During the last leg of our internship in the year 1993

Rakesh Biswas

Professor of Medicine at Kamineni Hospitals (company) (2017–present)Updated 5y

It was our community medicine posting during the last leg of our internship in the year 1993 and we had managed to get leave from the hospital to take a trip to the Sikkim Himalayas (off course we couldn't have mentioned that in our leave application).

We made the customary trips to Gangtok, (the 15 rupees thali in Jain Dharmashala was unforgettable as we were also on a budget) and Tsangu lake (it was the first time some of us were touching the snows and a customary snowball game was in order between the four interns and one Geographer who worked for the National Atlas). The image of Tsangu lake you see above was clicked in 1993 by Basubandhu, the geographer and all the other images here below are taken by him in 1993.

Finally we decided that a trip to Sikkim would be incomplete without a trek.

Some of us had already done the Yuksom Zongri circuit earlier, plus it wouldn't suit our budget in terms of time (limited internship leave etc) and so on our way back to Siliguri, after our bus had crossed over from Sikkim to district Darjeeling, we got down from the bus at a place called “27 miles.”

The first thrill to the place, which looked like it was in the midst of nowhere, was the rickety ropeway we needed to ride (made out of a wooden precarious bench it was unlike any ropeway we rode before).

Once we rode the ropeway marvelling at the exotic birds flying over the jungle canopy below, we also crossed the river Teesta (branching into Relikhola) and once we deboarded the ropeway bench we took a dip in the pristine river just before we began the trek.

The place near the river was called “Samco farm” and the trek to Samtahar was steep and gruelling but enjoyable at the same time and when we finally appeared to reach our destination we were covered by a “white out” mist that didn't allow us to visualize any of the homes in that sleepy hamlet and all we had were some audio cues of barking dogs that told us that we had arrived into human habitation.

As we were interns on a budget we had already decided to try and find out if they would allow us to sleep in their “primary health center” PHC, which we were lucky to locate in the midst of the mist and were greeted there by a kind “sister in charge” who agreed to shelter these urban interns for the night in her PHC.

Image of the white out in Samtahar taken by Basubandhu in 1993

The next day morning is actually the real answer to the A2A here.

A young primi was brought to the health center with delayed labor and luckily one of us interns had finished his obstetrics posting and had delivered sufficient amount of babies to gain enough confidence to manage the situation and even when the sister in charge of the PHC appeared to panic and ask if they could refer, he stood resolute that they could get the baby out and it was a matter of time.

I'm sure that intern wouldn't have dreamt of taking that risk today but in 1993 his blood was younger with all the enthusiasm needed to drive his aspirations. At that moment his reflexes appeared to declare that he should just keep his hands over the baby's crown which had been trying to free the rest of it's body for quite some time.

And finally after what seemed like an eternity the rest of the baby's body obliged but there was no sound from the baby and it appeared listless but then a few mouth to mouths (through a gauge piece) later, there it was, the most pleasurable cry of a child that promises to live.

It was a girl and all the villagers in that matriarchal village (that strongly valued a girl child above a boy) rejoiced (contrast that with the desolate silence this intern had experienced in his own urban hospital when he announced, “its a girl”)

The villagers treated the interns to a sumptuous lunch perhaps as the interns had saved them from carrying the mother through much more gruelling treks through steep hills to an urban hospital in the plains where it may have become too late by the time they could have reached.

Image of Basu Bandhu playing with children in front of the PHC.

That intern who took the biggest risk of his life has become a Professor now and wonders if he he would be able to take the same risk now.

What was it that gave him the confidence to do that in internship? Was it the faith in the eyes of the villagers, the other difficult alternatives?

Is it because urban patients have more alternatives that they would not be able to put the same amount of trust in their doctors, trust that may have made their doctors more confident for the better (or unfortunately yes even for the worse)?

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Mahatama Gandhi's list of CBME competencies

From his autobiography and other's testimonies:

1) CBME procedural competence in surgical dressing and administration of medicines:

"His early experience in healthcare started when his father was suffering from a fistula; he was one of the attendants to his father. He had duties, which mainly consisted in dressing the wound, giving medicine to his father and compounding drugs whenever they had to be made up at home. Gandhi was thus initiated into  medical service!"

