DR. VAIBHAV SABNIS

One of my most unique experiences was working in the Subdistrict Hospital (SDH) of Dharni, a subdivision in Melghat, for close to two years. My wife was posted as Subdivisional Magistrate as her first posting in IAS  and I decided to join her leaving a fellowship in one of the most renowned hospitals – Medanta Hospital, Gurugram. There cannot be two more contrasting healthcare facilities in India than the ones mentioned above. It was a radical shift. From reporting advanced studies like whole-body PET, MRI liver, prostate and rectum, I went on to performing Ultrasound on pregnant women all day. A couple of months after I shifted to Dharni, the COVID pandemic struck and justified my decision in a way.

Dharni is one of the most remote places I ever lived in. It is a tribal tehsil separated from the nearby cities by several acres of dense forests. The nearest airport is in Indore, almost six hours away. The nearest railway station is Khandwa in Madhya Pradesh, about 90 km away. It took three hours and a tumultuous journey through a treacherous hilly terrain to reach the district headquarters in Amravati. My wife used the Government-allotted SUV – Bolero for work-related travel. The first time I travelled with her, our driver, a local named Darasimbe, was swerving and swivelling at high speed along the bumpy roads subjecting me to several anxious moments. But over the next two years, I realized his judgement and control were impeccable. And the word ‘tired’ did not exist in his vocabulary.

I joined as a specialist doctor in the SDH under NHM (National Health Mission) on a pay-per-scan basis. At the time, I was the sole MD Radiologist in the public and private sectors in the Melghat area. I worked on my terms – five days a week, five hours a day. There were six PHCs in Dharni and I clubbed two small ones on one day. Pregnant patients would come in an ambulance by around noon. I was consistent and would not take a public holiday if it came on a weekday.  The Government priority was antenatal scans, but I would still reserve a few slots for OPD patients of Dharni. I was paid the same amount for every scan – Rs 400. For an anomaly scan, it was woefully inadequate but I had no choice. The referrals were erratic and the patients even more so. Many times it happened that pregnant patients came for a scan only in the third trimester. I made a rapport with the Medical officers at the PHCs asking them to prioritise 18-20 week pregnant patients and those who never had a scan even in 3^rd trimester. I worked on a pretty basic Doppler Ultrasound machine. There were days when I had to do 8-10 anomaly scans but my speed increased gradually. I diagnosed several congenital anomalies like neural tube defects, renal anomalies, congenital heart defects, abdominal wall defects, musculoskeletal abnormalities, etc; pregnancy-related complications, liver and bowel masses, appendicitis, intussusception, and ectopic pregnancies to name a few.

There were several perks of being the spouse of an IAS officer. The Project Officer’s residence was a large bungalow with a larger garden. The fragrance of Madhumalti flowers, blossoming in bunches of pink, refreshed the night air, while the large Mahua tree littered the courtyard with yellow, sweet-smelling flowers in the morning. Large lemons weighed down the lemon tree in the backyard, while I tasted some of the sweetest carrots and guava grown in our garden. There was no concept of commuting as the Subdistrict Hospital was a 300-meter walk, while Mittali’s office was just across the road from our house (she did have to go for several field visits to remote villages most of which were connected by narrow dirt roads). In the mornings I used to go jogging or cycling along the highway. In the rainy season, the lush greenery was a sight to behold. Wild mushrooms sprung along the roadside. With the onset of summer, the Gulmohar trees blossomed a burning orange. The temperature soared but the forest cover made the heat tolerable. Although Melghat is a tiger reserve, sighting a tiger was quite rare. Sloth bears were the most dangerous wild animals known to inhabit the area. I shuddered to think what would happen if I encountered one, although that never happened. Once I just managed to avoid running over a snake while cycling.

Although gynaecologists and paediatricians were available in SDH, there was a severe deficiency of specialist doctors – the most glaring being no MD medicine or MS Surgery doctor. After a few months, a surgeon from Thane was transferred to SDH for the post of Medical Superintendent. Dr Rekha Gajalarwar was a proactive administrator and had a great work ethic. She started performing surgeries like hernia, hydrocele and several minor surgeries. Still, people in Dharni had to travel to Amravati, Burhanpur or Khandwa for emergency conditions like head injury or intestinal obstruction; advanced medical care like dialysis, ICU care; or cancer evaluation. No CT or MRI facilities were available. However, with the onset of COVID, we took the opportunity to get a CT machine installed in SDH. We sent a proposal to the District Collector through the local authority, Subdivisional Magistrate (who happened to be my wife) and he got the funds from a bank under CSR (Corporate Social Responsibility).

             Most of my stay in Dharni was during COVID times as the pandemic started within three months of my shifting to Dharni. But since it was a remote area separated by vast expanses of forest, the rise in cases was gradual. I believe Melghat experienced the first wave when the rest of the country was in the second. My wife being the SDM was at the helm of affairs. My services as a radiologist were more valuable and therefore, I was never called upon for COVID duty. But I made sure that Ultrasound services continued uninterrupted in Dharni during the pandemic. The lockdown created more problems for us than the first wave of COVID. Several non-essential food items (that we were accustomed to) were not available like bread, idli-dosa mix, mushroom, cheese, frozen peas, lays etc. Once we went without bread for so many days that finally we decided to make our own. It was a failed experiment. But then I started accompanying Mittali whenever she went for a meeting in Amravati and got supplies for a month or so from the D-mart there.

