, we all understand the misuse of poverty status well anywhere outside hospital, but somehow when this happens in a hospital, the blame is automaytically pinned upon the hospital or the doctor.

But who among the vote-mongers will speak against the majority voting bank?

(c) Dr. Rajas Deshpande

The Other Side Of Life

(c) Dr. Rajas Deshpande

“Wear your helmet” said my grandma, as I kicked my scooter “and don’t argue”.

I could have argued with the POTUS, but not with my grandma. I had come to my uncle’s house to visit my grandma, with the additional attraction of eating the delicious Diwali snacks she made. I wore my helmet and scooted back as fast as I could. My duty started at eight PM in the ICU, and the resident doctor who was on duty had warned me that she had to be with her in-laws for her first Diwali with the new family. All icu beds were full, one patient was intermittently gasping, unlikely to recover, and three others were fluctuating.

Firecrackers, lighting, happy people in new clothes were all around, yet out of mind. I parked the scooter outside the ward and ran in.

“Thank you thank you” said my predecessor, and explained me the cases and ongoing treatment.

When at the bed of the patient who was intermittently worsening, she told me “Listen he’s on dobutamine drip, we don’t have it, I have borrowed two ampoules from the medical shop outside. I will pay him later. His family has no money”. Many critical drugs were not available in the icu, a common problem even today across India.

She left.

Behind the ICU building, a political party was celebrating the festival in a pandal, with repeated announcements of its achievements. Loud lewd music was playing, less irritating than the dramatised loud repitition of the party leaders’names. (c) Dr. Rajas Deshpande

Three more heart patients came in, but the ward beds were full, there already were twelve patients on the floor. This is a common scenario in almost all government hospitals across India. We begged the ward resident doctor to help us, and he agreed to shift three of his patients to the floor. The heart patients were taken on the beds outside ICU, and their medicines were started. We struggled at every step. The student nurses, enthusiastic and energetic, virtually carry half the weight of the doctor’s work upon their shoulders. (c) Dr. Rajas Deshpande

A municipal councillor walked in drunk, and started abusing the ward resident doctor for shifting “his”patient to the floor bed. Aggressive and drunk, his language was more offensive than his personality. We tried explaining to him that there were critical heart patients, but he insisted that his patient be taken on the bed. We then requested a stable young patient, who agreed reluctantly to go to the floor bed.

While this was being done, another old man was rushed in, his bronchitis/ asthma had worsened due to the excess pollution, a common problem in modern India. He was too late, his ambulance had been held in traffic. Already blue-black, he could not be saved inspite of frantic efforts. There were no relatives with him, we completed the paperwork and sent him to the mortuary.

In a few minutes, the fluctuating icu patient had a cardiac arrest. Loud noises of emergency carts, glass ampoules being broken open, and panicked cries filled up the ward. Starting CPR, we tried best to restart the silent heart. Such moments are beyond prayers, the doctor’s heart appeals through his hands, a dead patient’s heart. After a few minutes, the best sound in the world- that of a heart beating again- could be heard. Fingers crossed, we restarted his life-supports and gently informed his wife about what had happened. She was sobbing violently. I went to the doctors’ room to wash my hands.

It was then that the political pandal music could be heard again. (c) Dr. Rajas Deshpande

“Our party has made this big decision. You will all have to pay a little extra, but we will give you a modern, advanced, beautiful India. We will make more advanced satellites, bridges, we will buy the best fighter jets in the world, more bullet trains and bigger statues shortly. We are already ranking very high in the world, we will continue to grow. The only major problem in India is other political parties” the speeches were heard loudly, with proud shouts of joy and claps from the pandal.

At about 5 AM, things settled down enough to sip some water. The nurses had made tea for themselves, the incharge sister Mrs Joseph lovingly ordered me to take a quick break and have a cup of tea. She read my face. (c) Dr. Rajas Deshpande

“Doctor, I have been in this government hospital for nearly thirty years now. Nothing changes, whichever party comes to power. No one cares about the poor patients or their life. We need millions of doctors and nurses more, we need beds, equipment, so many more medicines, but we have to keep begging to the government as if we need it for personal use. Hundreds of patients die every day due to lacknof Medical care, because they cannot get beds, medicines or critical care. I was fed up long ago and wanted to quit. I had excellent offers from middle east and even UK. But I thought, if I left, who will look after these poor patients?”. She was to retire shortly.

Thousands of excellent doctors and nurses, pharmacists, and oher hospital staff carry on caring for poor and desperate patients in government and even private hospitals all over India, they are paid peanuts, are exploited inhumanly, yet keep working through festivals and celebrations, away from their families, with a smile upon their face. Right now, millions of critical patients are being attended by thousands of doctors, nurses and other hospital staff without thinking about salary, rewards, medals, sweets, new clothes or any form of celebration. The only medical festival is a saved life.

This post is to stand up and say a heartfelt “Thank You” to these doctors and nurses who are spending this Diwali with their patients.

(c) Dr. Rajas Deshpande

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The Tribe and The Ring

(c) Dr. Rajas Deshpande

“Before coming to India, I searched a lot and bought this holy stone for you, the same one I was given as blessing for a good future. I wear exactly the same ring. As a mark of my gratitude for the treatment my son Hathim received in India, we want to make you a part of us. Please wear this ring” said Mr. Jade from Yemen.

About a month ago, he had left for Saudi Arabia, leaving his children back in India, to continue treatment. His younger son suffered from a very rare type of epilepsy (Lennox-Gastaut Syndrome) of uncontrolled fits / convulsions and was not mentally growing up well. The 16 year old elder brother cared for the younger one, as they stayed at a rental house in Pune. The case was very difficult, and I had to seek help from my teacher Dr. Sangeeta Ravat in Mumbai, who suggested crucial inputs in managing the kid. Fortunately, the fits are now controlled well, and the father arrived in India to take back the kids to Yemen.

