Somewhere in 1984 I decided to leave medical college midway and see the villages of

India. Somehow the people at CRHSE Tirupattur (Centre for Rural Health and Social
Education) got me to talk to the college about it. Anand Zachariah asked me to speak to
his father Dr P Zachariah and finally the college gave me permission to leave for 6
months. Meanwhile I had spoken to many people and got a variety of ideas. Among them
was the suggestion by Dr Sharada L (now at Indian Institute of Science in Bangalore) that
I meet Dr Binayak and see the Shaheed Hospital. I had planned to spend a few months in
each of three or four places, but the short period granted by the Senate forced me to
restrict myself to a month of travelling, followed by 4 months at CRHSE.
I began with visit to Bangalore where I spent a week with Dr Ravi and Thelma Narayan
while studying sociology under Fr Claude. Then I visited Mysore followed by week at
CINI near Kolkata, a day at Santiniketan, and some time at St Luke's Hospital Hiranpur
and in the districts of Sahebganj and Dumka, ending up at Palamau in western Jharkhand
(now considered a strong hold of the Maoists).I finally arrived in Dalli Rajahara around
the middle of August
When I first met Dr Binayak Sen in August 1984, he was examining a child in the
verandah of the Shaheed Hospital (Dalli Rajahara, Chattisgarh). Just then the child passed
stools. Binayak went and fetched a mop and cleaned up the mess. He told me that he was
as qualified as anybody else to handle a mop- so why not?
This intrigued me. I waited for Binayak in the OPD that evening. A health worker saw
three patients and prescribed simple medicines for them. Then a patient with ten days'
cough came and he asked me to see the patient. I didn't feel confident. But I was
impressed at how he rationalised the decision to refer.
The next day I think I had a loose stomach and rested at Binayak's home in the small
town. I glanced at some of the books which Ilina had gathered for her research on
working women. She was away in JNU at the time. I went to the hospital in the evening
and spoke to Dr Saibal Jana and Dr Ashish and learnt about CMM and its struggle, about
Shankar Guha Neogy and a bit about the Gondi language and about Chattisgarhi.
On August 15th Binayak took me again to Shaheed. He introduced me to the person who
hoisted the flag that morning. He was a Gond tribal priest who proudly carried a CMM
flag to show the jeeps when he travelled around. Then I met the health worker and asked
him why I had not seen him the previous day. He said, "I went to work". So I blurted out-
"But you are a health worker."
"No", he said, "I work in the mines. In my free time I come here to learn medical work
and serve the patients".
That I think was when Binayak's point sank in- a hospital for workers, of workers and BY
workers!
In fact the committee that ran the hospital included all staff- sweepers, nurses, doctors
and so on- and all of them had equal rights. If a doctor had no children they earned less
money and the sweeper with a larger family earned more.
At the end of 1984 I had a chance to join a medical relief team in Bhopal.
I continued to meet the quiet and polite gentleman (Binayak) after 1984 nearly every
winter at Sewagram in the Medico Friends Circle meetings including the one on TB in
Bangalore at which Binayak was a leading personality.
Suddenly after listening and participating for a day or two he would suddenly say, "I have
to go home today. It is time to harvest the rice. I am a farmer you know."
My first job in 1987-8 was in CRHSE again. Then I went to West Bengal to work with a
PVOH (USAID sponsored) called Sidhu Kanhu Gram Unnayan Samiti. From there I
went to Hiranpur to learn Santali. I hd first visited the Thompsons in Hiranpur during my
student travels.In the 1990s I spent three years as a junior doctor in Hiranpur and another
6 years in Santal Parganas in various other jobs. While I was at Hiranpur in 1990 a group
did a study in Bhopal (on gas victims- it was to be part of a court proceedings). Binayak,
Dr Rajiv Lochan Sharma and Dr Punya Gun were also in the team. Sathyamala, Sathyu,
Mira Shiva and a large number of volunteers were involved. The bricks for Ram
controversey was at its height and a riot almost occured at Bhopal.
Later many of us from MFC also took part in translating for the International Medical
Tribunal for Bhopal in 1994.
Punya was writing health booklets in simple Hindi at Shaheed and he used to send these
to me. They were much appreciated in Santal Parganas. Binayak moved on to a mission
hospital. He had a high BP I think. CMC could not give him a job in Pediatrics, but Dr P
Zachariah suggested this place at Tilda to him. Meanwhile Shankar Guha Neogy was
murdered. In his last testament (he recorded these on audio tapes) he asked CMM to get
Binayak back to guide their health work.
By this time I suppose Rupantar had been formed and Binayak started commuting
between Raipur, Bagrum Nala and Dalli Rajahara.
Later on the Bilaspur group started work and Binayak supported them. I know that
Binayak trained health workers and later Mitanins for the government. In 2000 both
Chattisgarh and Jharkhand became new states. Binayak was involved in the Right to
Health movement. Both our states held a common hearing at Ranchi. I was able to send
three or four patients from Godda to present testimonies. Binayak was at the hearing by
the NHRC. He was very disappointed that I could not go. Since I knew of many Kala
Azar patients and their problems he thought that I might accompany some of them.
More about my work nowadays- see the notes at http://karnajora.blogspot.com for 2009
and http://prabirkc.blogspot.com for 2008. Other than that my work since 2000 has
mostly been in Polio Surveillance and Routine Immunization- which is rather different
from what Binayak has been doing.

