Letter from Mumbai

https://esichumanitiesclub.blogspot.com/

May I introduce you to a site featuring essays rich in compassion, common sense and native wisdom? Such a site is not easy to find in the world of commercial medicine in India.

The authors deserve recognition and applause. Thanks to Georgiaria Fernandes, I was able to learn more about the three founders of the blog. They are based in Chennai. Dr Vijayprasad Gopichandran is an Assistant Professor at the Department of Community Medicine in the ESIC-Medical College and Postgraduate Institute of Medical Science and Research, Chennai. Dr Sudarshini Subramaniam works in the Department of Community Medicine in the Madras Medical College. I have yet to learn details on Dr Vinod Krishnamoorthy. Dr Gopichandran also writes for the Indian Journal of Medical Ethics. Dr Subramaniam has published, among other topics, on inequities in public health in India, especially where Dalits and Adivasis are concerned. I am passing on this information as readers may wish to get in touch with them for discussions on the excellent work they are doing. Let me try and give you a flavour of what is in store for you on this site. Vijay Gopichandran’s (VG) essay is entitled Trust is a privilege. He is obviously a senior figure in his institution and also works in a rural clinic. This is how the essay starts:

Yesterday a first-year medical student accompanied me to the clinic. This student is a very intense thinker and has ideas that are sometimes very radical, rebellious and sometimes outright revolutionary! He once told me that human beings are unable to fly because we don’t think we can. If all of us sat together and decided that we can fly, then we can. He gave a very elaborate and convoluted explanation for this idea, which I still haven’t understood. I have found his questions and interventions in the classroom to be intriguing. When he asked me on Saturday whether he could accompany me, I had no hesitation in inviting him. The three hours of the train journey and the opportunities for conversation would help me understand him and his thinking.

The student asks why VG has few friends. When he replies, ‘I basically have problems trusting people’, and elaborates that he considers trust a weakness, the student counters, ‘Trust is a strength.' I will not rob you of the joy of reading the rest of the essay where student turns teacher.

Another essay on the site by Vijay Gopichandran, Sudharshini Subramaniam and Vinod H. Krishnamoorthy, pertains to an interesting topic—social distancing. Encountering an ageing patient whose symptoms could be due to viral infection, the clinicians advised her and her daughter to isolate themselves in their home.

The reply should be made required reading for everyone who mindlessly champions such distancing to the very poor, who form the majority in our country: ‘Doctor, what you are saying is not practical. Our house is a little hut and all four of us live in the same room. We have enough room just to lie down and sleep. Keeping a one-metre distance is impossible. Three of us are women and it is not safe for women to sleep outside the house. There is also the threat of scorpions and snakes outside.' The suggestion was modified to: ‘At least keep your mother at home so that she does not spread the infection to others.' The daughter patiently explained why this too was not feasible. ‘All four of us go to work. Even if all of us go to work every single day, we barely make enough money to sustain us. My amma goes to graze the few goats that we have. Rain or shine, sick or healthy, she must go out to graze the goats.'

Once again, I will not disclose the essence of succeeding paragraphs. Suffice it to say that city-dwellers often have no comprehension of the difficult circumstances under which our poor villagers and tribals live, work and survive.

The comment on how every doctor in a public hospital is skilled in triaging and needs no special lessons when dealing with patients in epidemics is wise and sad at the same time. The last paragraph sums up the authors’ advice on dealing with epidemics in our country.

Gentle reader: should you know more about this group and the institutions they work for, please let the rest of us also learn more about them.

Local History Groups: Cause for Optimism

Mumbai is seeing a slow but steady increase in groups interested in local history. The first of these—to my knowledge—was started by the late Father John Corrieo-Afonso, professor of history at St Xavier’s College and head of the Heras Institute in that institution.