He not only gifted a bag of perfumes, dates and sweets from his country (most Arabic patients, however poor, usually bring gifts for the doctors they visit), but also personalised the bond by bringing for me the same ring that someone had given him for a good fortune. Superstitions apart, but wishing for someone the same that one wishes for oneself is the core of almost every religious text.

Of course the major credit here is that of my teacher Dr. Ravat. I did nothing extraordinary, many doctors treat their patients with their soul, and get excellent results. The reason for this post is the pride of belonging to that tribe called “Doctors” which breaks not only the boundaries between countries, but all the walls between cultures, languages, and societies. This “Doctor”tribe has the rarest opportunity in the world: a free entry in the heart of any human being anywhere upon earth!

This ring is dedicated to that tribe: all doctors who have gifted health and life to millions.

As the beautiful kid travels back to his country, we pray for the best health and happiness for him and his entire family!

(c) Dr. Rajas Deshpande

With Mr. Jade, Master Hatham, and a friend Ms. Arwa.

Hon’ble Babaji’s Medical Interview

© Dr. Rajas Deshpande

A long fleet of luxury cars entered our big hospital. Sirens and whistles, security guards brandishing their AK 56s. and shouts of humiliation for the common men and women suddenly filled up the scene.

Hon’ble Babaji had arrived. A vacuous smile and blessing hands greeted one and all. Babaji was known to cure one and all with his blessings, secret medicines, chants, touch, and even exercises. There was nothing he didn’t treat, so he was the ultimate superspecialist with highest experience and cure rate. No deaths were ever reported among those millions treated by Babaji.

I was in the ward with some of my colleagues, a junior doctor then. The most reliable pleasure in the life of junior doctors is pretty, beautiful and handsome colleagues to work with! Rare exceptions with extreme merit are of course there.© Dr. Rajas Deshpande

A rich businessman and senior minister was admitted in emergency with a heart attack last night. Doctors had performed an emergency angioplasty, barely in time to save his life. Highest offices in the country had warned doctors to ‘do the very best’ for him, till the time he could be flown out of the country for the most advanced treatment. After the meeting of money, influence and power, we got a chance to request Babaji for a small interview to guide us inexperienced doctors. Looking at some of the prettiest faces among us, he gracefully consented. Here are some excerpts of the interview for the benefit of mundane, inexperienced new generation doctors and junta:

Doctor A ( looks OK): Namaskar Babaji! Can you tell us where you studied this art of curing all the illnesses?

Babaji: Beta this is the inheritance of generations, bestowed upon those who perform some secret rituals, it took me many years in the forest to learn it all.© Dr. Rajas Deshpande

Dr. Me ( looks ugly as you know): But Babaji, did you have patients to treat in the forests?

Angry Babaji: No. To learn this secret art you do not need to practice upon patients like your medical science. Once we know, we can directly cure everyone.

Doctor B (stunningly beautiful, common crush): Babaji, can you tell us how you treat a case of open head injury?

Babaji (with an gracefully sexy smile): Come beta, sit here, so you can hear me. We first hold some leaves hard pressed against the wounds to stop bleeding, then pray for the patient with some internal healing chants. We then call the relatives and explain them how futile and fragile life is, and ask them to accept fate. Usually they do. Some rare ones take such patients to hospitals. There too, some die and some survive. Those who survive mostly do because of the prayers. You can come to our place if you want to know how to treat all types of emergencies. We have even made some dead alive!© Dr. Rajas Deshpande

Doctor C (Meritorious. That’s all.): Babaji, there are so many poor patients dying in so many government hospitals, in small villages, everywhere. There are so many hunger deaths too. How come you and your chelas are never seen working your magical powers for such poor and needy patients? In the same time that you visit a businessman, minister or appear in a TV interview, you could treat and cure hundreds with the power you claim to have.

Babaji (red): You will not understand, because you do not have faith. Next question.

Doctor B: Babaji, you and your drug company earn in multiple billions. You are a saint yourself, and do not have material aspirations. Then where does all this profit go? Are you secretly using it to help treat poor and downtrodden?

Babaji (drinks water): There are many charities we do, but one must not tell others what charity they do. We submit the reports to the government. I am getting late, beta, it is my prayer time.

Doctor A: Just one more question, Babaji.. it is said that you cure diseases like cancers, AIDS etc which have no medical cures. Is that true?

Babaji (winks one eye): If you ask me in front of media, I will say no. Because I do not like too much attention and fame. But if you come to our place, you will see the miracles that our ancient formulas and personally researched products can make. They are all FDA approved and safe. Millions have been cured. We treat everything!© Dr. Rajas Deshpande

Babaji smiled proudly and got up.

As he walked in the lobby, many poor patients and their relatives who tried to touch his feet were pushed away by his security. Only pausing to answer questions by TV channels, posing holy, Babaji disappeared in his luxury car.

I went back to the room of the rich senior Minister to record his blood pressure. He was on the phone, talking to someone “Yes, yes, Babaji just confirmed his plan to buy another aeroplane. I have promised him that you will design the customized interiors for his new plane. Come over tomorrow”.

Then, as I recorded his notes, I politely asked the rich minister “Sir, why didn’t you go to Babaji first when you had chest pain?”

He replied what most Indian Politicians, Media personnel, and many Judicial experts feel: “You are too inexperienced about these things, Doctor”!

