The Ugandan Medical Safari... Part III -- Certainly Not A Cupid's Arrow...

After a very brief stay in Tororo, I was transferred to Kapchorwa Hospital. Kapchorwa is in the eastern part of Uganda and is located at a height of 6,000 feet above sea level. The beauty of the lush green mountains is breathtaking. The air is cool and crisp almost all the year around. I still remember vividly the red earth that stood in stark contrast with the lush green mountain slopes. Kapchorwa is in the Mount Elgon region of Uganda, a massive volcanic mountain that borders Kenya. Kapchorwa is home to many indigenous tribes, most notably the Bugisu tribe, that were still very traditional in those days.

It was here in Kapchorwa that I saw the beginning of the biggest upheaval in the history of Uganda. The brutal dictator Idi Amin took over the reins of Uganda on 25 January, 1971, in a sensational coup that took place while President Milton Obote was attending the Commonwealth Heads of State conference in Singapore. 

On the same day, I was summoned to attend court in Tororo in a medico-legal case concerning a patient I had treated while I worked there. The matron of the hospital dissuaded me from traveling to Tororo as it might not be safe. She was quite careful in using the words of caution regarding the events unfolding there in Kampala at that point of time. Somehow I was made to understand the gravity of the ground situation. 

Eventually I sent a radio message (these were the days when you used Ham radios for long-distance communication) through the kind (and understanding) police there regarding my inability to attend the court on some vague pretext. 

Over the next few months I had the chance to meet Uganda's most brutal dictator (some call him butcher) in person. Idi Amin visited Kapchorwa a few months later. He was traveling around Uganda telling people his reasons behind the coup. I had a close look at him, while I sat a few feet away from him with other town functionaries on the dias. He and his reasons seemed so genuine at that time.

Kapchorwa had a salubrious climate, which I enjoyed for a year. In those days there was no electricity in the town, but it didn't bother us much. The hospital did have a generator but we had to use paraffin lamps at home. Here I was completely on my own, the only doctor in a 60-bedded hospital. There was no one like Dr Gosavi to turn to in an emergency. I had to manage everything alone with my little acumen for almost one year, June, 1970 to May, 1971. There was no radiological facility, so for X Rays I had to send patients to Mbale Hospital, 32 miles away almost once a week. Referrals were also made to Mbale Hospital.

One morning I received a patient and one look at him left me dumbfounded. None of my textbooks in medical college had prepared me to handle arrows. The patient had an arrow piercing through the epigastric region (upper abdomen). As the patient was lying on the stretcher, the arrow stood stuck vertically. It was the kind of thing you'd probably see only in movies.

My first reaction was that perhaps it could be pulled out. But then it dawned on me that the structure of the arrow could do more harm on its way out. I asked the anesthetist in the theater to explain the structure to me. He illustrated with a diagram that the arrow had a set of fangs on two sides, hence pulling out would mean more damage to the tissues or organs. It was illuminating to me and I patted myself on the back for not taking quick action without understanding the full import of the situation. 

Eventually I had to make an incision at the entry point of the arrow in the epigastric region just to widen the approach and visualise the fangs directly and gently remove the arrow without hurting tissues or internal organs any further. I inspected the inner tissues and stomach which were okay. Then I sutured the wound, and kept the patient on intravenous fluids and nil food by mouth for two or three days. He recovered well and was later discharged from the hospital in a satisfactory condition.

This patient also taught me something -- something I couldn't have learnt if I was working in a big city hospital -- and I felt hugely rewarded when he recovered.

The Ugandan Medical Safari... Part II - Dealing With A Ruptured Uterus

During my stint in Tororo, I had to handle one of the most difficult cases in my first few years as a doctor. One night during my emergency duty I was called upon to see a lady. She had gone into labour for some hours and then suddenly her contractions stopped. When I examined her, I found her to be full term pregnant, but my heart sank when I realized that her contractions/labour pains were absent. On palpation, her abdomen was quite tender and to make things worse, The foetal heart was not audible. 

I had never seen a case like this before. Being raw and very much inexperienced, I was baffled and couldn't make out what the problem was. I had to consult Dr. Gosavi, who in some ways was like my mentor there. I told him everything I could deduce about the patient and related all my findings to him on phone. After a few more queries, he deduced the uterus had ruptured and asked me to get the theater ready and shift the patient.

On opening the abdomen, we found that the uterus had ruptured transversely (horizontally), in the lower segment. Luckily for the patient, it was just at the site where we make an incision for the lower segment ceasarean section. Through that gaping wound, we removed the dead foetus, and then sutured the uterus in a way that it would not complicate matters when the lady had children in future. After that, I watched in amazement as the lady made a steady and uneventful recovery. It was a great solace for me especially to see her recover so well.