…........24 years on.................15th January 2008

8am I got off at Raipur Station. It cost me Rs 10 by auto to the bus stand.

Bus Stand at Raipur

Another Rs 40 took me by a Sleeper Coach Bus to Dhamtari town. I reached at 10am.
The Christian Hospital is just opposite the bus stand. Prahlad picked me up at the bus
stand and took me to the Rupantar office. I met his family, who stay there and at 11am
we set out by motorcycle for Bagrum. We passed Kukrel and two Primary Health centres
on the way. Paschim Keregaon actually starts at the 10 km mark from Dhamtari. Another
18km down the road is Keregaon (28 km from Dhamtari) junction where we had tea and
a tuber called Khesar Khond. We bumped into Jaffar Ahmed, a former Rupantar staff
who now works for ASTHA at Nagari (the block town of Nagari is 37 km away from
Keregaon). Then we left the Nagari road and turned down the Ghattasilli road. This road
continues to Bhopalpatnam on the Andhra or Orissa border. We travelled about 6km
down this road and then took a moram road (in 2009 this was in the process of being
converted to a
Pradhan Mantri Gram Sarak). 2km later we were at Bagrum Nala. Here we met shanthi
and Ghasia.

Ghasia at the Bagrum Clinic

The earlier laboratory technician Puroshottam Yadav has left to set up a private lab.
There were many malaria cases here around 2000. There were also many patients with
TB. The first recorded patient was in 1995 and many in 1997 and onwards. Patient cards
were started in 1999. Now there are over 2500 patients recorded.
The anganwadi and the primary school were open. But the panchayat was closed.
Possibly owing to the large distances, panchayats here cover only a small population. The
local sub centre (which has 2600 population) includes 3 panchayats (250 people live in
Bagrum and 300 in Bindrapani). A male health worker arrived on a moped with a vaccine
carrier. Tuesday is immunization day in Chattisgarh. The expected births every year are
around 60. The health worker had OPV, DPT, TT and Measles vaccines. He had a
reconstitution syringe and a used auto-disable syringe. He had given one child measles
here in Bagrum. According to him the vaccine could be used up to one hour after
reconstitution. He also had two unused AD syringes.
The ANM has gone to Dhamtari to withdraw funds to send the Mitanins for a rally at
which the new Rice for Rs 3 scheme will be inaugrated tomorrow. There are 400 odd
Mitanins in Nagari block. There are a smaller number in Magarlod Block, which is also
supervised by Rupantar.She usually visits each of 4 Anganwadis in rotation on
Tuesdays.On one Tuesday she attends the sub-centre. Keregaon sub-centre is attached to
a larger Primary Health Centre. There was no doctor there apparently in 2008 or 2009.
Other staff are also said to be irregular.
Electricity first reached this area around 1995. Now there is regular supply of electricity.
1 km behind the village is the reservoir of a dam. In fact there are 4 dams on the upper
Mahanadi. The first is just outside Dhamtari town. The road that we had traveled on in
the morning crosses the main feeder canal of this dam just after we left the Rupantar
office.

View of the river Mahanadi just below a dam at Dhamtari- a rich town with 40 rice
mills.