© Dr. Rajas Deshpande

Please share unedited. Any resemblance to any human being or animal is deeply regretted and unintentional. Praying for better logic and reasoning in all human beings.

The Parceled Sandwiches

(c) Dr. Rajas Deshpande

Entering the hospital that morning, I was wondering if I could finish early and go for a relaxed dinner with a friend who was visiting. Iwas in an excellent mood when I entered the hospital at about 10 AM. That’s when I heard the noise.

In the entrance lobby, there was a group of men, women and children, wailing, crying, shouting, pulling their hair, beating chests, and throwing their hands and legs around lying upon the floor. Few of them were shouting loudly “All doctors are looters. They robbed us and still killed the patient. How can our patient die? Catch them. Kill them. Burn the hospital” this was accompanied by abuses that cannot be mentioned. The security staff and PROs were patiently trying to tell the violent relatives that there were other patients and relatives, that there were women and children around, but the most vulgar of the abuses continued.

I walked past the abusive crowd and met my resident doctor in the ICU. The first case was that of an old man who had had a fall a week ago, but was treated at home for the first three days. Three days later, the old man had suddenly become unconscious, and on admission was found to have a large bleeding in his brain. If not operated within minutes, he would have died. Our neurosurgeons rushed in and operated him with a huge risk. Now he had just started responding, but was still not fully conscious. (c) Dr. Rajas Deshpande

“Why is he still unconscious, doc? Was the surgery not done correctly?” the son asked.

“We have repeatedly told you Sir, the delay in admitting your father has caused a lot of damage in his brain. We cannot predict when and how much he will recover. The surgery was done to prevent imminent death. In my opinion, he is steadily improving. ”I explained again.

One after another, different faces of suffering and allegations, pain and expectations kept mounting and in a few hours it became difficult to feel happy. I am seriously not the type who can keep a perpetual meaningless smile upon my face without actually being happy. However, I must keep calm and smiling, because the next patient will be coming in with a lot of hope, expectation and fear. I did my best.

But my hope of having a relaxed dinner with the friend was gone. All I wanted now was to go home, take a hot shower and try and kill the negativity that was cluttering my mind. The wails and cries of the crowd were still noisy in my heart. “Who must have died? What must their family be going through? What about their children and spouse? Was this preventable?” I was curious. (c) Dr. Rajas Deshpande

The casualty called. A young girl had come with fits. Her old farmer parents had brought her. Stabilising her, and completing the examination, I asked questions to her father. With teary eyes and folded hands, he told us “We have no one and nothing left. Please do something”. Reassuring him, I messaged my CEO, who graciously allowed to treat her as a free case. I started writing notes.

“What was the ruckus in the morning?”I asked the resident doctor standing besides me.

“Oh that!” he replied “That patient was admitted for a head injury two weeks ago. He drank too much alcohol, and his bike had slipped. We admitted him as an emergency, and treated him on compassionate grounds as he was comatose. The relatives were well aware about the poor outcome. We did everything we could. I don’t know why they reacted so. Someone told me that the local politico wanted to extract some funds from the hospital”. This was not unknown, but loss of life does cause unexpected reactions, the doctors and the hospital staff bear the brunt.

Many patients were treated that day, many came cured, many went home happy, many expressed gratitude. But the fact remained that I was unable to forget the wailing family and the accusing son of the ICU patient. Am I supposed to smile and be happy for those cured and improving, or am I supposed to feel sad about the death and suffering I see every day? The emotional highs and lows that happen in every doctor’s day are too wide, too heavy and dynamic. It is not easy to forgive and forget bitterness, thanklessness and paranoid accusations on a daily basis for years, and keep smiling in between. (c) Dr. Rajas Deshpande

My friend called. “Rajas, I am standing outside your hospital. Come let’s have a quick bite. My bus leaves in anoter one hour” she said. We entered the nearest restaurant. Her witty words indeed relaxed me somewhat, and she ordered soup and sandwiches, knownig my favourites. As the steamy soup eased my throat, I started telling her about my day. My cellphone rang.

“Is that you, doctor Deshpande? Do you remember my father Mr. Ramakant who you were treating? He passed away today. We were supposed to come to you three months ago, but as I was out of India, I couldn’t bring him. He had stopped all medicines”.

I winced. Mr. Ramakant was fairly healthy, happy and stable on medicines, they were told never to stop the treatment. How should I react?

“Very Sorry to know” I said.

“That’s okay doctor. My problem is that no doctor is giving a death certificate for him, as he had not seen a doctor since long. We need it for the funeral. If I come to you now, can you please write a death certificate for him? I will pay your charges” he said.

“Sorry, someone has to examine him and issue a certificate. Please call your neares doctor home, or take thepatient to the nearest hospital” I told him. As I kept away my cell, I avoided looking at my friend.

“What happened?”my friend asked. Looking at my face, she sensed it.

“Oh. Sorry” she asked the waiter to parcel the sandwiches.

Both of us knew that neither was going to eat them.

(c) Dr. Rajas Deshpande

Please share unedited. Please let the society know what a doctor’s day is typically like.

“My Turn Now”

©Dr. Rajas Deshpande

“I don’t want to live like this. I have stopped eating since today. Please do not be angry with me for this, but I cannot see you and my children suffer because of my illness. Let me go with peace” Geetanjali said to her husband.