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2) AETCOM CBME cognitive competence in helping patients and prompt referral for further help:

From his Autobiography, “The question of further simplifying my life and of doing some concrete act of service to my fellowmen had been constantly agitating me, when a leper came to my door. I had not the heart to dismiss him with a meal. So I offered him shelter, dressed his wounds, and began to look after him.” But later he was sent to the government hospital for indentured labourers. He further said, “I longed for some humanitarian work of a permanent nature."

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3) AETCOM CBME cognitive competence in history taking and case presentation as well as perceiving healthcare as a calling and finding mental peace as a currency for job satisfaction:

"The work of dispensing medicines took from one or two hours daily, and I made up my mind to find that time from my office work, so as to be able to fill the place of a compounder in the dispensary attached to the hospital… This work brought me some peace. It consisted in ascertaining the patient's complaints, laying the facts before the doctor and dispensing the prescriptions. It brought me in close touch with suffering Indians…”

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4) CBME procedural competence in Obstetrics:

"There was no time to summon a doctor or nurse because Kasturba got the labour pain so suddenly and the birth came quickly. Once again the birth was difficult but this time Gandhi delivered the baby safely all by himself! Devadas, Gandhi's last son, was born on May 23, 1900. Gandhi said, “The birth of the last child put me to the severest test. The travail came on suddenly. I had to see through the safe delivery of the baby. My careful study of the subject in Dr. Tribhuvandas’ work was of inestimable help. I was not nervous."

5) AETCOM cognitive and procedural competence in Infectious disease epidemic management:

South Africa 1904 , Sjt. Madanjit sent a note to Gandhi saying, “There has been a sudden outbreak of the black plague. You must come immediately and take prompt measures, otherwise we must be prepared for dire consequences. Please come immediately.” The municipality thanked him for this prompt action and supplied him with disinfectants and also sent a nurse. He gave medical aid and cleaned the patient's beds, sat by their bedside at night and cheered them up."

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5) CBME procedural competence in Patient transport and administration of medications:

"Gandhi recollected the services rendered in the Boer War, “We soon got work and that too harder than we had expected. To carry the wounded seven or eight miles was part of our ordinary routine. But sometimes we had to carry badly wounded soldiers and officers over a distance of twenty-five miles. The march would commence at eight in the morning, medicines must be administered on the way, and we were required to reach the base-hospital at five. This was very hard work indeed.” 

6) AETCOM CBME procedural competence in silent service driven empathic communication:

"The good Doctor told us that he could not induce Europeans to nurse the Zulus, that it was beyond his power to compel them and that he would feel obliged if we undertook this mission of mercy. We were only too glad to do this. We had to cleanse the wounds of several Zulus which had not been attended to for as many as five or six days and were therefore stinking horribly. We liked the work. The Zulus could not talk to us, but from their gestures and the expression of their eyes they seemed to feel as if God had sent us to their succour.”

7) CBME competence in actionable empathic buy in of a doctor patient relationship:

"Gandhi had a glum, ferocious, uncommunicative African jail mate attendant. One day, he was stung by a scorpion. He was screaming like anything and Gandhi saw this intolerable pain. He immediately took the African's hand and washed it clean and he started sucking the injured area. He was extracting the poisoned blood as much as he could and spitting out. He was relieved from pain. Gandhi applied tincture and bandaged his arm. He became Gandhi's devotee thereafter."

8) CBME cognitive competence in observing procedures (see one, do one, teach one, skipping the latter two):

"Noted in Gandhi's diary on May 15, 1947, “Manu has a severe stomach-ache, she also had vomiting and is running temperature. I therefore called in the doctors who examined her. Manu's complaint was diagnosed as appendicitis. I had her removed to the hospital immediately. She will be operated upon at night. Watched Manu's operation at the hospital. Mridula and Madu were keeping her company. But they were not allowed inside the operation theatre. I had put on a surgical mask and watched the whole operation."