Now there are 2 crops of rice a year. Remember that Chattisgarh and Madhya Pradesh are
home to many ancient varieties of rice. The rice plant seems to have been cultivated here
earlier than in other parts of India.
We had local organic rice and dal for lunch. It is machine-milled rice however. Ghasia
showed me the old records. We agreed to meet on Friday.
Notes on a TB patient in Dr Sen's handwriting at Bagrum

In the evening we went to Dhamtari Christian Hospital. I found Dr Vaibhav Londhe, who
had done his internship in CHAD when I was doing my MD there. He was quite
surprised to see me. His mother in law knew Binayak. She appears to be a niece of
Bishop NM Bagh, who was CNI Bishop of Patna when I was in Hiranpur. She had also
been to the recent CMAI meeting in Shillong. Vaibhav’s daughter was fast asleep. His
wife Dipti came down a little later and for a minute mistook me for Binayak! She thought
I looked familiar but didn’t remember me from her student day Community orientation
Programmes when we had taken their class to the villages. Vaibhav is an MD in
Obstetrics. His elder sister Megha is also an MD in Obstetrics and now works at the EHA
Hospital in Herbertpur. Vaibhav suggested an ante-natal clinic a Bagrum Nala. First
Saturday sounded like a good day to him. He told me to talk to Pappu Bhaiya (PK
Martin) about this. We heard that Anil Henry and his wife Teresa (nee Martin) are at
mungeli (between Bilaspur and Ganiyari). Sachid Das has moved to a hospital near seoni
in Madhya Pradesh. Dr PD Deshmukh, whose mother had received the Paul Harrison
award, is now at Tilda. Renu Jogi is apparently looking after her husband and his work.
She is probably related to Dipti too. Dipti’s father was the Secretary of the Eastern
Regional Board of Health Services of CNI for many years. Vaibhav remembered
Rakhal’s visit to Dhamtari. Rakhal had done an evaluation of Mitanins. The Dhamtari
block Mitanins came out top. Dr Netam of Dhamtari CH had been one of their trainers..
Iheard that here is a Panchakarma (AYUSH) clinic in the Dhamtari Christian Hospital.
P K Martin looked much older than when I last saw him with a backpack in 1981. He still
drops in at Men’s Hostel where his son Aditya is now a fixture. Grandpa Martin was in
the clinic when I arrived Martin’s father retired as Superintendent of Dhamtari CH many
years ago and they now have their own 30 bedded private hospital. PK (aka Pappu
Bhaiyya) told us that “Cherry” (Thomas Cherian who works for WHO in Geneva) was
surprised that he still stayed at the hostel when he was in Vellore and he (Martin) had
said, “That’s where all the men stay, yaar!”
JP (one time Principal) had phoned PK as soon as Binayak was arrested. The Martins
know the local police well. In the 1980s PK was an amateur shikari on a motorcycle
(“poacher”). He knew where to get a donga (makeshift boat) and shoot ducks at the dam.
And to be sure the best boar in the area was found near Bagrum Nala. We confirmed the
location on the map in the clinic. PK agreed that the panthers who attacked the dogs at
their mango orchard west of Dhamtari might not trouble the people at Bagrum. The SP of
police had recently asked Pappu Bhaiyya whether he would help them hunt Naxalites.
Nobody knows the backwoods like Pappu Martin, ex-poacher and now surgeon to the
poor and the rich of Dhamtari. We met his Jeevodaya (local Catholic dispensary I
believe) patients and heard about his patients from the Mandir Trust. We met Harmeet
Singh who was born in Dhamtari and trained in Raipur as an orthopaedic surgeon. He
works for the ESI and uses the Martin Hospital operation theatre. PK told Harmeet how
he amputated the legs of a supporter of Shankar Guha Neogi who had been subjected to
roller torture. I watched a video in the evening of a meeting of Mitanins at Kukrel in
2006. Chandrika sang in Chattisgarhi. There was a discussion on NREGA and on the
health system. They say Johar here, just like in Jharkhand.

Anganwadi/ government creche children at Bagrum

16th is Makkar Sankranti- day of the Rs 3 rice rally- the mitanins' travel to the rally was
funded by the untied fund for the sub-centre. The newspapers say that Ram Vilas Paswan
started an NFP scheme in Dantewada today. Bailadila II B was started too.

See this film-

Keregaon Tea Shop with Prahlad
Keregaon and Bagrum are in Nagari Sihwan block. Bagrum road branches off the way to
Gattasilli after 8 km

Tribal children around the fire near Bagrum

Forest Jhum is the Slash and Burn agriculture practiced when there is low pressure on the
land. Many communities practise this for subsistence (to get food) while doing other
trades to earn some money
• See videos of Lagni Kamar's mother, a basket weaver. Basket weaving is their
traditional trade
• Chamar Singh who excelled in his exams is a Kamar first generation learner from a
Rupantar hostel

Chamar Singh of Amapara

Hazaron Nalaon aur Ek Hi Nagari could be the name of the story of Sail Bahara village
The Jharia or pools of the drying brook (brook is called Nala) used to be the main source
of water in Sail Bahara.
In 1990s Rupantar advocated a well. The well prevented the outbreaks of diarrhoea which
plagued this Kamar basket weaver settlement in the past.

