Rescuing Sugunamma
Ramulamma returned from the city full of good cheer, her mission accomplished of
helping out her sister-in-law during her pregnancy. The city held several attractions
for Ramulamma, who always liked to learn new things, see new sites and shops, even
if she could never afford to buy anything. During this visit she had run into the chief
minister, or rather he had run into her, and that encounter had been lucrative.
However, the city was not really her place, and she was more than happy to return to
her own hut in her own village, though the summer was at its peak, and stepping out
on to hot blacktopped roads was excruciating in bare feet. She was amused to see
even a long cobra swiftly slither its way across, barely touching the road surface in a
couple of spots with its twisting coils.
Well, the village was much as she thought it would be, with none stirring out in the
blinding light of day, and the trees a hundred yards away shimmering in heat hazes.
Those who had to go to work had left early, wrapping rotis and onions in a wet cloth to
eat for lunch, under the cooling shade of some tree. It never failed to surprise her that
even a thorny babul tree could act better than most city air conditioners. The bus had
let her off in a storm of hot dust at the stop within two kilometers of her village. She
had walked home, greeting the few villagers still around in the heat, and after washing
her feet, hands, and face, perfunctorily with two glassfuls of water, and cleaning her
house, she decided to lie down on her charpoy and rest during the rest of the day.
The growing heat of the day, beating down on her from the slate roof, drugged her into
fitful slumber. Tired from the long journey back to the village, and at last relaxed after
the tiring events of the city, she slept longer than she expected, and it was quite dark,
when she woke with a start, hearing her name being called in some agitation, and her
flimsy door rattled with repeated thumpings. She got up groggily, her heart thumping,
her eyelids gummed together, her mouth ropy with dry spittle, and flung open the
door. She hunkered down in her small front yard, which she had freshly swept and
cleaned with cowdung after returning, and thoroughly washed her face with water
from a plastic bucket. She was then ready to talk with her caller, who was sitting on
the front step, with a kettle of hot tea and two tiny glasses in his hand.
Her visitor was Laxmaiah, Sugunamma's husband, whom she had left a few weeks ago
in the sixth month of her pregnancy, looking well and glowing, with no complications
to be foreseen for the delivery.
"Laxmaiah, you are a good man," she said accepting the proffered glass of hot tea. "
Few husbands care so much for their wives if anyone knows, it is me. But you you
are different. How many times must I tell you not to worry? Sugunamma is fine I
wouldn't have gone to the city if I had suspected the least problem. And remember this
is not her first confinement. Everything will be all right."
" God willing, everything will be all right," said Laxmaiah hastily. " She is not well. She
is badly ill."
Ramulamma looked at him a little fondly. How many such caring husbands were
there? "Look, I tell you she is all right. Trust me."
Laxmaiah looked around as if seeking support. " She fell ill about ten days ago. Fever,
very high fever, we all thought it will go in a day or so, but it's got worse day by day
and that too in this hot weather. Last two days, she couldn't even walk to the nallah
by herself I tell you, I had to hold her. I am cooking, looking after the baby. I couldn't
leave her. Today I got her sister to come, and I came straight for you."
Looking into his eyes, Ramulamma could see he was scared, genuinely scared.
" Have you taken her to a doctor?" she asked quietly.
" Yes, two times, already. I couldn't take her to the district hospital. It would take all
day there, and I would lose a day's work, as it is, the dorra is very angry with me, says
`all you Harijans are the same, never work any time, and you want wages.' So I took
her to that new private doctor, you know, the one with that fancy office, near the bus
stand? Doctor Prasad charged me fifty rupees each time, said in the city he could
charge two hundred. These are the pills he told her to take, but the fever has been
getting worse, all the time."
Laxmaiah took out a dirty envelope from his pocket and showed the pills to
Ramulamma. She looked at them gravely.
" Did you take Sugunamma to the clinic, did he examine her?" she persisted.
" Of course I took her there, ill and fainting, her body is like fire!" said Laxmaiah
hoarsely. " He looked at her for just a minute half a minute from a distance, and
waved her away. Said if the fever does not come down, he would give her an injection
tomorrow, but that would cost three hundred rupees."
Ramulamma got up and went inside, lit a small wick lamp, placed it on her window
sill, and then securely locked her door, pulling at the lock two times to be sure. They
set off for Laxmaiah's house, a good distance, beyond some millet fields, and down at
the end of a palm-lined dirt road. When they got to it, they could hear the baby crying,
and Malli, Sugunamma's young sister, came out looking scared, and holding smelly
rags in her hand. Her face lit up when she saw Ramulamma.
