Telemedicine: A Retrospective

Around March 1997, we got an invitation from the Department of Electronics (DOE), which is now called the Department of Information Technology (DIT) under the Ministry of Communication and Information Technology (MCIT), Govt. of India, for writing a proposal on a low cost telemedicine system. During that time the concept of telemedicine was just beginning to catch the imagination of the medical world. However, there were quite a bit of confusion and myth around it not only among laypersons, but also among many doctors and health administrators. Some of them considered it as the replacement of medical professionals, and had a negative and sarcastic attitude towards its adoption. Some thought it was a utopian sci-fi solution for the future generation. The net effect was that none took it seriously and there was a lack of enthusiasm in using this technology for improving the health care delivery to the people.  In fact, when we approached the then Health Minister of the Govt. of West Bengal, we got a lukewarm response. The proposal though got a push due to the enthusiasm and energy of a doctor, Dr. V.K. Gupta. At that time he was the Head of the Dept. of Leprology of the School of Tropical Medicine (STM), Kolkata.  Previously he had been collaborating with us in developing an expert system for treating leprosy. So exactly a year after we proposed to make a telemedicine system using low bandwidth channels like POTS, for treating the patients of chronic tropical diseases, such as leprosy, Malaria, Kala-azar, etc.  It took almost one more year to get the sanction from the DOE and the project started in the January of 1999. We got an able partner with us, Webel Electronics System Ltd. (WECS), Kolkata in the execution of this project, and since then the partnership has been growing strong in executing different other telemedicine and related projects.

First Telemedicine System

Within a year and a half (August 2000), we developed a prototype system on a Windows-NT platform. We named the system TelemediK. As the system was meant for low-bandwidth data communication we took care of the following for reducing the requirement of bandwidth.

(i)                 Adoption of  store-and-forward methodology for data transfer supported by organized capturing of patients’ data in a back-end RDBMS, and

(ii)               Design of an online graphics communicator for data conferencing between two doctors against medical images with annotations, file transfer and text chatting.

The system went through several test runs using ordinary telephone lines between distant places, such as Kolkata and Bhubaneswar, with Kharagpur. As our Institute has centers at these two places, we could perform these experiments conveniently as and when required. Finally the system was installed in the STM, Kolkata in November, 2000. The first beta test between STM, Kolkata and IIT, Kharagpur took place in February, 2001.  We found that our system can work with a data rate as low as 5 Kbps. In our design, we kept a separate telephone line for audio conversation and there was no scope for video conferencing. We made some attempts on supplementing the consultation with online video frame transfer at a very slow rate of 1 frame per second.  However, it failed to clear the acceptability test from the conversing participants. In our early days, we went to several places, such as Christian Medical College, Vellore; Westbank hospital, Howrah; Mahatma Gandhi Institute of Medical Sciences, Wardha; Sikkim Manipal Instititute of Medical Sciences, Sikkim, Elitex exhibitions held at Delhi, etc.,  to demonstrate the system and got appreciations from different corners. At that time, a few commercially available telemedicine systems used impromptu data transfer for tele-consultation and were not bothered about their organization and archival for subsequent uses. Our system was a departure from that trend, as it used a back-end RDBMS. Gradually, other systems also started using data bases for archival and retrieval of patients’ data during telemedicine sessions.

In 2002, the first telemedicine network in West Bengal was set up with the referral center at STM, Kolkata, and two other nodal centers at the State general hospital of Habra, North 24 Parganas, and at the district hospital of Coochbehar, a place at a distance of  about 500 Km. from Kolkata.  The doctors at referral centers were supposed to provide their expert opinions to their peers at nodal centers. In the later versions of the software, however, we removed this distinction and two doctors at two ends are able to participate with equal roles and rights for consulting over patient’s data.  WECS did excellent work in setting up the network and building the local infrastructure at those centers. They also provided necessary man power support for its daily operation. A good number of referral cases were discussed using telemedicine services during the project-period. Around 1400 patients of these two nodal centers were treated in next two years. Interestingly, by observing a large number of referral cases in dermatology from Habra, the Health department posted a dermatologist there. Naturally, this reduced the requirement of referrals. This also shows the evanescent nature of telemedicine. Through planning aided by its history of referrals, or training to a non-specialist by tele-consultation, the intensity of its use for the same purpose diminishes with time. However, as medical knowledge is dynamic and expansive, it is expected that there will be always a need for such consultation, with an improvisation on the quality of knowledge sharing.