Eighteen years after her marriage, in her late thirties, Geetanjali suddenly lost the function of one half of her body. Her children were still in school. Her husband Gajendra Jagtap works as a school teacher and does some farming on a small piece of land they own. The whole family was shocked and shattered with this calamity that befell Geetanjali. But Gajendra Jagtap decided not to be broken down by destiny, and took his wife immediately to the best hospitals in Mumbai. They were told that Geetanjali was suffering from Multiple Sclerosis. After a few days of treatment, they could not afford to stay in Mumbai and came to Pune as it was nearer to their village. The Multiple Sclerosis Society of Pune extended its helping hand. Geetanjali was yet unable to stand up or walk. ‘This illness is totally unpredictable, anyone can develop blindness or disability anytime’ doctors told them. Geetanjali felt hopeless. She was very depressed with the thought of stressing her husband financially to provide for the treatment expenses. She also worried if her children’s education will suffer due to her illness and financial constraints. This was the reason she decided that she did not want to live any further, and gave up eating or drinking anything.

But Gajendra was not the typical Indian husband. This B. Sc. Graduate who had taken up teaching in a rural school as his profession had a big heart, and harbored principles of equality and respect for women, just like a highly educated spouse in a developed country. He told Geetanjali, ‘You have served me and our children for over eighteen years now. When I was working in the school or in the farm, you looked after the home, cooked for us and fed us sumptuously. Now give us a chance to repay for what you have done for us. It’s my turn now. I am going to take care of you just like you cared for us.’ Geetanjhali could not hold her emotions and sobbed when she narrated this story to me.

‘At that point of time, I felt like living only to help my family. I decided to use whatever few healthy days I had to make my husband and children happy.’ She started to fight her disability with a new spirit, and in a few months could walk very well again. Since then she had attacks of this disease many times, but vehemently fought it to recover every time, with the help of her husband.

Gajendra told me “I explained my children our situation. I told them that we don’t have much money left, and that they must only complete their education based upon merit. We are very fortunate that our children decided to grow up quite early in their childhood. Both of them studied very well, and my elder son is now doing his post graduation which he got through a scholarship in Delhi. Even my daughter got excellent marks and is now pursuing her post graduation by winning a scholarship. Both of them take care of their own expenses, and never bother us for money. Even I have decided that whatever our destiny presents us with, we will face it with a smile, and never accept defeat in any situation. We have to visit hospitals many times, spend on treatment and investigations, travel many times, but we do it all with a spirit of winning together. Whenever she can, she still takes care of the home, and when she can’t, I do it with the help of my daughter. But we never feel desolate or depressed”.

In the developed world, people suffering from this illness get a lot of healthcare facilities, and even income tax concessions. However, this farmer from a lower middle class background who does not receive any such help, has not only resurrected his family, but created a new life for his wife with his sheer love and determination. The most admirable thing about his love story is the respect and feeling of equality with which he thinks of his wife. Geetanjali also stood up firmly with him to conquer this illness, with all her love and might. Together, they have indeed defeated their destiny.

We sincerely pray for the excellent health, well-being and long life for each member of this wonderful and ideal family.

© Dr. Rajas Deshpande

Neurologist, Pune

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Snake! Snake!!

Snake! Snake!!

©️Dr. Rajas Deshpande

She felt a sudden sharp pain on her hand, as she was cutting grass in their farm. She saw bleeding from her hand, she threw away the grass and looked carefully. The head of an angry snake with open mouth, fangs popping out terrified her at once. It was a Russel’s viper, a deadly venomous snake that causes shock, bleeding, and clots the blood inside the arteries.

She grabbed her cellphone and called her husband.

There is a superstition in rural India: that husband or wife, if bitten by a snake, should not see each other’s face for eight days, or one of them will die. Her relatives told her not to see her husband, even her husband was told so.

They unheeded the superstition. He tied a rope around her bitten hand, started his bike, she sat behind him, and they rode away to the nearest rural hospital about seven kilometres away. They had only a few minutes. In a short while she started feeling giddy and had a vomiting. They reached hospital just when she was about to collapse. Her whole left hand was swollen upto the shoulder and was turning blue-black. The face had started to swell too.

The doctor there rushed her to the intensive care unit, did not wait to waste time in paperwork or financial questions, and started emergency treatment. Knowing that people don’t carry money during such emergencies, he arranged for all the medicines himself. In a few hours, her blood pressure started to return to normal. The swelling onher hand increased, causing severe pain. For the next five days, the doctor struggled to counter every problem that popped up: it is extremely difficult to treat a patient who has bleeding and clotting together.

Science won, sitting on the shoulder of the logical and determined doctor. In seven days, Mandakini was discharged, with only a minor swelling on her hand still persistent.

In any big hospital in a metropolis, this would have cost her more than a few lakh rupees. However, a doctor practicing in a rural area, just like doctors working in many government hospitals, took it upon himself to save her life without caring about money at all. With minimal expenses, he saved her life. As Mandakini is under my treatment for Parkinsons Disease, she followed up today and told me this story in te tones of a typical farmer: as if it was just another trivial deviation from normalcy “That was a snake bite last month. I am okay now”.

While the big name doctors in big cities are well publicised and noticed by the media, thousands of the rural Indian doctors, who slog day and night saving thousands of lives every day usually remain neglected and away from limelight. There must be so many hundred snake bites happening every day, so many accidents, and so many doctors practicing in rural India must be saving them. But what’s so sensational about saving lives? Instead, if the poisonous news of doctors being beaten up by violent crowds and hospitals vandalised are shown, it gets huge TRPs! There’s no treatment for the poison spread by some politicians and media against the medical professionals..

A heartfelt, respectful salute to the thousands of medical heroes practising in rural India and government hospitals, who form the base of Indian medical profession.

(c) Dr. Rajas Deshpande

PS:

Awaiting the permission of the doctor mentioned above, from a rural hospital, to publish his name😊

Marathi version:

साप साप!

