The Saint

The man joined me around noon. As I walked on my pilgrimage on the mountain road.

He was old. Leaning on a stick. A rug warming his feeble body. He did not speak. He walked by me. Slowly.

Men and women from the mountain passed by. Young and old. They bowed. To the man in obeisance. The old man walked on.

The old and the young, they said ‘Glory to you, O Saint.’ And in soft steps they passed. Hands folded.

He was in tatters. Old and rugged. A Saint? I wondered.

‘They call you a Saint? Are you a Saint?’ As if afraid that he may spend his remaining strength he looked up and shook his head. From one side to the other. ‘No. No’. Feebly he said.

Darkness approaching, the mountains faded. A mist black and dark descended all around. The valley below began to light up. And round the corner a small light flickered.

A hut. By the mountain side. A little below the road.

It was not wise to walk in this dark. I stopped. So did the old man.

He beckoned. ‘Come. This my dwelling. Spend the night.’ He softly said.

We walked down the path. He with my support. A soft stream flowed. By his hut. There was no door. No windows. One opening. An entrance. For one man to enter.

I asked ‘Are you not afraid of wild animals in the night?’ He smiled. ‘I welcome them.’

There was no food in his house. I shared the dry food from my luggage. He ate little. And we slept. Beneath the sky. Stars twinkling. Dark mountains. Yet a light that I cannot describe floated in the darkness.

I lay. Exhausted. The cool breeze. The sound of water flowing softly. Sleep descended.

When I awoke it was still dark. I suddenly felt heavenly. There was a music in air. That reverberated in the mountain.

A girl was singing a tune. So magical. It seemed the mountains stood there in silence. The stream stopped to listen. And the sun waited to rise from its sleep.

I sat up. Consciously silent. And looked around in darkness with the magical light floating.

There by the stream sat the old man. Eyes shut. Singing. And it seemed as if that magical light emanated from him. Not disturbing the darkness. Yet I could see the birds perched on the trees. Listening quietly. I could see his face magically serene. Eyes shut.

Saint of the Mountains.

For music is the Religion of the Mountains. And silence its audience.

Onward Ho!!

For 15 years Ram Kumar had worked in public sector. In delivering vaccines through public health programs. When in 2008, he received a new offer. To develop medicines for a neglected disease. Ram was tempted. New job. A compensation hike. A prestigious job title. A stable company. Why not? Ram’s wife said.

Ram thought. Ram was nervous. After all he was on a smooth sail. Doing good work. In good times. With good rewards. Yet. The new job was tempting.

Ram took a few days of leave. And travelled to Binsar. In the quiet of the forest, in the majesty of the mountains he would decide.

Returning to Delhi after seven days of leave, Ram submitted his resignation and accepted the new offer. A new journey would begin in eight weeks.

Ram had a mentor. A supervisor from his first job. He was not much literate in letters but had seen the world. Ram trusted him. Immensely.

One Saturday evening Ram called him. Mr. Manager. And after the usual icebreakers, Ram said “I need some guidance from you, Sir.”

Thereafter, Ram explained his problem. New job. New work. New location. All new. He has never worked in product development. Never in medicines that cure. His focus had been on prevention by vaccines and the geography was new.

“Lovely, exiting times ahead.” Said Mr. Manager. Over the next 30 minutes, Ram heard and Mr.  Manager told the story of his life. From one challenge to another. From one location to another. From familiarity to unfamiliarity. “And I was never scared for I knew a mantra. That I will teach you today. Learn this Mantra. Practice its essence. And you will feel more secure.

The 5 P mantra.

In every new job, you will come across personalities. Your boss. Your peers. Those who you will manage. And they will not be as you like them to be always. You can not ignore them. You have to live with them. Try to know them. The personalities. Broadly. Some will love a conversation over coffee in the cafeteria. Some will expect a pen-notebook conversation. Some will be mindful of punctuality. Some will believe it is the output that matters- when it is done is not the most important. Some will like a hint of humor in a conversation. Some will consider humor in a serious conversation as a sacrilege. Know these personalities and for the first few months as much as possible try to accommodate their traits. They must know your personality too.