Expansion of Network

In the year 2003 the network was expanded to include a few more hospitals, including referral centers at NRS Medical College and Hospital in Kolkata, Chittaranjan Cancer Hospital, Kolkata,  Bardhaman Medical College and Hospital, Burdwan, and North Bengal Medical College and Hospital at Siliguri. The nodal centers were set up at district hospitals in Darjeeling, Purulia, Suri, Medinipur and Baharampur. This time we made several changes in our system as it used relatively higher data rates of 512 Kbps from the West Bengal State Wide Area Network (WEBSWAN) of the Govt. of West Bengal, which run on fiber optic links owned by BSNL. Some centers were also connected through ISDN links. The system was also supplemented by video conferencing functioning independently over the same link. The formal inauguration of the services took place on the 26^th January, 2004, by the then chief minister of West Bengal, Mr. Buddhadev Bhattacharya.

Another stage of expansion followed soon with a new version of TelemediK (TelemediK-2005) installed in 16 hospitals (including the previous hospitals) across the state. In TelemediK-2005 we removed the distinction of referral and nodal centers, and made provisions of multi-referencing of a patient. During the project period a number of patients (about 3000 patients in six years) were treated from remote ends using this infrastructure. In particular, there were regular referral cases from Purulia, Baharampur and Raiganj. However, the usage was largely dependent on individual doctor’s enthusiasm and dedication. Many of the centers remained practically defunct since their inception. In spite of our repeated urge and suggestions on increasing the awareness of patients and doctors about the infrastructure, we failed to enthuse the officials of health department and local administrators for integrating the systems in their environment.  We visited some of the centers and met the doctors to discuss their problems on using the system. We conducted a few workshops and conferences with demonstration of the system. A few meetings were also held in the Department of Health and Family Welfare in Kolkata for planning and coordination.  However, they were not enough to overcome the inertia of the physicians for using the system. At one point, WECS wanted to make awareness campaign locally with hoardings and posters for drawing attention of people. Even the content of the advertisements were also provided for the approval of the Health secretary. For reasons unknown to us, the approval never came. Naturally as soon as project periods were over and systems were handed over to the State Government for their maintenance and sustenance, the telemedicine services were stopped. Even the active centers like Baharampur and Purulia stopped functioning due to lack of proper maintenance, planning and coordination from the Department. Presently, those infrastructures still exist in some of those hospitals, but they remain largely unutilized. Ironically, due to its operation during the project period, Govt. of West Bengal bagged the “National award for exemplary implementation of E-Governance initiative – 2004 on Telemedicine Project in West Bengal”.

Telemedicine in Tripura: A different experience

Our work in the hospitals of West Bengal drew attention of other state governments.  In particular, the Government of Tripura showed interests in its deployment throughout the state. They were encouraged by the then undersecretary of DIT for putting forward a proposal in this regard. So in the summer of 2004 we went to Agartala and discussed a proposal with Mr. S.K. Ray, at that time the Secretary of the Govt. of Tripura for Health and Family Welfare. He was also the secretary for the Department of IT of the state. He had given us the options of connecting either district hospitals (DH) or sub-divisional hospitals (SDH) to two tertiary hospitals in Agartala, namely GB Pant Hospital (presently it is also a medical college) and the Indira Gandhi hospital, which handles child birth and gynecological diseases. In Tripura SDHs are not so equipped and they fall in the category of Primary Health Centers (PHC). From our experiences of West Bengal, we opted for connecting PHCs, as we felt they have more needs for availing telemedicine services. The district headquarters have better infrastructural support with digital connectivity through Tripura’s SWAN.  For initiating a pilot program, DHs would have been convenient for us for a speedy implementation. On the other hand, many subdivisions were situated at places, where physical transportation itself through hilly terrains and bad road conditions was a nightmare. The problem got aggravated due to insurgency problem in the state reigning at that time.  No one was ready to move without the security cover provided by the state. At places, even a distance of 50 Km. would take about 4 hours to pass through in those days. Apart from poor communication infrastructure, they also lacked several civic amenities. However, we took the challenge of setting up the centers in subdivisions instead of district headquarters, as we needed no new proof of concepts of our technology. We were eager to see its usage in health care services. The decision proved to be crucial for the success of the telemedicine in this state, a very different experience from what we had in the state of West Bengal.

