Saturday, June 17, 2017

HIV Tales from my diary-Tale 15

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 Tale 3 of healers suffering themselves )
Ram Prasad was successful BAMS ( Bachelors in Ayurvedic Medicne and Surgery) doctor practicing as an allopath ( as usual) in a midsize ,peaceful town ,of one of the most picturesque state of India, Himachal Pradesh. He was married to Nirmala and was blessed with a son and a daughter. The famous doctor came into my contact in 2006, when he was 44 years of age and in fourteenth year (7×2) of marriage. He was brought to me in a serous condition by his sister – a staff nurse of civil Hospital , Gurdaspur, a neighboring town. He was having Varicella infection ( chicken pox ) along with Erythema Multiforme, type of a drug rash ,which was, caused by illogical self medication by doctor himself. He needed admission. My advise for the same led to a request ,which was ,sort of ,unusual. The doctor wanted himself to be admitted in a hospital with altered name ( that too of my choice ) and that too ,in a hospital ,where secrecy of disease can be kept. ” what name ?? What disease ??”, I simply asked. The doctor already knew his HIV status and wanted me to hide . Instantly, I gave him a new name ” Champak Lal” and he and the family happily accepted too. My query of mode of transmission of virus in him got the usual answer which is given by erring medicos. ” Occupational hazard , Sir. I must have got a prick of needle from some patient”, he said. Believer in others , as I am, I believed him too ,despite his revealing no specificities. The admission to hospital was uneventful and he was discharged in about a week’s time after full recovery from EM and Varicella both , leaving some scars although. For his HIV , I prescribed Zidovudine , Lamivudine and Efavirenz treatment. Things were all getting back to rails of normalcy and he started coming on his own , alone for follow ups. It was his third or fourth visit to me , when he removed the veil, of occupation hazard ,he was wearing so far. He talked about his lust for sex and the seven year itch.
The seven-year itch is a psychological term that suggests that happiness in a relationship declines after around year seven of a marriage. Wikipedia suggests that the phrase originated as a name for irritating and contagious skin complaints of a long duration. Examples of reference may have included STD outbreaks that are known to significantly decrease in frequency after seven years. Later on in the 19th and early 20th centuries it was viewed as an expression of imagined appropriate punishment for antisocial behavior, or as a simile for a situation with little hope in relief.
The phrase was first used to describe an inclination to become unfaithful after seven years of marriage in the play The Seven Year Itch by George Axelrod, and gained popularity following the 1955 film adaptation starring Marilyn Monroe and Tom Ewell.
The doctor accepted that it was not the occupation, but his extramarital sex and his lust for sex , which has caused his ailment. He suffered from the proverbial 7 year itch. He wanted my help. He wanted me to tell his wife that she still can have sex with him , although protected one. Nirmala, his HIV negative wife had gone into a ” No Sex” mode after discovering his ailment. I counseled her about barrier protection while having sex with her HIV partner so as to protect herself from the virus. I also told her to report to me immediately, if the barrier protection , someday , sometime , gets broken/ forgotten.
The couple must have resumed their sexual self till that day when Nirmala called me at an odd hour. She was calling from a public booth.
” Hello , Doctor Sahib, I am Nirmala , wife of Champak Lal calling from —–, do you recognize me ?” She opened the conversation.
” Yes Madam I can recognize you but please don’t say wife of Champak Lal ,from a public booth , where there might be more ears to listen to. Those ears may draw wrong conclusions and one day you may find yourself surrounded by fingers pointing to your character. For them , you are Mrs. Dr. Ram Prasad only ”
She laughed at her folly but could not forget the folly for which she called me. She reported broken barriers. Post exposure Prophylaxis was ordered on phone itself. I told her to take the same tablets as her husband , sensing non availability of other more appropriate ARV. She did comply.
Doctor’s wife , however , could not give company to him for long , in the year 2008 she died in an accident. His son and daughter were away to a medical school to pursue MBBS. Ram Prasad felt lonely. Not only that his itch and lust persisted. His resistance and societal shame gave way to his lust and he ,despite having a doctor son and a daughter of marriageable age , married himself. The newly wed girl, however, could not digest the so far hidden reality of HIV in her husband. Once she was upfront with the reality she deserted him in no time , two months to be precise. Loneliness became killing. Ram Prasad took an asylum in the lap of drugs. He got hooked to drugs. The drugs , which he started in the garb of cure of his insomnia , became his home. He became irregular in treatment. First , it was lipodystrophy disfiguring the renowned doc which led to change of ARV from Zidovudine to Tenofovir and then his sleeping pills and irregularity became the cause of resistance of HIV to drugs leadingbon to second change of drugs. He was switched this time to Atazanavir, Ritonavir and Tenofovir , Emtricitabine combination.
The change , however ,could not change his fortunes.
Seven years later , in 2013 , his seven year itch proved lethal and he succumbed to the virus.
His son , who is now himself a qualified doctor might have taken over his roaring practice but I sincerely wish that he doesn’t follow his father’s seven year itch steps.
Rakesh Bharti

