Life of Doctors – Patients, Medicine and Beyond…

Dr Suresh Venkita, our Group Medical Director, a senior cardiologist and an avid writer, has yet again shared this lovely story from his desk.

No land’s man

“I’m not a refugee. I am an immigrant.”

I proudly told the immigration desk at a gleaming airport of a relatively young country with vast lands that could be home to the homeless of the world, if only its government permitted. But they had stridently announced their immigration policy over and over again, that they have “zero tolerance” for refugees, and only welcome those who negotiate and succeed on the immigration route.

I felt confident; I was dressed reasonably well, in a decent suit, shirt and tie, and polished shoes, and even sporting a modest hat. I had a valid passport and a neat folder with all the right documents.

But I did not hear the slap of the stamp on my passport. Instead, I heard a firm voice and felt strong hands that shook me by the shoulder as I woke up on this cold trolley. “No. You are not. You are a detainee on the Island, and you are now in the hospital. How are you? I gave you anesthesia so that I can stitch up the cut you made at your wrist with a piece of broken glass. You almost died from the bleeding.”

I wish I had died. That was the intention, but like at all else in my life in recent times, I had failed at that too.

I had not begun my life by failing. In my village, I had earned the love and affection of my family by being respectful to elders and by being helpful in many small ways to my very large family. I had enthusiastically run errands, carried out physical tasks, attended the house of God, learned the scriptures, participated in rituals, attended school, and scored well at examinations. Though nervous about leaving the familiar and comforting environment of my home and village, I was looking forward to going to university in the faraway city and study engineering and build roads, schools, hospitals, and sporting arenas for my country.

Much later, I came across an American expression that graphically described what later happened to my life, which was- “the way the cookie crumbles.”

Everything that I knew loved and cherished crashed and crumpled around me for reasons I never fully understood. Our government was seated somewhere faraway and its affairs did not usually affect our daily lives deep inside the country. But I sensed that our leader was failing in governing the country and that was causing the destruction of our way of life. I understood that my plight did not matter at all to those who ran my country or to others who had a stake in my country. We ordinary people had become just pawns in their power games. Guns were firing, bombs were falling and rockets were exploding around the country. Our houses and roads were getting damaged, and our water, power, and crops were failing. I, along with others, had lost our families and community. I felt abandoned by my own country. There was not even a flicker of hope that normality, as I knew, would ever return to my life.

That was when I decided to leave my shores and sail to distant lands. I learned later that I had thus become one of a new generation of “boat people,” who were welcomed by only one other kind of people- the human traffickers who were hovering like eagles in the sky, hyenas on the roads and sharks in the sea, hungry to devour easy preys like me.

A few surviving members of my family and community scrounged and found some resources to fund my travel, most of which was consumed by the ‘‘agents’’ who arranged our travel. Many of us on the boats were not seafarers. But the perils of a long voyage by sea turned out to be nothing compared to the trials and tribulations that lay in wait for us.

They began when we were intercepted on the seas by the coast guard as we were nearing the shores of the country of our destination. Our incarceration and interrogation began almost immediately, and we learned that we are “detainees” to be eventually classified into refugees and non-refugees. A tortuous process of interview and investigation began to determine whether we were refugees or non-refugees. Our fate depended on which side of the divider we fell.

Thus we, belonging to ten nationalities, entered a tunnel in which we lived for almost seven years, fervently hoping to see the light at the end of it. Some of us would die waiting in the darkness and dampness of the tunnel, a few fortunate ones would emerge into the bright light, but most of us would never reach our desired destination.

Life on the Island was one of suspended animation. A single thought dominated all of our waking hours and haunted our dreams- which was ‘’How to reach the country of destination?” That preoccupation made us irritable and irascible. We admit that we must have been very trying for the citizens of the Island and most annoying for the administrators of the detention centers. We were attacked once by the citizens of the Island who felt that we were being pampered with accommodation and food when they were poor and neglected. There was a riot, and one of us got killed.

Most of all, the health care system must have found us their most frustrating and ungrateful body of “patients”! None of us were patients. We were tormented souls constantly preoccupied with our dream of a liberated and fulfilling life in the country of our destination. Some of us had families with us, and some had families in the country of destination. But that country was determined to deny us hope and deprive us of an opportunity to find life again.

Some of us would use our meager financial resources to engage lawyers and plead to international humanitarian organizations like the UN High Commissioner for Refugees. But all those efforts would be predictably stymied by the mighty administrative and legal machinery of our destination country.