In Tripura, four of the five proposed centers (at Amarpur, Gandachhara, Kanchanpur and Chailengta subdivisions) started functioning within a year of the sanctioning of the project. The network was inaugurated by the Health and Family Welfare Minister of the state on 9^th June, 2005. We must mention about two persons, who played vital role in the speedy deployment of this network.   Mr. Rajat Bhattacharya, the then Asst. Executive Engineer of the Department of Health and Family Welfare, Govt. of Tripura, took all the trouble and care for providing logistic support from the Govt. of Tripura in identifying the centers, allocating space, arranging escorts and transportation to remote interior places of the state, etc.   The other person is Dr. J.N. Maiti, the Director of WECS. He with his dedicated team of young engineers, who braved all odds in installation and training of the system, supervised and monitored the execution with passion and diligence. From the very beginning the doctors at the SDHs and PHCs  took the telemedicine services for consulting with specialists of  two hospitals at Agartala. The local populace also enthusiastically welcomed the facility and put pressure on hospital administration, if the system remained non-operational due to failure of links or machines. With the increasing use of tele-consultation the Govt. of Tripura requested for more deployment and the DIT supported expansion of the network in three stages connecting 11 SDHs  / PHCs with their two resource centers. About 14400 patients were treated in five years (from June, 2005 to October, 2010) using this network. It is heartening to see that every year the number of patients treated through telemedicine is increasing. Presently from these centers over 4000 patients per year are getting the benefit of this technology. The State Government is also proactive in the sustenance of the services. After the completion of the project period, the state government took special initiative for arranging funds for maintenance of the systems and supporting trained manpower to the telemedicine centers.

iMediK: Telemedicine over internet

TelemediK was developed as a peer to peer application. Though it was designed as an internet server, individual hospitals would require hosting this server for communicating with their peers. From this model, we moved to a more cost effective centralized server based system, which would be able to cater services to its clients over the internet (or intranet following standard application layer protocols).  We named the telemedicine server iMediK, which processes clients’ requests in a four layered architecture providing much needed security to patient data from their unauthorized access. The centralized server based system reduces the cost of installation to a great extent.  The client end does not require any special application software other than an internet browser. Similarly, the cost of communication link was also brought down, as it does away with the need for a dedicated link for data transfer.  In the four layered architecture, a request is handled through a proxy server, which initiates a succession of internal sessions for accessing the data from data base, processing it and presenting it to the user in the form of a HTTP response. This methodology of data access prohibits their direct access and allows only controlled access through query processing at the business logic layer, which sits atop the database layer. The presentation layer on the other hand isolates the process of data formatting and has the flexibility of supporting client specific modules for presenting the result of a query.  For example, we made separate modules of presentation for processing requests from clients of desktops, PDAs and mobile phones, while all of them use the same set of functions of business logic layer, which is immediately below the presentation layer in our architecture.

iMediK was installed in Medical College and Hospital, Kolkata in the year 2008. It has special modules for treating pediatric patients of HIV and drug resistant tuberculosis. iMediK also has an improved user interface, where a doctor could get the summary of patients’ record relevant to the diagnosis and treatment of a disease. The summary page is customizable and different for different diseases. It has also features of tracking patients’ visits, and presenting temporal trend of any measurable attribute through graphs and tables. HIV pediatric module also has a decision support system for drug administration and patient follow-up. Around 530 patients were treated from April 2008 to October 2009 using iMediK. During this period mostly patients were referred from the Raiganj SDH.