You are coming to a new field, you said. But you know more than me that this space had not remained vacant for so long. There are partners who have been in this space for long. Do not ignore them. Listen to them. Tell them you appreciate all that has been done. And you come humbly to join hands. To lend a hand to a vehicle they are pushing uphill. You can be a partner in many ways. You can complement. Once you learn more, you can challenge. You can even disrupt. But be transparent and keep engaged with them so that they know transparently what your thoughts are. Your strength can never move the vehicle alone. Together you can.

Be patient. Very important. You will have just entered. And you would love to make a stamp. And hear me and make no mistake. Any attempt you try to make of a hasty impression will have a huge risk of portraying negatively. Wait. Be patient. Listen. Learn. Look. And then when a time comes prove your worth.  Always know, nothing happens overnight. It takes time. It will happen eventually. Be patient. Win the war. Battles will be won and lost. Do not worry as long as you are honest and transparent.

Be careful of the promises you make to the organization and your partners. You will be tempted to make promises. Promises that you will have to keep. It is always so tempting. But if you make promises too early before you have gained good knowledge the promises may become your liability. Therefore, do not promise early. In fact, if possible, avoid promising anything. Making promises makes you feel super human. Try to avoid that image.

Lastly, do not be naïve. You are not entering heaven with your new job. There will be politics in work and office. You will also be affected. No one on earth can remain immune to politics. I do not know what good politics is. So, I can only tell you politics is bad. But unavoidable. I cannot tell you how you should address office politics and work politics. Just do not be naïve that it does not exist. Address the politics in your own way. Because of all the Ps, you may end up finding that what mattered at the end of the day was this very P. How well you addressed it will determine how content you are with your job.

So, go Ram. With the 5 Ps to your new job.

  1. Know the Personalities.
  2. Respect your Partners.
  3. Be Patient.
  4. Do not make Promises early or ever.
  5. Address the Politics.

There is a sixth P that you may require. But leave it to your Ma, me and your well wishers to address that. We will Pray for your success.

Ram Kumar joined the new company after eight weeks. And continued for five years with two Promotions in his stint with the company.

A Curious 20-point Anecdote in Ramapada’s Professional Career

Ramapada had been promoted recently. Hard work. A few accomplishments. Good feedback from fellow colleagues. Promotion.

Ramapada had accepted his new role with humility. And a promise to continue the hard work.

Ramapada’s old boss was relocating. A new boss Alan had joined.

This was Alan’s second week in office. Today was Monday.  

The Monday. Ramapada had been waiting for long. Today an hour had been scheduled for him to brief Alan of his team’s work. What had the past year looked like? What was the team’s plan for the next year? Budget? And seek guidance from Alan on his vision for the organization.

Ramapada knocked. 9 AM sharp. He did want to create an impression. First one to one after all. With the new Country Director.

Ramapada knew everything of his project. To the minutest detail. He had had a final glance at the budget before coming. So that he did not get the dollars wrong.

Ramapada entered. Alan greeted him with a wide grin. The curtains had been changed. Colorful. There was a bright picture of Alan and a lady on the executive table. His daughter perhaps. Ramapada thought.

Alan asked for coffee.

Alan looked at Ramapada for a neat 30 seconds. A smile on his face. Ramapada looked back. Smile on his face.

Ramapada said “Please call me Rama Sir.” Alan said “Good, Call me Alan.”

“Is this the usual weather in Delhi in June? I was expecting it to be hotter.” Alan asked putting his pen in the shirt pocket. Ramapada began speaking of Delhi’s weather.

From there Alan went on to converse cuisine. The blend of Mughlai cuisine and the remnants of British influence on India’s cuisine. Ramapada was good at this. He conversed. Delhi’s cuisine.

From these the conversation moved on to Cricket. Alan was from Wales. Now settled in USA. He talked of his trips to Lords. Of games that Allan Knott and Keith Richards played.

Ramapada looked at the wall clock. It was ten minutes to the hour. He would have to discuss the project. He asked “Sir, I wanted to brief you about the Project and seek your guidance.” Alan smiled. And asked “I am so much looking forward to spend Diwali in Delhi this year with my daughter Liz. There on the table. Both of us. Clicked before I flew to Delhi. So, what should I tell her about Diwali?” Ramapada spoke. New dress. Food. Light. Diwali.

It was now two minutes to the hour. Ramapada politely asked “Sir, shall I fix some other time for our conversation?”

