1. The room seems quite dark in contrast to the harsh sunlight outside. The only light comes from a small window high in the rear wall and even that has a security grill. It is furnished simply, a desk, two wooden chairs and a single light bulb sometimes there is electricity, but once you have adjusted to the poor light the room does well enough. In the corner is an ancient book case, now full of the out of date medical books that are all my predecessors could afford and even older surgical instruments almost never used because of the impossibility of obtaining anaesthetics. In the corner is a sterilizer, used when we have power otherwise a pot over the fire has to do. Methylated spirits for sterilization is something else on the no-can-do list, because it is alcohol and this is a Muslim area. In another room there is space for an examination couch and the windows are bigger, the light from which helps when deciding exactly what kind of rash is presenting itself. There are two more rooms a storeroom and the dispensary where William mixes his various potions and charges an extra rupee for bottles when he thinks I'm not listening. You may see this as wrong the people are as poor as he is, but William just sees it as providing for his family as best he can and I could not manage without him so he stays.
Outside there is a large, shady veranda which serves as waiting room for the seventy- five or so patients we see each morning. There used to be a system of tickets so that people would be seen in order of arrival unless it was a real emergency, but some people, usually young men, still pushed to the front. The system now in use works better anyone caught pushing in is asked to return on Friday the day when we have our antenatal clinic and sexually transmitted disease clinic. The men find it humiliating to be seen waiting outside such clinics and so the pushing has stopped.
We are close to the Himalayas, though they are just out of sight across the distant haze of the Punjab plain and on Tuesday it was cold enough for frost, a brazier alight in the clinic despite the smoke problems that this caused, but this is Thursday and by midmorning the thermometer reaches the low hundreds. It is the end of April and summer has arrived with a vengence.
We keep few records, only those for tubercular patients who have or who need foreign sponsorship. Treatment for t.b. can be very cheap, but however many times we tell them that the tablets must be taken for 6 months at least, as soon as symptoms subside people decide that 25p per week is 25p too much and so they stop coming for a while at least. Often, because houses are small and everyone sleeps in one room the whole family is infected, though maybe only one turns up in clinic. I try to insist on seeing everyone in the household, but when this means several people travelling 25 miles or more it proves impossible The coughs soon return, but now a new treatment has to be tried as the first will no longer be effective, and it will cost a little bit more, because we always start with the cheapest form of treatment.. And so it goes on through all the available medicines until we reach the one that costs 25p per day beyond the reach of almost every one of my patients. I find this the most frustrating situation with which I have to deal. The reason for few records is that the patients carry their notes around with them. Sometimes they get lost, but usually written records are carefully preserved even by the 85 % majority who are illiterate. The system works because when people trail round from one clinic to another we at least can see what has been diagnosed and prescibed in the past and so people do not generally get three doses of steroids or other potentially lethal drugs.. On the other hand these are freely available in the market and every day I see people suffering as much from the treatment they have taken as from the original condition.
12 25pm. Clinic is over for the morning. We have seen 15 T.B. cases, various burns and scaulds and several people complaining of infertility including a gentleman in his eighties who had travelled all the way from Kabul. A six week old baby has polio which is worrying, there is another case of lockjaw, scabies galore and the secret police who want to know the name of my grandfather this is after I have explained that 'No, I am not married,' ' No my father does not live nearby' 'No, I am not engaged.' They simply cannot understand how a woman can have no male relation responsible for her. When they ask why I am in their town I suggest they sit in the corner and watch then they will learn why I am here. After 3 or 4 visits we stop making them cups of tea and after 5 or 6 visits they stop coming. The last patient had been an upper class girl surrounded by a bevy of giggling friends. She explained that she had been married for ten months and there was no sign of a baby. I'd learnt a lot over the last few months so my first question was Where is your husband living? followed immediately by When did you last see him The answer to the first was Saudi and the second was on her wedding night. It is common for young men to go to Arabia for a couple of years immediately after the wedding in order to help pay their way. Unfortunately no one explains to their brides that it takes two to tango or in this case produce a baby. I asked if she wanted her friends to wait outside, but it turned out that they didn't know the facts either so there followed an impromptu sex education lesson. They had gone away still giggling and I'm not sure they believed me. The general consensus is I'm married therefore I will have children , but we all know that if no baby is expected after a year the marriage may well be annulled.
I lean on the white painted wall that surrounds our compound to await transport home that is until I realise that the paint is still sticky. Everytime a v i p comes to town the police come round and insist upon all buildings on his route being given a new coat of paint even if it is only six weeks since the last time, and we are on the main route from from Lahore to Multan. To my left a barber daubs his foam around the chin of a young man out to impress, while other customers crouch patiently on the ground. To my right a peanut seller is surrounded by a group of young people. They seem a little over anxious to get exactly the right packet of peanuts and when I see that they are handing over five rupee pieces instead of the usual one I wander over to investigate. The nuts are wrapped in exam papers clearly marked with tomorrows date! I suppose that if everyone does it at least they are all on the same footing.