See the preview videos at

http://prabirkc.blogspot.com

http://www.youtube.com/profile?user=cprabir&view=videos

http://cid-06aa90f278b5c9e9.skydrive.live.com/browse.aspx/Bagrumnala

See these films

• Story of Sail Bahara- Pilku Ram and son of a villager
• Jhari(a)- dried Nala/ stream
• The Well
• Water Arrives in Bagrum Nala
• School Pump in Bagrum

Lawyer Sudha Bhadwaj of Bhilai discusses with Medha and Gabriele of NAPM
Team to meet Binayak at Raipur Jail
Binayak and Ilina's daughters Pranhita and sister Aparajita at the jail

Ilina and Aparajita at home speaking to PUCL's Raju Sail after we met Binayak
that day
Prahlad and family in 2009 (the elder son is at the computer). Prahlad is a staff of
Rupantar and was my guide on my trips to Dhamtari

2009...another year has passed. …. Binayak is still in jail. I visited Bagrum again.
Maina's son and his father seem contented. They are at granny's place -a tiny tribal

Maina's son and his father

settlement in the forest. Maina arrived at her mother's home by motorcycle late in the
evening with her family. The next morning the doctor visited them before returning to the
capital city of Raipur (100kms away). I used the same MP4 player-cum-camera to take
this snap and to take a lttle video of raised pulsations in Maina's neck veins. We sent this
by email to the consultant internist at Bilaspur (who travels all of 6 hours each way for a
fortnightly clinic) with a little note on Maina's condition. He in turn phoned instructions
for her treatment to Ghasia the village health worker, on the WLL (wireless in Local
Loop) telephone which was recently installed in the remote tribal village.
Little changes- electricity, motorcycles, roads, WLL phones and cheap digital cameras
that bring the benefits of specialist doctors' advice to the remote jungles of central India.

This is about Maina Bai (25/F), who probably had RHD with a ? diastolic murmur on the
left sternal border (am I correct in guessing tricuspid regurgitation?)
She complains of cough for 2 weeks.
Saw her on 6th February morning. She is the ex-Pradhan's daughter and an old patient at
the Bagrum clinic. She was advised an operation, but has married 3 years ago and has a 2
year old son. They live in Bathina.
She was on Enalpril 2.5mg, Frusemide 20mg and Folic Acid since 2003 at least. She had
stopped Penicillin G (oral daily doses).

She now has a pulse of 66/min which appears regular and BP 120/60mm Hg.
Her JVP is raised (see video clip)
? diastolic murmur on the left sternal border

Her respiratory system seems to have no creps or rhonchi, but she has incessant coughing
and possibly throat congestion. There might be a patch of increased vocal resonance at
the left posteriorly.

Her LMP was 20 days ago. She has regular menses.

For now I have advised her to increase Frusemide to 40mg (watch out- the prescription
does not mention whether she misses weekend doses) and restart Penicillin if it is
available (Prahlad is trying).
Her mother wants her to have Sputum testing as she has lost weight. This will be done.

A brother of hers had congenital heart disease and was operated. He has used Rotahaler
caps in the past and they want to try it for her. Sounds unlikely to help- have not
forbidden it.

There is a WLL phone at Ghasi's place 07841 298225- so you can easily contact and
make the needed corrections. Maina will be there for the 13th clinic.

Prabir

Dear prabir,
…............ and all the technology employed.
The first time ever that i have seen a JVP on the internet!The JVP is
indeed raised, and there are prominent cv complexes possibly because
of tricuspid regurgitation. With a diastolic murmur and her gender, i
would think she has mitral stenosis as the root cause and the
tricuspid regurgitation is due to pulmonary arterial hypertension. In
future, you might consider one of the new Littman electronic stetho,
whcih can give you a phono recording immediately!
the cough is likely to be due to pulmonary venous congestion with her
CHF, although there could be an intercurrent LRTI as well. Apart from
the raising of the frusemide dose, and advising some bananas on a
daily basis for the potassium/oral potchlor, i would advise a course
of amoxicillin/doxycycline ( if the 2 year old is not feeding ). she
also seems to be in atrial fibrillation, and should be on digoxin 5
ug/kg/day to control what appears to a very rapid rate.( 66 per min is
not what her JVP seems to announce)
5% of people on enalapril can also develop dry cough as an adverse effect.
She can be considered for intervention at AIIMS. Recently we sent 5
women together with our escort to AIIMS and they have come back, with
wide smiles and widened mitral valves.
i shall ring up ghasia tomorrow and follow this up.
with best wishes,
anurag
(then at JSS Ganiyari and currently on the faculty at Mc Gill University)