HIV Tales from my diary – Tale 16

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( Tale 4 of healers suffering themselves )
The earlier tales of healers suffering thy selves were not because of their profession. It just happened that they were in healthcare profession and were victims of the virus too. But Dr. Sagar Ratna’s tale is of pure professional hazard. After attaining his MBBS, he decided to try his luck in Nigeria , often referred to as the “Giant of Africa”, owing to its large population and economy. With approximately 184 million inhabitants, Nigeria is the most populous country in Africa and the seventh most populous country in the world. The country is viewed as a multinational state, as it is inhabited by over 500 ethnic groups.
Choosing that land as his work place was a choice by design as some of his family was there. Once he reached foreign shores , he made it his own home. Soon he became known for his extraordinary medical and surgical skills. To the alien country natives ,he was ,what Dr. Kotnis was to Chinese. Dr. Kotnis was sent to China during the Second World War to provide medical assistance to the troops fighting against the Japanese invasion in Yenan province.
While in China Kotnis met and courted a Chinesegirl Ching Lan. His main triumph was curing a virulent plague. Eventually he succumbed to the plague himself.
Dr. Sagar’s story was not much different from Kotnis. The only difference, was that he was not sent by anyone , he did not court a Nigerian national. Period.
The similarity was ,Kotnis succumbed to a disease he was curing in Chinese people, Sagar succumbed to a disease he contracted by helping Nigerians.
When we met first , he told me ,” you are lucky doc, you work with so many facilities at your back and call. I was not that lucky and used to operate at times even without gloves, with bare hands. Nigeria was not that rich then but the spirit to serve the nationals of my second home was rich in me”. Dr. Sagar went on to tell his Saga of contracting the virus. He told that he was active till the age of 65 years that is 2003 and it was during a camp held in a Tribal area that he got injured while amputating the arm of a HIV patient. He took the Post Exposure Prophylaxis (PEP)against HIV as per recommendations of his co professionals dealing with HIV. Got the tests done too. But PEP Could not prevent ,the punishment ,of his carelessness. He contracted the virus.
He came to India , in the meantime for a vacation. One day during his vacations, he had a seizure. Friends admitted him in a hospital specializing in neurological disorders. Radiological investigations did not bring a good news , neither did the hematological evaluation. He was once again confirmed to have HIV. Shunning to keep such patients , even if the patient was a doctor ,the neurologist took no time in passing the buck.
He referred him to me , being the sole HIV physician in the area. I asked for more tests to evaluate his virological and immunological parameters. He was put on antiretroviral drugs. I started him with best possible 3 drugs combination available at that time ( d4T, 3 TC, & EFV) , one of which drugs ( d4T) is now extinct. His roller coaster ride between life and death hanged in neurological uncertainties. Deteriorating conditions forced me to add Indinavir , a protease inhibitor ( again a drug which is extinct today from ARV scene ). Six years he lingered on and kept telling me type of cases he used to handle in Nigeria. I used to enjoy the experiences he used to share and learnt also. The most important lesson ,I learnt , from this veteran doctor ,was that a hurry of a minute spent on wearing gloves can not save any life , it may however , jeopardize your own life. New costly PI’s ( Loprinavir plus Ritonavir) were added to save his wrecking ship in 2008.
I saw him last on day one of new year , year 2009.
I ,really don’t have to guess much ,about the final outcome of a doctor. He must be my first patient who gave away his life to the profession and succumbed to the virus which he procured as a professional hazard. He was another Kotnis in my eyes. May his soul Rest In Peace.
Rakesh Bharti