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9) CBME competence in medical decision making (such as to operate or not to operate):

In the letter to Jaisukhlal Gandhi, father of Manubehn Gandhi, on the next day, Gandhi said, “I had suspected even in Delhi that it was appendicitis. I had hoped that treatment with mud-pack would help her to get well. But it did not help her sufficiently. I, therefore, called in the doctors yesterday. They advised an operation, and I therefore got her operated upon.”

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10) Competence in making career choices:

"It was Gandhiji's elder brother who dissuaded him from pursuing medicine because he said their father would have disapproved of the decision; since the Gandhis were Vaishnavas, they would have nothing to do with dead bodies. His brother suggested instead, it would be wiser to study law and become a barrister, which is what Gandhiji did."

"Later though, even as he practised law, Mahatma Gandhi continued thinking about visiting London to study medicine. However, in 1909, he wrote to a friend saying he had heard from certain doctors that they had killed about fifty frogs while studying medicine. He said, if so, he had no desire to do the same, because he neither wanted to kill nor dissect frogs."

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11) CBME competence in enterprise and innovation:

"With the help of three colleagues, Gandhiji put all the patients in a vacant house and took on the role of both doctor and nurse. Even though they did not have the means needed to manage a situation of this magnitude, they did all that they could to help. The Council, on their part, provided a vacant godown for the patients; however, this building was unkempt and filthy. Gandhiji and his colleagues not only cleaned up the building, they also raised money to buy a few beds and other necessary things by reaching out to charitable Indians. Soon, an improvised temporary hospital was set up. The local authorities sent a nurse, who arrived with brandy and other hospital equipment. Instructions were given to provide frequent doses of brandy to the patients. Gandhi had no faith in the beneficial effects of brandy and, with the permission of Dr. Godfrey, who was the doctor in charge, he put three patients who were prepared to forego brandy under the earth treatment, which required applying wet earth bandages on their heads and chests. Two of these patients survived. The other twenty died in the godown. Gandhiji said it was impossible to ascertain how the two patients who had agreed to the earth treatment were saved, but this incident enhanced his faith in the earth treatment as well as strengthened his skepticism for the efficacy of brandy as a medicine."

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12) CBME competence in putting prevention above treatment:

"I overeat, I have indigestion, I go to a doctor, he gives me medicine. I am cured, I overeat again, and I take his pills again. Had I not taken the pills in the first instance, I would have suffered the punishment deserved by me, and I would not have overeaten again. The doctor intervened and helped me to indulge myself. My body thereby certainly felt more at ease, but my mind became weakened."

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13) CBME Competence in designing rural medical learning and practice centers:

"He said the halls for treatment and experiment should be surrounded by huts that could serve as residences for patients and children who were being treated there. He also said the sanatorium should grow fruits, flowers, food grains and vegetables, that it should have cattle sheds and roads good enough for vehicles. He also suggested having a gymnasium, a tank for bathing and other facilities. Gandhiji said it was best to avoid procedures that required electricity, such as hot and cold water and steam regimens."

Unquote 

1-9 points above have been quoted from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6515737/, which again has collated quotes from sources such as:

1. Bandopadhyaya A. Bahuroopi Gandhi. Popular Prakashan, Bombay. 1964 [Google Scholar]

2. Gandhi A. Mumbai: Jaico Publishing House; 2000. Untold Story of Kasturba. [Google Scholar]

3. Gandhi M. New Delhi: Publications Division, Ministry of Information and Broadcasting, Govt. of India; The Collected Works of Mahatma Gandhi; p. 20002001. [Google Scholar]

4. Gandhi MK. Ahmedabad: Navajivan Publishing House; 1927. An Autobiography or The Story of My Experiments with Truth. [Google Scholar]

10-13 have been quoted from:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6515724/

Notes:

Abbreviations used:

Competency-based medical education (CBME).

CBME is an outcomes-based approach to the design, implementation, and evaluation of education programs and to the assessment of learners across the continuum that uses competencies or observable abilities. The goal of CBME is to ensure that all learners achieve the desired patient-centered outcomes during their training.