" She is babbling, and won't wake up. She just passed stools in her sleep. I cleaned
her there's blood!" She held out the rags to Ramulamma, who looked closely at the
filthy cloth, and just nodded. Telling Malli to mind the baby, she gave Sugunamma a
close examination. The delirium was just breaking, and beads of sweat were drenching
the woman. She looked into the sick woman's eyes, felt her pulse, and then told the
anxious Laxmaiah to make his wife a lime sherbet with three spoons of sugar and a
pinch of salt.
" Both of you must keep giving her a lot of water to drink, whether she likes it or not.
This is a hot summer, and she has fever, she must drink water. Add a pinch of salt
and two three spoons of sugar, that's important, you understand?"
When finally the husband turned to her, she gave him the bad news. " She has got
malaria a bad form of malaria it goes to the head. The doctor should have known,
ordinary malaria would be cured by these pills, but this kind, no! We must take her to
the district hospital tomorrow morning there is no other way. The government doctor
there is experienced; he would know what needs to be done. Don't worry, God protects
good people, you and Sugunamma are very good people, and everything will be all
right."
Both Laxmaiah and Malli seemed almost cheerful now that she was around, and he
made a joke about the new private doctor, but she kept to herself any anxiety she felt,
and talked with them easily about her city experiences. They were laughing when she
told them how the chief minister had run into her, in front of all the TV cameras, and
decided to give her some money. While they were talking, she put a pillow under
Sugunamma's feet, removed the sodden sheet, and replaced it with a clean but old
cotton sari. After an hour or two she left, instructing them to keep Sugunamma
comfortable, give her water with sugar every now and then, and assuring them she
would be back early in the morning.
Next morning, she first went to the main road, caught up with Afzal mian at the
Punjabi dabba and over a cup of tea and a plate of puris, she fixed up his auto-
rickshaw for the morning, after some good-natured but hard bargaining. Then she
drove up to Laxmaiah's house. He was already on the street looking round the corner
to see if he could spot her coming.
" We need Afzal mian's auto, Laxmaiah," she said getting down. " Sugunamma must
be carried to the hospital. We will both take her there now, so that we are ahead of the
O.P. queue. Malli, you will be all right here with the baby, right?"
They reached the district hospital by eight-thirty, and Afzal drove his auto-rickshaw
almost to the every door of the Out Patient's Section. Laxmaiah and Ramulamma had
held the sick woman between them on the back seat. She was no longer delirious, and
the temperature had come down, giving Laxmaiah back his confidence, but
Ramulamma knew that it was only a short reprieve. They were almost the first on the
long bench in the waiting hall, but the clinic door was firmly shut and there was no
sign of doctor or nurse. The orderly who was dusting the room refused to answer any
questions, and left soon after. Within the next couple of hours the hall gradually filled
up, and became oppressively hot. Sugunamma started to moan with the rising fever,
and wanted to lie down, which of course she could not do in the crowded hall. When a
ward boy informed the crowd in general that the doctor was on leave, attending a
relative's marriage in some other town, but a junior doctor would be there soon, it
seemed pointless to stay in the hall, and they half carried Sugunamma to the shade of
a large peepul tree outside, and Laxmaiah went to get her some thin buttermilk to
drink.
Minutes later by the general bustle in the hall, Ramulamma deduced that a doctor had
arrived, and telling Laxmaiah to bring his wife along behind, she pushed and shoved
her way expertly to the front of the jostling patients. After all, she had been there
before anyone else, so why shouldn't she get to the doctor ahead of most? Finally, by
twelve-thirty they were in the small, crowded clinic in front of the harried doctor, who
though quite young, was beginning to lose a lot of his hair. Ramulamma tried to tell
him about the case, but he shut her up firmly.
" Nurse! Tell these women to keep quiet. This is a hospital, not a bazaar. Let me
examine the patient." He looked briefly at the pallid woman in front, turned up her
palms, pulled down a bottom eyelid, and turned away from them on his swivel-seat,
speaking over his shoulder. " This woman has got jaundice. You people drink dirty
water, what can I do? There is no medicine for jaundice. No fat, no milk, no oil, she
will be all right in two weeks!"
Ramulamma, pushing back the crowd that surged behind her said very loudly: "She
has got malaria, Doctor Sahib! I am her dai. She has not got jaundice that is just
anemia, Sir!"