He set up the Bombay Local History Society (BLHS) and sponsored seminars on selected subjects. The seminar started after lunch on a Saturday and continued throughout most of the day on Sunday and was held at the college. Speakers were invited on the basis of their published work or work in progress on one or more aspects of the subject. They were requested to prepare and hand in a note that contained the gist of their talk well in advance of the date of the seminar. These were cyclostyled and the collected papers in a colourful folder with an illustration on the theme was sold at a nominal cost to all those attending the seminar.

BLHS also published The Bombay Explorer with invited essays on a variety of topics on the history of Bombay. Issue 50 was published in June 2011. Visits to important historical institutes and sites were also organized.

I remember especially the seminar on epidemics in Bombay and a visit to Acworth Leprosy Hospital, Wadala. Memorable among the other seminars were those focused on the Time Ball at the Fort (which was used by ships in the vicinity to set their clocks) and on the oral tradition by which local history is being preserved.

In January 2018, 90 years after the disappearance of two of south Mumbai’s historic landmarks—the Nakhoda Tank and the Holy Trinity Church—members of the Society located their remnants with the help of old colonial maps. The church had been opened for worship in 1890. The tank had been constructed in 1856 by the family of Mohammed Ali Rogay, a business partner of the first Indian Baronet, Sir Jamsetjee Jejeebhoy, to provide a source of water to the public. It was one of the four major tanks in the city. It served its purpose well till the pipelines were laid to provide Bombay with water from the Vehar lake. By then the tank had also become infamous as the site where those suffering from leprosy committed suicide. In 1928, part of the land made available by draining the lake was used for the expansion of the Seth Goculdas Tejpal Hospital run by the Government of Bombay and of St Xavier’s School. In exchange, a plot of land, 2000 sq. feet, adjacent to the Anjuman-i-Islam school was given to it to enable expansion of its facilities.

This could be a worthy model for the city planners today. Such exchanges of land in a city with little scope for expansion of institutions could enable their growth.

Alas! The demise of Father John was followed by dwindling of interest in the elders at the college in the affairs of the Society.

In August 2019, Dr Joan Dias—who had taken over the reins of BLHS—announced the decision by the college management representative, Fr Pesso, SJ that they would like the Society to discontinue functioning from the premises of St Xavier’s College due to space and fund constraints. The Society then had 250 members on its rolls.

Members of BLHS felt that the Society should not be wound up. Suggestions included functioning from some other premises outside St Xavier’s College and the registration as a society under the Societies Registration Act. I am afraid the loss of the stimulus provided by the hallowed Heras Institute has proved fatal to the Society.

We now have a number of groups taking interested and curious Mumbaikars through parts of the city they knew nothing about. The routes are carefully chosen and include fascinating sights and sounds. One such tour, organized by the Bombay Natural History Society, made its members gaze in wonder at the mahogany tree planted by Dr David Livingstone during his visit to Bombay in 1865. Another group takes its members through the historic parts of Parel where the palatial grounds of the erstwhile residence of the Governor were used to set up a cluster of medical institutions—the Haffkine Institute, Seth G.S. Medical College and K.E.M. Hospital, Tata Memorial Hospital and the two Wadia Hospitals for Children and Women, respectively. I learn that a tour of the historic campus of the Grant Medical College and Sir Jamsetjee Jejeebhoy Hospital is also being planned.

Our readers and I would love to learn of similar walks in other parts of India—especially those based on the local history of medicine.

Poetry oft Cheers as it Makes us Think

In 1964, J.B.S. Haldane wrote about his rectal cancer in a most unusual manner in New Statesman. He gave it a title that must count among the most amazing things ever said of the disease: Cancer’s a funny thing.

For those who have not yet had the pleasure of reading this remarkable poem, I reproduce it below:

I wish I had the voice of Homer

To sing of rectal carcinoma,

Which kills a lot more chaps, in fact,

Than were bumped off when Troy was sacked.

Yet, thanks to modern surgeon’s skills,

It can be killed before it kills

Upon a scientific basis

In nineteen out of twenty cases.