Unquote:

https://www.aamc.org/about-us/mission-areas/medical-education/cbme

AETCOM: An Indian abbreviation coined by the Indian medical council, a medical education regulatory body, which stands for Attitude, Ethics and Communication and is designed as (AETCOM) modules to develop a foundation of positive attitude, ethics and communication in the Indian medical graduate.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9480674/#R11

"Gandhi was able to walk about 79000 km in his lifetime which comes to an average of 18 km per day and is equivalent to walking around the earth twice."

https://en.m.wikipedia.org/w/index.php?title=Practices_and_beliefs_of_Mahatma_Gandhi&wprov=rarw1

Past lectures on "Indian informal healthcare" , Patient centered CBME as a game changer, Generalism in medical education and The ultimate "role playing in education" in the search box in our departmental website here: medicinedepartment.blogspot.com

Creative commons license: https://commons.m.wikimedia.org/wiki/File:Gandhi_suit.jpg#

Wiki UDLCO: The ultimate "role play" in a participatory action learning and practice strategy

Summary: From an educational learning perspective looking at utility of "role play" as a learning tool, this wiki and other user driven  learning community generated content dwells on historical archives highlighting Bhagat Singh's participatory action learning and practice strategy through role play that culminated in his execution by the imperialist rulers of his time. The introduction highlights a chance evocative signboard in Telangana that sets off a train of thought around atheist Bhagat Singh and his association in that signboard with a deity.

Keywords glossary: https://userdrivenhealthcare.blogspot.com/2023/11/glossary-of-user-driven-healthcare.html?m=1

UDLCO Conversational learning transcripts:

[04/10, 07:53] : Any idea what does this signboard mean? Why's Bhagat Singh's picture with this deity?

[04/10, 08:18] Kmcq: Bhagat Singh youth association

[04/10, 08:27] : In Telangana?

What about the deity?

[04/10, 08:28] : Yes..Bhagat Singh youth association is wishing Happy Navratri

[04/10, 08:48]: In that signboard?

Bhagat Singh was an atheist!

[04/10, 08:48] Kmcq: Yes

[04/10, 09:07] : I tried a lot of Google searching about the connection of Bhagat Singh to Telangana, Nizamabad but couldn't find any except the veneration and God like status for someone who played the ultimate role play in education in "Theatre of Oppressed" style much earlier than someone actually named it theatre of oppressed when he designed a staged surreal drama in the parliament house that eventually led to his arrest and hanging but he meant the entire process as a drama

wiki quote:

For some time, Bhagat Singh had been exploiting the power of drama as a means to inspire the revolt against the British, purchasing a magic lantern to show slides that enlivened his talks about revolutionaries such as Ram Prasad Bismil who had died as a result of the Kakori conspiracy. 

In 1929, he proposed a dramatic act to the HSRA intended to gain massive publicity for their aims.^[21] Influenced by Auguste Vaillant, a French anarchist who had bombed the Chamber of Deputies in Paris,^[36] Singh's plan was to explode a bomb inside the Central Legislative Assembly. 

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Another wiki quote 

From May to September 1928, Singh published a series of articles on anarchism in Kirti. He was concerned that the public misunderstood the concept of anarchism, writing that: "The people are scared of the word anarchism. The word anarchism has been abused so much that even in India revolutionaries have been called anarchist to make them unpopular." He clarified that anarchism refers to the absence of a ruler and abolition of the state, not the absence of order. He went on to say: "I think in India the idea of universal brotherhood, the Sanskrit sentence Vasudhaiva Kutumbakam etc., has the same meaning." He believed that:

The ultimate goal of Anarchism is complete independence, according to which no one will be obsessed with God or religion, nor will anybody be crazy for money or other worldly desires. There will be no chains on the body or control by the state. This means that they want to eliminate: the Church, God and Religion; the state; Private property.^[87]

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Another quote

On 21 January 1930, during the trial of the Lahore Conspiracy Case, Bhagat Singh and his HSRA comrades, appeared in the court wearing red scarves. 