m-Medicine

The term m-Medicine is coined against telemedicine over mobile devices. Our research group is one of the few, who explored the development of this technology in mobile platforms at a very early stage.  The TelemediK system was integrated with applications developed on WinCE based Pocket-PCs. Through these applications a user could enter patients’ data from a hand held device and also browse them, which may be available in the form of graphics, images, audio-clips, text and structured text. In our design we took care of constraints imposed by the limited memory space and small display screen of the device. For displaying medical forms, an intelligent text fragmentation algorithm was developed. The technique adapts the number of fields to be displayed in a single view by accessing the data related to screen size and resolution of the client device from HTTP request header. Further, fields are also displayed in order of their relevance, determined a priori. The relevance map is generated through a statistical analysis of number of occurrences of key-words of related documents fetched from internet using a crawler. Moreover, we have also used abbreviations for text compression and assigned color codes to highlight the normal or abnormal ranges of values. A large image is displayed using an adaptive partitioning scheme and by showing the position of a partition with reference to its thumbnail. We have also developed an interactive downloading scheme for browsing images through selection of the region of interest with varying level of compression.

While integrating with iMediK, we changed the design paradigm. Previously our approach was to develop client applications in mobile devices, which directly interact with patient databases. However, due to the security measures imposed through four layer architecture of iMediK, this direct interaction is prohibited. Moreover the advancement in mobile computing and technology makes it possible to work with the new generation of devices, which support internet browsing on LAN and WAN. In iMediK we moved all the related computation of data formatting and image partitioning to the server, in its presentation layer. This also increases the portability of the system.  Like desktop computing, in this case also, we do not require any specific client installation. This is the technology we used in integrating decision support system and other modules for treating HIV pediatric patients with mobile devices. It got recognition from the World Health Organization (WHO) as one of the innovative technologies in their report entitled “Compendium of new and emerging technologies that address global health concerns 2011”.

New directions

It has been more than a decade that we are involved in the research and development of telemedicine systems. We are grateful to the DIT, Govt. of India, for their patronage and constant encouragements in our endeavor. We started with the design of telemedicine system in peer to peer network architecture and moved to a centralized server based system. We also considered other architectures of distributed systems, where a combination of nodal and centralized servers share the task of handling local and referral patients, respectively. Another interesting variation of peer to peer model is a hierarchical-referencing model, which is usually practiced in Government hospitals for patient referrals. For example, a patient from a block primary health center (BPHC) is referred to an SDH or a DH, whereas from a DH doctors refer to tertiary hospitals only. We carried out testing and performance analysis of such systems in a simulated environment. Their large scale deployment, however, requires planning at the central or state level.  We hope to see such planning and deployment of this technology in the public health care system. Our experiences from the state of Tripura show that rural population of our country could immensely be benefitted from telemedicine, as it brings the quality health care at their door steps.

08/09/11

The Head Teacher

We addressed him ‘Master-mashai’, sometimes qualifying it by adding the word ‘Head’ before. ‘Mashai’ is a colloquial abbreviation of the Bengali word ‘Mahashay’, used for addressing a person respectfully, closer to the use of ‘Sir’ in English. Usually in village areas we used to address our male teachers as ‘Master-mashai’ and a woman teacher as ‘Didimani’.  I think in many of our villages, still some people use these addresses, though it is common now-a-days to address our teachers as ‘Sir’ or ‘Mam’ (Madam).  Our Master-mashai was also the head teacher of a primary school. My mother newly joined as a ‘Didimani’ of that school then. It was in the year 1971. I was a kid of eight years old, and was about to repeat a year in my third grade for failing in Mathematics twice, both in my half-yearly and annual examinations.  I was reading then in another school of our town. As a kid, I had little idea how serious the matter was. But it must have been very tormenting for me even at that stage, as I still have the visual memory of those red-inked letters on my mark-sheets, in one of which the number 19 was written, and in the other a little improvement with 25. The qualifying mark was 30.  From my school, my parents were advised to make a prayer to the school administration for my promotion. In stead, they decided to keep me in the third grade itself. It must have been a very painful decision for them too. Just a year before, they were proud parents of their son, who stood first in the final examination of his second grade. One day in the last week of December of that year, my father announced it to me with a happy smile. I naively asked him, “What does the first boy mean?” He laughed and presented me two badminton rackets with a plastic cork, “Play with your brother.” Both my brother and I were so excited with those bats, that without bothering for any further explanation we rushed to our playground. Incidentally, that was also my first year in a school, where I was given a direct admission to the second grade.  Initially, my parents thought about putting me to the first grade. However, after going through my performance in the admission test the teachers there advised my father to get me admitted into the second grade.  So when I failed to clear Mathematics in my third grade, they might have thought that the early advancement of a year of study was taking a toll on me, and decided to keep me in the third grade for one more year.  

