As a young doctor fleeing from the perpetual anxieties of city life, I came to Fakirpur to work in a
hundred-bed hospital managed by nuns. Fakirpur was eighty pothole-ridden dacoit-infested kilometers from Patna.
Given the bare facilities, we did a decent job of treating those who could not afford city prices.
Antiquated medicines like tincture of belladonna, ipecacuanha, canninative mixture and plaster of turpentine were in common use while penicillin was reserved for nasty infections. We were cheap and reliable. I performed surgery with the naive poise of a fledging, using a hallowed textbook of surgery as my surrogate boss, friend and adviser. Over the years, I became isolated from the progressing world of medicine. And when I made mistakes, I found out the hard way.
In my fourth year at Fakirpur, a new administrator took over. Sister Perpetual Succour was a nun who had taken her medical degree abroad. She was determined to modernise the hospital and take it to 'new heights of excellence'. Out went the mixtures, plasters and even penicillin; we prescribed capsules and higher antibiotics. Suddenly realising that the hospital was really very backward, the nuns went on a buying spree. Patients watched bewildered as some equipment or the other was unloaded from a truck every week: a new ECG machine, a cardiac monitor, a pulse oximeter. The nuns worked hard to get donations from the local landowners and merchants. The expenses went up and so also the bills. The villagers believed that machines and expensive medicines would somehow provide good health. And they did not complain.
Sister PS was set on making us efficient.. Work started at 0700 hours and finished at 1800 hours with a 35-minute break for lunch. She set up committees: waste management committee, drug purchase committee, food committee. She encouraged us to read the foreign journals which she subscribed to. Aware of the deficiencies in my knowledge I made amends by staying longer in the library. I walked with brisk steps to the hospital, relied on machines to tell me the diagnosis, did less and felt triumphant.
Everyone was given a responsibility: I was on the food committee. Instead of the usual thali meal nerved at the hospital canteen, we had boiled-egg-and-tomato sandwiches wrapped in plastic; puris and idlis for breakfast were replaced by bread and jam. Easier to serve and less messy. For some of the staff including me, it felt good, almost fashionable to be munching abacterial, aseptic sandwiches while reading a journal in the library.
Soon food came to preoccupy me in another way.
An international medical conference was to be held in Mathura which PS kindly recommended that I attend: a
two-day jaunt to the land of Sri Krishna, a chance to meet experts, hospitality and entertainment thrown in. I
The main symposium during the conference was on Nutrition. Why, when there was all of medical science? A little thought and I realised that many lives were cut short because of the food people ate or did not eat.
The conference was two months away. Being alert to the possibility of impressing people at an international conference, I decided to present a paper: The importance of Food in Post-operative Care. I read journals and research papers, prepared slides and realised that it was too dull a subject to impress people with. So I wrote another: Rare Surgical Cases. It was a showy piece with spectacular, lurid details about some of the operations I had done that were in someway connected with eating. I wrote about the chunk of just-eaten meat I had found in the gut of an undefiled brahmin; the gravel, two pounds of it, that I had evacuated via the rectum in a eight-year-old; the roundworms wriggling inside the belly of a man whose gut was cut to pieces from a gunshot; and about the congealed ball of toffee wrappers blocking the intestines of a young boy Very clever. I could see myself on the podium; and later, the doctors milling around me, eager to listen to more heroics.
I sent in both the papers and waited. Two weeks later came the reply that the papers had been rejected. We have too many submissions, they said, which was a polite way of telling me that mine were inconsequential.
Humbled, I went to the conference, taking the overnight tram to Mathura. I was to stay with Dr Sadashiv, a friend of a friend in Fakirpur and who was originally from the same area. The doctor was slightly built and fortyish, with paan-stained teeth and the pinched look of one who thinks too much. He looked so pensive, I labelled him Dr Sad. He wore terylene bush shirts and scuffed sandals, spoke good English with a Hindi accent and rode a fourth-hand Bajaj that sounded like the ratted breath of am old woman.
Dr Sad's wife was a coarse-tongued rustic and they had four children. I shared a cramped little room with one of his school-going daughters. His clinic was an extension of his house. Outside it, a once-white board screamed in red letters that he was MBBS, FR -- Foreign-Returned. Judging from the number of times he was being called to the clinic on a Sunday evening, I reckoned that Dr Sad had a flourishing practice.