HIV Tales from my diary - Tale 17

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 Tale 5 of of healers suffering themselves )

It was a hot summer day and the dentist was surrounded by shadows of patients around. The patient sitting in front wanted a tooth extraction. An extraction of a tooth which  was already loose , like lost character , was a proverbial left hand work for a right handed dentist. The right handed dentist , however , forgot to take right precautions which are universal in nature and usage. Shhhh, trrrr and the tooth was out but in the process Madam dentist got her hand injured by the tooth extractor. There was blood everywhere. Patients shadows disappeared so as to allow some Sunshine in the form of help from dentist working next to her. The Govt. Dental Hospital  , Amritsar facilities were better than many similar govt hospitals in the country. Still , Dr. Sandeep , made sure to get it seen and cared for by best of surgeons around. Stitches were not suggested. A course of antibiotics, shot of tetanus and few pain killers were supposed to do the healing job. The wound , however , was taking long time to heal. Worried Sandeep took the help of a dermatologist, who ensured the wound healing.
The injury disappeared from the body and was also on the verge of extinction from her grey cells, when a lady pierces the usual crowd of patients surrounding her. The lady wanted to talk to her in camera but sensing  the dentist's reluctance  , she started whispering in her ears. The whispers soon became louder and louder in Sandeep's auditory interpretation cells. The lady just told about the HIV status of her husband , whose loose tooth had struck her hard a few days ago. Panic set in.
Sandeep rushed to the nearest lab and waited with missing breaths for the result. How she passed those two suspense hours , were no less than the best of horror movies. She was bathing in her own sweat in the air conditioned lab. A tentative positive tests made her paler than a severely jaundiced patient. Looking for experts , she reached a trusted and trained pathologist for confirmation of HIV presence in her body. She was to marry a veterinarian from Canada after few months and this jolt might be lethal for everything ahead n her life , she thought. She was repenting the day , she did not take universal precautions. Proverbs ,at times ,describe the situations best. She was in the hearsay of " ab pachtaye hot Kya jab chirian chug gayi khet- its useless to cry over spilt milk. ".
A drowning man will clutch at a straw, and she was no exception. True to the character of the nations natives , who are snake charmers and believers of tantras and mantras , she also took the shelter of a " Sadhu Baba". Babaji gave her a straw of assurances of removing HIV from her body. She also clutched to the straw like a andh bhakt ( blind follower) believing in miracles.
Miracles neither occur nor occurred. She reached the limits of her stress coping capabilities. Her conscience forced her to run away from the marriage and save the life of her fiancé. In the suicidal bid, she called him and announced the break on phone itself. She cited serious ailment as a reason. The fiancé was by now had started loving her. He did not run away from showing  it too. He arranged a personal meeting in no time so as to understand her ailment. The love and affection showered by him succeeded in knowing the truth. Behaving much different than many " gentleman ", the ordinary looking veterinarian, convinced her to age together despite HIV. He assured that no one on the families will ever know and they will tie the nuptial knot. Once the marriage is solemnized, he will assure her reaching his work place Canada at the earliest. They will have best of treatment there and live happily ever after - was the ultimate plan.
Execution of the plan started in right earnest, marriage preparations were on and in full swing , when one day Sandeep got a devastating phone call. The person on the other side of the line was none other than the Sadhu Babaji, who once showed her the moon. Babaji had somehow come to know about their plans. He was no more a baba now and became a Bhai- Bhai of Bollywood. He stepped on to the black mail ladder.  Sandeep herself ,in her weaker moments told him about the boy and his family. Baba started threatening her with disclosure of her status to boy's family ( boy he knew was already in the knowhow of Sandeep's disease). Blackmailers have their own tactics and simpletons like a dental surgeon girl can't succeed in not falling prey to them. Sandeep was no exception. Babaji  started exhorting money. The silsila ( process) went on till Sandeep exhausted her financial resources.She had to tell her fiancé about the new developments. The fiancé, however, could deal with Babaji
with strong arm tactics. Marriage got solemnized. The Honey moon period once again saw precautions being thrown into wind. Sandeep's husband returned to Canada with all promises of calling her asap.
Proverbs did not leave Sandeep however. Man proposes God disposes became true for her once again. The short honey moon became a nine month wait for pleasure. Sandeep despite being a medico still did not know about mother to child prevention.
She delivered a healthy female child. A child with all ten fingers intact, a smart nose , ears and two beautiful big eyes. The baby was duly named Mrignaini.( eyes like peahen) Happiness of motherhood overshadowed  her knowledge. Ignorance could not last although. Mrignaini refused to thrive , a worried Sandeep took the little bundle of joy to the pathology lab with all hopes that she will be amongst 2/3 babies born to HIV mothers and be negative. She thought , if her husband has escaped getting the virus ( sex with HIV positive woman has 1:1000 chances only of transmission of HIV, she has read somewhere and her husband was in 999 group) why not the baby will also escape ( virus is transmitted in only one third of babies born to HIV positive mothers even without MTCT prevention). Her wishful thinking , however , was not right this time. Sunaina was HIV positive. The tests at that time used to test only antibodies. This fallacy kept her hopes alive. May be this tests are showing maternal antibodies only, she thought. Loaded with these thoughts, she one day landed in my chamber on the recommendation of the pathologist who tested her baby. Mrignaini was put on ARV's and was back on track of life. She showed signs of improved health, started gaining weight and reaching the milestones of her childhood.