Before her marriage, my mother was a teacher in a nursery school. She had gone through the Basic training, a year-long education program of Government for nurturing primary school teachers. After her marriage too, she was teaching for a few months. Then my father got a transfer, and they came to the town of our present dwelling.  Mother had to leave her job, and she could not get any, until she received an appointment as a primary teacher in the village school, I was talking about. On the very first day of her service, she took me with her to the school. The village was at a distance of about five kilometers from our residence. There was no public communication for going there. Its nearest railway station then, was the railway station of my town. That was also about three kilometers from it. We needed to cross the railway station on our way to the village. The path from the railway station to the village was non-metal. A considerable portion of it ran through paddy fields.  During rainy season it would become so treacherously muddy and slippery, that even the cycling and walking were difficult. So in a good weather, the comfortable option was to travel by a rickshaw, and in any season the other feasible option was the long tire-some walking.  My mother mostly preferred the latter, as the first one, even if available, was not sustainable by her paltry salary.  Today I cannot remember, whether we enjoyed a rickshaw ride on our very first journey to her school.

The Head Teacher of the school was waiting for us. He was then in his fifties, of medium height, with a head-full of curly hairs, lean and stout, wearing a Dhuti (a typical dress for a Bengali gentleman consisting of a piece of robe, worn in a specific style covering the lower part of the body), and a Fatua (a long and loose shirt without any collar and with a full covering of both hands), and having spectacles on his face.  He welcomed us and introduced to his only colleague there – a very old person, who must have crossed seventies by then, but was still in the service. My mother became the third teacher of the school. The Head Master-mashai called me, “Babu (The little master)! Come here. What is your name?”

 On my mother’s prodding I touched his feet for his blessings (a common gesture for showing respect to elders) and told my name. Then he asked, “In which school do you read?”

I told my school’s name. The next question was too embarrassing for me. He asked, “Which class (grade)?”

 I remained silent and was hesitating how to explain him about my state of academic misfortune. My mother replied, “He was supposed to be in the class four. But he failed in Maths. That’s why we decided to keep him in three (third grade) again.”

 He stared at me. I could see from his expression that I did not satisfy his expectation, and was repenting on the fact that I came with my mother to this place. The Head Master-mashai commented, “But he looks so bright! What is his problem?”

“Oh! He could not do a single sum correctly,” mother replied dejectedly.

“They were big numbers, and too many of them!” I tried to defend my inability by asking for a little more humane consideration on the difficulties of handling large numbers.

Master-mashai told me, “Is it so? I always thought there is a fun in adding numbers. Let me see how you perform.” 

He gave me to add a few four digit numbers on a slate. I like an obedient student, engaged myself on that fearsome job, and was careful enough to run my fingers several times on my palm to keep track of serial accumulation of numbers in my computational steps. Master-mashai snatched the slate from my hand, “What are you doing?”

I was surprised and also apprehensive whether I made any heinous crime of committing an error in between.

“Why are you counting your fingers? That is the stupidest thing to do in adding or subtracting numbers,” he exclaimed.

I kept mum, as it was what I learnt for doing a summation. He continued, “Do it mentally. There won’t be any error.”