“What conversation, Rama?” “Our Project. Your guidance.” Rama replied,

With a smile Alan asked “How often did you seek guidance from my predecessor?” “Once a month Sir” Rama replied,

“So, tell me Ramapada what did she guide you in the month of March? Three months back.” Alan asked. “Ahhhh, I do not remember Sir” Ramapada replied. “Ok, go bring your notebook. And tell me from your notes.” Alan said. “I did not take notes Sir” Ramapada replied. Alan stared at Ramapada for another thirty seconds. And said “Remember one thing Rama. Neither me nor are you a genius. We have our limitations in our memories. Therefore, we take notes from official conversations. See here. I had a notebook in front of me. And a pen. When you entered the room, I saw you had neither a pen nor a notebook. Therefore, I assumed you had come for a casual chit-chat. Which I am always happy to do. And we did. Lovely conversation. But if you are seeking someone’s guidance on a professional matter and not taking notes, it seems you actually are not interested in the guidance. It is a mere formality that you have come to execute. It is an insult to the person who you seek guidance from. Set up an hour tomorrow morning for our conversation. I will come with a notebook and pen. You too come with a notebook and pen. We will discuss the Project. And, by the way. Do not think we wasted the hour today. I am now much enriched in my knowledge of Delhi. Have a good day.”

Ramapada and Alan had an excellent professional relationship thereafter. Three years later when Alan left Delhi for a different role in a different organization, he promoted Ramapada to a Senior VP role in the organization. And Ramapada never ever forgot to carry a notebook and pen to a meeting thereafter.

The L in Leadership

My good friend P was retiring. After an illustrious career in WHO and many other organizations he chose his retirement day in Delhi.

I would take over the Program Director role from him from tomorrow.

After a daylong meeting, we sat at the hotel bar. Exhausted from making, hearing and moderating presentations through the day. We chatted over whiskey and salted nuts.

How does it feel my friend, I asked. Fine, P said. And then after a pause added, I leave behind the next generation to carry on the work that someone had passed on to me. You are now in-charge of the work. Therefore, I am happy to retire.

I felt very humbled. And a little awed. P has been a legendary leader in his field. He is widely recognized and respected. I was only some ten years in the field of public health. And a novice when all these responsibilities are now coming over to me.

I asked P, what is your guidance to me P on how to be good. Good what? P asked. A leader, I replied. P smiled and said, just be yourself Raj Shankar. All shall be good.

I insisted and there was perhaps an element of genuine appeal in me. P ordered for more whiskey and spoke. Raj Shankar, I do not know what a good leader needs to do. But I will tell you what I have done when I have led teams. For the past thirty years. You can try those. Whether they are good or not I can not say.

Below is what P said that evening in a bar in Delhi. Over whiskey. On what he did as a leader.

In your leadership, remember 4 Ls. I have practiced at every step.

  1. Learn. A leader who does not learn from the team fails to succeed. To learn, you must listen. A leader must learn more than each member of the team because only when a leader learns, she or he can demonstrate the learning to the team. Knowledge is very dynamic and always on the move. If you stop learning, you become outdated. Therefore, as a leader never stop learning.
  • Leverage. Your team members will have strengths. They will have weaknesses. Please know those strengths and weaknesses thoroughly. If you do not know your team with strengths and weaknesses of each member, forget being a leader. Once you know their strengths and weaknesses leverage your knowledge to get the maximum from your team. The trick that I have applied was to find how I could convert some of the weaknesses to strengths. Strength and weaknesses are actually virtual terms. And contextual. Bottomline, leverage the strengths and weaknesses of your team members well.
  • Lead. If you are a leader, the first expectation that the team would have of you is to lead. You will have read of the various types of leaderships: authoritative to participatory to various neo-styles. Read them. Follow or develop your own style of leadership. But if you are a leader and that has been made known to the team, demonstrate your leadership. One key ask of a leader is decision making. Follow your style of decision making. The how part. You can always learn from the team and work on your style but for heaven’s sake never step back when your team is asking you to make a decision. You may think many will not like your decision. But it is a myth. If you make a decision then the team irrespective of whether they like it or not will accept you as a leader. Do not scratch your head on being a good or bad leader. The first step is to be a leader.

