Tuesday 11 June 2019

How Ladakh’s 1st gynaecologist changed the face of women’s health in India’s cold sesert

“The trust between a doctor and patient is very important… I have been here since ’79, and now you can imagine I am delivering the grandchildren of my own patients,” says the 74-year-old doctor whose groundbreaking work has earned her the #PadmaShri. #Respect #RealLifeHeroine

Every Thursday, Dr Tsering Landol, a retired gynaecologist, conducts a clinic with the Ladakh Heart Foundation, a charitable medical facility.

Here, she screens, counsels and guides women patients, particularly those who are pregnant.

“We prepare them for all pregnancy-related eventualities, counsel them on the precautions they need to take, and address hygiene and nutrition-related concerns,” says the Padma Shri award-winning doctor who is also Ladakh’s first gynaecologist, to The Better India.

“Even though I’m 74 today, I still serve because it’s part of my duty,” she adds.

Born into an agrarian household in Leh district where no one had undergone formal education, Dr Landol was one of six siblings in the family.

After finishing primary school at Moravian Mission School, she pursued her matriculation from Government High School, Leh.

“There was a doctor, an assistant surgeon, who had come to Leh when I was a child. He always had a stethoscope around his neck wherever he went. After this caught my attention, there was no looking back. I wanted to become a doctor,” recalls Dr Landol.

“But there was a lack of quality science faculty at my school. We got to learn English alphabets only from Class VI onwards. Other than English, we had to study classical Tibetan, Hindi and Urdu. All the textbooks were in Urdu. At the matriculation level, the questions were in English while the chapters were in Urdu. It was quite difficult,” she adds.

However, she soon made her way to Srinagar, where she studied at the Government Medical College, specialising in obstetrics and gynaecology.

Dr Tsering Landol treating one of hundreds of patients at a clinic for the Ladakh Heart Foundation. (Source: Facebook/T Chosgyal Lharjey)
In hindsight, she credits her father for encouraging her interest in women’s health.

“My father, Rigzin Namgyal, was a farsighted man. At the time, there was a lot of superstition surrounding childbirth. Even family members were barred from attending to the mother, lest the ‘deity got angry.’ As a consequence, there were a lot of pregnancy-related illnesses and deaths. Despite these superstitions, my father supported my endeavours. Maybe, that’s I wanted to become a gynaecologist from the outset,” she recalls.

After serving in Srinagar for a few years and gathering experience, Dr Landol joined the Sonam Norboo Memorial Hospital, Leh, in 1979 as the region’s first practising gynaecologist. What she remembers are the severe conditions under which doctors had to work in the only district hospital.

“Today, it is difficult to comprehend the difficulties that doctors had to undergo while performing surgeries. The facilities were a bare minimum and deliveries would take place in freezing temperatures. A doctor had to be versatile, improvising with equipment during child delivery. There was no regular electricity, and the heating system was non-existent. During winters, we would use a bukhari, a wood burning stove, which is particularly toxic during child delivery because of the emissions. Using anaesthesia was also a problem near the bukhari since it’s highly inflammable,” recalls Dr Landol.

However, she stresses that what the doctors at SNM Hospital did have was a solid camaraderie and would help each other out whenever possible, even during certain procedures.

Take the example of the heating system.

With the Bukhari heating system proving to be unviable, Dr Landol looked to the traditional hamam structure imported from Kashmir. This allowed the doctors to work under optimum temperatures during the biting winters when temperatures would go way below zero.

“Thanks to contributions from foreign NGOs, we made hamam rooms for both the operation theatre and labour room. Things began to change slowly, but even then we didn’t have proper running water. But we continued to strive for these facilities, pursuing the local government. Eventually, our then administrator Dr Smanla, went before the government requesting for a heating system. After a long tussle over many years, the government finally installed a central heating system at the hospital,” she recalls.

That was only part of the problem.

What she saw around her, in terms of women’s health in the early days, especially on issues of body and food hygiene, deeply bothered her.

Dr Tsering Landol writing a prescription. (Source: Facebook/T Chosgyal Lharjey)
To begin with, as a consequence of freezing conditions in this cold desert, people would rarely bathe. Some would bathe once a month and eat food that was out for days. This is deeply problematic, and even more so in the case of pregnant women.

Another major concern, which went beyond particular ailments, hygiene or child delivery, was shedding the social stigma associated with women talking about their health problems. That hesitation eventually came down slowly, particularly when they saw a lady doctor before them who specialised in these issues.

With assistance from fellow doctors, Dr Landol had to communicate to them that they did not have to be ashamed of these health problems, and urged them to express themselves freely.

“Communication is the most important element in the medical profession. Allowing people to speak with total honesty, listening closely, maintaining their trust and professional secrecy, besides giving them confidence that we will resolve their problem are critical elements. Merely writing a quick prescription is nothing, when you can’t communicate,” says Dr Landol.