The doctor swiveled back, and blinked at her angrily through his glasses. " So you are
a doctor, now? Treat her yourself, then! I have enough work to do without wasting
time on stupid women!"
Ramualamma was too tough to give up. " Sir, she has got malaria, Sir! On and off high
fever ..."
"Get a blood test done!" roared the doctor. " You say you are a dai. At least you can see
she is pregnant? Woman, do you itch? Are you itching?"
Sugunamma nodded unhappily.
" There, I knew it," said the doctor confidently. "In her term it is common for women to
get jaundice. Here, I'll write out what needs to be done. Give this slip at the clinic. Get
a blood test done, and be back by four latest! Go now! Go! Go! Let me do my work."
The crowd impatiently pushed the three of them out. It was very hot in the sun. They
made their way back to Afzal's auto, parked in the shade of a small clump of trees,
and woke up the owner, who was curled up on the back seat, with his slippers kicked
off. Afzal got up slowly, complaining that by then he should have been on the road.
Quickly, Ramulamma stopped his complaints by hiring him for the day, with a thirty
percent increase on the half-day charge.
Krishna was on the point of leaving the town clinic, which was a pharmacy, doubling
as a testing lab. He was a second year medical student, the only one from that poor
part of the district, and was back home on a brief vacation.
He greeted Ramulamma with affection. " Arre! Ramulamma, you will live a hundred
years! I was just now enquiring about you, and hoping to come round and see you this
evening."
Ramulamma smiled back. She had known this handsome boy since he was a child,
and was as proud of his getting into medical college on merit, as his own parents were.
" Where's your father?" she asked. " We need some tests done in a hurry, and get back
to the government hospital by four."
" I'll do them for you, Ramulamma," said Krishna enthusiastically, turning back into
the clinic. " What won't I do for you? You taught me more medicine than anything I
learn at that great big college," he added affectionately.
Mary, the little, dark, lab assistant from Kerala, came out from a backroom. Laxmaiah
gave her the slip of paper from the doctor.
Krishna chatted away as they prepared Sugunamma for the blood test. He was doing
well. His parents had gone on a week-long pilgrimage to Tirupati to thank God for all
their successes, including that of their son, he said, laughing. He was in charge, but
really Mary could any day handle everything.
" I want you to do an RDT," broke in Ramulamma. " I want to test for falciparum."
" The doctor does not ask for it?" queried Krishna tentatively. " But what does that
matter? I'll do it for you, at no extra charge, OK?"
After the tests were done, and some polite chit-chat, they left, promising to return
before four for the reports. Sugunamma had developed high fever by then, and it was
essential they should sit somewhere in the shade. Luckily, there was an old wooden
bench outside a cycle-repair shop, which also fixed tire punctures. It was shaded by
two heavily-laden trucks parked alongside, the Sikh drivers having gone across the
road to a dabba for a leisurely lunch. They sat down in a row on the bench, and while
Ramulamma supported Sugunamma, Laxmaiah sent to a tea-shop and placed an
order for three cups of tea, and two plates of samosas. A pleasant-looking boy of about
seven came running across to them with tea and samosas, and put down the tray on
the bench, generously spilling the tea. As he was turning to run back, Ramulamma
told him to get them some ice from the cool-drinks ice-box for Sugunamma. For the
next couple of hours, she supported the sick woman on her shoulder, made a pouch
for the ice with the end of her sari, and applied it to her forehead, sometimes even
giving her a cube to suck, as relief against the hot winds that kept swirling dust round
them.
By four in the afternoon they were back at the hospital, and though there were still
many patients, the crush of the morning was gone, and they could get into the narrow
doctor's clinic before five, without too much pushing.
The doctor did not seem to recognize them, as Laxmaiah diffidently handed him the
reports.
Before the doctor could comment, Ramulamma said hastily: "This man took her to
that private doctor Prasad, by the bus-stand. He prescribed chloroquine tablets,
Doctor Sahib here, see these tablets?" She held them out, and the doctor peered at
them. " Sir, they are ineffective, for she has falciparum malaria, Sir, resistant to
chloroquine he did not realize!"
The government doctor looked at the tablets in a pleased manner. He hated the
thought of up-start private practitioners taking away patients whom he could tell to
come round later in the evening to his house for `special treatment.'
" Yes, totally useless, totally useless," he said triumphantly, flinging the pills down on
the table. " These people just make money out of poor people, killing them! And you
fellows, what do you do?" he demanded loudly, glaring round. " You go to these
uneducated quacks, pay good money, kill yourselves, and come too late to me. To me!