Sandeep was desperate to join her husband and get the Canada Visa. She knew that it will not be easy for her and her daughter to get the VISA in terms of procedural ease and time. She asked for my help in getting her tests reports changed. Sensing my firm " No", she changed path. She stopped visiting me. Not many months would have rolled ,when I got her call from Toronto.  Surprise in my voice subsided with the information she wanted to pass me on. She was visiting after few months for further consultation of drugs etc of both hers and Mrignaini.
A typical smell of the perfume she used to wear even in India , announced her visit to my chamber that day. She came loaded with small gifts for me and queries for giving birth to a HIV negative son, without affecting her husband. Before replying her I had a question of mine. The quest to know the method to beat the system was at full to its brim. " Money makes the mare go"- it was her turn to push forward a proverb to quench my thirst. She paid 50 K ( the year was 2005 or so ) for each test to be reported negative and beat the fool proof ( so called ) medical exam system of Canadian appointee doctors ,conducting the medical exam.
Once in Canada  as a dependent of a citizen ( her husband) , she could walk into their health system and get the ARV 's , counseling to get pregnant again. Her wishes to have a Son and that too free from HIV got fulfilled. The only sacrifice, she had to make now was to live away from her own daughter , the daughter with beautiful eyes was denied the pleasure of seeing parents on a daily basis.
Mrignaini is now in her teens , on ARV's, living with her maternal grandparents.
Sandeep's journey with HIV which started with a professional knock out punch on her knuckles ( while extracting the tooth). It went berserk in the beginning , courtesy Sadhu Babaji. The loving husband and modern science however could put it on the right track. She is a practicing  dentist once again and never forgets the Universal precautions. It is a different matter that she learnt her lessons hard way of self harming professional negligence , few lacs as black mailing money and one lakh of rupees to beat the system.
Some lives are different.
Rakesh Bharti

HIV Tales from my diary – Tale 18.

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HIV Tales from my diary – Tale 18.

