Another Day in Duncan
Five years ago, I wrote a blog called "A Day in Duncan". It was a snapshot of the critically ill patients I encountered during a typical day in the hospital.
If you revisit that post, you'll notice that many of those patients were battling non-communicable diseases, while the major infections were tuberculosis and HIV. The rest were a mix of drug-related complications (such as steroid dependence leading to hyponatraemia), trauma, and a few immunological disorders.
Fast forward to a recent "Day at Duncan". Among roughly 50 patients admitted in the wards, more than 20 were critically ill.
What stands out is that the disease landscape continues to evolve. We are seeing unusual infections more often, the familiar HIV and TB pairing but with increasingly complex complications, rising addictions, attempted suicides, growing mental health concerns, all layered on top of the ever-present burden of non-communicable diseases. Diseases, it seems, are becoming increasingly creative in finding new ways to keep physicians occupied.
As I reflected on my mental notes from 1996, nearly three decades ago, I realised how much and how little has changed. Back then, with the same number of beds, ten would routinely be occupied by tetanus patients. Tuberculosis was abundant, severe infections were common, and poisoning and snake bites never seemed to take a holiday.
The urban world may be changing at breakneck speed, but rural India continues to carry a remarkable complexity of health challenges, albeit with shifting demographics and patterns of illness.
What has changed significantly is the hospital itself. Today, we have ventilators and a range of supportive technologies that would have seemed almost luxurious in earlier years. Consequently, we are also caring for patients who are far more complex and critically ill than before.
Another striking change is the sheer volume of patients.
- 1996: Approximately 100 medical patients out of 350 total OPD visits.
- 2019: About 150 medical patients out of 450 total visits.
- 2026: Around 250 medical patients out of 700 total visits.
The arithmetic is straightforward. The workload, less so.
What has not changed is the people. Faces have changed, generations have moved on, children have become parents and grandparents. Yet the commitment remains remarkably similar. There is still one physician and one critical care specialist to shoulder most of the burden, with small number of JMOs, although to be fair, the critical care specialist was missing from the cast in the 1990s.
The burden has increased. Thankfully, compassion seems to have increased proportionately. If not, none of this would have been sustainable.
And so I find myself returning to an old quote from the Good Book: "When he looked out over the crowds, his heart broke. So confused and aimless they were, like sheep with no shepherd. “What a huge harvest!” he said to his disciples. “How few workers! On your knees and pray for harvest hands!”"
Three decades later, the harvest appears even more plentiful. Many more in pain and challenged. The labourers are still few. The technology is better, the illnesses are more complex, the queues are longer, and yet the calling remains the same.
https://santhoshsramblings.blogspot.com/2026/09/unconsciously-comfortable.html
I still wonder: will there ever be a solution to this equation, or is it one that each generation is called to wrestle with afresh?
Very true! Thanks for sharing!
ReplyDeleteWonderfully written sir, one might think that India is developing and there is no denying that it indeed is but the enormous burden of India especially mental health problems, lack of awareness about timely intervention, health etc never seems to get any better even after so much of community efforts, working in Duncan and seeing the deprived community has opened my perspective in ways that no literature could ever capture, it's truly only by God's grace and wisdom which enables Frontline health workers to work in such challenging atmosphere.
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