This is the main road from the airport to the town centre and traffic is busy. One of the problems here is that driving licences are usually obtained not by taking a test, but by giving someone your details and a handful of money. You meet him again the next day and there is your pristine licence with all the correct stamps. The other problem is that though people on the whole stick to the left hand lane a legacy from the British everyone moves at a different speed. In the few minutes I wait I see an ox cart moving at less than walking pace being overtaken by a lorry full of sugar cane . The lorry wing mirrors are adorned with black streamers, not as decoration, but to distract the devil from the driver and so keep him safe He is going at the speed lorries normally do but school is out and this lorry has several small boys hanging on the back, each with a firm hold on to a freshly cut cane. Their weight will eventually pull the cane out from the pile and they have their reward though they do tend to land with a thump in the middle of the road. Two camels go past, their pelts carefully trimmed into pictures depicting the life of Mohammed. From their mouths green foam drips in great gobs after their lunch time feed of fresh alfalfa. The luxury flying coach goes past air conditioned, comfortable, and the most dangerous thing on the roads as they never slow down. Every week one sees a crashed coach. Often at night as though the law requires a vehicle to carry lights this often consists of a storm lanturn sitting in the lap of the driver to keep him warm The bus goes past, every seat taken and with its roof piled high with luggage, crates of chickens and several small boys who stand holding holding hands and swaying as they are jolted from side to side. A tonga comes along, but it is empty. If I get on that one and tell the driver where I want to go I know that it is highly likely that half way home he will be waved down by a group wanting to go in the opposite direction and I will have to get off so I let the horse drawn carriage go past. The noise of traffic is intense and it isn't helped by the donkey tied to the guava tree in the compound behind me. He has interrupted my conversations all morning, but no one knows who he belongs to, and if he stays there long enough he'll become ours. At last a small boy, perhaps only four years old, comes and collects him. I ask why he had left the animal in our compound. Because there the people will feed him. and he disappears into the crowd.
It is hot and I am aware of the smells around me the worst from the pond behind the clinic where the tonga drivers let their horses wallow in the heat of the day. The water there is fetid and thick with a revolting over baked khaki crust. I look at the horses in the pond. Some are in a very bad state. I never know whether or not to go in a tonga whose horse is in poor condition. If I don't choose it the driver will be all the poorer and so his horse is even less likely to be cared for.. On the other hand if I do choose such a vehicle I know that the horse will struggle even on these flat, flat roads. The breeze brings me another smell, that of hot, spicy dhall from the building behind me and I am reminded that it is a long time since breakfast It almost covers the smell of the sewer that runs down the middle of the pavement. Not that it is an open sewer, its just that there are gaps in the paving so that when the monsoon breaks in a few weeks the water will have somewhere to run. A donkey goes past, but I don't know the rider. The choice today seems to be a Suzuki a small motorised bike which has had a chassis added so that two or three very slim passengers can sit in relative comfort in the back. Unlike tongas they usually take you all the way.
While I wait for one to come along I stare at sights I would not have believed a few weeks ago. Opposite me a queue of women are buying milk from a churn. I don't spot it today, but I know that if the level in the churn gets too low for the number of people in the queue it will be topped up from the canal and the women will stand and watch this because for them any milk is better than none.
Two men go past on bicycles one is carrying a bed on his head, the other has a large piece of hardboard wedged in front of him. As the wind gusts the top of the board bends back over his head completely blocking his view, but he peddles on without a change of pace A family I know wave from their motorbike. Dad is driving, with eldest and second son on the crossbar in front of him. Mom and daughter sit side saddle on the luggage rack and baby dangles from mom's lap. I suddenly realise that she is not holding on to the baby, but on to the bike, yet somehow he defies the laws of gravity and remains in place.
These are followed by a white van of the type often used here as a mini-bus. Today the rear doors are flapping and two men stand on the footboard to guard the contents a large white cow who fills the whole width of the interior with her hip bones. I consider for a moment whether they will need a shoe horn or a can opener to get her out. The fear inside her lands in moist, wet piles on the roadway
A Suzuki screeches through the resultant mess to halt in front of me sending up a spray of fetid cow pie, causing a flock of parrots to rise screaming from the guava tree, but when the driver, who looks about 14, hears where I live he doesn't belive me. This is a regular occurance. Foreigners don't live there. They live in the city, in grand, three storied balconied houses behind high walls with hibiscus flowers, amazing misty blue jacaranda trees, with mulberry trees dripping black juice on the ground beneath and with chokidars drowsing in their huts, but ready to move at the first sign of intruders. That's where they live. Not out in the jungle.Ingrezis don't live by themselves in the jungle
It's actually no more jungly than your average English country lane, many of the plants would be familiar to you, though perhaps not the creatures that feed on them, but it leads to the lepar colony and to another town where the locals are referred to as jungley people, a euphemism for monkeys, because they speak another language After a minute or two I persuade the young driver to at least take me to the city boundry, which he does although half way there he suddenly demands double the usual price. He doesn't get it.
Read more articles by Margaret Watson or search for articles on the same topic or others.