 Now I will come to the last L. And this I believe is as important as the previous three Ls.

Ok, Raj Shankar tell me what is the latest buzz word in a public health program. The word which everyone is talking about. Sustainability.

Similarly, in leadership there is an important word that I have always remembered. Legacy.

  • Legacy. Please seek to identify new leaders. As much as knowledge is dynamic, the art of leadership is dynamic too. Groom, nurture, accelerate those who you identify so that after years when you plan to retire and go back to your private life, you can drink whiskey happily in a dim lit bar knowing that you have exciting family times ahead and that the work that you inherited from some leader is smoothly passed on to someone you trust. Most importantly do not leave a void when you leave. Do not leave till that leader is available who you can pass the baton on to.

And then, P ordered dinner.

The Minamata Disaster

The background: A village’s prosperity

On the west coast of Kyushu in Japan was a small village called Minamata. By the coast of Shiranui sea. Established in 1889. With fishermen huts. The fishing village prospered through hard work of its dwellers. The village grew to a town in 1912. And in due time the town further prospered. Hard-working men and women. 1949. Minamata became a city.

And then one day disaster struck.

The Report: A unique disease

This is the story of that disaster. This is also the story of marvel of public health. This is the story of resilience- of a city bouncing back to life from a disaster. This is the story of a movie of the same name.

In mid-1950s a funny incident happened in Minamata. The cats of the city went crazy. One by one. To begin with. Then in hordes. Crazy cats. They simply jumped into the sea. Men and women wondered. Why were cats on a suicide spree!!

Before long however, a strange disease began to surface among city folks. People started reporting in hospitals with numbness and loss of sensation. In lips. In limbs. Some presented with more severe conditions. Symptoms that doctors diagnosed as their brains being affected. A disease of the nervous system.

The investigation: Who; What; How

As the number of cats committing suicide and men reporting with a similar disease pattern increased, a team of experts from a higher centre of learning – Kumamoto University came for investigation. A thorough investigation on epidemiological principles of who, what, and how of the problem.

Three things were established early. One, the staple diet of the city was fish. Two, that the city had a large petrochemical plant called Chisso Corporation. Three, Chisso freely dumped its chemical wasted in water of the sea. From which fishermen fished. And public consumed.

With these three things established an investigation was carried out.

To understand who were having the disease. It was clearly established that those who consumed fish in large quantity suffered the most. The disease was not reported from people who did not consume fish. It was also found that some of the visitors to the city who stayed there for short time also did not have the disease.

The next question was around what. It was observed after analysis that Chisso Corporation’s chemical waste was rich in Mercury. Chisso denied that the Mercury was of significant amount. Only much later was it revealed that Chisso had actually dumped over 27 tons of Mercury in the water.

Was Mercury the problem?

Chisso denied. And continued its dumping. Result? Poisoned women gave birth to deformed babies. Neurological defects. Blind. Deaf. Limb paralysis.

By then there was a strong understanding of the how. Chisso dumped large quantity of mercury in water. Fish thrived on that water. Poisoned. Fishermen caught poisoned fish. Cats and citizens ate fish. Were poisoned. Developed neurological problem.

On November 4, 1956 the research group announced its findings.

Minamata disease is considered to be caused by poisoning with heavy metal and presumably enters the body through fish and shellfish.

Post- investigation: The deal

Citizens of Minamata revolted. Protested. 1959.Chisso did what corporations with financial powers do. Tried to make deals. Chisso will cover expenses of treatment of those ill. And as weak and helpless citizens do. They signed a deal. Received compensation. And this deal ruled out any future liability to Chisso.

It took 9 more years. Finally, in 1968 Chisso stopped dumping its mercurial waste in water.

Government figures have calculated that around 3000 people have had the disease now called Minamata disease. And around 1800 have died from it. But experts have said this is a gross underestimation.

Victory to People:

2004, October 16. A historic day in Japan’s legal history. The Supreme Court ordered the Government to pay around 72 Million Yen to the victims as damage.

2010, Chisso was made to pay 2.1 Million Yen (and a monthly allowance) to those that the Government had not identified for compensation. A whooping 50,000 people applied for the compensation. An illustration of how effects of disasters remain for many years after the root cause of the disease has been abolished.

