Final Year MBBS
Grant Government Medical College, Mumbai
He lay on the floor of his miniscule shack. Correction. Miniscule yet robust shack. The hut had been an abode to many. The innumerable generations of his family, his comrades from the tiny hamlet of St. Petersburg, South Africa (that had been his home since he entered this world), and any traveller who stopped by for a homely grub- all housed and hosted in this age old dwelling.
What had seemed to be robust over these years now appeared to be tumbling down gradually. No, not only the walls of this hut, I am talking about our old man’s spirits as well. His hair slowly silvering by the gifts of wisdom that age bestowed. Bloodshot eyes and a tremor in his hands. He gazed blankly at the thatched roof, listening to the sound of raindrops, trying to seek its musicality. His ears were also filled by the cries, from the next room, of a pregnant woman, his wife. The women of the village had been with her for almost a day now.
“Mhadi!” someone called.
But Mhadi closed his eyes, heavy with sleep, and still the lack of it. He could still picture those happy days. He could still picture his little boy.
Berko was not like the other boys. He was born during the chilly months of December, when everything failed to grow. The quiet one, the effeminate one, the one who preferred lending a hand in his mother’s household chores over a hunting game, unlike the other boys. His peers mocked at him, branded him a woman in the guise of a man. The entire village had failed to accept him for what he was. It was his father who was his pillar, who urged him to believe that he was unique. That he was special.
Night was drawing close to the end of a hot summer day. It was that time of the year when the rivulet was frequented the most by the youth, who were now returning back after a refreshing swim. Berko was also on his way back home; bringing berries he had collected from the forest. He strolled past the rivulet, whistling to himself, when he saw three Herculean shadows behind him. He increased his pace, sweat beads appearing on his forehead. One of the men grabbed his shoulder and before he could free himself, he was pinned to the ground.
“Look what we have here”, said one of the men, his body sculpted to perfection like that of the others, several streams of perspiration coursing down his bare chest.
“It is the little pansy, isn’t it?” enquired the other.
Berko tried crawling backwards, but two of those villains had already caught hold of his arms and turned him so that he lay on his stomach. He cried in resentment as he was ruthlessly disrobed, while the third man pulled down his trousers as well. The cries of anger were replaced by cries of agony, as Berko felt an intolerable pain inside him. His eyes welled up with tears, as his fingers clawed the earth. And when the job was done, the men left him alone, blood spattered around him like the berries fallen from his basket.
“Berko?” he heard a voice. Berko opened his eyes to find himself surrounded by nearly half the hamlet. He felt very weak, his head spinning, his vision blurring. He closed his eyes again.
In the months that followed, Berko became extremely frail, emaciated actually. Some days he was burning hot with fever, other days he remained in the backyard of his house, vomiting and coughing out blood. There were nights when he was drenched in his own sweat, when it was icy cold outside. There were times when he was thrown into a bout of seizures. The neglected sanitation of the village harboured the diarrhoeal epidemic, though not so monstrous, nearly took the boy’s life.
The village folk spoke of him that he had contracted a deadly ailment of which there wasn’t any known cure. The local medical man turned his back on Berko, saying that he was possessed by an evil spirit that made him ‘less like a man.’
Berko’s father put his life’s savings together in an attempt to give a life back to his son. The nearest town was a hundred miles away. Lack of proper mode of transport as well as Berko’s deteriorating health made travel out of question
And then one fine day, Berko was found sprawled on the floor, blood pooled around his wrist, a treacherous blade of metal smothered with it.
“Berko,” whispered Mhadi to himself, his eyes moistened the slightest bit, and then closed for the last time. Mhadi was gone. His soul freed from the shackles of grief. His soul freed to meet Berko’s. His soul probably making space for another in this world.
Samuel Jenkins. A 25 year old investment banker in Boston, Massachusetts. A workaholic, working more than twelve hours a day, and hence having to face the biggest ordeal of being confined to bed of hospital since the past 3 months.