I am not God, I cannot save you if you come too late!"
The doctor mopped his brow, the afternoon heat was still oppressive, and his rising
gorge at injustice had not helped. He turned to Ramulamma with a friendly smile. " I
will prescribe an injection that can save her, but it is not available here in this
government hospital, we have no budget for costly medicines. Get it from a pharmacy,
seal unbroken, look at the expiry date, and bring it to me this very evening, her
condition is serious round to my house!"
The doctor had swiveled away to examine his next patient, having thrust the hurriedly
written prescription into Laxmaiah's hand. A few aggressive patients pushed back
Ramulamma, Laxmaiah, and his wife. In the little space round the ward boy, holding
open the clinic door, Ramulamma caught a quick look at the prescription, and then
lunged back towards the doctor.
" Doctor Sahib! Doctor Sahib! She is seven months gone, Sir!" she shouted out over
the heads of people. " She had blood in her stools, Sir!"
" Keep her bowels moving," said the doctor matter-of-factly, without interrupting his
examination. " Give her fruit, leafy vegetables to avoid piles."
" Sir, you have written out primaquine injection, Sir! She is in advanced pregnancy,
Sir..." " howled Ramulamma over irritated commands to leave from those in front of
her.
" Shut that woman up! I can't work with all this noise!" It was the doctor's turn to
shout. There was immediate respectful silence in the room. " Here, you!" The doctor
looked round searching for Laxmaiah, who went forward obediently. " You! Your wife is
seriously ill! Do you understand! It will cost you money, if you want to save her and
your child! Do you understand! And tell that illiterate, ignorant dai woman to shut her
mouth! Now go and come to my house this evening with the injection." His command
over the patients restored, the doctor completely ignored them, as Laxmaiah hustled
the women out of the clinic and the hospital.
Afzal, who was on the lookout, promptly puttered towards them. As they made their
way back to Krishna's pharmacy, Laxmaiah and Ramulamma broke into a loud
argument, the patient between them, her lolling back and almost delirious, her lips
puckering uncontrollably.
" Look at her, Ramulamma! Look at her! What will I do if she goes!" His voice cracked,
and an unexpected tear ran down his face. " Surely the Doctor Sahib knows. Let us do
what he says. I don't care about money, when have I had any money? I will borrow,
work double time that is our fate. But save her, save her, save her!"
Ramulamma was holding Sugunamma tightly to prevent her from injuring herself as
the auto-rickshaw bumped over ruts in the road.
" She is one of my best friends, why don't you understand?" she said calmly to
Laxmaiah. " I know this disease. The doctor has learnt in colleges and from books, but
I have experience. I tell you, this is no time for us to experiment on her, change
medicine, there is no time left. What he says is wrong for her, I know!"
" Then what is to be done?" challenged Laxmaiah.
She was silent. She knew what needed to be done, but she needed a doctor to do it,
and there was none they could go to, none closer than the city, and even if they found
the astronomical money involved, she knew Sugunamma would not survive the
journey. There was no answer, no solution. They reached Krishna' s clinic in silence.
He was there, and signaled them in.
Before Laxmaiah could produce the prescription from his pocket, Ramulamma spoke
directly to Krishna. " This woman Krishna is very ill with malaria, falciparum, you did
the RDT earlier, you know. She already has had a week of chloroquine, and now the
doctor wants to inject primaquine, which is good normally, but she is seventh month
pregnant, she cannot take it, he doesn't have the experience. Will you help me treat
her?"
Krishna's face blanched. " I am you know I am still a student I can't you know?
If I interfered now, they may never let me be a doctor."
Ramulamma's face was hard. " I am asking you to save this woman's life. You can say,
No. You can become a doctor and make money. But if you want to be a doctor and
save a life, you must start now!"
They were silent. Laxmaiah looked at the floor in deep misery.
" What do you want me to do?" asked Krishna thickly.
" We have to set up her house like a ward. Everything you can bring from here. I need
to start a dextrose drip soon. Do you have artesunate injection?"
Krishna shook his head. " No demand, yet. But I can ring up a friend in college, and
maybe get it by tomorrow, day after tomorrow?"
Ramulamma shook her head. " No, we do not have any time left. Quinine and sulpha
sulphadoxine? Am I right? I know she is not allergic to sulpha, so it's less of a risk. All
right. That's what we will do." She turned to Laxmaiah. "It's up to you to believe me or
the doctor. It is a great risk, and we may be too late already, but I know the doctor is
wrong. No one will blame us if we do what the doctor says, but we will lose
Sugunamma."