We had a simple dinner of deal, chapatti and egg bhujiya. "I love food but keep things simple," said Dr Sad. "This meal hasn't cost more than ten rupees." Sad could get away with serving dinner to a guest and then announcing how cheap it was. Later, over elaichi tea, we talked.
He had started m the '60s as a compounder, worked his way into Patna Medical College and then gone to England for a while. He came back after eight months because they objected to his chewing paan.
It was not an irony that the money he made was inversely proportional to the quality of his work. Sad belonged to that rare breed of doctors who believe that their work should be superior to what they earn. I was nonplussed and slightly annoyed by his simplicity and told him in elaborate detail about the changes in our hospital in Fakirpur, about the monitors and scanners that had made work efficient. He was unimpressed. "Sounds like a too-quick transition from a bullock-cart to a bulldozer," he remarked. "The patients will be paying more but are they getting better health?"
He said -- without arrogance -- that he was a good doctor because he made illness more interesting to the patient. Food had great power over the psyche. "Every prescription of mine comes with a diet," he said. "One spoon of oil a day, no chicken; a glass of beetroot juice in the morning for a week, carrot juice the second week and cucumber the third. Patients are happy that their doctor is so caring." He saw the puzzled look on my face. "It's a carefully thought-out strategy. Have you ever wondered about the money patients have to spend on medicines? We know that the drug companies make huge profits on everything they market. A patient can buy half a kilo of carrot or beetroot or cucumber for the price of a vitamin capsule." He looked intently at me. "You service the same type of community as me. I'll give you a bit of advice. Don't prescribe more than one or two medicines. But prescribe a diet, always. What does it cost you? it is one way of ensuring that poor people spend their precious money on some decent nourishment."
I listened with mild contempt. He was making too much of a fuss about the food people ate. And what could I do about drug companies making profits? As if that was a doctor's business. Pondering over it later that night, I decided that he was an old-fashioned stick-in-the-mud whom I had to suffer for a couple of days.
Imagine my astonishment when Sad told me that he was to speak at the conference. Could he have written a paper so imposing and scholarly that it pipped mine to eligibility? He was secretive, and would not talk about it.
Mathura had donned a festive look, with banners screaming Welcome. Distinguished delegates arrived, and were put up in posh hotels. The two days were as hectic, mismanaged, chaotic, opulent, superficial and meaningful as any conference I had attended in the past. I listened to lectures and wandered around the drug stalls put up to entice us. I learnt all there was to learn about the harmful effects of cholesterol, fatty acids, sugars, food additives and alcohol; heard that the millions who starved in Africa and Bangladesh were being rescued by foreign aid; then headed for lunch, tea or whatever repast was appropriate for the time of day. I ate paranthas with mughlai chicken, ghee rice with lamb curry and finished with Agra pedas; carrying my cup of coffee I staggered back to the conference hall to listen to the Swedish expert talk about the micronutrients essential to health, and to the Danish dietician advocate a daily dose of twelve vitamin tablets and two cholesterol-lowering capsules.
At tea, I sat in the foyer trying to clear my fogged brain. Delegates zipped about carrying their complimentary travel bags that came filled with high-protein breakfast bars. Stalls displayed slimming tablets, easy-to-eat lunches, low calorie biscuits, no-calorie biscuits and health drinks. Sad stood a little away near the water cooler pulling at his Charminar. His eyes were busy, thinking. He pointed out to me that the infant food package being sold at one of the stalls was unbeatable value. "For every thirty tins of the infant formula purchased you got two free packets of multipurpose protein powder to give poor patients." A long queue had begun to form at the infant food stall. "It's always nice to help someone while helping yourself" Was he being sarcastic? In any case, I had no interest in infant foods and passed up the opportunity to do charity. I asked if listening to the eminent speakers had put him in a panic. A rare smile scissored his face but he wouldn't tell me about his paper.
The first evening passed pleasantly, with light entertainment, drinks, scrumptious food and a special appearance by a TV celebrity. She made a touching speech about how doctors were the cream of society. Replete with food, I listened.
The second day began with an American surgeon speaking about the treatment of obesity. "Calories are the scourge of society," he said, his trim, sun-tanned body taut with the sincerity of his belief. "Fight calories with the same fervour with which you fight any vice. Teach it to the kids: Calories are evil!" Besides a surfeit of pills to restrain hunger, there was the wiring of jaws to prevent any solid food being eaten; as there were operations that helped melt away fat. His own time-tested method was to cut off a portion of the gut and thus limit the absorption of food. If ten out of the twenty-two feet of intestine were knocked off, the food speeding through the shortened gut would have less contact time with the intestine. It would pass out without absorption of the malevolent calories. No calorie build-up, no fat accumulation. Result: you eat and get thin. Among the hundreds of cases he had done, there were a mere eight deaths and one of them was from a non-surgical cause. The lady had fallen off the stretcher while being wheeled to the operating theatre and broken her neck. This surgeon who made calorie-fighting his mission had started a helpline for the obese in the town where he lived. One had simply to call the number to find someone with whom to chat, over cake and coffee.
