Medico in Green Pastures

He lit a cigarette, and in between puffs he went on talking to me “Doc! This is a transit in your medical career. As long as you are here, you should try to contribute as much as you can, and remember what Alexander Pope said hundreds of years ago, “Honor and shame doth no condition arise, act well your part there all the honour lies”.

Doc ! “Will you Join as the medical officer in the faculty of Agriculture waudra Sopore1, we have a vacant post there”? Prof GM Wani who was then Director Extension Education of Sheri Kashmir University of Agriculture Sciences & Technology (SKAUST), inquired with an infectious smile. He had been admitted with pain abdomen, and an inflamed appendix was taken out in the emergency theatre of SMHS hospital Srinagar where we were pursuing our house job years back. My batchmate Dr Ali Mohamad had introduced me to him, and we had a lovely chat full of wisdom with him in the hospital. Well, the professor’s gridiron incision (appendectomy incision) on his lower abdomen was still raw, and he was thinking of medical facilities in the faculty of Agriculture. This spoke volumes about his concern for the college. I joined as medical officer days later, and this marked the start of my medical career after my MBBS.

“I am pleased to be here and to see you all. I have come to live among you, as Rhizobium lives with legumes as a symbiont and not as a parasite”, with these words I started my job as a Medical Officer at the Faculty of Agriculture in Wadura  Sopore, Kashmir, nearly 60 miles to the north of Srinagar. It was a happy coincidence that on that same day, students were celebrating their fresher’s day and by addressing them thus, I was given the opportunity to share my emotions about the enormity of the task facing me. While acknowledging their applause, I was acutely aware of the lack of medical facilities at my disposal. For years the faculty had had no Medical Officer, and I could feel the weight of my responsibilities on my shoulders. “Doc! You are most welcome”, said the tall, well-built senior pharmacist Mr Bashir Ahmad Nanda, as he took me around the College’s medical unit, which is situated on one corner of the lush green campus of the College. I made a quick assessment of available medical facilities, and together we started compiling a list of essential missing medicines, instruments etc. which would be needed for the unit. That very week I was allotted accommodation in the staff quarters, which came together with a young boy, Mr Ghulam Nabi Bhat from a village near Kupwara, who was to look after me. The faculty apartments were in the heart of a pear orchard. Although there was more staff housing available on that lush green campus, only two units were occupied, one by the late Dr Nirmal Singh, the Dean, and another where I had started to live. Invariably, we would meet in the evenings after our day’s work. Dr Nirmal Singh was a very dynamic administrator, and he had a perfect sense of humour. During the spring season, one could take pleasant walks amongst the soothing white flowers. The Faculty is situated in more than 250 acres of beautiful lawns, and a large variety of flowers and fruit trees all providing a unique fragrance to the passerby. The Hurmukh  range of mountains seems to safeguard the serenity of the campus. A small river called the Phoru  flows calmly along the exterior boundaries of the campus, and a population of a few thousand souls lives happily on its banks. Well, dear reader, from a tumultuous doctor -patient-doctor relationship, I had chosen a place where as a doctor I had very little or no work at all to do. However, with the passage of time, I started realising that being a doctor does not mean being a prescribing machine only. I, therefore, in addition to my official assignments, extended the remit of my services to this nearby Wadura village. I would often come to collect post from the administrative section of the college from Mr Ghualm Mohamad dar, Qibla, as I would often call him, as that used to be the only way I remained connected in that internet-less era. One day I met the late Prof J.D. Safaya while collecting the post and he took me to his office.

I patiently listened to his excellent advice like any disciple should, and my only negative thought was that his smoking habit was both worrying and annoying me a lot. I felt it was too premature to counsel him directly at that juncture, but I made up my mind to do so, albeit indirectly. Consequently, I undertook my first study4 on high-risk smokers and associated risk factors of atherosclerosis on the campus. A series of lectures on preventive medicine followed.

One day a young boy was brought to our clinic with pain in his abdomen from the village. He was writhing in pain, and a clinical examination displayed the possibility of a worm colic, a widespread problem in Kashmir. “Doc,” his mother asked me innocently “he has not taken anything since yesterday morning. Will it be possible for you to give him glucose (IV-fluids)?”. Her innocent request made us start thinking harder about upgrading our medical unit. “Doc! Why don’t we de-worm all children in the village”, the senior pharmacist suggested. “To the best of my knowledge, worm infestation is quite prevalent here. You probably know most of the children miss some of their classes due to pain in the abdomen caused by worms,” he went on. The senior pharmacist who came from Baramulla5 had been living in the Wadura village for years together and would visit his home on weekends. The loud sounds of his old Yazidi motor bicycle every Monday morning would mark his arrival back at the faculty. He had very good experience of the clinical problems found in the village, as he would practice there after hours. I found him a very co-operative team member during my tenure in the faculty. Finally, one fine day we conducted a mass de-worming program in one of the schools of the village. Tab. Pyrantel Pamoate was given on the spot to all the school children, followed by health education, with an emphasis on personal hygiene. The drug was well tolerated by all, and we did not observe any untoward side effects in any of the children who received it. Intestinal helminth infections are prevalent in most developing communities, and school-age children harbour some of the most serious infections, which can produce adverse effects on health, growth, and school performance. A while later, a smiling senior pharmacist told me “Doc! This morning on my way to college I met the principal of another school. They too have requested a camp like this in their school.” He was feeling satisfied with the results of the previous camp. Consequently, under the auspices of the National Service Scheme (NSS), all local schools were finally included, and the late Prof G.M. Wani was crucially helpful. Our medical unit carried out a series of medical camps in Wadura village and also in Bomai, another community, again under the auspices of the NSS. It set the trend among the local population. Suddenly, all parents were de-worming their children every six months without any fear of untoward side effects of the de-worming tablet. We didn’t study any impact of de-worming, but the number of students coming to us for treatment with worm colics decreased drastically following the mass deworming programs in the locality. Well-designed studies6 treating school-age children with anti-helminthic drugs have shown that mass de-worming results in improved growth and nutritional status. There is enough data to suggest that after de-worming the children also have higher scores on tests of cognitive function as well.

Our next milestone was the establishment of a small clinical laboratory, as the whole area was devoid of any laboratory facility, and patients needed to go miles away to get a simple investigation done. There were the myriad administrative hurdles found anywhere in cases like these, for instance, the creation of a post for a new technician, purchase of lab equipment, etc. While the proposal was under the blanket of red tape, awaiting official sanction, I suddenly had an idea. “Why don’t you learn basic lab investigations?”, I suggested to the senior pharmacist. He happily agreed, and he was duly officially deputed to the sub-district hospital in Sopore where he was taught to do basic lab investigations. No sooner was his laboratory training complete, than we were able to start the budding clinical laboratory in the medical unit. Basic investigations such as hemograms, urine examinations, ESR, etc. were all done free of cost to students and on a “No Profit No Loss” basis for Faculty employees and local villagers. In this way, our laboratory was soon paying for itself, without any financial burden on the Faculty. The influx of patients from the nearby village increased rapidly, and soon our medical unit felt like a small busy hospital.

Excerpt from the Book Bumby Roads authored by Dr. Ibrahim Masoodi.He can be mailed at ibrahimmasoodi@yahoo.co.in

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