डॉ. राजस देशपांडे

शेतात गवत कापत असताना मंदाकिनीच्या हाताला एकदम काहीतरी टोचल्यासारखं वाटलं, म्हणून तिनं हातातील गवत फेकून समोरील झुडुपाकडे नीट पाहिलं. जबडा वासून त्यातील विषारी सुळे दाखविणारे ते रागीट फुरसे तिच्यासमोरच डोके बिळाबाहेर काढून बसले होते. रक्ताच्या गुठळ्या आणि रक्तस्त्राव करवून काही मिनिटातच मृत्यूच्या जबड्यात ढकलणाऱ्या त्या विषारी सापाला पाहून तिचे धाबे दणाणले. तिने तिच्या नवऱ्याला फोन लावला.

ग्रामीण भागात एक अंधश्रद्धा आहे. साप चावल्यास नवरा अथवा बायकोने आठ दिवस एकमेकांचे तोंड पाहू नये, नसता एकाला मृत्यू येतो. त्यांच्या नातेवाईकांनी त्यांना एकमेकांसमोर जाऊ नका असे सांगितले. पण मंदाकिनी आणि तिच्या नवऱ्याने तिकडे दुर्लक्ष करीत आधी हाताला कापड करकचून बांधले आणि दुचाकीवर स्वार होऊन ते दोघे आठ किलोमीटर वर असलेल्या ग्रामीण दवाखान्यात निघाले. काही अंतर गेल्यावर मंदाकिनीचा हात खांद्यापर्यंत सुजला, काळानिळा पडायला लागला. तिला चकरा येत होत्या. एक वांतीही झाली. कसेबसे ते दवाखान्यात पोचले, तेव्हा तिचे ब्लड प्रेशर कमी झालेले होते.

त्या ग्रामीण दवाखान्यातील डॉक्टरने तिला ताबडतोब तपासले. कुठल्याही कागदपत्री व्यवहारात वेळ ना घालविता त्यांनी तिला आय सी यू मध्ये घेतले आणि औषधोपचार सुरु केला. पैसे, बिल, आर्थिक परिस्थिती याचा विचार अथवा चर्चा करायला वेळच कुठे होता? अशी वेळ आल्यावर पैसे घ्यायला वेळ असतो कुणाकडे? डॉक्टरांनी त्यांच्याकडीलच सर्व आवश्य औषधे वापरली. काही तासांनी तिचे ब्लड प्रेशर नॉर्मल ला यायला लागले. पण तिचा हातावरची सूज मात्र वाढली, आणि तिला प्रचंड वेदना व्हायला लागल्या. पुढचे पाच दिवस तिची प्रकृती वरखाली होत राहिली आणि डॉक्टर येणाऱ्या प्रत्येक आपत्तीशी झुंजत राहिले. आठ दिवसांनी तिला डिस्चार्ज मिळाला. फक्त थोडी हातावरची सूज बाकी राहिली होती. काही हजार रुपये बिल झाले होते, ते त्यांनी आनंदाने भरले.

कुठल्याही मोठ्या शहरात, मोठ्या दवाखान्यात तिला याच ट्रीटमेंट साठी अनेक लाख रुपये मोजावे लागले असते. पण भारतातील एका लहानशा खेड्यातील एका डॉक्टरने स्वतःच सगळी औषधे वापरून तिचा जीव वाचविला. भारतातील ग्रामीण भागातील हजारो सरकारी आणि खाजगी डॉक्टर पैशाचा विचार ना करता अत्यंत कमी खर्चात हजारो रुग्णांचे जीव रोज वाचावीत असतात, पण त्याची दखल घायला वेळ आहे कुणाला?

पार्किन्सन’स च्या आजारासाठी मंदाकिनी देवकर माझ्याकडे ट्रेंटमेन्टला अनेक वर्षांपासून येतात. या वेळेला त्यांना उशीर झाल्याने मी त्यांना सहज विचारले, तेव्हा रोजचाच विषय असल्यासारखे त्या सहजपणे म्हणाल्या “काही नाही डॉक्टर साहेब, मागच्या महिन्यात साप चावला होता म्हणून उशीर झाला”! अजूनही सुजलेला हात त्यांनी मला दाखविला.

मोठ्या शहरातील मोठमोठे डॉक्टर अनेक वेळेला टीव्ही वर दिसतात, त्यांच्या बातम्या छापून येतात, त्यांना खूप प्रसिद्धीही मिळते. काही डॉक्टर तर प्रत्यक्षापेक्षा फक्त टीव्ही आणि पेपरातच खूप चांगले काम करीत असतात! पण दुर्गम, ग्रामीण, कठीण प्रांतात राहूनही माणुसकी जपून, अखंड मेहनत करून, पैशाचा विचार न करता अनेकानेक रुग्णांचे रोज जीव वाचविणाऱ्या डॉक्टरांचे नाव क्वचितच छापून येते. या देवमाणसांची दखल वैद्यकीय व्यवसायाविरुद्ध सतत गरळ ओकणारे आपले राजकारणी आणि मीडिया कधी घेणार? माणुसकीने सेवा करून लाखोंचा जीव वाचविणे यात सेंसेशनल ते काय? त्यापेक्षा एखाद्या डॉक्टरला वेडसर जमावाने केलेली मारहाण आणि तोडफोड दाखविली की जास्त लोक पाहतात! डॉक्टरांविरुद्ध विष पसरविणाऱ्या या सापाचा मात्र काहीच इलाज नाही!