Then he started asking me the sum of a pair of numbers, the last one being a single digit, and I had to respond fast to each of his queries. I felt at ease, as there was not a single mistake in my instant responses. Finally, he told my mother, “Let him study in my school. Why should he lose a year? I can guarantee you that he would get a scholarship in the class four board examination.”  

In our time we used to have a board examination in grade four for each district. From each district, a few top rankers of this examination were used to be awarded with a scholarship (or Britti in Bengali) from the Government. That is why this examination was called the Britti Pariksha.  It was a matter of pride for the teachers of a primary school, if any of its students gets this scholarship. During the rule of the left front, in early eighties this school board examination was abolished, and the tradition of a competing atmosphere among the schools for showing good performances in the board examination was also lost. 

My parents were initially hesitant and a bit reluctant to accept Master-mashai’s suggestion. First, my age was relatively young compared to the grade I was studying. They were considering whether it was prudent to allow me to continue further. Next, the village school had a very poor infrastructure compared to the town school, I was studying then. My mother’s new school had only one large hall under a tiled roof, with a few partitions to segregate classes for students. Its foundation was of brick, but a part of it was still built with mud and bamboo sticks. There were no separate entries from the outside for each partition, where classes were held.  For attending any class, one had to get inside using one of the two doors of the hall-room and move to a specific class.  As a result, the humming and uttering of students and the teacher of a class were clearly audible by all others present in the school. There were effectively two teachers, including my mother, for all the students in the school starting from grade one to grade four. The old Master-mashai was about to retire, and he had been given partial responsibility to teach only students of grade one, who used to sit on the floor to take lessons from their teachers.  Other than grade one, each class was equipped with a few benches, a table for the teacher, and a black board. The school in my town was run by a Hindu religious organization with strict adherence to discipline and punctuality. We used to get a number of teachers according to subjects even in the lower grades. We had separate class rooms and, the school building was being newly renovated and expanded that time. But, the most worrying factor for my parents was the distance of the village from my home. They were concerned whether I would be able to walk such a long distance regularly to attend the school. Still I do not know how they were persuaded by the Head Master-mashai.  Our new session in my town school was yet to start. So I was still going with my mother to her school, and used to attend classes with others. For a few days, I did maintain a state of fuzziness of my belongingness to the school, saying to my friends that I would stop coming once the session at my town school begins. After a few days, to my delight my mother informed me that they had decided to shift me from the town school to her own, and I would be studying in the fourth grade in stead of repeating a year.

Suddenly everything around me changed. I was feeling myself at the center stage of an exciting experiment, where our Head Master-mashai electrified me by his guidance and encouragement. He told me, “Do you know the story of Arjun from the Mahabharata?  While aiming his arrow at a wooden bird kept on a tree with his bow, Arjun was asked by his teacher Dronacharya, what he was able to see then. Before him, all his brothers replied to the same question differently. Some said the tree, some said branches, or some pointed the bird. Arjun replied that he was seeing the eye of the bird only and by saying he sent the arrow straight into the bird’s eye. You should also prepare in the same way for the scholarship.  I know you will be able to get it and make us proud.”  

Those were not his mere words of encouragements. He believed in my ability so much, that he proudly declared to the villagers and teachers of other schools that, that year his school was going to produce a boy with a scholarship. So I was enjoying the attention of the villagers also. I was quite naïve in my attitude towards any success or failure at that stage.  My Head Master-mashai instilled his belief in me so strongly that I never doubted that I was going to achieve what my teacher was saying.  However, my mother must have felt the pressure of meeting the expectation from her son. She often advised me, “Try your best. That is what finally matters.” She used to teach me every day, and helped me solve old question papers of the final examinations of different school boards of districts of my state.