Invariably the most faceless people rise to espouse the cause of the hapless. Over the years of our incarceration on the Island, many ordinary citizens and politicians of the country of our destination pleaded our cause.

But the courts were moved only when our health issues became precarious. The destination country felt obliged to ensure that we would get their standards in health care, which the Island and their referral sources would find impossible to provide.

That spawned a pipe dream in us to exploit that provision to escape the confines of the claustrophobic Island. That led us to sharpen the instrument of “self-harm.” Every possible object served that purpose- we would swallow blades, scissors, nail cutters, paper cutters, tools, in fact, any sharp object that could be accessed, including broken glass. Cutting arteries at the wrist was common, and some attempted to hang themselves with just a shoelace.

We would often break up our lodgings when we could and set them on fire, given the opportunity.

We would also invite complicated infections. As our immunity was low due to the constant and high level of stress, even surface wounds would get infected and often lead to sepsis and its life-threatening complications. The Island’s health care system, and its in-country referral hospitals, would try their best to manage these emergencies and the administration would arrange prolonged and expensive telephonic or video consultations with specialists abroad, but aeromedical evacuation to the destination country was rarely approved. Even if evacuated, we would be returned to the Island as soon as we recovered. Occasionally, one of us would succumb to the infection; the press would be shrill and hysterical, the lawyers would be strident, courts would pass strictures, but we would still be on the Island.

The destination country would spare no expense in “treating” us on the Island or at nearby referral hospitals. We would be flown by chartered aircraft for incountry referral for both outpatient consultations and inpatient treatment. We would be housed in hotels for protracted consultations with an assortment of specialists and admitted for a variety of imaginary or real ailments, often a bit of both.

Physical symptoms would receive elaborate over-diagnosis and over-treatment at the referral hospitals. All of us were in our thirties and were unlikely to have any chronic disease. Any pain anywhere would immediately receive a CT or MRI scan and, more often, both. Any digestive symptom would receive an endoscopy or colonoscopy depending on which end of the alimentary tract was suspected to be the source of discomfort. A sneeze was enough to initiate a CT-MRI of the paranasal sinuses and invite a nasal endoscopy or repair of a nasal septum removal of tonsils. A headache was enough to be sent for CT and MRI. Incidental findings would lead to laparoscopic surgeries. We would undergo extensive “laboratory work-ups.”. The destination country spent taxpayers’ money lavishly, and contractors made lots of money.

By then, most of us had learned English by association. But we would frustrate and infuriate the medical and supporting system by demanding a translator or interpreter each time and pretend not to understand the technicality of most medical discussions.

It was clear to us that we were a burden on the doctors, which they were kind enough not to show. We were not their work; we were an interruption in their work!

Mental health was the ‘Holy Cow !” An army of mental health professionals hovered about us through the waking hours, and security guards watched over us while we were asleep. Two psychiatrists were on the Island, and the army of mental health nurses assiduously tried to evaluate, assess and improve our mental health. Most of us were on some or other psychoactive drugs. But they were given to us only dose by dose to avoid self-overdosing.

As the years dragged on, it did dawn upon us that we would never reach our desired destination. A distant country accepted some of us and they flew away to distant dreams. We wished them well.

Some of us had the option to stay back on the island and its parent country. But we did not leave our home countries to settle for a very slowly developing country that had come out of oblivion only a few decades back. We were adamant and steadfast in refusing that offer.

As the political compulsion to close the facilities became compelling, it was clear that both the non-refugees and a good number of refugees not accepted by countries other than our destination country would have to return to their home countries under escort.

I was among the chosen to be “repatriated.”

I was determined to leave this chronicle behind to ensure its publication. My adult life went unwitnessed by anyone I loved. I did not wish to vanish from the face of the earth without a trace.

I was going back to a certain death. I would be met at the airport in stony silence, taken in an unmarked van with dark windows and taken to interrogation and torture.

I would be blindfolded and asked to kneel. I would be allowed to pray and request the almighty to forgive me. A shot would execute me through the front or side of my head (a shot executes foreign hostages through the back of their head). They would dispose of my body in whatever manner expedient.

To have been born human was not an ascent along the evolutionary ladder for me. A mongrel on the street of a truly democratic country would have had a better life and a less ignominious death than me.

My adult life was to end soon, as a futile exercise “up the down staircase.”

I hope my soul will rest in peace.