On most days, Dharni was a quaint little hamlet, where sundown heralded a diminution in activities. After 8, if one were to take a walk, there would be acres of pitch-dark forest beyond a radius of one kilometre. Weekends were equally laid back. We used the abundant time to improve our musical skills. I started my YouTube channel collaborating with one or two musicians whom I happened to meet. Mittali started learning the guitar and made considerable progress with the assistance of the Yousician app. Talented and resourceful as she was, it wasn’t long before recording a song and putting it on YouTube became our weekend routine.

During the second wave, Mittali was called upon by the then Municipal Commissioner of Nagpur to streamline the operations of Indira Gandhi Medical College and was deputed as an Officer on Special duty, in addition to her charge in Dharni. I accompanied her for a week as a Consultant but had to return for my Ultrasound duties. Living alone in Dharni for a while, I became friends with a few locals who were cycling enthusiasts. One morning, on Ram Navmi day, we went on a cycling excursion to a nearby village, Harisal, about 25 km from Dharni. Although most of them except Nilesh, an NGO activist, were in their fifties or sixties, they were experienced riders. After having breakfast at an eatery in Harisal, they decided to pay a visit to the Bamboo Kendra in Harisal. The director Mr. Sunil was a naturalist and considered to be a Melghat elite. Naturally, the discussion drifted to home remedies for COVID. There was some talk about the hype around COVID, and Mr Sunil claimed that the best way to tackle COVID was to have organically grown onion or garlic or some other condiment (I don’t recall). We had a meal at his place after which l and Nilesh parted ways with the rest of the group as they wanted to continue up to Semadoh (50 km from Dharni). On our way back we bought some delectable melons locally grown in Dr Ram Kolhe’s farms. The latter had settled in Dharni for several years and was known to provide his services to the poor and needy in Dharni for a nominal fee. Both his sons were into organic farming.

That evening I developed a cough and cold and feared the worst. I enquired with my cycling group but they were all fine. Mittali returned the following day and I sent a COVID sample before quarantining myself. After three days, I got a negative report, but that evening I developed anosmia. Since I didn’t have any serious symptoms, I completed my seven-day quarantine and re-joined work. Two weeks after that I got a phone call enquiring about O₂ availability in SDH. The caller identified himself as the brother of Mr Sunil. It seemed the latter had also developed symptoms similar to mine but being in his sixties, the virus hadn’t been so kind. He was admitted to Dr Ashish Satav’s Mahaan Trust hospital. Dr Satav (the only MD Medicine in Dharni) and his team were a boon to the people of Melghat, no doubt. However, despite all efforts by Dr Satav (and a host of home remedies), eventually, Mr Sunil passed away. None of us had had any symptoms the day we had met, so we had no way of knowing where the infection came from or whether there was an asymptomatic carrier amongst us. However, the guilt of not following social distancing norms loomed large on my mind.

Once on a trip to Chikhaldara,  we came across two puppies in the Government guest house. We learned that a leopard had killed their siblings and it would be their turn soon. We adopted one on a whim while our driver took the other. My wife named them Lama and Reba. The experience of adopting a dog transformed us. Lama means a spiritual teacher and she taught us love and patience. Within a month of adopting her, she began showing signs of parvovirus infection which is supposedly a deadly disease for puppies. She had to be given IV fluids as she couldn’t eat or drink anything. Most breed puppies cannot survive the disease, however, Indie dogs are known to be resilient. Soon Lama recovered, however, her sister Reba became very weak post-recovery and died a few months later. My bond with Lama grew stronger with time. She would wake me up around 6 am and then we would play for a while. Once our domestic help, Nandu Kaka came, I could go for my exercise (jogging or cycling). Nandu Kaka was an adorable person. He would love fixing things – be it some leaking tap, some electrical problem, setting up my digital piano etc. He was also great with dogs and he developed a close bond with Lama. Often monkeys would visit our compound in the morning. Lama chased them ferociously. A particular monkey would visit often and jump from tree to tree around the campus with Lama chasing after him. Initially, I was afraid that he would hurt her. But soon we realized that he would come to play with Lama.

On the last day of June 2021, my wife got her transfer orders to Chandrapur. It was a bigger district and a city with more facilities and better connectivity. Dharni may have been a difficult place to live, but we had gotten used to the serenity of the forest and the simplicity of rural life. There were trips to the elephant reserve in Semadoh, Melghat tiger reserves, trekking expeditions, and a memorable lunch at Nandu Kaka’s place.

  Mittali was a wonderful leader and earned glowing testimonials from her staff and praise from the people of Dharni. Some of the memorable projects she initiated were GIS mapping of Dharni for malnutrition, ‘Chuttiyon ka maza’ a summer workbook for government school students (I could make a small contribution to it as the language editor), a documentary ‘Rani beti’ produced by the Project Office, Dharni which won a prize at the Pune film festival, the migration tracking project for migrant labourers and their families, innovative strategies for implementing COVID vaccination among tribals (first village in India with 100% COVID vaccination), and convergence of community forest rights and MGNREGA.

For me, on the work front, I may have left the fellowship in body imaging at Medanta midway. But the stint in Dharni was no less than doing a fellowship in obstetric ultrasound, except that there was no accrediting body. In general, life in Melghat for me was a lesson in patience, humility and service.

It is no wonder then that the times spent in Dharni have a special place in our hearts even after so many years.