( Tale 5 of of healers suffering themselves )
Balwinder was a FEMALE ( in my state names can be differentiated with suffix of Kaur or Singh only ).
She was FORTY.
She had two children , proving her FERTILITY.
Denying the zero mania she was little FAT too.
To complete the The 5-F rule referring to risk factors for the development of cholelithiasis, she even was FAIR.
The only unfair thing to happen to her was her widowhood to HIV and now this pain abdomen. The pain turned out to be sticking to the rule and gall stones were found. Surgery was on the cards but surgeons were reluctant. She started running helter skelter, did not loose even a gram of weight , but did loose her patience. Impatient patients often land into my territory ; don’t know why. She also came to me , not for treatment of HIV but seeking help in getting a surgeon to operate upon her. As per my habit, I started searching for right guy. Right, because , majority of surgeon won’t take up a patient , who has been wronged by the society ( rightly or wrongly). My search took a pause ,when a visiting surgeon to a big private hospital acceded to my request. Feeling victorious , I asked Balwinder to see the surgeon and assured that her work will be done. Hospital did admit her same day but the owner’s brother , a surgeon was perturbed. He called me instantly to lodge his protest. ” Bharti, it is not fair yaar. You are now referring surgical cases to other doctors rather than me “, he grudgingly asked for an explanation.
Reassuring and reconfirming my friendship to him, I said,” don’t you worry dear. If you are ready to operate on HIV patients , there is no dearth of needy and I can always compensate for this folly”. My words , I could sense through the phone , made him look here and there and when he could not find any escape route than he came straight to the point,” No, please don’t send seropositive patients, I don’t operate on them for various reasons including professional hazards”. The banging of phone was loud and clear.
It was just a coincidence that same night , I got a frantic call from a classmate , a surgeon from a nearby town ,Batala. He was operating upon an old man suffering from intestinal obstruction due to intussusception. He did not wait for test results because of the age of the person and the emergency. The report after the surgery , however, led to a situation, in which ,the surgeon himself landed in emergency.
He was desperate to know the post exposure Prophylaxis. The incident made him brush up his knowledge on HIV. Besides the books ,he even took the help of his brilliant son studying in first year of MBBS, at the premier most institute of medical sciences in the country, AIIMS, New Delhi.
Balwinder Kaur , in the meantime was once again out of the hospital ,as despite surgeons wish , the whole staff including the anesthesiologist refused to operate fearing contracting HIV through her surgery.
The ball was back in my court. But this time , the ball was served as an ace. Balwinder asked me ,” what if I get a forged HIV negative report by paying double the amount to the labs???!!!!!!”. The sarcasm ,showed me the mirror of our medical world. I could not return her ace and she did score a point. I needed a breather ,after this match point. I bought some time.
The time bought was sufficient to convince the Batala Surgeon ,classmate of mine ,to operate on a HIV patient , this time by design and not by default. He too ,by now was armed with refreshed knowledge about HIV.
The match was fixed again with same vigor , the only difference being , this time coals were to be carried to Newcastle. All these years people from Batala used to be referred to Amritsar ( being a better equipped city as far as health services were concerned) but this time an Amritsar resident was to be referred to Batala and that too for a left hand game for surgeons. Cholecystectomy, after all ,is never a big deal for surgeons ,since the time I graduated ,at least.
The operation day once again met the same fate. Batala doctors whole staff went on a ” leave” leaving the patient in lurch once again. I asked my friend ,” what next ”
He assured ,” don’t worry, they can’t remain on leave forever , I am certain we shall do this elective surgery soon”.
The “D” day finally arrived. Patient was given the premeditation, and shifted to the OT. Surgeon was busy scrubbing and came the nose of his wife , a Gynaecologist herself. She could not resist poking it ,smelling a fish ” HIV”.
I could , however , telephonically convince her that it is better to operate electively taking effective precautions rather than operating in ignorance , throwing precautions to wind and end up taking PEP. I also told her that someday ,someone has to put his foot first , on Moon, then why not her husband should be the one.
Surgery ultimately was done and Balwinder discharged in due course of time after an uneventful post op period.
I am no more in touch with the patient, but her tale touched many aspects of dealing with such victims ,in the earlier days of the epidemic called ” AIDS”.
How far things have changed after three and a half decades can be anyone’s guess. Specially for those are suffering and those who treat them. My assessment,”we have miles to go before we sleep, woods are dark and deep”.
Rakesh Bharti