Minamata Disaster is a must lesson for all public health students for it illustrates how beyond genetics and natural infectious agents’ man-made catastrophes affect lives of humans and animals.

Thank you for reading

Further Reading: http://www.verywellhealth.com;

A Public Health lesson learned on a late evening

1999. Siliguri, West Bengal.

It was late afternoon when I received the call. Report of a child suffering from sudden onset of lower limb paralysis. About 100 kilometres from my headquarter. I hopped in my office vehicle.

About two and a half hours later I reached the village. The house. Darkness had set in by then. The music of evening prayers from the village temple floated in air.

A child was lying on a bed. Beside his mother. Relatives, neighbours stood outside. In silence. Grandma, Papa stood in the room by the bed as I examined the child.

This was indeed a case of Acute Flaccid Paralysis. I filled necessary record forms. Provided Grandma with two containers for collecting stool specimens. And explained procedures.

As I collected everything and proceeded towards the door, Grandma asked the one question which I was silently praying no one would ask. “Doctor, does my child have Polio?”

I stood. All eyes and ears were on me. Neighbours and family members.

I said “I do not know. We can only say after I have the stool specimen results”. And I began walking, Grandma repeated “Please tell us Doctor, you have seen many cases. Does my child have Polio?”  I repeated “I do not know”.  There was absolute silence everywhere. Grandma started weeping.

The mother had not spoken till then. Suddenly at this point, she spoke. Loudly. “Doctor, you can send the specimens to the laboratory but my son does not have Polio. Do not worry. I am sure.” She said firmly. No one spoke thereafter.

I left.

The firmness in the mother’s voice, her conviction that her son did not suffer from Polio bothered me. How could she be so sure, I thought. It did look so much like Polio.

The specimens arrived after 48 hours in cold boxes. And were immediately sent to the laboratory.

Over the next days, I investigated other cases. Similar.

But this case kept on haunting me. I almost knew that this was a case of Polio. The history and presentation were so typical of Polio. I almost knew what the laboratory result would be.

And I knew I would have to go to deliver the report.

I kept on calling the laboratory in Kolkata every alternate day. It was after around 10 days that the results came.

The tests were negative for Polio. I was overjoyed.

It was afternoon again when I received the report. Yet, I decided to inform the family that very day. I boarded my jeep.

On my way I bought a packet of sweets for the family.

Another two and a half hours later, I reached the village. When I reached the house, I found the child crawling outside the house. Slow. But crawling. It was late evening.

Neighbours came running as I entered the house. I gave the sweets to Grandma and said “Good news. Your child does not have Polio.” There was a sound of relief and joy among the small crowd that had now entered the room. Grandma placed her palm on my head and muttered a blessing.

The mother was sitting on the bed and smiling. She was looking at me. When our eyes met, she said “I told you so.”

This was my turn to ask her. “How did you know Didi?”

She smiled. And said “Doctor, every time ANM Didi came to our house to give my son Polio vaccine, I fed him with two drops. I have lost count of the number of drops my son has received.

 ANM Didi told me that if he takes Polio vaccine, he will never have Polio. So, he can have other diseases but not Polio. He is protected. I know.”

And she smiled again.

I truly did not know what to tell her. What she said was so logical, yet. I nodded and told her “Yes, you are right.”

I have never forgotten that evening ever. And the lesson I learned. Of trust.

And ever after, I have been very careful about what I say to the community on vaccines. Truth. Always the truth.

In public health, we must be very careful how we say and what we say. For community’s trust on our programs largely determines the success and failure of public health programs.

P.S: On a follow-up about 6 months later I found that the child had fully recovered.

Stop Racism Now. To Anyone Anywhere

“Injustice anywhere is a threat to justice everywhere.” Martin Luther King, Jr.

The events that have unfurled and gained momentum on US soil in and following the death of George Floyd are not local to US. Injustice against one anywhere is a threat to justice for everyone everywhere. If we do not join hands today in venting our anger and frustration, we do an injustice to humanity, to ourselves.

Three world leaders have demonstrated the power of protests. Mahatma Gandhi in India. Martin Luther King, Jr. in USA and Nelson Mandela in South Africa. Against one common sin. Injustice and hatred. And the path that these leaders have shown us is the path of non-violence.