On the last day after tea were the free papers. I was feeling a bit sorry for Sad by then. He had requested that he be the last speaker. With the grand finale of the closing ceremony and the banquet afterwards, he did not have much chance of being listened to. He had no slides, no photographs, no text to be flashed on the screen. He asked that the main lights be switched on and in their glare he looked ludicrous, standing there on the dais in his ill fitting trousers and bush-shirt.
He had titled his talk 'The Nutritive Value of the Sky'. I shifted uncomfortably in my seat. "I have studied the food habits of people for eighteen years," he began. "In the rural town I come from, people eat chapattis, daal, raw onion and green chilli and chew a raw radish or carrot afterwards. Some families buy a metre-length of sugarcane at the market as a Sunday special. Roasted wheat, groundnuts or cucumber with salt serve as snacks. Tea is drunk once a day in summer, twice in winter. For many of the poor, the staple food is sattu -- a mix of channa daal and a little salt, powdered fine and carried in a twist of cloth or a tin. Mixed with water, it is an excellent meal. Sattu does not spoil and so it is never wasted.
"The mushahars are a rat-eating community in our area. They live on large field rats and eat house mice for festive occasions. I have an excellent recipe for rat fry, If anyone is interested. Whether it is sattu, rat meat or chapattis, the caloric value of their diet is 1500 calories a day, plus or minus 200. They put in eight hours work in the fields on this diet and return home to cope with housework: drawing water from the well, feeding the cows and collecting dung.
"I learnt in medical college that an average healthy diet for a working man is 3000 calories, for a woman 2500. Who are they talking about?
"At dinner last night, it occurred to me that there are three categories of eaters: Those who can afford to choose what they eat; those who have just enough and no choice; and the third, who have nothing. The last group lives on any food that comes their way. They live on pavements and in the slums, make our cities ugly and spread disease. We, who belong to the first group, would like them to disappear. But we're good people, we don't go about killing others. Instead we quietly let them starve while we refine our food habits and expand our choices." Sad paused to catch his breath "Last night a doctor I know well ate and drank enough to please the drug company which hosted the dinner. And them vomited it all out in the garden at the back of this hall. While he was thus lightening himself, a few feet away at the garbage bin where the food we wasted was being dumped, I saw two children and a woman. They picked out half-eaten rotis, chicken bones and crumbs of laddu and stuffed it in a plastic bag. For them too, it was a festive meal.
"I have learnt a great deal about food, from the experts here. I wonder: how do some people -- several millions in fact -- survive on a diet that you or I or my patients would starve on? Is there a nutritive value in the sky that looks down on their labours, in the air they breathe, in the sunlight that falls on them as they work, to supplement their power lunches? May we have a long and mindful discussion about the true meaning of malnourishment and its causes? In college I learnt about first-degree, second-degree and third-degree malnutrition. Seeing those children pick at wasted food last night, I thought instead of first, second and third-degree murder. Who is guilty?"
I sat in my seat in the fifth row drinking in the scene. The Americium surgeon, the Danish dietician, the Swedish micro-nutritionist and our own specialists and super-specialists were seated in the out rows: clones of clones sweating manfully in sober suits, their faces stony, impassive. Here was a doctor with his sorrowful, paan-stained smile and his sandpaper voice slipping in the barbs that none of them could counter. Compared to him, they looked second-rate.
There was silence followed by polite applause. Any questions, asked the expert who had chaired the session. Someone cleared his throat, of embarrassment. No questions We filed quietly out of the trail to have tea and samosas and then wait for the closing ceremony. Dr Sad stood near the water cooler, drinking glass after glass of water. He looked crestfallen. "There was no response," he said. "Absolutely none. I thought that at least a few might appreciate what I was trying to say..."
A doctor by profession, Kaveri Nambisan is also the author of The Truth (almost) About Bharat, The Scent of Pepper, Mango-coloured Fish and On Wings of Butterflies.
Other short-listed entries will be available on the site tomorrow and the day after.