Sonam Wangchuk, a former diplomat and now a self-employed businessman, believes it was Dr Landol’s innate understanding of Ladakhi people that proved to be a real asset.

“Her ability to understand the language of the people, economic conditions, family backgrounds, climatic conditions, dietary habits and communication skills helped her a lot in promoting women’s health in Ladakh,” he says.

As a consequence of her efforts, many Ladakhis slowly started to get convinced about the importance of maternal health. People soon began to stream in regularly for advice.

“Women health and hygiene was once not a point of focus in Ladakhi society, but with our constant efforts, these things began to change. Besides working at the district hospital, I also visited the far-flung areas of Ladakh like Turtuk and Bogdan. We conducted camps, mobilised people, spread awareness on health and hygiene,” she recalls.

She was also a pioneer in broaching the subject of adolescent healthcare education in schools across Leh, helping young girls understand the process of puberty, which would bring about changes in their body, hormones, thought process etc.

Among Dr Landol’s significant achievements is the work she has done to promote family planning and institutional deliveries in Ladakh.

For many mothers, who would deliver four to six children (often at home) without the necessary nutrition, care and hygiene, this was a difficult process.

“Initially, there was a great deal of hesitation against family planning, particularly from conservative elements who said it was sin and against Buddhist culture. There were similar issues within the Muslim community as well. With the upgrade in the education system also came an upgrade in the health system as well, but we worked extensively on outreach and ensured things got better over time. We did our duty and not more than that,” she says.

She adds that the emphasis should not be on producing more babies, but quality citizens.

On the question of safe institutional deliveries, here is an excerpt from the 2010 ‘From Home to Hospital: The Extension of Obstetrics in Ladakh’ report by Kim Gutschow, an anthropologist and lecturer at Williams College, USA.

“[In] the first year (1980), there were only 114 births, but by the next year, the number had doubled, and it grew steadily over the next decade. By 1995, nearly half of all births in the district were at the government hospital. The number of hospital deliveries rose every year until they reached 1241 in 2003/04, when Dr Lahdol [Landol], the chief obstetrician who had been at the hospital since its founding, retired.”

Her work at the district hospital not only improved conditions in Leh but also Kargil.

“Dr Lahdol’s [Landol] reputation spread into the neighbouring district of Kargil, as in 2006 one fifth of all women in Zangskar travelled to SNMH [Sonam Norboo Memorial Hospital] to deliver their babies. These Zangskari deliveries accounted for 10 per cent of the deliveries at the hospital in early 2006 according to my estimates. While 74 per cent of all deliveries in Leh district were institutional by 2007, only 45.5 per cent of all deliveries in Kargil district were institutional that year,” the report goes onto add.

There is a reason why Dr Landol has such a special reputation with the community.

“She treats her patients with compassion and takes time to explain the procedure she is going to conduct and her rationale behind it, especially for illiterate patients. There are very few doctors with such patience,” says Tsering Angmo, a housewife in her 60s, from Leh.

“The trust between a doctor and patient is very important… I have been here since 1979, and now you can imagine I am delivering the grandchildren of my own patients!” Dr Landol once said in an interview with this academic back in 2017.

Thanks to her work, there is a lot more awareness around women’s health today in Ladakh.

“Women come and talk about their health problems without any hesitation. Earlier, they wouldn’t tell us directly. For example, if an unmarried woman got pregnant, they would lie. Today, they come straight away and let us know what happened. We then help them any which way, besides offering counselling,” she says.

Her groundbreaking work in women’s health in Ladakh saw her receiving the Padma Shri on January 29, 2006.

Former President, Dr. A.P.J. Abdul Kalam presenting Padma Shri to Dr. Tsering Landol, a Gynaecologist & Obstetrician of Leh at the Rashtrapati Bhavan. (Source: Wikimedia Commons)
“Receiving the award, I felt good and encouraged, and that’s all. My sense of responsibility increased even more with greater appreciation,” she says.

Despite her tireless work (she famously never took leave except for training purposes for which she had to leave Ladakh), Dr Landol still feels a lot more needs to be done, particularly with sedentary lifestyles and changing food habits.

“Today, I see many young soon-to-be mothers indulging in fast food. There is not enough focus on whole meals. Also, vegetables coming in from outside, which contain a lot of chemicals and preservatives, are very unhealthy and cause many problems during pregnancies. Prosperity has indeed come a long way in Ladakh, but we have lost touch with our heritage and values,” she informs.

Listening to senior citizens talk about ‘values’ often takes us down an unwanted or often preachy road, but Dr Landol’s work is a testament to the sort of compassion and empathy we hope from the medical profession.

It’s something we can all learn from.

(Source: TBI)

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