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Today is world malaria day, recommitted to eliminating malaria from the world. In last one year, we witnessed and responded to a major outbreak of malaria across two tribal communities. These communities live in the catchment areas of our AMRIT Clinics, that aim to provide high quality and low cost primary healthcare in remote rural areas of South Rajasthan. Within a month, progressively, we were swamped by patients of all age groups, men and women, coming to the clinics with high grade fever, pallor (haemoglobin as low as 2 and 3 grams) and big spleens on palpation. Many pregnant women and many infants came too. We detected and managed 2496 patients of malaria between the months of August and January. Many walked tens of kilometers to reach us. Most of them were malnourished.
We came dangerously close to touching one-another when we came through the door into my consulting room. I held it open for her so she would not have to touch the handle. She held it open with her left foot just as I let go with my outstretched right hand. I had placed our chairs three meters apart, and we sat down facing one another. I sat with my back to the window which meant that her face was lit by the sun while mine was masked by the shade. It wasn’t a deliberate ploy to expose and conceal, but we noticed it as soon as we looked up at one another.
“While we are social distancing in our homes, it’s time to have that conversation that most of us have avoided ? or didn’t even know we needed to have.” Earlier this week, a 30-year-old patient with COVID-19 passed away on a ventilator. He hadn’t laid out his end-of-life wishes ? what in the medical field are called advance directives. His father, devastated after seeing the numbers related to his condition, didn’t want any further treatment that would prolong the inevitable. His mother wanted to try everything that could possibly be done to save him. If the patient himself had been able to speak, he might have expressed what his wishes were and saved his family a heartbreaking conflict.

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