HIV Tales from my diary – Tale19

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( Tale 6 of healers suffering themselves )
Healthcare services in developing countries, like India ,are strange. They are strange because every time you visit a healthcare provider , you find a stranger in him. There are no fixed SOP's, mostly. Qualified doctors in their pathy's usually do follow standard text books but those who become doctors by back doors ( read qualify in one type of pathy and practice another , grab a RMP or experience label , at times even degrees through various reservations - ranging from caste ,creed ,politics to money  ) have their characteristic ways of practicing medicine. Hit and trial is their best bet. Copying prescriptions of those ,who are big names in their fields ,is the route for hitting highways for such gentlemen. This also happens with qualified ones at times , specially when they have no time to refresh their knowledge. I am reminded of an ophthalmologist prescribing a certain tube with a suffix " pox" , to a Herpes Zoster ( a sequel of chicken pox of childhood ,in later years of life ) patient. When questioned by a well wisher , he quoted a prescription of a senior dermatologist and said ," I thought it must be for viral ( pox) infections being named Dermapox". The well wisher (me) informed him that it was a steroid and is rather contraindicated. Goes without saying ,how his figure was cut to apologetic levels. Period.
It is in this background that I have to tell a tale of an
RMP,  Dr.  So and so . He had a roaring practice in a border town of Amritsar. He was Jack of all trades and master of none , literally. His Jackalness , however proved to remove his outer coatings. Remember that Panchtantra story of " ranga siyar "- ( folk tale of strange blue colored king ) a jackal after falling in a blue colored tub of a washerman starts scaring Jungle animals because of his strange color. He started thinking himself to be the king of the jungle , a lion. One day , when rain falls , his color runs away and friends call, his reality becomes obvious. The real kings tear away the virtual king , the Jackal. This Jack of medical profession also lost his masque , once he got exposed to an HIV patient's blood while carelessly stitching his wounds after a road accident.  He ignored the exposure and resultant was expected. Once tested positive , he reached me with all relevant tests done. That was the time of two drugs regimen to treat HIV. He was put on Zidovudine and Lamivudine combination ,by me. The doctor was regular in his visits to me initially ,but for once. When I tried to contact him to remind his due medicines etc , he politely and firmly told me not to contact him on phone as his patients may come to know of his status.. He feared the impact of his HIV status on his professional status and personal medical practice. His orders were followed. The doctor patient ,however ,did not follow me. Suddenly ,one day after many years ,he was brought back to me , by his Medico sons ( who were by now in third and final years of MBBS). He was failing clinically, immunologically and virologically. This was obvious too. The whole world by then had learnt to treat HIV with three drugs but Doctor sahib was still on two drug regimen ,which started failing. Loads of counseling, switching to the right combination was my duty which I did once again. Before seeing him off, I shot a natural query" doctor sahib, how many patients of HIV are you treating now a days and with what medicines??".
Sheepishly he admitted ten to twelve and all on the same combination of two drugs ,which he was taking ,on my advise ,some years ago. I saw quackery raising its head instantly. I bowed my head to him for his confession and at the same time  felt like banging my head, to the nearest wall of medical system in this country. Once again ,the doctor so and so , is lost in the jungle of " lost in follow up" cases , but what I have found is that the healthcare system needs much more attention by those who are in authority and matter. Else the situation is like बाड़ ही खेत को खाने लगे ( boundaries start eroding the field ) or we can say what if those who are meant to save our lives ,themselves become life takers.
It's a sad ,sad and  sad tale indeed.
Rakesh Bharti

HIV Tales from my Diary -Tale 21

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HIV Tales from my diary -Tale21

