Registered with the Registrar of Newspapers for India under R.N.I 53640/91
Vol. XXVII No. 1, April 16-30, 2017
Although his stay in Australia was a brief two years, Dr. Mani learnt a good deal in his field of specialisation while thoroughly enjoyed working in Sydney Hospital. Known popularly as the Rum Hospital (the local governor had given the builder the monopoly for alcohol imports – hence the name). Sydney Hospital had been built in 1788 and was almost as run down as Madras’s Stanley. But it did have a very good renal unit. As Dr. Mani observes, “The clinical load in any Western hospital is far less than that in India.” So he could at last savour the pleasures of a 9 am to 6 pm job after getting over the initial confusions resulting from the Australian accent.
But the hospital tried to persuade him to stay on, with promise of excellent pay and facilities. However, once Dr. Mani felt confident of having learnt enough to set up his own renal unit back home, and decided to leave, explaining his decision. “…India had given me a medical education and I felt I owed it to India to give her some service in return. Also, there was no dearth of trained nephrologists in Australia, and there were very few such in India, so there was a greater need for me at home.”
Back in Madras in 1970, Dr. Mani found that he was not being posted in the newly-started nephrology unit in the GH but would be sent to Stanley as Assistant to Physician. He reported there as assistant to Dr. K. Natarajan, who, although not a nephrologist himself, helped immensely in setting up a renal unit in Stanley. The facilities were obviously basic and the unit did not get an artificial kidney for dialysis. But Dr. Mani and his hard working team managed to work around that, by resorting to peritoneal dialysis.
Dr. Mani observes, “One often hears complaints by doctors about lack of facilities in India… This is an obvious fact but many (doctors) have demonstrated that good work can be done in the worst of conditions, if one has the will. I know of nephrologists who do not dialyse because they do not have a sterile dialysis room with suitably gowned and masked nurses, for fear of infection. We did dialysis in the crowded open wards of the Stanley Hospital, with no higher infection rate than that occurs in the most sophisticated centres.”
Despite his good work, Dr. Mani did not get governmental recognition as a nephrologist and continued to remain an Assistant. He got plenty of advice on how to get his promotion and much of it was not to his liking. A friend advised him to ingratiate his way into the home of one of his politician patients, become his family doctor and once that happened, it would be easy to get his own nephrology unit with the help of the politician! “How we had fallen!” comments Dr. Mani.” What a far cry from the days of Dr. Sanjivi, who refused to see me, the Health Secretary’s son, because he had to go to his GH out-patient clinic.” Frustrated by the increasing amount of bureaucratic hurdles in his way, he decided to accept the offer of being chief of the renal unit in Jaslok Hospital in Bombay in 1973.
Jaslok was India’s first multi-disciplinary hospital, with enough facilities so that no patient had to go abroad for treatment. It had the best medical talent in India. The hospital was inaugurated in 1973 and Dr. Mani joined the hospital some months before it formally opened and had plenty of time to settle in. As a result the renal unit was the first to function in the hospital.
Dr. Mani was quick to observe that the best and worst of Indian medicine could be found in Bombay. ”With an admission system based on merit, and with a larger exchequer… the Government and Corporation ran medical colleges of a higher standard than others in the country. There is money in Bombay and large, private hospitals thrived and had funds to buy the best of equipment. Bombay’s doctors always looked to the West… and the public were willing to espouse the new, whereas conservative Madras tended to remain a step behind. So much for the good…. On the other hand, there is only one yardstick by which people are measured in Bombay, and that is money.” This meant that even doctors were not above adopting practices that were strictly not ethical but good for business, like getting commissions on referrals. The trend of pampering wealthy patients while ignoring the poor had also started.
Among all the people Dr. Mani treated in Jaslok, and many of them were VIPs, Dr. Mani chooses to remember Jayaprakash Narayan, the Sarvodaya leader. JP’s kidney disease and its treatment proved to be a challenge for Dr. Mani, given the hectic schedule of the leader.
