Today I am going to tell you a story - the story of how anti T\tubercular treatment evolved with special reference to Mangalore. You may wonder how am I authorised to tell the story -in fact, my father (late Dr. VR Bhat) is the one who started the anti tubercular treatment in Mangalore. He started his practice at Chitra Clinic in 1947 and as he was specially trained ( at Madras) in handling tuberculosis, his patients mostly were suffering from tuberculosis / its / complications / sequellae /mimics like bronchiectasis.At that time tuberculosis was a dreaded killer. We (my sister and me) watched it from close quarters. Both of us saw dad work hard and save lives. Treatment was very little in the beginning when no specific anti TB drugs were available - the concept was to give good food and rest to the lungs and offer them good ventilation and fresh air. Sanatorium treatment fitted the bill very well. The worst patients were referred to Perandurai sanatorium at Madras. Artificial pneumothorax to intentionally collapse the lung harboring the lesion having caused life threatening haemoptysis was another modality of treatment which needed immense skill so that air embolism a dreaded complication had to be avoided.
Almost at that time Injectable Streptomycin became available. Each injection of 1 gram would cost more than a couple of sovereigns of gold! At Rs. 32 it was an expensive lifesaver if the patient lived long enough. The trouble was to get Streptomycin. Being expensive, no chemist would touch it. It had to be imported from London, bought at Madras by paying cash and then transported to Mangalore by train in a cold chain (in ice as was the custom then) and stored in a refrigerator. Refrigerators were hardly available in Mangalore. My dad felt that the facilities for these patients must be provided in one place and therefore, he provided Chest X Rays, facilities for blood counts, for sputum AFB testing all in his Chitra Clinic where he did all of these himself for reasons of accuracy and privacy. After procuring the Streptomycin, it would be stored in a fridge at the Sri Ramakrishna Ashram where one of the swamiji was his close friend.
Imagine the scenario which was common and which we (the family) witnessed almost every night. A patient would have haemoptysis and one of the relatives would rush to our house. Dad would ask his address, and ask him to go home. Then he would wake up our next door neighbour - his man Friday for such occasions. Both would go in my dad's Morris minor car and reach the side of the road outside the window of the roomin the Sri Ramakrishna Ashram where the swamiji slept. They wold throw a stone at the window pane with just enough impact to wake up the swamiji without breaking the glass pane. The swamiji would come out with 1 injection of Streptomycin. Armed with that and other paraphernalia ( a BP apparatus, a stethoscope, sterilised glass syringe, cotton, spirit etc in a handsome Doctor's bag ) they would reach the patient's house, examine him reassure him, start Inj Streptomycin and other available treatment. Next day he would be evaluated at the clinic for the proper diagnosis. The best part was the charges levied to the patient - Streptomycin would be passed on at no extra cost. Many patients being poor failed to pay even that partially or completely - dad just forgot and forgave them and moved ahead. The consultation, chest x ray, blood and sputum tests would cost the patient Rs. 30 (a little more than the actual cost price)!Naturally, we had to get a merit seat to be doctors. But with all that I am grateful to the tuberculosis patients - after all, they are responsible for my food, shelter, clothing and education.
The newer medicines came later. They changed the entire outcome and the outlook of the disease. The victory over Tuberculosis which at one time seemed to be imminent now looks distant and even impossible.We are already feeling the "power" of drug resistance. With the emergnce of MDR (Multi Drug Resistane) and XDR (Extended Drug Resistance) and TDR(Total Drug Resistance) looming large, we will be probably returning to the bygone era of "no drugs" worth mentioning for the dreaded killer disease! Tuberculosis!
Almost at that time Injectable Streptomycin became available. Each injection of 1 gram would cost more than a couple of sovereigns of gold! At Rs. 32 it was an expensive lifesaver if the patient lived long enough. The trouble was to get Streptomycin. Being expensive, no chemist would touch it. It had to be imported from London, bought at Madras by paying cash and then transported to Mangalore by train in a cold chain (in ice as was the custom then) and stored in a refrigerator. Refrigerators were hardly available in Mangalore. My dad felt that the facilities for these patients must be provided in one place and therefore, he provided Chest X Rays, facilities for blood counts, for sputum AFB testing all in his Chitra Clinic where he did all of these himself for reasons of accuracy and privacy. After procuring the Streptomycin, it would be stored in a fridge at the Sri Ramakrishna Ashram where one of the swamiji was his close friend.
Imagine the scenario which was common and which we (the family) witnessed almost every night. A patient would have haemoptysis and one of the relatives would rush to our house. Dad would ask his address, and ask him to go home. Then he would wake up our next door neighbour - his man Friday for such occasions. Both would go in my dad's Morris minor car and reach the side of the road outside the window of the roomin the Sri Ramakrishna Ashram where the swamiji slept. They wold throw a stone at the window pane with just enough impact to wake up the swamiji without breaking the glass pane. The swamiji would come out with 1 injection of Streptomycin. Armed with that and other paraphernalia ( a BP apparatus, a stethoscope, sterilised glass syringe, cotton, spirit etc in a handsome Doctor's bag ) they would reach the patient's house, examine him reassure him, start Inj Streptomycin and other available treatment. Next day he would be evaluated at the clinic for the proper diagnosis. The best part was the charges levied to the patient - Streptomycin would be passed on at no extra cost. Many patients being poor failed to pay even that partially or completely - dad just forgot and forgave them and moved ahead. The consultation, chest x ray, blood and sputum tests would cost the patient Rs. 30 (a little more than the actual cost price)!Naturally, we had to get a merit seat to be doctors. But with all that I am grateful to the tuberculosis patients - after all, they are responsible for my food, shelter, clothing and education.
The newer medicines came later. They changed the entire outcome and the outlook of the disease. The victory over Tuberculosis which at one time seemed to be imminent now looks distant and even impossible.We are already feeling the "power" of drug resistance. With the emergnce of MDR (Multi Drug Resistane) and XDR (Extended Drug Resistance) and TDR(Total Drug Resistance) looming large, we will be probably returning to the bygone era of "no drugs" worth mentioning for the dreaded killer disease! Tuberculosis!
Dr.Raghavendra ,is truly doing a very humane Service ,much like his Saintly Father. Its Only when a Son narrates the ringside story ,can we fathom the depth of the Doctors sincere & Life Saving Efforts. Unlike today,where the doctors are forced to be commercial & expensive. BUT its Inbuilt in Dr.raghavendra Bhat. Its in his DNA. Thank You Respected Doctor.
ReplyDeleteInspiring Story. Thank you for sharing this anecdote from a by gone era. We are proud of your father, like we are of you.
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