Their protest did not stop till the goal was accomplished. The goal of abolition of dominance by one group of people over another group.

In 1893, Swami Vivekananda had travelled across seven seas to Chicago to address “Brothers and Sisters” of America. He talked of love and brotherhood. Across borders. Across religions. Across humanity. And it is he who had also told his fellow countrymen to “Arise, awake and stop not till the Goal is reached.”

Across countries, irrespective of a human’s color of skin, caste, gender and faith, the opportunities must be equal. And everyone must have access to power of justice with equal opportunity. Unless we have achieved that, let us hold each other firm. And we must remind each other the most important question in our life.

As Martin Luther King, Jr. had said “Life’s most urgent question is: What are you doing for others?”.

At the end of the day, “All lives have equal value”. To reduce inequity, we must be optimist. And impatient till the goal is reached.

Noodles before Marx

It was a hot April Day in Kolkata. Sometime in the decade of the 80s. The temperature of the city was higher. From the strikes. Left parties. Worker-Student solidarity. 

They had sat in front of the closed gate. Decorated with Red flags and banners. From early morning. Smoking. Sipping. Waiting for the result of the day long negotiations. Trade Union and the Factory Management.

Metal Box. One of the largest companies in the city. On lockdown for eight months.

Hungry Workers. Angry Students.

Among those waiting in the crowd of students and workers was a Medical student. In his third year. He was a member of a student’s union. Marxist.  Democratic Students Center. He had been coming every day for the past three months with his fellow students. To the gate. In protest. With them came their teacher. Comrade Roy. He taught them Marxism and Leninism. The factory gate was his University of practical learnings on Marxism. Direct contact with labor unions. Factory workers.

A different world from the comfort of his upper middle-class home.

Around six o’clock the results of the negotiation were declared. The Management had relented. Workers got all their demands in place. There was jubilation at the gate. International was sung. In loud chorus. Claps and slogans.

Someone suggested. ‘We must have a party.’ So, some students decided to go to one of the worker’s house. They poured out their pocket. Coins. Notes. ‘Let is have Noodles. Food of the Proletariat.’ They said. On their way to the worker’s house they bought a few packets of noodles. And tea dust.

The worker had four daughters. The eldest was acclaimed for her cooking. Father said ‘She will cook noodles for all of us today. She cooks so well.’ Shy daughters ran to light the kerosene stove in one corner of the room. Tea. Black. Boil water.

The students and a few workers sat on the floor. Cross legged. And analyzed the strike. The negotiation. From a Marxist angle. How would a Maoist have approached it? Was there an element of Revisionism in the last days of the strike? It was a theoretical debate. The medical student was vocal. He had been reading Marx and Lenin and Mao too for the last one year in much detail. He even asked for a paper and pen. To draw his interpretation. Of the flow of events in the Strike.

Tea came soon. They drank absorbed in their theoretical analysis of a Marxist analysis of the strike.

About half an hour later, the daughters all came beaming. With small bowls of noodles. Enamel bowls and spoon. The students were hungry. They stopped their discussion to eat. 

As the medical student took his first spoon of noodles he wanted to throw up. It was noodles boiled in water with salt. It tasted horrible. He just wanted to run out of the room and throw up the food. On the road outside. His other Comrades were all busy eating. 

The teacher pulled his student’s plate. ‘I am very hungry.  Can I have some of yours?’ He asked. The medical student was feeling sick. He drank the glass of water kept in the middle. And shook his head. ‘Yes. I am not hungry.’ He faintly said. 

After the noodle party, they got up to leave. Congratulating the worker again. And the daughters for the noodles.

On his return home the medical student and the teacher were in the same bus. The student felt guilty. Embarrassed. Depressed. He was depressed. He confessed to his teacher that he could not eat the noodles. Nausea gripped him. With the first spoon.

The teacher smiled. ‘I know you are far ahead of them. The other students and the workers. In your reading of Marxist and Maoist Theory. Knowledge is powerful. But if you want to be a Marxist, you must learn to eat noodles in a worker’s home. Unless you enjoy their Noodles, you will never be one of them Comrade. And unless you are one of them, you can never work for them. I strongly recommend this for you. If you want to serve the workers, learn to enjoy their noodles. Or you can just be a good doctor and serve human race. Workers too. That also is a good service. To Workers. For Workers get sick too.’ And he laughed. The student laughed too.