On the day of his execution, Bhagat Singh was reading the book, Reminiscences of Lenin, authored by Clara Zetkin, a German Marxist.^[93][91] When asked what his last wish was, Singh replied that he was studying the life of Lenin and he wanted to finish it before his death.^[94]

Bhagat Singh wrote an essay entitled "Why I Am an Atheist" to address the question of whether his atheism was born out of vanity. In the essay, he defended his own beliefs and said that he used to be a firm believer in the Almighty, but could not bring himself to believe the myths and beliefs that others held close to their hearts.^[99]

Towards the end of the essay, Bhagat Singh wrote:

Let us see how steadfast I am. One of my friends asked me to pray. When informed of my atheism, he said, "When your last days come, you will begin to believe." I said, "No, dear sir, Never shall it happen. I consider it to be an act of degradation and demoralisation. For such petty selfish motives, I shall never pray." Reader and friends, is it vanity? If it is, I stand for it

Killing the ideas"

In the leaflet he threw in the Central Assembly on 8 April 1929, he stated: "It is easy to kill individuals but you cannot kill the ideas. Great empires crumbled, while the ideas survived."^[100] While in prison, Singh and two others had written a letter to Lord Irwin, wherein they asked to be treated as prisoners of war and consequently to be executed by firing squad and not by hanging

Four years after Singh's hanging, the Director of the Intelligence Bureau, Sir Horace Williamson, wrote: "His photograph was on sale in every city and township and for a time rivaled in popularity even that of Mr. Gandhi himself"

[04/10, 09:12] Kmcq through an AI LLM: Bhagat Singh's connection to Telangana, Nizamabad:

While Bhagat Singh's primary association is with Punjab and the Indian independence movement, his influence and legacy extend beyond regional boundaries.

Possible connections to Telangana, Nizamabad:

1. Ideological inspiration: Bhagat Singh's socialist and nationalist ideas may have inspired Telangana's struggle against the Nizam's rule.

2. Revolutionary methods: Bhagat Singh's innovative use of drama and public protest may have influenced Telangana's own struggles, including the Telangana Armed Struggle (1946-1951).

3. Education and awareness: Bhagat Singh's emphasis on education and awareness may have resonated with Telangana's own efforts to empower marginalized communities.

"Theatre of the Oppressed" style:

Bhagat Singh's staged drama in the Parliament House (1929) was a bold, symbolic act:

1. Protest against British rule

2. Exposing colonial exploitation

3. Inspiring others to join the freedom struggle

This act predates Augusto Boal's "Theatre of the Oppressed" (1970s), which aims to empower marginalized communities through interactive drama.

Bhagat Singh's "drama" in Parliament:

1. Throwing leaflets and shouting slogans

2. Challenging British authority

3. Using performance as protest

This event led to his arrest, trial, and eventual hanging (1931), cementing his martyr status.

Legacy in Telangana:

Bhagat Singh's ideals and methods may have influenced:

1. Telangana's peasant movements

2. Student activism

3. Cultural resistance against oppressive regimes

Veneration and god-like status:

Bhagat Singh's sacrifice and conviction have made him an iconic figure, transcending regional boundaries:

1. Symbol of resistance against oppression

2. Inspiration for social change

3. Embodiment of patriotism and selflessness

Would you like more information on:

1. Bhagat Singh's life and legacy?

2. Telangana's struggle against the Nizam?

3. Theatre of the Oppressed and its applications?

4. Revolutionary movements in India?

[04/10, 10:02]: This could be an important link to the Telangana Bhagat Singh connection 👇

To quote:

Anabheri Prabhakar Rao was a regional hero who gave a new wave to the revolutionary movement in Telangana. 

Anabheri studied revolutionary movements as a teenager and was attracted to anarchism and communism very similar to Bhagat Singh!

He was known as Karimnagar/Telangana Bhagat Singh

Anabheri died in battle aged 37. In a fight against the Police and Razakars led by Nizam's close adviser Khasim Razvi, there was a fierce exchange of fire on 14 March 1948 between the police and the communist squad in the hills and hillocks of Muhammadapur near Husnabad in Karimnagar district.[1][2] [3]

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https://en.m.wikipedia.org/wiki/Anabheri_Prabhakar_Rao