No amount of classroom teaching can prepare you enough for a real life situation. When faced with a patient in a grave situation, you need to keep your wits around you and do the best you possibly can. For me there was a lot to learn through my seniors such as Dr Gosavi there. I realized that I had to take big strides in terms of learning on the job and gaining experience so that I could be useful to the ailing community.

The Ugandan Medical Safari... Part I

Going to Uganda as a young medical graduate with a lot of enthusiasm to serve offered me an immense opportunity to grow as a doctor. There was plenty of work to do and a lot to learn at the same time. Soon after I was exposed to the patients there with routine and casualty duties I realized that I was inadequately prepared to handle them efficiently. The internship training period we had in India was not properly utilized, as the young medical doctors would feel elated, having finally qualified after slogging for so many years of rigorous theoretical education. Also, working as a House Surgeon did provide ample chance to handle patients but in that particular specialty only in which you are posted. 

The work in Ugandan hospitals in the seventies expected you to handle cases on your own especially while on emergency duties. This was really a very challenging task and required a sound practical knowledge and grit to tackle the patient.

Here, I found that the young Ugandan doctors were bolder and better prepared as they had already been exposed to cases like minor simple fractures, obstructed Hernias, hydrocoele, minor amputations, D and C, Caesarian sections etc. while in medical school. They would approach such cases with more confidence, whereas in our case we were rather timid or just not able to deal with the problem at hand. This was due to faulty or inept practical training and lack of serious attention to acquire skills on the part of interns or both. However, it was imperative to acquire greater practical skills in order to fit into that medical setup where medical facilities were few and there was a dearth of the specialists as in Uganda of those days.

In such situations, we had to handle the cases with our utmost and sincere abilities, and despite the challenges, the results were 80-90% good. It was sometimes a do or die situation: in case we didn't try to handle a complicated case, there were greater chances of fatality. Referring patients to higher centers was not always feasible most of the time due to lack of transport or fuel, or the sheer distance, or all the factors combined. If one took the plunge, generally the outcome, would be rewarding and greatly encouraging. I stayed in Uganda for 11 years and worked in hospitals like Tororo, Kapchorwa, Mubende, Hoima, Masaka and Mulago in Kampala. This gave me ample clinical work to practice my skills, learn on the job and draw a great satisfaction at the same time. Unfortunately this sojourn of mine (1970 to 1981) happened to coincide with the tyrannical and murderous regime of Idi Amin, a very trying period especially for Ugandans.

Kwaheri Uganda!

The summer time spent in India during April-June, 1980 was a harrowing experience especially for the children as they were not accustomed to the heat which is quite extreme in the months of May and June. We started our return journey and on arrival in Nairobi, thought of visiting my sister Kamla and his family in Lusaka, Zambia. So, we travelled to Lusaka by Kenya Airways and had a glimpse of relaxed and tension-free life in Zambia. It was also a good extension of our holiday. While we were there in Zambia, there was a welcome proposal for us to explore an opportunity to work in that country. It was a politically stable and peaceful country under the dynamic leadership of President Kenneth Kaunda, popularly known as KK, who advocated the philosophy of "Humanism". So I appeared for an interview there in the Ministry of Health and then we moved back to Kampala, Uganda, and resumed our duties in our respective workplaces.

At the time of renewal of work permit, I was informed by the Ministry of Internal Affairs that the permit could not be renewed as I had already enjoyed the privilege of staying and working in that country for 10 years which was the maximum limit. As such, we were expected to leave the country. Meanwhile, we were being issued three monthly short-term work permits to allow us time to make arrangements to return to India. On the contrary, the Ministry of Health was not very keen for me to leave, as they were really short of manpower those days. They promised to solve this tangle at their own level and told me to hold on. The main reason why people wanted to leave the country was general insecurity and unavailability or scarcity of essential goods. 

However, as we were contemplating our future course of action, I received an offer letter from Zambia. It gave us an option as well as time to plan out our strategy to exit Uganda. It was not an easy decision to make as we were so well entrenched in our work and life there. My wife Meenakshi was teaching Biochemistry at Makerere University, Uganda's most prestigious university, and I was working at Mulago Hospital, the country's biggest hospital. In fact, it was painful to end our beautiful relationship with Uganda. 

One fine day I presented my resignation letter to the Ministry of Health, routed through the Medical Superintendent of Mulago Hospital, Dr Jagwe. At first, he refused to accept it and asked me to go home and discuss with my wife and reconsider or reverse our plans. We had taken the decision after careful deliberation. After a lapse of 3-4 days, I once again presented my resignation letter which he accepted with regret and forwarded to the Ministry. Similarly, Makerere University did not want to lose Meenakshi, but had to relent.

