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(ARCHIVE) Vol. XVIII No. 25, april 16-30, 2009
Engaged in changing lives
in Madras
(By Susan Ingraham)

“I don’t need money, I need hands,” R. Desikan repeated, peering through thick eyeglasses that magnified his brown eyes giving him a startled look.

The “hands” that Desikan needed were hands to help with the work in a small roadside leprosy clinic he had established in the village of Pammal outside Madras. He was sitting in our living room, and my husband Ed, who served as Consul-General Hank Ramsey’s political officer, was protesting that he couldn’t spare his hands – but “Susan can,” he said, referring to me.*

And so it developed that during our posting at the American Consulate-General in Madras, Desikan would be waiting for me in the driveway every Tuesday afternoon. We would go out along the San Thomé High Road toward Pammal, stopping to pick up other volunteers along the way. The car I drove was a Chevrolet station wagon, green with a “solid ivory top,” as Ed described it – adding with a smile, “I’ve been in India too long!” There weren’t many other station wagons in Madras in 1956; not many cars of any sort, in fact.

The volunteers we collected were mainly young men, just out of college. Desikan himself had dropped out of college when he was diagnosed with leprosy. He had been treated with an experimental pill, a drug made from “throwaway substances” left over after the sulfa drugs used to treat leprosy were manufactured; and it was, therefore, very inexpensive. Desikan distributed these pills to the villagers who assembled on Tuesday afternoons.

The clinic was a small, one-room adobe building with a doorway and a verandah that faced out toward the street. There was no electricity or plumbing. When we arrived, Desikan jumped out of the car, handed me a small broom and assigned me the task of sweeping the building, while he headed off to the village well.

Desikan returned with two buckets of water, which he poured into a large ceramic pot that could hold about four gallons. Stretching a cheesecloth over the top of the jug, he slowly poured in the water. Then he moved the two chairs and one small table out to the verandah, setting the card file on top of the table. He motioned for me to sit at the table, and as the patients came up and called out their names, I would look up their card. He would drop one tablet on the tongue of the patient,and I would note the date on the record.

There were more than 30 patients. Some walked for many miles to reach the clinic. They stood in line quietly. Most of the patients were men, but there were a few women and a few young children. Desikan said they had a hard time getting people to come to the clinic because no one wanted to admit to having the disease. But the older people recognised the importance of the medication, probably because Desikan could point to himself as a “cured” patient. Indeed, he had not lost any fingers or toes or his nose, and neither had any of his patients.

The importance of pain

I read as much as I could find in Madras about leprosy. I learned that the disease was not easy to catch; simple health precautions were all that were needed. The servants at our home were shocked by my work, however, and would keep the kids away from me when I returned from the clinic. I would walk right up to my bathroom and climb into the tub, scrub thoroughly and then toss in all my clothes, including my sandals, and wash everything, hanging it all out on the rooftop clothesline. This seemed to satisfy everyone.

One book I read was by Dr. Paul Brand, an Englishman and missionary doctor based at that time in Vellore. (He became an international authority in the field and subsequently won many awards for his work.) He had developed many useful tools and practices to allow lepers to maintain functionality in their limbs, including a way of rearranging the muscles and nerves of damaged hands to make them work.

When I eventually met him, Dr. Brand explained the basis for many of his inventions: leprosy strikes first at the extremities, killing the nerve endings, leaving the patient without the feeling of touch. So, for instance, he developed a coffee cup that fit inside a wooden rim, with a wooden handle on the rim. A patient who has no sensation of hot or cold in his nerve-impaired hands will pick up a scalding hot tin cup of coffee, badly burning his hands.

That is the reason so many leprosy patients lose fingers and toes – not because of the disease, per se, but because they have no perception of pain and therefore unwittingly damage their fingers and toes. “Pain is a very important sensation,” Dr. Brand had said.

A providential development

Meanwhile, news of my extracurricular activities was spreading among the wives at the Consulate-General and now and then one of them would join me for the junket to Pammal. Then, at a meeting of the American Women’s Club, a providential development occurred.

Mary Clubwala Jadhav, a portly woman from New Delhi who was a well-known organiser and worker in women’s group, had come to address the group on the problems of India’s poor. During the talk she mentioned that tons of powdered milk, in five-gallon cans, were sitting on the docks right then waiting to be collected by one or another of the missionary groups in South India. No one would claim the milk, because they were quarel­ling with each other, and
Mrs. Clubwala was worried that it would go bad.

“Too bad we can’t get it for the clinic,” I muttered to my neighbour.

There was no further discussion of the milk powder, but the next day a huge army truck pulled into our driveway. I ran downstairs just as Ragavelu, the head bearer, opened the gate. The driver asked us where he should unload the milk. I asked him carefully if he was sure it should be delivered to our house, and he showed me his ‘chit’, signed by Mrs. Clubwala, with our name and address.

Milk for the clinic

“Ragavelu, what’ll we do?” I asked helplessly. But he was way ahead of me. (The servants in my house always knew what was happening before I did.) Opening the door on a small unused shed at the end of the garden, he told the soldiers to stack the tins inside. Ragavelu picked out a couple of tins that had been punctured and gave one to the truck driver. Another one he said he would take to his family. All the others were placed in the little store-room, and then he locked the door.

