By Ravi Shankar
I fondly remember my first place of work after graduation and the lessons it taught me. My education and house surgency had prepared me well for medical practice. I was removed from the cocoon of my alma mater and learned to practice medicine in the community. I have not visited the place after I left, and the ensuing three decades must have brought about a lot of changes. Unsure if any of my colleagues are still working at the hospital. I owe a debt of gratitude to the nurses, fellow resident doctors, specialists and others who got me started on the long road toward independent medical practice!
I recall… in the 1990s, the time was after two in the afternoon when I reached Perumpaddapa in Malappuram district of Kerala state in India. I had used public transport. Public transport in Kerala is mainly provided by private buses. I was happy to meet two of my seniors working at the KMM hospital as medical officers. The hospital had advertised a resident medical officer (RMO) post in local dailies, and I had travelled to apply for the position.
Coincidentally, two seniors both had the same name as me — Ravi, and they strongly recommended me for the position. The Medical Superintendent was a paediatrician. Based on my academic records and my friends’ recommendations, I was offered the position. The hospital was a busy one and it was my first job after graduation and house surgency. Soon we had three Ravis as RMOs at the hospital. The other two RMOs were named Abdul Ghafoor.
The hospital was next to the famous Puthenpalli (new mosque in Malayalam) and was located at the Southern border of Malappuram district. There was a strong influence from the neighbouring district of Thrissur where I did my undergraduate medical degree. The nearest town was Kunnamkulam. I had frequented the town many times before. We, the RMOs were posted in different departments, and had to take emergency duty in turns. There was an emergency duty room. We spent the evening and night there while on duty. The hospital had a psychiatry department and a coronary care unit (CCU). These were not common in the 1990s. In the evening, we accompanied the psychiatrist and the internal medicine specialist on their rounds in the psychiatry ward and the CCU. The hospital was not built to a central plan, and buildings had been added as per need leading to a warren of buildings and structures.
During the mornings I worked in the Paediatrics outpatient department (OPD) and assisted the Paediatricians. Our lead child specialist was very popular in the region and had a lot of patients. Most doctors working in the hospital did private practice in the afternoon and evenings. On my non-duty days, I would be free by around two in the afternoon. I stayed in a quarter provided by the hospital. The quarter was a two-story building surrounded by swaying coconut and betel nut trees. I was on the top floor and my apartment had a small sit out, a living room and a bedroom and a kitchen. There were two quarters on the top floor while the ground floor only had one large quarter occupied by our orthopaedic surgeon. There were two buildings in proximity.
The rooms had basic furniture — armchairs, cots and beddings. There were no curtains and old fashioned open wooden cupboards fitted into the walls. These consisted of wooden planks and frames recessed into the wall. These are often depicted in older Malayalam movies.
I occasionally made house calls. The region had a lot of individuals working in the ‘Gulf’. Remittances had made the region prosperous.
It was a short three-minute walk to the hospital. Puthenpalli was a popular place for pilgrimage. The mosque contains the maqbara (grave) of a renowned Sufi saint, Sheik Kunjahmed Musaliyar. Devotees believe that his blessings keep the place safe and radiant. The consecrated water at the mosque is believed to have divine healing powers.
Puthenpalli Nercha[1] was the annual festival and drew pilgrims from far and wide. Ghee rice was distributed to the pilgrims and the needy. Ghee rice is a popular delicacy in the Malabar region. The flavour was largely syncretic as the festival was in December around Christmas and it catered to all communities irrespective of religious inclinations. A grand procession involving elephants and traditional musical performances like Chenda Melam using the traditional drums of Kerala and Mapila Pattu… dances like Kol Kali and Duffu Muttu followed.
It is typical of Kerala that religious festivals have both a religious and a community purpose. Over centuries, different religions have co-existed in harmony. Elephant processions are common in Hindu temple festivals and are also increasingly used in church and mosque celebrations.
In the olden days these festivals were also important locations for commerce as various stalls were set up selling a variety of goods. Today with online shopping sites and home delivery this may be less important though the shopping attraction still exists. These festivals enable people to forget the challenges of daily life and be transported to a different world for a few days. The Hindu festivals are called Poorams or Velas, the Christian ones are termed Perunnal and the Muslim ones are called either Nercha or Perunnal. Puthenpalli Nercha also boasted a mesmerising fireworks display at night.
The mosque committee served the community by running a school and an orphanage.
We were provided with food from the school hostel. The food was usually par boiled rice and sardines. We were provided with both spicy sardine curry and sardine fries. Two sardines in the curry and two or three well fried and crispy ones for both lunch and dinner. Eating the same food day after day could get a bit boring though! There would also be a vegetable that used to vary daily. And Kerala papadam. The Kerala fish curry used plenty of coconut and tamarind. A coconut and chilly paste was coated on the sardine and it was then deep fried in coconut oil before being part of the curry. Shallots, Kashmiri chillies and curry leaves are common ingredients. I discovered as you travelled up the Malabar coast toward Mangalore, the coating became less spicy.
The emergency department was busy during the evenings, but things usually quietened down at night. I always found night duty tiring as it took me a long time to go back to sleep after attending to a case. Injuries were common and we also received psychiatric patients for admission to the psychiatry ward and cardiac patients as we had an CCU. We were not sufficiently trained to handle aggressive patients. We did have a security person on duty outside the emergency. There were also other security personnel on duty at the entrance to the CCU and at different outpatient departments.
The hospital was surrounded by village homes, and we often walked along the quiet by lanes. The quarter next to me on the top floor was occupied by a lab technician and he was good company and had a wealth of stories to tell. The buses were usually very crowded.
The coast was not far, and you could also walk on the beach and watch the fishermen set out in their boats. The mosque was usually crowded. There were no academic activities at the hospital, and we learned by doing. We would get a break after finishing our night duty and I used to combine my leaves and spend two or three days with my uncle in Palakkad once every two months. KMM hospital was a good place to work. I eventually left to join a small hospital and clinic at Areacode further north in the same district.
[1] The Perumpadappu Puthen Palli Nercha is a Muslim festival that celebrates Marhoom Kunji Mohammed Musaliar. https://www.keralatourism.org/1000festivals//assets/uploads/pdf/1515486704-0.pdf
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Dr. P Ravi Shankar is a faculty member at the IMU Centre for Education (ICE), International Medical University, Kuala Lumpur, Malaysia. He enjoys traveling and is a creative writer and photographer.
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