We spent our last two days in Lake Victoria Hotel, Entebbe, before taking the flight home in July, 1981. We left after spending almost 11 youthful years in Uganda doing work energetically under the most trying conditions during Idi Amin's despotic rule. At the time of departure from Uganda, we had a very strong conviction that one day we will be back here once again as we had fallen in love with the Pearl of Africa. Despite our great desire, it hasn't materialised so far.

Strangely, our daughter Neelima who went to University of California, Berkeley, on a Fellowship, got the opportunity to visit Uganda for a project on coffee and climate change through the Bill and Melinda Gates Foundation. She was only 2-plus when we left Uganda and she went there in 2010 after about 30 years. Through her, we visited Uganda once again. She sent us photographs of Makerere, Mulago, Rubaga Hospital (where our son, Rajeev, was born) Masaka, Kapchorwa, Sipi Falls, Jinja and Mbale, all those nostalgic places where we had worked. She even visited our apartment in Quarry House of the Makerere University campus where we stayed for some years.

The Festival of Lights in the Middle Kingdom!

We are here in Beijing, China, on a holiday, with our daughter Neelima and her husband Maulik. It has been a very nice trip and we have thoroughly enjoyed it. It is always a great pleasure to be with children. 

It gives immense satisfaction that we can be of some assistance to them albeit for a short period, running a bit of their errands for which they can’t spare time in their very tight schedule. That is the usual pattern of life for the young couples when they are both so occupied with their work and fast pace of life. To give them a helping hand is really of utmost significance and relaxing. 

On their part they have taken us around Beijing showing us various places of interest, historically and culturally and to a far off place like Hangzhou too. The latter too is a very scenic and beautiful place with Buddha relics, a Buddha temple, estates growing the famous green tea on the slopes of the land with a nice lake – the focal point of attraction. 

It was a great time for us to be here with them as Diwali happened to be on Sunday, 3rd of November. We were looking forward to celebrating it with them.  Celebrating festivals in a foreign land is quite different, starkly different from what we would do in India, though the festive joy is no less. 

We improvised tea lights as diyas and they served the purpose very well in place of the traditional earthen diyas. Once the diyas were lit, we did puja in our own simple way as we always do and wish for the good health and the prosperity of all. 

The big difference was that there were no crackers, no noise, and no consequent air pollution arising out of the smoke, though otherwise, air quality in Beijing is generally quite poor.  Moreover, the noise of the crackers could bring about an unnecessary panic or confusion in the society here, who I presume, may not be accustomed to such celebrations. However, today, the use of crackers is increasingly being discouraged in India too, because of obvious hazards. 

Taj Pavilion, one of the Indian restaurants, here in Beijing was considerate enough to wish its regular clients like Neelima and Maulik a very Happy Diwali with a box of traditional Indian sweets which served us well for the occasion. 

Meenakshi's culinary skills were at their very best - a special meal cooked at home gave us a treat for Diwali in our own way. On the whole we enjoyed the Diwali with children after a long time. 

The Indian Embassy here did invite the members of the Indian community on Sunday, 10th November, over a Diwali dinner. Due to other commitments, we had to miss this occasion.

And this reminded me of my time in Africa. Several years back we had a very pleasant experience of celebrating Dussehra in Kampala, Uganda. Before the rise of Idi Amin, there was a very large, progressive and vibrant Indian community there, especially the Gujaratis. We used to have Garba dance for some days, just like we would have in India. The diaspora was so keen to participate in all the activities there with a great fervour.  The venue used to be the Hindu Temple. The great nostalgic memories of those days are still fresh in our minds. We did miss our kith and kin at such times when we are far away from them. No doubt that is an integral part of life.

Certainly, this was an enjoyable Diwali!

Some Quirky Chinese Beliefs & Taboos...!

It is very interesting and a good learning experience to know about the weird thinking of different communities and nations, how they conduct themselves. No particular community or nation is immune to this. The western and so-called developed nations have similar notions. 

No wonder we observed similar things in China!

We stay with our daughter Neelima here in Beijing in a multi-storey tower on the 12th floor.  As we took the lift very often to go up and down, we noticed that the floors 4 and 13 are missing. We learnt that people avoid taking any apartment with an address bearing number 4. Towers and the hotels avoid having floors and rooms with such numbers since the clients won’t take them.  The number “4” is an unlucky number in Chinese. It is a homonym for “death” or “to die”. For the same reason, numbers like “14” and “44” are also inauspicious and avoided. Some hotels in China now don’t have a 44th floor because many Chinese guests wouldn’t like to stay there.