The student tried to eat noodles boiled in salt-water again. At home. He threw up. Twice.

Then one day he put his collection of Marx and Lenin in the shelf. Sad. And concentrated wholly on reading medical science. His teacher in Marxism approved wholly.

The student never forgot his teacher’s lesson. If you want to serve them, you must enjoy their food. Their lifestyle.

In public health, first you need to be a ‘public’ and only then can you be of any service to their ‘health’.

The Miracle/ Magic of being Max von Pettenkofer

(To all in love of Sanitation practices; Science and of course a good Story)


Memorable Max von Pettenkofer


The life of Max v Pettenkofer is straight out of a Jeffrey Archer novel. The only catch being that it is a life lived in real. A great life in service of humankind. A Messiah spreading the words of hygiene, safe water and sewage disposal. All elements that Covid-19 reminds us.


But this is not about his teachings and preaching. It is about the colorful life of a Chemist from Bavaria (Germany) who could have become many things in life but ended up being what he was. A legend in his own circle of admirers. A life that points to the non-believer there is a word in the dictionary beginning with D. Destiny. Max had eight siblings. Father, a small-time farmer. But as happens in novels, he had a rich uncle. Mr, Uncle for no special reason known (except that he had no child of his own) fell prey to the “D” word and decided to adopt Max. There was a pharmacy shop that Mr Uncle owned. And he had planned to pass on the succession to Max.


But German they were. Mr. Uncle & Mr. Nephew Max. Each with their own temper. And muscle. And a fancy to punch as and when asked for. As happened during a public display. Mr. Uncle threw a punch. Mr. Nephew received it on his ears. And muttering “to hell with your shop”, Max left his Uncle and joined a theatrical company. Why? Ask “D”.s


But Max was a failure in theatre. So, he was in a soup. He had left his uncle in a huff. But then at such times “D” calls for help. And therein comes “C” with an arrow. Cupid.


Mr. Uncle’s daughter aptly named Helen. Came. Pleaded. Begged. Max to return home. Mr. Uncle accepted. Max wanted to study in University. Complete his education. But Mr. Uncle was wise. He insisted Max study medicine. For Medicine was a sure cut to livelihood.


Nothing of consequence, but good for us to know lest I forget to mention in the story of the miraculous life later, C played her role. In later life, Max and Helen were united by marriage.


Max was good in academics. A few boring things happened in his life. He passed his exams. And joined Liebig’s Laboratory at Giessen, Germany. It was a prize appointment that just did not come. He had to wait months before he got there. In the period of joining he kept on with his academics and did boring things like devising the test for bile acids. The test bears his name.


After some time, he moved on from Liebig’s laboratory. Moved from one university to another. Was offered academic posts. D kept on playing its role. And he kept on refusing the positions offered to him. For he was different. However, he did rise in his position and kept on getting recognized.

And ultimately got the prestigious honour in administration. Chief of the Court Pharmacy and Apothecary to the Court. 1850.


Max would have died a man remembered for a few years by his friends and admirers. But Max is remembered. For a reason extremely odd. And to some extent audaciously funny.


In the 1850s, there was an outbreak of Cholera and Typhoid in Munich. Max was sceptical of John Snow’s idea of infected water as cause of disease. He thought this was a grand opportunity to test Snow’s theory with an intent to prove Dr Snow wrong. He conducted his investigation. And magically proved that he was right. It was all about the moisture content in the soil and to hell with germs and infection.


This aside Max worked hard in improving the sanitary systems of the city of Munich. And the overall impact on health of its citizens was high.


But then came the discovery of Robert Koch. In 1884. Cholera is caused by a germ. Robert Kock demonstrated and proved. A bacillus. Vibrio cholerae. This was now too much for Max. It irritated him that a wrong theory of germs continued to be pursued by scientists. He had to disprove these theories. Once and for all. Max asked Robert for a vial of water filled with Vibrio cholerae. He would drink the whole vial’s water. And prove Vibrio cholerae is a bogus theory. He did. And with him two of his students drank the infected water too. Blindly believing their Master Max.


Miracle. Miracle. Miracle.