Laxmaiah sat down on the floor with his head in his hands. " You are like my elder
sister. What is the doctor to me? We will do as you say. If she lives, it is God's will, if
she dies..." His words ended in a whimper.
Ramulamma turned to Krishna with a smile. " Be brave. It is brave doctors who save
lives. You are the educated one among us. Read the instructions carefully, prepare the
injections carefully. It is all written down, so there will be no problem, now that we
know what we must do."
Krishna stayed in Laxmaiah's little house all night long, spacing the injections, and
watching his patient's every move. Ramulamma was more relaxed for she had spent a
lifetime attending on very sick women, and the routine of making the patient
comfortable, turning her round periodically, changing the drip, cleaning the bed, kept
her from thinking of the risks they were taking. Once the decision had been taken, she
was calm and assured, knowing they were right, and that there was nothing more to
be done, except help the patient's own body fight the disease.
By the second day, Sugunamma's mother, and two women friends had come to the
house, to stand looking silently at the ill woman with their sari ends over their
mouths. Then they started to demand loudly of Sugunamma how she was, and what
would happen to her child if she kept lying down like this, and there was also the baby
in the belly to consider. Despite such forceful reminders of her duty, Sugunamma
hardly made any response, and in fact barely recognized their presence. Once out of
the house, her mother clung to Ramulamma, relating in detail how she had raised her
daughter, how good she always had been, how she only lived to see her grand-
daughter married. Ramulamma kept assuring her Sugunamma would be all right.
After a while, the old woman left, putting a large watermelon she had brought along as
a gift into Ramulamma's hands.
That night drums started beating rhythmically at the Yellamma temple, and they
could hear snatches of someone singing the praises of the Goddess, invoking her help.
Sugunamma showed little improvement for the first forty-eight hours, but she was
alive, though her breathing was shallow, and she was barely conscious. Once they had
settled into a routine, Krishna left to reappear at set intervals, administer an injection
or check the drip. The third evening, round eleven at night, when Ramulamma
returned to the house after answering a call of nature, she found Laxmaiah and Malli
huddled in the dark outside, under the window, but it was fear that held them
together, not lust. She sensed that special tension when the end is near, and went to
the bed with tightened lips. Sugunamma was still in coma, and her breathing came in
wisps. There was nothing to be done but wait for that moment.
To everyone's surprise, Sugunamma was alive in the morning, the fever had broken,
and she was conscious. But Ramulamma knew it was still touch and go, she was very
weak, and any complication could set in. The next few days were her hardest, for she
watched her patient like a hawk to see that nothing delayed the recovery, spending her
money and Laxmaiah's like water, on medicines, glucose solutions, fruits, cooking soft
rice, and feeding Sugunamma like a child with little balls of rice and curds. The young
woman responded bravely to the medication and the care shown to her. Ramulamma
encouraged her will to live by saying comfortingly that the son inside her was doing
very well. After ten days or so, Ramulamma felt confident enough to leave Laxmaiah's
house and go to her own to see that everything was all right, and meet her other
friends, and potential patients. But the nights she spent with Sugunamma. By the
twenty-first day her patient had shaken off the dreaded disease, though she still had a
way to go before being able to work as usual. Laxmaiah was congratulating her for
saving both his wife and his child, when the monsoon broke in lashes of rain,
sweeping the oppressive heat out of their skies, and leaving the world clean and green.
Everyone she knew was standing out in the rain, getting wet and grinning.
Ramulamma had to get a hole in the roof of her hut mended, if she did not want all
her things to be washed out. So it was a few days before she visited Laxmaiah and
Sugunamma. There were quite a few people in that house all laughing, and preparing
a meal. Laxmaiah got up to greet her, while Sugunamma sat on her doorstep, looking
up and smiling. Malli brought her a plate full of hot rice, some beef, and very hot, red
chili chutney. It was a special celebration, and everyone regarded her with the respect
shown to a giver of life.
" You are the best dai in Telengana, I am the first person to say it," said Sugunamma's
mother. " And you did what you could, who can do more? But Yellamma saved my
daughter. She came to me in a dream, and I said `How can you take her away? Did I
not give you my first daughter?' Yellamma is just, she listened, and decided to save
Sugunamma."
No one laughed, it was not safe to do so, within earshot of the temple. Nor did
Ramulamma. Who knew? She was too experienced a dai to put her trust only in
medicines. All she could claim was that she had rescued Sugunamma from the
doctors.