वैद्यकीय व्यवसायाचा पाया भारतामध्ये ग्रामीण भागातच आहे. माणुसकीचे सर्वोच्च आदर्श डोळ्यासमोर ठेवून रात्रंदिवस खेडोपाडी झटणाऱ्या सर्व डॉक्टरांना आमचा सन्मानाचा सलाम!

डॉ. राजस देशपांडे

न्यूरॉलॉजिस्ट पुणे

काही कारणामुळे वरील डॉक्टरचे नाव येथे देऊ शकलो नाही. त्यांची परवानगी मिळताच ते लिहीनच. .

The Medical License to Kill

© Dr. Rajas Deshpande

The five year old girl stopped breathing. Her father shouted in a state beyond panic. With a fear of a death worse than his own, he choked upon his own shouting. It was about 4 AM. The dozing relatives of other patients in the casualty woke up startled.

The intern doctor Anu tried to insert a breathing tube in the child’s throat, but the right sized tube wasn’t available. Dr. Anu shouted at the nurse to wake up the medical officer on duty. She couldn’t: he was deep asleep, being drunk. The child started getting blue. The heartbeats became feeble. Another nurse ran upstairs, and literally dragged the junior doctor in the ICU to the casualty. He struggled and managed to insert the tube somehow, and with the breathing bag, artificial breathing was started. The child stayed unconscious, but the heart beats were heard well now. There were no beds in the ICU, so they managed her there itself, in the casualty.

Two hours later the medical officer woke up. Unclean and unkempt, stinking of alcohol and sweat and yet careless about it, he was usually seen roaming in the hospital with swollen red eyes, talking usually about the only three things so called “Men” talk about. In hating him, many diversely thinking junior doctors united. There were complaints about him: nurses, junior doctors and patients had all written to many authorities about his drunken demeanor, ill behavior, swearing and abusive language, and even a violent attitude: he was known to slap attendants, drivers, assistants, and throwing instruments in the operation theater. © Dr. Rajas Deshpande

Dr. Anu not only hated him, but was scared of him too. She hesitantly reported what had happened in the night. “We tried to wake you up Sir, but couldn’t” she said cautiously, just like all brave girls who cannot hide what they dislike. He laughed in the style of a famous ‘Manly’ hero of the times. “Such small things keep on happening in big hospitals. Don’t worry. If I wake up for every emergency at a government hospital, I will myself die. I am doing the duty for five medical officers alone. You must accept death as a part of your daily life. Don’t get emotionally involved in patients. Some will die, we can do nothing about it”. Then, without even visiting the child once, he left, as his duty hours were over. © Dr. Rajas Deshpande

The disgust and anger that flooded Dr. Anu came out in the form of tears. She went to the nurses room and sobbed. She had not dreamt of becoming a doctor like this: helpless and suppressed. The nursing Superintendent, a motherly lady, patted her. “It is good that he didn’t wake up at night. He doesn’t know even the simple procedures. He would have probably harmed the child more in that drunken state. The only thing you can do now is to quickly learn all the life saving procedures that you can, and then don’t be dependent upon anyone else to save lives”.

“I want to complain against him. How can a doctor sleep when a child is dying during his duty?” Dr. Anu asked.

The Nursing Super smiled in shame.

“My dear, who will you complain to? This drunkard is the son of a ruling minister. They own a private medical college themselves, many come to him to get medical seats there, so they have friends and defenders in almost all high offices. Whoever questions anything about him, faces not only the ire of his father’s political goons, but suffers at many other levels to. Do you think people don’t know his addictions and ill behavior? But when the government protects him, what can anyone else do?”.

Then, as Dr. Anu stared in vacuum, the Super told her one of the most beautiful pearls in medicine: “There are some bad doctors dear, but that’s where you come in. Your responsibility increases. Learn to be strong, learn to compensate for what others cannot do. Such sick doctors who pass out without learning, who come drunk to the hospital and mistreat patients are a curse to our profession. We can’t change them. The lesser number of patients they see, the better it is for everyone. You compensate for them by becoming better”. © Dr. Rajas Deshpande

The day forever changed Dr. Anu. Providence, as always, had rewarded her for her efforts in saving the child’s life only a few hours ago.

The sad fact still remains: that some students are not trained well. Some do not have the capacity or wish to become good doctors while some are ‘pushed’ by money and power. These are the people who have learned the most deadly Indian trick: to find a political godfather who protects them from anything you do, Feed his wallet and ego, lick him all over, and then retain the ‘license to medically kill’. Please check out how many ministers and political bigwigs own medical colleges, and how many use these as ‘power channels’ to make undeserving doctors, and one can easily know where the problem lies. This by no means suggests that only the doctors from private colleges are bad, there indeed are ill behaved and drunkards among doctors passing out from govt. colleges too. The point is that they are protected by some. To first satisfy all vote banks, then collect the multicrore moolah for admissions and then create yet another channel of corruption: Eligibility test! This is a nightmare for the truly willing and deserving merit holders. About this aspect of the matter, no politician ever speaks. Who protects the Medical admission scamsters? Why do not our courts act suo moto, knowing that so many lives will be at risk with doctors produced via scams? © Dr. Rajas Deshpande. The saddest part is that many corporate hospitals look for such doctors who are also financially recklessly aggressive, and then make them compete with the good and ethical doctors.

Today on the occasion of Gandhi Jayanti, many “trumpet tongues” will be heard speaking through their hats about the Mahatma. Introspection and truth are the beginnings of even knowing the Mahatma. The criminal corruption networks which produce bad, ineligible doctors by the force of money and power must go! These are the very doctors who bring a bad name and a shame to our profession. Many a good things in the profession, saving a million lives every day and sacrifices made therein bt thousands of good docs all become a waste because of such few bad doctors. Let us all stand united in improving ourselves, giving up what’s not the part of a good doctor.