JP had been a diabetic for twenty years. He was constantly on the move, ate a variety of foods at odd hours and never had one constant medical attendant, because he never stayed long enough at any one place. He also had high blood pressure, his heart was beginning to buckle under the strain, but no one suspected kidney disease when he was incarcerated in 1975. He came out five months later, almost dead from kidney failure. Rumours spiralled, of course, that he had been poisoned during his confinement, or that his kidneys had been deliberately damaged. “I must state categorically that JP had kidney failure due to diabetic nephropathy and not due to negligence or foul play. There was no medical means by which his kidneys could have been saved between June and November 1975, for the disease process must have started long before 1975,” Dr. Mani states.
Why had JP’s kidney disease not been detected earlier? “People with kidney disease are often not aware of its presence till it has advanced too far for cure,” Dr. Mani says. This is apparently what happened to JP too. “When I first saw JP, he was a sick man indeed. He could not keep awake for more than a moment or two and would lapse into stupor as he was talking. He needed dialysis before he could be restored to normal mental function”, recalls Dr. Mani. It took a month of dialysis before he could be discharged from hospital but he needed to be on dialysis at home too. He could have had a kidney transplant except that his blood-related donors were all too old or frail. Given JP’s poor health, the doctor decided it was not worth exposing him to the risk of this major operation when only the second-best option of a kidney from an unrelated donor was available.
Too much the cost of an artificial kidney so that the JP could be dialysed at home, a get-well post card was printed and sold at a rupee a piece to the public, to be posted to JP. Lakhs of people bought the postcards and mailed them. It was easy to buy the artificial kidney from the money thus collected.
JP’s secretary, Abraham, and Janki Pandey, a Sarvodaya worker (whom JP later adopted) dialysed him at home after being trained by Dr. Mani.
How much information should the doctor treating a VIP patient divulge to the outside world? No more than what he would release about any of his other patients – that is, none at all. “The case of a public figure is obviously different. The public has a right to know whether their Prime Minister is well enough to discharge his duties, or they may just want to know about an adored figure like JP… I left it to Jaslok’s medical director, Dr. Shantilal Mehta… to issue a daily bulletin,” recalls Dr. Mani. He himself never spoke about his patient to anyone.
As for speaking about him in this book, Dr. Mani writes that this was on JP’s express directions. “He had asked me to make public the details of his illness, to settle the controversy which arose about the manner of its causation.” What a difference from the mystery surrounding the illnesses and deaths of present-day politicians!
In 1977, Mrs. Gandhi -announced General Elections, thereby energising a somewhat depressed JP. He wrote to Dr. Mani asking him whether he could travel to campaign for the Janata Party. Would the doctor permit this?
“Of course I would permit it,” writes Dr. Mani. “In fact I encouraged him to put everything into it. Dialysis is a facility to enable a man to live. Life is of no value if one does not do what one wants to do… we would dialyse him in Patna or Bombay and he could be dialysed in Calcutta and he could travel… if he restricted his absence from these dialysis centres to not more than three days at a stretch, he would be able to work. JP embarked on an Odyssey unparalleled in the history of haemodialysis. He had a dialysis, then flew hundreds of miles to address mammoth meetings in Delhi, Ahmedabad, Hyderabad, Bombay. He moved constantly, this 74 year old invalid, snatching his life-giving dialysis on the run. Most people his age would have called it a day.”
The Janata Party won that election by a landslide. As for JP, he was readmitted to Jaslok and due to the strenuous efforts of doctors there managed to survive for another two years.
In 1984, following his mother’s recent death, and other family commitments, Dr. Mani returned to Madras (he never ever calls it Chennai!) and joined Apollo Hospitals at the request of Dr. Pratap Reddy. He continues to work there. Known to be a stickler for discipline and punctuality, the good doctor almost sighs as he says, “Patients are no more punctual at Apollo… so a few letters get done in the time I have to wait.”
“The patients pour in, the work goes on. We win many battles and lose some. We save most of our patients but we are losing the battle against disease…. I would love to play a role in preventing disease, in keeping normal people healthy rather than struggling to make ill people well.”