Nothing happened to Max. He was fine. He had the last laugh. Vibrio cholerae germ theory does not work. But magic is magic. Miracles are miracles. Science does have the last laugh always. The two students fell seriously ill with bouts of cholera. Scientific thinking makes us believe that Max might have had cholera in his early life. He was probably immune to the germ Vibrio.


But with this episode and magical last laugh Max became famous in the annals of history.


Good stories always have an ending. That leaves its readers remembering the story for life.


There is a theory as to why Max drank the water from the vial full of Bacillus. It was not because he challenged Robert Koch. Which he did in his outward gesture. But perhaps internally he did believe Koch. And that is why he drank the whole water from the vial. To commit suicide.


Max had lost his wife and three children. He wanted to commit suicide. The vial of bacillus laden water was his poison. And his act of drinking it. His death-wish.


In 1901, Max Pettenkofer suffered a sore throat infection. He could not sleep for nights. With having lost his family and this illness he suffered from, Max had had enough of his illustrious life. He took his own life.


Max Pettenkofer wrote more than 200 publications in life and is considered to be one of the revolutionaries in the field of public health. What we call WSH today. Water. Sanitation. Hygiene. He was one of the pioneers in thinking and executing.


A memorable life. A gift of Science. Max Pettenkofer.


(Source: With resources and publications from The Lancet; NEJM; and Max’s publications)

Support Nurses & Midwives

From medieval to modern age, the treatment of the sick has had three elements.
Cure, Care. Compassion. Cure by God/ healer/ physician. Care by the family/nurse. Compassion by the community.
Today is World Health Day. April 7. This year’s theme: Support Nurses & Midwives.
Wish them well. For Nurses walk miles and miles amongst the sick and the wounded in very difficult times and conditions to provide care. They are truly the Angels on Earth. In flesh and blood.
Here is my personal story of a Nurse who taught me the crux of care in my early days as a house-physician. In my pedestal of teachers, she sits very high.
1990. I was a House Physician in Shambhu Nath Pandit Hospital, Kolkata. A fresh graduate from Medical College. Suddenly thrown into managing patients in the Medicine ward of one of the busiest hospitals of the city. Wards overcrowded. With huge case-loads. I was in the learning phase. From text book to bedside medicine.We had a Nurse. Jagat -Di. We called her. She was aged. She was unlike other nurses. Stern. Strict. Sombre. Serious. In nutshell. She was no-nonsense. She scolded us when we forgot to sign a discharge certificate in time. She shouted at us when we forgot to write the dose of a medicine. And she shouted at patient parties. When they stayed back beyond visiting hours. She shouted at patients who did not eat their meals. She shouted at ward-boys who did not do their duty well. Everyone was scared of her. Because of her temper.
Sometimes, I asked her why she shouted so much at others. She replied because she can not tolerate negligence of duty and indiscipline. I grew used to her temper. Her shouts. And her scolding.
That was a busy day. My admission day, I think. I was on night duty. Late in the night I received a call. For a patient who was having severe asthmatic attacks. Male ward. I went. Saw the patient, Did the needful.
I then decided to visit the female ward just to check. The lights were dim. I watched from the door. Everybody sleeping. Quiet. As I was turning to return, I thought I saw a figure at the last corner. By a bed. I walked.
Beside a girl, on a tool sat Jagat Di. I came close. She had a plate in her other hand. Some chana/paneer. Home-made. She was feeding the girl. I stood there. I did not ask any question. After a few seconds Jagat Di looked at me. And said very softly almost in a whisper “Have you noticed that this girl has no visitor ever? Her family is in Bankura. They do not come to see her. I thought…….” She did not complete her sentence. I did not ask her any further. For even in the dim light I saw the moistness of her eyes. I stood there for few seconds more. Jagat Di sat there on the tool. Embarrassed that I had seen her in such soft care.
I knew the patient. A case of fever of unknown origin. Had been in the hospital for a couple of days with anaemia and fever getting treated for Typhoid.
Jagat Di and I never spoke of this incident again. And she resumed her scolding and shouting at me from the next morning. As if the night yesterday never happened.
In her scolding, shouting and seriousness she taught me bedside care in those two years like no one could have ever.
I support Jagat-Di. I support every Jagat -Di standing and sitting by those who need care and love in times of their ailment.