Jai Hind!

Mahatma Gandhi ki Jay!

© Dr. Rajas Deshpande

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Hats Off, Phoenix!

(c) Dr. Rajas Deshpande.

She had paralysis, over eight times in last six years. Lost vision few times. Lost balance many times. Even lost speech and bits of memory. Severe vertigo wouldn’t let her move for days. Many hospital admissions, many injection courses and tests. Barely two weeks ago, she had come to the OPD unable to walk at all. Yet, when she entered the OPD today, walking with a spring in her steps and a smile upon her face, the first thing she said was “I am joining my office tomorrow, Doc! You must convince my husband to let me. I am all fine now”.

Dinaz Dastoor, diagnosed with Multiple Sclerosis, a cruel, unpredictable and disabling disease of the brain and spine, sets an example of grit and positivity for patients and doctors alike! She refuses to be defeated by the disease, does not take any advantage or ask for sympathy, and deals with it like a phoenix: whenever it gets her, she rises above it and flies again.

She refused to take costly medicines with many adverse effects. She refused to give up her chosen duties: housekeeping and bringing up two daughters while fighting with this monster called MS. She attributes all her victories to an ongoing support and encouragement from her husband Rohinton Dastoor and their daughters “ Everytime I feel low, every time I am down in with disability, my husband sits by me and tells me that I am going to recover. He and my daughters have adjusted their lifestyles to accommodate the unpredictable attacks of my illness. Even when growing up, my daughters took care to keep troubles out of home, never argued with me. They all kept stress away from me. Without this supporting family, I won’t be as strong as I am today.. I am really lucky” says a smiling Dinaz.

She started working and is carrying on her job very well, of course her office and superiors have been quite accommodating, a rare scenario in India.

Her husband, one of the most polite and sweetest gentlemen I have ever met, handles all situations with a smile. The only time I ever saw him worried was when Dinaz had once developed a very severe attack and was paralysed below neck. “Do what is best for her, doc. I have complete faith in your decisions” he had said.

Today, he opened up when I requested their permission to share their beautiful story. “It is not that we didn’t have to compromise. There are many desires we had to curb: traveling, adventure sports, and what not. But I always tried to imagine myself in her shoes: what if this had happened to me? How would I have liked her to understand and accommodate my troubles? That way, it was easier for me to make decisions. There are more things we can do together even now than what we can’t. We always think about what we can do, never about what we can’t”. He had just said something that would put so many “MCP” husbands to shame, especially those who ill-treat their wives holding them guilty for their illness.

“A patient and her family only expect that the doctor spends enough time with us to listen to what we have to say, understand and address our concerns, and cares for us” Mr. Dastoor commented.

Meeting this smiling couple not only brightens my day, but makes me feel grateful that I can witness this happen, and write about it!

Hats Off to this beautiful couple, who define the spirit of love in its purest form.

(c) Dr. Rajas Deshpande

Medical Profession and Charity:  A Guideline For Medical Students (Speech at a recent Medical Event)