HIV. This triple letter entity had claimed the lives of millions in the past few years. Our Mr Jenkins had been the victim of just that. The how and why and when did he contract the diabolical condition was still a matter under investigation.
“You are quite lucky, Mr Jenkins,” said Dr Roberts, a fair skinned, tallish man, with jet black hair combed back to perfection, “that you have been diagnosed at an earlier stage when your cell counts have not dropped to irrecoverable levels.”
“More so that you work in a government establishment offers you an additional advantage of getting your medical bills subsidised,” said Dr Jones, an African-American, well built, with short curly hair.
Samuel nodded; spoke a few words of gratitude to the doctors as they left. He extended his arm to the nurse who collected his blood to run a few tests. He remembered his urine that had been collected the same morning- as red as his blood.
He had been diagnosed three years back with this grave illness, on which he therefore conducted an extensive research. HIV, Lymphocytes, CD-4 counts, ELISA, Western blot, opportunistic TB, Lymphadenopathy, Nevirepine, Lamivudine, Efavirenz- he knew all about them. And so he also knew what his odds were if he stood up against Death.
He knew he only had a few years to live.
As the scorching heat of the summer afternoon gave way to the cool evening, Samuel left his hospital room for a walk in the garden below. It was his favourite time of the day, when he could stretch his limbs a bit, relish the breeze, and dive deep in the ocean of his thoughts.
He thought about his life in this amazing country, in this city of opportunities. The times that had not been kind to him, the reason being he was ‘coloured’, labelled a ‘negro’. He had been forced to sleep on the footpath, just because no motel was ready to provide him a roof. The job he was doing had not been a bed of roses either; he and his many black colleagues had to face the mockery and discrimination of their white counterparts. The blacks had been denied access to all sorts of services- transport, food, residence, and even basic health services.
But the Gods had been kind to him, he felt. As time went by, it carried the adversities along with it. He became a recognised citizen of the USA, and so did the other people of his community. One’s qualifications governed one’s state of employment, and not the mere colour of one’s skin. The Whites finally seemed to have shed off their coat of racial discrimination and had moulted (more or less) into individuals who became Samuel’s closest friends.
Samuel looked at his hands. His fingers had been reduced to bony remainders. But he did not mind, staying grateful that he had been bestowed at least with a couple of more years to survive. He was appreciative of the fact that the health services were attaining great leaps, with a remedy for every malady. He was gratified with the availability of health for all, whether you belonged to a particular culture or to a particular sex other than male or female. The progress in the means of transport had enabled medical personnel to cross boundaries. It was through the developments in information technology that people like him, without a medical background, could look for the red flags which drove them to the physician.
Samuel took out his wallet. Opened it, and held it close to his chest, closing his eyes. The one thing that he had strongly desired, but which he had to leave perforce. His Africa. His home. He reminisced his days of youth, the hunting trips to the forest, the wholesome crop that reaped season after season, the life of toil yet a life worth living. He remembered his mother, who told him of his father and his elder brother. His father had died the day he was born, and his brother a few years before.
Then came along the awful memory of the separation. When he and his mother were compelled to run away from the village, as the floods destroyed their house and lands. When his mother let go of his hand as the water tore them apart. Samuel had thence been carried away, through the unending lands and endless seas, to the biggest piece of earth he had ever set foot on- the Americas.
His mother had told him stories of his father and his brother. That his father was an honest man, who earned an honest living. That he had died the day he was born. Of his brother, who had been a strong little man, battling a deadly disease.
Just like Samuel, except that Samuel could never know.
He looked at the picture in his wallet. A tear or two fell on Mhadi’s and little Berko’s smiling faces.
Mhadi and Berko. Beings of the 20th century. A time when the air inhaled was purer, when the eyes were fortunate enough to witness the beauty of the countryside.
A time when medicine was evolving and growing. Medicine had attained great heights in most countries, from treating a simple case of flu to the treatment of retinoblastoma.