Even Twenty years after the discovery of HIV, there was still no vaccine. A vaccine trial did fail in 2003. This was, an envelope vaccine ,aimed at stimulating neutralizing antibodies and it was unable to protect against infection ,in phase 3 trials. Despite this failure more than 20 HIV vaccines ,designed to stimulate T-cell responses ,were being developed. The world was worried “Will any of them work?”
The medical fraternity, in countries like ours ,however,were still struggling ,to get a strong foothold ,even ,in diagnostics. I am reminded of one ,Dev Raj from Pathankot. Dev Raj was in his mid fifties having a good Bussines, a happy family and was well settled in life. His health , however , was showing not so good signs. Loose motions , fever , some glands etc were bothersome symptoms specially after the local doctors were unable to manage his health. One of his distant relation working as a resident in Dayanand Medical College , asked him to travel down to Ludhiana, so as to ensure ,a proper diagnosis and treatment for his falling health. Extensive diagnostic evaluation ,led to a suspicion of a type of malignancy. The word ” Cancer” becomes scarier, if it descends to personal levels. Dev Raj was dejected , depressed and felt defeated. He was aware of side effects of cancer treatment in terms of both money and side effects. It was with this awareness ,that he came back home and there started a search for treatment by alternative medicines. Assurances by the practitioners of alternative medicines remained like wishes which were not horses. Back to allopathy, Dev Raj now went to a smart GP of his own town. The GP turned out be real smart and looked at his ailment from new and fresh angles. He was not overawed ,by the labeled diagnosis ,of and by a , tertiary care teaching hospital. His out of the box thinking ,took the actual disease out of box. He could detect HIV in him. But his smartness buck stopped there. Now a search for HIV specialist was on. It was ,at this point ,that the so called ” Cancer patient” ,landed in my clinic. This was 14 years ago. Today Dev Raj is once again leading a happy and healthy life. His story of “from rags of ill health “to “riches of good health ” is now history for me. Thanks to the smart GP and the antiretroviral drugs. I can not imagine any doctor can miss the diagnosis of HIV these days, after so much awareness about the disease. It’s been thirty four years ever since the medical world was introduced to the virus, after all.
I am , however a fool ,who keeps on living in a paradise of his own thoughts.
What happened with Hardeep Singh in 2017 ( fourteen years later then Dev Raj Saga) outsmarted my thinking and showed my ignorance about ignorance of others in medical field. Doctors still miss the diagnosis by yards.
Like Dev Raj , even Hardeep was suffering. He had fever which was refusing to bow down to best of doctors , medicines and a long list of investigations.
September 2016 to June 2017 was a running period for Hardeep’s family. Jammu today , Srinagar tomorrow, one day to Jalandhar , other to Chandigarh. They were running helter and skelter and were getting out of steam. The pause came ,through ,once again a smart GP ,taking the bull by its horns afresh. Lo , behold your breath, the culprit in Hardeep’s body was also HIV. A Dev Raj story replayed.
I am ashamed of the evaporation of the thirst for knowledge amongst our own folks.
Why do we still waste nine months ( in this much time a human being can his or her progeny ) in diagnosing a simple infection ,which is totally manageable ,these days.
I wish the buck stops here. No Dev Raj or Hardeep has to run from anywhere to anywhere. Let no doctor miss HIV , let history be not repetitive.
Rakesh Bharti