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© Dr. Rajas Deshpande

My dear friends, you will receive many sermons about your responsibility to do charity and social service from those who do no charity themselves. Many who have never done anything worthwhile for the society will remind you of your Hippocratic oath. Beware of these distractors, your social service and charity is your own choice. Thousands of doctors who chose to settle down in the remote place, purely with an intention to serve people, and carried on general practice for over 50 years are now dependent upon someone helping them for their own medical treatment. Neither the government, nor those whom we help reciprocate. Those who lecture doctors about serving the society never answer this simple question: what if a doctor serving the society very well, needs help? Who will help him? The answer is clear. First safeguard your career, reputation, family, home, parents, future and then do charity like a king, confidently, freely and with pride. Professional goals are not the same for everyone.
Some base the entire concept of charity on the low fees, without any analysis of the quality of medical care provided and the outcomes. A patient treated free but wrong, a patient treated at a low cost with a poor outcome cannot be considered charity. “Self-Declaration” of numbers of such patients treated without an analysis of outcomes and patient feedback is nothing but cheap hidden advertisements.
All of us don’t come from the same background: Some families have lived in perpetual poverty, selling off land and compromising quality of housing, clothes and even food to send their children through the medical education. Some must repay their loans, some must attend too many family duties and some just struggle to survive with a middleclass lifestyle. The first thing that we must overcome while doing any charity or social service is the feeling that those who are unable to do it are somehow lesser to us. That discrimination must go. A doctor doing his / her job well is enough charity, they have sacrificed their youth for the society. © Dr. Rajas Deshpande
Let us look at the career options most Indian doctors have.
Medical teachers have already accepted a very low salary compared to what they truly deserve, The average salary of a medical professor in USA and UK exceeds INR 8 lacs per month, working 8 AM-4 PM, with one emergency per week. Although I do not contribute to the school of thought that one must accept the low Indian financial status, at one-fourth salary per month, our medical teachers work three times more than the doctors in the developed world (because in India the staff is never filled adequately) . Still they continue to put in their blood and sweat, training thousands of medical students, working almost 24/7, seeing far more number of patients in OPD, IPD and Emergency. This is the best possible medical social service, nay, charity being done in India, let me first respect and salute this unrecognized social service. This is an ideal premise for those who want to continue to be available for the poor masses, keep themselves abreast of the most modern medical knowledge, and impart it to the meritorious future generations of doctors.
A similar career is working as medical officers in rural / semi-rural areas, where doctors are most deficient. In most Medical Institutes run by the government or municipal corporations, sycophancy and suppression , hopeless bosses, poor administration and heavy paperwork, punishment transfers and bribery are huge limitations for those who want to honestly serve patients. Life isn’t easy in rural surroundings. Right from the lack of basic amenities like water, electricity, good schooling and transport, to a severe threat to personal security by the rampant Political Gunda culture in a superstitious, orthodox community. Who will want to voluntarily expose their family to these? However, if one does have a social standing in one’s homeland, it becomes an excellent option to serve the society. © Dr. Rajas Deshpande
Coming to the non-government career options in medicine, one is either left to private practice as an individual practitioner, which offers a lot of freedom but limited resources, or a salaried practitioner at a corporate hospital.
In the corporate hospital culture, individual charity and social service becomes almost impossible. Contrary to the image created by the media, most of the corporate hospitals actually comply with the mandatory charity, worth crores of rupees every month to those BPL, but the need of our society is far more than that, the demands are never ending. The new doctor who wants to earn a good name and income, but also wants to do something worthwhile for the society as a free service, the corporate culture offers two options: a low-salaried position for looking after the mandatory charity, or working in their low input peripheral schemes. For a beginner, especially a specialist, these are both excellent options . © Dr. Rajas Deshpande
Coming to the last option: an individual private practitioner, there are many choices but also a stark reality: you are on your own, and on the day that you don’t earn, no one else pays for your innumerable bills. Remember that when you are an independent medical practitioner, you have zero income every day that you don’t work, so a single illness or problem that keeps you home for a month will bring your bank balance to zero. Unless there is an alternative source of income, which is rarely the case with a doctor, this jeopardizes your whole existence. You may be prepared to walk through this, but you will be doing your family a great injustice if you push them into this fate. Look at those who have done the greatest charity upon earth: Bill Gates, JK Rowling etc. They have first earned, secured themselves and their dependents and then returned in plenty to the world. That is the safest way to serve the society effectively and for long.
I know almost everyone in this hall is eager to help the downtrodden, poor and helpless. But there are some things you must first thrash out for yourself. Firstly, do not feel any obligation to copy charity. You can discover your own new ways to serve the needy. Completely ignore those who tell you what should be your financial worth. Once you decide what lifestyle you want, you can chart out how much percentage of your time you can work for charity. You may want to reserve one hour a day or one day every week. Be comfortable, choose what does not become a stress factor, but please stick to whatever you decide.
One hour a day by an Indian doctor means 4-5 free patients a day, that is 30 patients a week, that is 120 patients per month, and 1440 per year. If one consultation is 300 rupees, this way you are giving 4 lac 32 thousand rupees worth service free to the society.
There is a major problem : those who take advantage of free medical service. There already are many affording patients whom most doctors voluntarily see free: relatives, teachers, other doctors and their family, classmates, staff in their hospitals, maids and servants, watchmen, neighbors etc.. There are also others who demand free consultations: administrators, politicos, local heavyweights, ministers and even top businessmen who our bosses accompany. People often say that free service does not have any value, it is not respected, but I will make a small exception here: I feel that the really poor and helpless genuinely respect your free service, remember it for life and place you near God. It is the affluent who are usually thankless for free services, and it is high time that we should stop serving them free, so that we are able to serve the really deserving ones. © Dr. Rajas Deshpande
False poverty/ income certificates, visiting repeatedly for trivial / tiny complaints, daily questioning, become a huge limitation in extending free services openly. Pune teaches you many tricks to identify and deal with such people.
An equal legal responsibility for even the free patients is the law, and a major limiting factor for private practitioners as well as corporates. However careful one may be, every doctor does commit mistakes, and our courts of law are yet unevolved medically, only rare judges are mature enough to understand the intricacies of medical decision making and still rarer doctors understand the law. Look at the big picture: a doctor is treating a poor patient as charity, and unfortunately something goes wrong. The instant conclusion that it was the doctor’s mistake, the sensational news story that follows, and the threat to personal reputation all come to play together. The chance of “Extracting” money from the hospital or the doctor, in case of any complication or death, is considered a lucrative opportunity by many local goons.
A poor young lady with a stroke presented to my free OPD. I found her to have a valvular heart disease with a clot in the heart. We arranged for her free treatment, the best cardiac team in the city operated her free, for a major valve replacement open heart surgery. Everything including all complications was explained, poof on paper. In a month, she developed valve failure, a rare but known complication. The relatives returned with a gang of goons, threatened us in the OPD with dire consequences and legal action. The very family which begged for concessions with folded hands a month ago now spoke of vandalizing the hospital, beating us up. We explained to the patient and family that this is not a surgical mistake, that this is a rare but known complication, and it was still possible to correct it. Fortunately for us, the patient herself agreed for a redo surgery. The cardiac team operated her again, free, and the patient went home walking in a few days, but no one from the family ever expressed any gratitude. We had learnt a precious lesson: do not risk your career for charity or social service, because medical degrees, once cancelled or suspended are almost impossible to get back. © Dr. Rajas Deshpande
My friends, the real richness is that of the soul, and by becoming a Doctor you have already proven all that you need to prove about your soul. Whatever I must earn, I must proudly earn without causing hurt or having to deceive anyone. And believe me, Lord has provided enough for me always. Yes, there was a time when I sat in my hostel room and sung that song “Chaand Taare Ttod Laoon” from Yes Boss . Over the years, the kind Lord has responded to most of my prayers. There is no other profession in which you have such huge opportunity: your charity and service will bring people health and life: so use it freely, every day, always. Just make sure to protect yourself to help others for decades to come, and to pass on this light to the future generations.
Jai Hind!
© Dr. Rajas Deshpande
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