I noticed I was passing blood

(Only a few drops, not a flood).

So pausing on my homeward way

From Tallahassee to Bombay

I asked a doctor, now my friend,

To peer into my hinder end,

To prove or to disprove the rumour

That I had a malignant tumour.

They pumped in BaSO₄

Till I could really stand no more,

And, when sufficient had been pressed in,

They photographed my large intestine,

In order to decide the issue

They next scraped out some bits of tissue.

(Before they did so, some good pal

Had knocked me out with pentothal,

Whose action is extremely quick,

And does not leave me feeling sick.)

The microscope returned the answer

That I had certainly got cancer,

So I was wheeled into the theatre

Where holes were made to make me better.

One set is in my perineum

Where I can feel, but can’t yet see ‘em.

Another made me like a kipper

Or female prey of Jack the Ripper,

Through this incision, I don’t doubt,

The neoplasm was taken out,

Along with colon, and lymph nodes

Where cancer cells might find abodes.

A third much smaller hole is meant

To function as a ventral vent:

So now I am like two-faced Janus

The only* god who sees his anus.

I’ll swear, without the risk of perjury,

It was a snappy bit of surgery.

My rectum is a serious loss to me,

But I’ve a very neat colostomy,

And hope, as soon as I am able,

To make it keep a fixed time-table.

So do not wait for aches and pains

To have a surgeon mend your drains;

If he says “cancer” you’re a dunce

Unless you have it out at once,

For if you wait it’s sure to swell,

And may have progeny as well.

My final word, before I’m done,

Is “Cancer can be rather fun”.

Thanks to the nurses and Nye Bevan

The NHS is quite like heaven

Provided one confronts the tumour

With a sufficient sense of humour.

I know that cancer often kills,

But so do cars and sleeping pills;

And it can hurt one till one sweats,

So can bad teeth and unpaid debts.

A spot of laughter, I am sure,

Often accelerates one’s cure;

So let us patients do our bit

To help the surgeons make us fit.

* In India there are several more

with extra faces, up to four,

But both in Brahma and in Shiva

I own myself an unbeliever.

A Cute Kidney Failure

I strongly recommend www.theintima.org/poetry-a-f from which I have borrowed the following poem. Intima carries the subtitle a journal of narrative medicine. It has other sections providing art, fiction, non-fiction, essays and more. There is much to learn and enjoy at this site. The sensitivity of the contributors is heartwarming. I give you just one example: Pat Arnow’s A death in Chicago, 1972 subtitled Elisabeth Kübler-Ross and my family. You will find it at www.theintima.org/a-death-in-chicago-1972-elisabeth-kblerross-and-my-family.

A cute kidney failure

I have a cute kidney failure

Lovable little organs

despite their present deficiencies

Favorite body parts from physiology class

but long forgotten, unappreciated

And now they’ve failed

getting a D- in life support

Kidneys, shmidneys

Who thinks about them

Chinese doctors, martial artists maybe

Most of us worry more about the Heart

the Lungs, the important ones

loath to discover the state of the Liver

or dark secrets of Pancreas and Spleen

But hardly a passing thought about the Kidneys

Now that they’re failing I think about them a lot

picturing those cute bean shaped blobs

mirroring each other, nestled under the ribs

colorful tubes extending down

a lovely symmetrical plumbing design

Spongy filters cleansing and draining away waste

Now they’re stopped up, inflamed, indignant

I’m sorry kidneys, for my neglect

Should have paid attention

Treated you with more respect

I beg forgiveness with pure water and cranberry juice

and promise never again to take you for granted

I kid you not, you cuties

—Sarah Safford

Sarah Safford is a lyricist and an educator, recently retired from NYC Department of Education. She has a Master’s in Public Health and is an alumnus of the BMI Musical Theater Workshop. Throughout her career she has combined arts and education, creating performances, songs, and most recently poetry, often with health-related themes.