Along the Banks of Lake Wular
By: Ibrahim Masoodi
It was month of July, I joined as Physician specialist at sub District hospital in Bandipora, Kashmir, some 50 kilometers northwest of Srinagar, in beautiful and calm surroundings.
This was my first time at the Bandipora hospital and it was very nice to meet other friends working in the hospital. The
buses from my hometown Sopore stop several times to drop and pick up passengers, some of whom wait up to one hour, along the way from Sopore to Bandipora. This makes the 30-
kilometer trip from Sopore two hours long, but not boring. The hilly road along the banks of Lake Wular, the largest freshwater lake in Jammu and Kashmir, provides picturesque views.
Historic sites and scenic panoramas along the Hurmukh mountain chain engage the traveler’s imagination. However, after few weeks I finally started to live in the town at Mr. Mushtaq Ahmad Lone’s home. The family was caring and life became very easy as the hospital was at a walking distance from their home. With the passage of time I realized that the people of Bandipora are educated and well-mannered. Most
of the residents are of average socio-economic status. People from adjacent villages, however, are poor. The people residing on hillocks in the medical block of Bandipora are ignorant about basic health measures and continue to follow traditional way of life. The prevalence of infections and infestations among
them remains high. There were at least 50 admissions per month in this hospital due to worm colics and biliary ascariasis, and a good number of patients were referred to tertiary care hospitals for intestinal obstruction management and other similar treatments. I was fortunate to be member of already existing very good team of doctors Dr Malik Bashir Ahmad, Dr Syed Rehman, Dr Mushtaq, Dr. Nisar-ul Hassan, Dr Muneeb Iqbal, Dr Qazi Haroon, Dr. Ajaz, Dr Afshan, Dr Imtiyaz, Dr Ishfaq and Dr Shahid. All of them are competent physicians and very good team members.
“Doc! Let us conduct one-day medical camp in each school and teach students principles of basic hygiene and hope it will help to decrease number of admissions due to worm colics in the hospital,” said Dr. Malik Bashir Ahmad then block medical officer Bandipora. Studies have shown that schools are important institutions through which health education can be taught to a particular community and accordingly I along with Dr. Nissarul Hassan, another physician specialist in the hospital went to Iqbal Memorial institute, one of the biggestschools in the town.
“You are the future and healthy child means healthy nation” spoke Dr. Nissar- ul Hassan to the august gathering of teachers and students in the school and comprehensive school health program was thus launched. Enthusiasm of the students and teachers was overwhelming. The utility of the program was emphasized to the teachers, and their participation was solicited. Later we examined ailing students and distributed anti helminthic tablets and multivitamin tablets among students.
“Doc! I was thrilled to see my son educating his mother at home about personal hygiene”, said one of the paramedical staffs of the hospital, the very next day after the camp. This reinforced the drive of comprehensive school health program in the block and all paramedical staff provided a wonderful support to the program. Later one-day medical camps were organized in various schools of the district under the supervision of assistant surgeons of the hospital and every week ambulance of the hospital would be seen leaving along with a doctor and medicines to visit the school. Not only doctors working in the hospital but other doctors who were working in different primary health centers of the block (Dr Khalid Parvez and Dr Fida Kanjwal) provided wonderful support as well. It was their enthusiasm and zeal that in addition to the schools of Bandipora, schools in other places in the district with limited transport facilities, such as Chuntimulla and Zurimanz, were also involved in the program.