The number “8”, on the other hand is a very lucky number. It sounds like the word “getting rich” in Chinese, especially Cantonese. Therefore, the business houses love to have “8” in part of their address or phone number. They believe that the usage of number “8” will bring them good luck and prosperity. In  fact, people spend a lot of money to get phone numbers or license plates that incorporate the number ”8”. Similarly, a real estate property with an “8” in its address will be in greater demand, and a vehicle bearing “8” in the license plate will signify that the owner has spent a fortune to procure it. A very similar thinking is noticeable in India where you may spend a huge  amount of money to get your desired number which you may think is going to be lucky for you.

The number “6” is also considered a favorable number. It sounds like the word “happiness” in Chinese. Beware of the number “38”; it is especially problematic when associated with women. In Chinese parlance, it can mean bitchy, bimbo-like, or shameless depending upon the context. Ironically, March 8, or 3/8, is the International Day of Women. It is a day when all Chinese women take a half day off from work. Stores and restaurants have special concessions for women on that day.

Big ears with thick and large ear lobes are considered auspicious signs and people who have those are thought to be very lucky in life. No wonder some of the great men like Gandhiji  and Obama do have big and prominent ear lobes and stand as a testimony to the belief  prevalent here in China. It is not to say that the greatness was thrust upon them. They did great things for the society to ameliorate their sufferings and earn a name for themselves.

One month long, post-birth rituals, or zuoyuezi, are the most well observed and well respected rituals in tradition. It literally means “sitting for the month” in Chinese. During this month, a new mother is not allowed outside of her house so that she won’t catch cold from the blowing wind. No shower or head bath to avoid headaches and arthritis in later life. However sponge baths are allowed. She has to follow a diet regime of lot of chicken or fish soup without any salt added to promote the production of breast milk. No television or reading of books or magazines allowed to protect her eyesight. Long-sleeved shirts, long pants and socks even on hot days to protect from cold in joints. Similarly the use of air conditioners or fans is prohibited. It is pertinent to mention here that such rituals are very much in vogue in India too, more so in the smaller towns and other rural places. Even the metros aren't immune to all this. 

Modern education, great advancements in medical science and improved civic amenities in life are bringing about a lot of change in the lives of people everywhere. While an upwardly-mobile lifestyle with a broader outlook is gradually replacing the old, rigid and dogmatic views, some quirks are bound to stay here in China, as we have seen in India. 

On The Trails of Marco Polo.... Part II

The Leifeng Pagoda overlooking the city from Sunset Hill is another attraction in Hangzhou. Originally built in the year 977, all that remains of the original pagoda is the crumbling foundation, to be viewed from outside the glass case that it is housed in.

Leifeng Pagoda

The Pagoda Remains Memorial Museum is at the bottom floor of the pagoda. With escalators and elevators, a totally new pagoda sits on top of the foundation. There is not much to see within the pagoda itself. It was most recently rebuilt in year 2000. However, the view of the city skyline and the vast lake is one of the best from here. The reflection of the beautifully lit pagoda in the evening and night in the lake waters gives a good view to enjoy.

Pagoda view at dusk

A few miles outside Hangzhou, tucked away in the hills west of the West Lake, the world famous Lingyin temple, boasts of a history of 1,600 years and is home to the country’s largest statue of Sakyamuni, rising 24.8 meters into the sky. 

Lingyin, meaning “heart of the soul’s retreat”, is one of the three oldest and most famous temples in China. There are hundreds of Buddhist stone statues carved into the cliffs in the “Peak Flying from Afar”.  This depicts very clearly the influence of Buddhism there in China as in the rest of Southeast Asia. It is very much evident that the people here have a great reverence for Lord Buddha. They prostrate before Buddha with all the humility and respect. We were lucky to be there when the evening prayer, much like the Indian “arti”, was being performed by the monks. They were 80-100 in numbers and were going round and round for about half an hour in three rows around the massive statue of Buddha humming a very soothing prayer. All of us (the visitors) were watching and soaking all this to our memories.

Monks prostating

Monks doing their aarti

Hangzhou is also known as the “China’s Tea Capital”. The Longjing tea is one of the most famous teas in China. It is a green tea, enjoyed by all here and taken several times a day. The green tea is hand plucked.  The tea plucked in the month of March is most expensive while the one plucked in April and May is a little cheaper.

Longjing tea gardens

Longjing tea, a kind of green tea

We enjoyed the tea at a local farmer’s house in Longjing village after visiting the tea gardens there on the slopes of the hill. The restaurants there were doing a roaring business. The city is also a blessed land of silk and sericulture with a China Silk Museum, China silk town and Du Jinsheng Embroidery Museum. Hangzhou is also famous for pearls after green tea and silk.