Thursday, July 2, 2015

Eye openers

The husband walked in with his wife. He said, I have been taking her to many places for these skin lesions on the face, have spend quite a bit of money and  in one sense "Suffered in the hands of many physicians" - can you do some thing for her. I looked at her - her face and body was full of "Pappular eruptions" what we call in medical terms as PPE. I asked a few relevant questions to her about the illness and send her to the examining bed to do a full physical. Then I turned attention to the husband. Asked him about his job - he was a migrant laborer, and I was sure that he would have had some "extra marital affair" and started asking about his way of life, habits, contacts etc. He was polite but clear and articulate - though he was illiterate - I do not do any such things. I go out for  a living, others might but I have my standards! I was quietly reprimanded about my own attitude of seeing beyond what was there. I still was not sure, and I wanted to probe more. The rest of the story came out. She had been married earlier, and her husband had died 2 years back. And this man married her so that she can be supported.

I started examining the lady and during the same, she herself shared her side of the story, that she had been married earlier, and her husband, again a migrant worker had passed away, due to some illness. More probing, she said it was told that he had TB.

With these history and stories, I asked for what was evident - a test for HIV infection. And it came positive. Now was the difficult part, how do you explain this to a man who had married this women with a desire to support her. He most likely would have been infected by now. As I shared the result, to my surprise, he was much more composed than what I expected and was willing to go through testing and go ahead with what ever could be done for both of them.

Complex lives, events which was never in their control, they were willing to face with the hope that some how things will work out.

Last few weeks have been an eye opener for me. In the ward every day there would be one woman with HIV infection admitted, with some serious infection, but cared for her by a loving husband or in one case by her mother in law, providing all the needed support. In the busy OPD patients with HIV infection will come, accompanied by their spouses, and get their treatment done, like any other patient. I remember, about 20 years back, EHA leaders talking about HIV friendly health care systems, where HIV patients could walk in without discrimination and get their treatment done like any other patient. That dream of the pioneers a reality today.

But the eye opening was not about the health care system, but the love, care and concern showed by the relatives of these patients, and the openness with which they were talking about their illness and disease. Most of these people were from the villages and from not so well off back grounds, some of them illiterate, but was pragmatic and matter of fact about the illness, which has been seen to have much stigma and discrimination in the urban context.

Is it that the rural and the illiterate are behaving so because of ignorance and fatalism - that is what many tend to believe. Or is it that these people from the under developed rural India, are much more mature and developed in their thinking and approach than the educated people from the developed urban India.

If the latter is true, the question we need to consider is - has our development and education, made us more immature, and retrograde in our attitudes? If so how do we develop  people with positive and mature attitudes - is education and development the answer or some thing else? Or an eye opening exposure to rural India for the urban India? A reverse migration which might usher in a mature generation?

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