In each medical camp the students were clinically examined, and ailing students were treated. Over the period of time basic health education was given to thousands of students in these one day medical camps. This translated into a similar number of families in the district. Emphasis was placed on personal hygiene, use of boiled water, iodized salt intake, vaccination etc. All the schools were supplied with basic first aid medications. Anemia prophylaxis, mass deworming, and booster tetanus toxoid immunization programs were carried out in these schools. In our clinical screening, a high prevalence of anemia and vitamin deficiencies, as reflected clinically by cheilosis, Bitot’s spots, and dermatitis were observed and treated. Mass deworming programs were carried out to decrease the worm load and to introduce a concept of regular deworming and emphasis on personal hygiene. We joined the ongoing project of research at Sheri Kashmir institute of medical sciences (SKIMS) on predictors of intestinal parasitosis in Kashmir valley. Dr. Charanjeet Singh then postgraduate student in medicine at Sheri Kashmir institute of medical sciences (SKIMS) coordinated the research and stool samples were taken from one of the schools to detect the prevalence of ascariasis and to know the worm load in the area. The results of this study showed ascariasis to be highly prevalent among school children and our comprehensive program went a long way to curb this menace as the admissions due to worm-colics decreased drastically in the hospital. Kashmir valley has been declared an iodine deficiency belt. We observed in these medical camps that there were good number of students who had squint and congenital deafness, probably due to maternal hypothyroidism.
Most of the villagers continue to use un-iodized salt. At our urging, local administration banned the sale of un-iodized salt in the block. Further, the use of iodinated injections during pregnancy was proposed as a measure to tackle the disastrous effect on newborns.
Our next mile stone was detection of tuberculosis cases in far of villages and accordingly under the auspices of national tuberculosis control program paramedical officials in remote villages collected sputum samples from patients. Local village- level committees supported the drive. Six open cases of tuberculosis were registered, and treatment was started.
One fine day we decided to hold a diabetic screening camp in the hospital. After advertising on the radio station, individuals with a family history of diabetes and symptoms suggestive of diabetes, such as excessive urination (polyuria) and excessive thirst (polydipsia) and obesity, were screened for diabetes and clinically examined for hypertension.
Studies have shown that widespread screening via the use of random blood glucose levels could aid detection of unrecognized glucose intolerance to permit early initiation of preventive management. On the day of camp hundreds of fasting patients thronged in the hospital compound to check their blood sugars and team of doctors working in the hospital went on tirelessly examining these patients. There are two large very beautiful chinar trees (Platanus orientalis) in the hospital compound. Autumn had turned their leaves golden yellow as if some goldsmith had painted their leaves with gold quite lavishly. Weather was very nice on the day of camp and all of us enjoyed our work whole day. Twelve new diabetics were detected in this camp and sixteen known diabetics were found to have secondary oral hypoglycemic agent failure and were referred to the Department of Endocrinology of SKIMS. The prevalence of hypertension and obesity was found to be very high in our study. The hypertensives were treated and were advised about the use of medications, regular exercise, and diet therapy. This again reflects the need of health awareness among the population and an emphasis on primary prevention.
It was month of May, I was selected as registrar in Medicine at Govt. Medical college Srinagar, Kashmir and I joined my new assignment. Looking back, I find the fragrance of blooming days and the refreshing breeze of Lake Wular buzzing in my heart. I express my gratitude to all the medical and paramedical staff of the hospital for their cooperation during my stay there, and I wish them all prosperity and good health.
Dear reader, primary health care in developing countries continues to lack ample resources in providers, equipment, and infrastructure to offer effective and efficient care. People in villages continue to live in poor conditions with minimal healthcare facilities. Doctors usually fear that rural postings distance them geographically from their families, professional colleagues and academic environment, and lower their professional standing. Unsatisfactory working conditions, lack of adequate staff and equipment, and primitive living conditions add to the list of factors that distract doctors from practicing medicine in rural locations. With a proper attitude; however, doctors can contribute in multiple ways, even in such settings while striving for better centers simultaneously. I must conclude with what Moulana Rumi said centuries ago
“Wherever youare, and whatever you do, be in love.”
“They say there is a doorway from heart to heart, but what is the use of a door when there are no walls?”
– Moulana Rumi
Note : Excerpt from the Book Bumby Roads
Author is a MD. DM (Gastroenterology) FACP, FACG Consultant Gastroenterologist & Associate Professor at School of Medicine, Taif University, KSA .