Powdered milk was like candy to local people. I had paid a hefty price for a five-gallon tin of ‘KLIM’, the imported European milk powder popular during the 1950s (and “milk” spelled backwards), at the local store and was careful not to check too closely on how much we consumed and how much disappeared into the servants’ households.

“Ragavelu,” I said, “Remember, this milk does not belong to us, so we must be very sure that none of it goes missing!” With a tiny smile on his face, he assured me that no one would enter the storeroom except himself or me.

The next week, we put five five-gallon tins of KLIM into the station wagon. Desikan was delighted. We headed out to the clinic and, once there, he prodded off the lid of the first tin. Then the problem of how to transport the dried milk to the homes of the patients suddenly struck us.

Without hesitating, however, a woman stepped forward, held out a corner of her saree, and we poured about two cups of powder into it. Then a man pulled up the edge of his kurta, and we repeated the operation. Every patient managed to find a way to take home the powdered milk.

But one of our visiting American women looked on at the proceedings with horror. She was new to India, new to the Foreign Service, and did not realise – the way the missionaries and I did – that some things were just impossible. The next day she showed up at my house with an empty ‘Dalda’ tin. ‘Dalda’ was, and still is the trade name for ghee, the nearest thing to butter. It was a sparkling clean one-pound tin, with a tight-fitting lid. “How about giving one to each patient, and telling them to bring them back each week, empty and clean?” she asked.

Excellent, but where and how could we acquire 50 or so ‘Dalda’ tins? Every bit of tinned stuff that I brought home from the bazaar or from my overseas shipments went out to the kitchen and just disappeared. A brief discussion with Ragavelu settled it: the tins were sold to dealers in the bazaar, and any idiot would know that all you had to do was go down to the bazaar and ask direction to the “tins” – as they were called in Indian English – and buy them back.

Can-do spirit

So the innocent newcomer went down to the bazaar and came back with a carload of tins, which she scrubbed carefully. She proudly brought them along to the clinic the following week. We handed one tin filled with powdered milk and tightly capped to each of the patients, instructing them to be sure to bring back the tins next week. Judging from the smiles on their faces, we concluded that would not be a problem.

But the next week, only a few patients showed up with ‘Dalda’ tins. I was annoyed – our new volunteer had worked so hard securing all those tins, cleaning them and making sure that the lids fit securely. Desikan took a different view. “Just fill the tins that have come back, and we can sort out the rest later,” he said.

We followed his instructions, and had the good sense to turn a blind eye to the little charade that went on. The first filled tin was accepted gratefully and the recipient moved away from the table, with his sulfa pill swallowed and his Dalda tin filled with powdered milk. He went back toward the end of the line, opened the tin and dumped the milk powder into the corner of his kurta, and handed the empty tin to the patient in front of him. This went on until everyone had received his medication and also had received a tin filled with powdered milk.

In the car on the ride home, Desikan told us what had happened to the patients the week before. ‘Dalda’ tins serve many purposes. When the patients walked home to their villages with the tins, the local police accosted them. The patients surrendered the tins and fled.

So our new assistant went back to the bazaar yet again. This time she painted the cleaned cans a lovely blue. Desikan informed the police that these tins came from the leprosy clinic and were for the exclusive use of the patients; in short, they should leave them be. That worked.

Foreign and local visitors

Visitors showed up periodically at the clinic, and some were more helpful than others. One day an American missionary, an old man whose name was not given to me, stepped forward when we opened the clinic, insisting that we begin the afternoon’s work with a prayer. Desikan came out and joined the patients, who formed a rough circle around the speaker.

The old man began a long personal prayer, asking God to look with favour on the patients and the workers. He carried on for quite some time, getting more and more emotional. “And God,” he commanded at one point, “Go out to these people’s homes, follow them home, and protect and care for them!”

He was looking up to heaven and shaking his fist at God. The patients probably couldn’t understand much of what he said, but they were with him in spirit, and nodded and looked up with him.

As the only other Christian present for this performance, I was struck by how unperturbed Desikan was at the intrusion. He stood quietly, letting it all wash over him. A Brahmin – his religion had been around centuries before Christ and the missionaries. Yet he was content to let them sound off.

On another occasion, a local city official came to visit the clinic. He gave a rousing speech to a crowd of people who showed up to hear him. It was in Tamil, and I could not understand a word of it; but evidently he told them that I was a complete outsider and a foreigner, and if I could show up at the clinic, certainly the Indians could, too. There is a photo of all of us – the assembled patients, Desikan, the politician and me. I look just like everyone else in the picture.

We were getting more ­patients, and the station wagon with the solid ivory top ­attracted more volunteers. One happy day as I drove the car filled with young college kids back from the clinic, they burst into song, and we had a marvellous chorus all the way home.


Years later, in 1988, I got a report. Desikan’s drug had been declared effective and was ­accepted as cure for leprosy. The clinic was still in operation, and the milk powder continued to arrive at the American ­compound. Each new arrival at that house on San Thomé High Road had become the titular head of the clinic and, although none of the succeeding memsa­hibs actually went out to the clinic, the milk powder was still housed in the shed, that Raga­velu managed its distribution each week.

Today, more than a half-century later, the house no longer belongs to the U.S. government and may not exist at all. I don’t know what became of the clinic, but tremendous gains have been made in India and worldwide toward eliminating leprosy. – (Courtesy: The US Foreign Service Journal)


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