HIV Tales from my Diary

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HIV Tales from my diary -Tale 23
Suba Singh was in his thirties , a truck driver by profession . He used to go on for long journeys and be absent from home for long time. In November 2000, he was ,however,desperate to cut short his journey and return home early. His wife was all set to deliver him the gift of fatherhood and like any living ,he ,also ,was anxious to see his progeny. This was the time to have some spice added to his life , which so far , was like any other trucker- dull, boring and monotonous. It was as monotonous as that of a pulley which is used to take out water from the well seeing the role going up and down day in and day out. Like all other extremely mobile truckers ,who will ferry endless cargos of freight the length and breadth of the country, he will also , ship tea from Assam, computer parts from Bangalore and exotic flowers and vegetables from the far southern states of the subcontinent, have a very stressful life away from home. Distressing moments ,will come only ,when he ,like all others, will stop ,at dhabas ,on roadside,
to shower for the first time in weeks, eat daal n chapatis and sleep on knitted charpais there. With little else to do ,it was also common ,for him too , to buy sex. Sex would cost peanuts ,literally and was the cheapest entertainment on the highways. The local women and teenage girls used to cost as little as 30 rupees, At times , he will have fun with his helper boy as well.
Suba Singh's marathon was like an unending race yet he could romp home ,in time. His wife also waited till his arrival. She presented to him , the much awaited gift ,the very next day of his arrival. His joy knew no bounds. He was blessed with a daughter ,with all fingers and toes intact, a nose like him and big eyes like her mother , hale and hearty. He was a proud , happy father now. He was enjoying the break , carrying the little bundle of joy in his arms. He made merry and had feast for full one week, almost. The gay period was over soon and the time to start a new journey ,to Mumbai , arrived like a pre-monsoon shower without warning. He wanted more rest and to stay longer but his employer was getting restless. The employer wanted the shipment to be delivered before the onset of foggy winters. Reluctance was writ large on his face ,when he had to leave behind the joys of his life. The unhappiness of separation ,stretched a little too far ,as he fell sick on the very next day of his journey. He had loose motions and vomiting . The highway doctors suspected food poisoning and treated with antibiotics, ORS etc. Treatment helped him to carry on with the journey , although slightly behind the schedule, yet reach the destination. His health did not recover full and final. Upon touching his destination, he rushed to a hospital. The journey ,which landed him in the hospital ,looked like reaching the dead end. The doctors of the hospital ,declared him ,to be carrying HIV. Distressing moments of highways ,were turning into most stressful times of his life . The announcements of bad days were loud and harsh. They were harsh for many other reasons too. The treatment of his ailment was either not available or was insufficient world over and costly too. Those were initial years of managing HIV and were characterized by treatment failures and disappointments. Although, 1985 was the year when clinical trials began with direct acting dideoxynucleoside reverse transcriptase inhibitors (NRTIs), the first being azidothymidine (AZT) and by 1987, treatment with AZT, later called zidovudine (ZDV), was approved for use in patients with advanced HIV. In short succession, three other NRTIs were approved for use in HIV-1 infection: zalcitabine (ddC), didanosine (ddI) and stavudine (d4T). Each had its own particular toxicities and none is widely used today. To avoid the toxicity profiles, attempts were made to administer drugs sequentially and to alternate therapies. But the availability of those drugs at affordable prices in India was still a distant dream even in 2000, when Suba Singh needed them. At most Cipla was making dual combination of AZT and 3TC ( Zidovudine and Lamivudine) by the name Duovir, available those days. The cost was 4000 Rs. Per month. Dr. D. G. Saple ( a national authority on HIV management) prescribed him the same and he remained in Mumbai for three months or so. His resources started drying up and the employer also refused to help further. Friends started showing chameleon colors. Suba Singh's parents however were the rock in which he could rest his body. They were ready to sell off their ,whatever ,land for the son. Dr. Saple asked him to see me while in Amritsar as were running a NGO and Dr. Saple was aware of it. Suba Aingh returned home and reported to me. I could arrange the same Duovir to him through the company at half the price. The antiretroviral drugs started showing its effect and he regained his health to quote an extent. His faith in me and drugs increased. He could resume his journey again. His visits to me became scarce. After many months , one day he reported sick to me. He suddenly felt like running out of steam. His body used to tire with the ease he used to control the tyres of his truck. He was feeling like filling diesel in his body all the time. Although, he was regular in his HIV Medicnes and was feeling good all along, yet a fear creeped in his mind after this weakling episode. Routine tests revealed severe anaemia and some chest congestion. His blue nails and pale conjunctivae were pointing towards the drugs , he was taking. Zidovudine is known to cause bone marrow depression and this anaemia. The chest congestion was adding salt to the injury. Hospitalization was the natural consequence. HIV patients are best treated as a team. The involvement of chest physician thus was a must. The hospital admission worked wonders for his recovery till a fateful night. It was a cold foggy wintery night. Me and the chest physician were delighted to see his recovery. Hemoglobin levels were , however still away from the satisfaction level. We two decided to infuse another unit of blood to him. I proposed to do that the next day , but my co consultant looked like in a hurry. The resident also sort of connived with him , as the blood was already available. Both wanted to transfuse blood that night only and discharge the patient next morning. They wanted to save his hospitalization money. Their intents were beyond doubt. But , my doubt was directed towards a possible transfusion reaction. It is always difficult to manage reactions at odd hours in all middle level hospitals where resources are in a crunch at nights. Two is to one vote and I was defeated. Defeat ,however ,came in pairs. Even Suba lost his battle for life. He did not develop reaction but died of , may be due to overload . An early morning call from the hospital to the two consultants was a mere formality. We could only see his pale , motionless face with no pupillary reflexes numbing our own reflexes. We were looking for a place to hide our faces and face the widow of Suba Singh with one and a half year daughter in her lap.
Even after passing of so many years of that night , I get goose bumps, imagining my spineless action of that night. I wish , I could have vetoed the blood(y) action that night. It is said that extra ordinary people burn fingers while doing fire worship हवन करते हाथ जलाना ) and the doctors learn by mistakes. This mistake was unpardonable.Although , I was not the direct party in the act, yet ,can not wash my hands off ,the mistake too. Facing the widow after few months was the real task. As a face saving I am helping the widow and the orphan by way of free medicines. Rest of their needs ,are taken care off by the deceased' younger brother , who has taken them in his fold and accepted to grow old with them. Suba Singh's daughter , who is HIV positive too is now in plus two and appears determined to be a doctor one day. I long ,to live to see her ,find a cure for HIV. Till then , Suba's debt to me will remain unpaid.
Rakesh Bharti