And yet a time when some parts of all nations were still orphaned. While a greater portion of the world had already been bestowed by the benefits of this boon, there were some homes like Mhadi’s that was miles away from this gift, owing to the lack of adequate means of communication. Berko’s was an untreatable disease, agreed. Yet, a better means of travel would have helped him make great strides in improvement.
As a part of an African tribe, which were not only financially backward but prey to superstition as well, the monstrosity of the situation was even bigger. Education and financial upliftment of such people was very important as was the expansion of the science to, if not win, at least stay in the battle against disease for the longest time.
The present, they say, is a gift. And indeed it is. More so in comparison with the times that have flown past. There is a remedy for almost any illness- physical or psychological. The most impressive development has been made in the field of psychological medicine, considering the levels of stress people have to live with, and the fact that depression has become a very common malady. The other being nuclear medicine, when cancer patients are being given a ray of hope. Patients with diseases like AIDS, with which one could live only for a few years, are showing an improved life expectancy.
Governments have made it a priority to support the health care of their people. In countries, including India, a major portion of the population is dependent on health subsidies of the government. Minor ailments and surgeries are treated at government hospitals at a cost which the poor an also afford.
But since there are two sides to every coin, the present scenario also has an ugly aspect. What with the fact that almost everyone is ‘entitled to’ an equal share of the endowments of the medical world, is everybody actually ‘receiving’ it?
Yes, there is still a section of the society that is remote from the developing health care. Be it in terms of enjoying the welfares of health services as patients or even opportunities to practice the medical profession. It is still held, by and large, that the coloured races are a different entity altogether, as is evidenced by Samuel’s experiences of being discriminated against. It was around 2007-2010, that a wave of opposition had arisen in the United States against the different treatment meted out to the Hispanics, the African Americans, Latinos, and South Americans. Undoubtedly, even after years have passed since the uprising initiated, by the local support groups, against racial discrimination, some notorious elements of society is always ready to reignite the fire again and again.
Differentiation on the basis of sex in case of the Lesbian Gay Bisexual Transgender communities is rampant even in what one might consider to be an educated society. Bias on such grounds in the provision of health care services is indeed shameful, especially if something is not in the hands of the patient. It is either stigma or the fear of the authorities that has resulted in the inculcation of such practices, as the acceptance of LGBT community is still far from being legal in a country like India.
Apart from this, the placement of people in different strata of the economy has made matters even worse. For some, it might be very convenient to afford medical aid for the most complicated of surgeries while for most others, seeking help for a minor form of trauma might consume their yearly earnings.
What the future holds for us is a tricky question to ask. Whether it will represent an ideal utopian society-one which offers equal allocation of services and resources to all or an era of dystopia, a phase of differentiation and discrimination at every step.
Apart from the continuing advancements in the field of medical science, telemedicine is expected to make the world a much smaller place. Training of medical personnel is possible across a computer screen that has connectivity over hundreds of thousands of miles in some of the remotest corners of the world. Conducting major surgeries will be feasible and save time required for transport.
Many people have been where Samuel once was, discriminated against for something he wasn’t responsible for. Several others victims of gender inequality. Education and awareness has opened the gates for wider acceptance in different walks of life, including both the patient cohort and the medical fraternity. It is hence expected that this trend continues in the future as well.
The future of medicine, though armed with the medical armamentarium, rests greatly on the shoulders of the beneficiaries as well. With the rapidly expanding population, equality or even equity in the distribution of resources seems a challenging task. Some part of earth still remains aloof from the aids of the science of medicine, and it is hoped that this gap is filled adequately. Also, personal hygiene, prevention of preventable diseases, protected sexual intercourse are some aspects that must be dealt with by the people themselves.
The nature of medical services in future greatly relies on the status of the current health care systems, as well as the culture and consciousness of the people who enjoy it. It is therefore imperative to protect and improve what we have today, to ensure a better, brighter tomorrow.
Tis’ human hands that heal
Man who can do harm as well
Will it be drought, or a hearty meal?
My Friend, only time will tell.