That was the year when I started enjoying my schooling. Even walking such a long distance was a fun for me. My mother was always with me, and I used to keep her busy with all sorts of queries on the subjects and objects, which would appear on our ways. I learnt to recognize many plants, trees, flowers and birds in those sessions.  More so, I was amazed by the unfolding of beauty of nature before me, as if my text book poems were throwing their rhymes on the three dimensional canvas surrounding me. In the last part of our journey to the school, we used to cross a large field. The path curved through it mostly uncovered and unshaded. There were only a few land marks in this part in the form of a lonely thorny Babla tree (gum tree) or a fence of a single farm house.  On winter days, it was lovely to enjoy the mist and coolness of the air across the open field. During that period, in stead of treading through the non-metal road, we could use a trail winding through the empty paddy fields (called aal in Bengali), which would shorten our journey to some extent. In fact, our school building was visible, from a place very near to my home, throwing an illusion of its proximity. But it used to take more than an hour to cover that distance. The rainy season was the hardest season, and we had to follow the longest path, along the railway track, to avoid the mud. Even so, we needed to negotiate some stretches of muddy segments. Sometimes my mother tried to keep me home during this period. However, unless I was sick, I always wanted to go with her.  The most enjoyable season was the autumn. During that period, the paddy fields were at their prime, filled with different shades of green. The sun and clouds used to play their usual hide and seek game on top of them. The village life also made some impression on me, though my interaction with the villagers was brief, as I had little time to spend there.  There was a large banyan tree in front of my school. It was the signature of my school.  Even from a running train, by identifying the banyan tree, we could easily locate the building of our school. During the recess, many students used to enjoy their rides on the hanging trunks of the banyan tree. One day, some of my friends took me to a field where peas were grown. They also plucked a few of them. When we returned, some villagers complained to my mother about my presence with them. I was not sure what the nature of complaint was. But on my denial of any wrong doing, my mother got very angry with me, and she started scolding and beating me very harsh. It went on for sometimes, until the Head Master-mashai intervened. I was still in the mood of defiance without understanding what grave crime had been committed by me.

After a few weeks from the beginning of our session, preparations for participation in the annual sports event started.  All the schools in a block (an administrative area covering a number of villages and the town) were used to compete in this event. Head Master-mashai took a great interest in identifying the suitable competitors for each event. A school was entitled to send only a limited number of participants for each event. There was an in-house competition for selecting the students for representing a school in those events. I was never good at sports. Moreover I was relatively taller, and that put me in the category of seniors (among the students of primary schools) in the sports. I failed miserably in all such events, running, long jump, high jump, etc. Master-mashai told me, “Still there is one event for you. I think you can win a medal for us.” I was not sure. He suggested, “Compete in the Maths race.”  It is a funny race. In this competition, one has to run for fifty meters, add a series of four digit numbers, and then run another fifty meters to finish the race. The winner of the race is the person, who reaches earliest with the correct result of the addition. In my whole life I won medals thrice in any sporting event. All were in those years. All were from Maths races, the first one was from the sporting event, I was talking about. The next was from the event organized for a circle. A circle consists of a few blocks, and the sports meet for a circle was the next higher level, where winners from blocks could participate. The last one was from a sporting competition organized in the village of my school.

My mother used to teach me all the subjects in our home. She would have preferred to keep me away from walking to the school, unless she felt my need of having lessons in Science and Maths from the Head Master-mashai. My parents grew a great respect for him as a teacher. He was indeed great. It is not that he had dumped us with fundas, and clear explanation of everything around. He was simple in his approach. He was friendly with his students, and could point out mistakes with a smile. Hardly had he scolded anyone in the class for not doing an assignment, or not able to comprehend a topic. He tried to raise curiosity among our young minds by telling different stories.  One day while teaching us planets and stars, he told us such a story. He would start, “Let me tell you a story of creation of these planets.” Then he went on narrating, “Do you think these planets were there from the beginning of creation? That is not true. There was a time when our Sun was a lonely star. He was big, but had no planets revolving around.  One day a foreign star came near it. It had lost its direction, and ways.  It became quite close to the Sun. Now these large bodies are able to pull each other. So they raised a fight. Each one tried to draw the other towards it.  The Sun is very hot, and its matter is made of gases. So the pull from the foreign star could tear many of its portions. Those portions went toward the star, but could not overcome the pull of the Sun. So these gaseous pieces started revolving around it. In the mean time, the foreign star also went far away. Those smaller pieces after cooling became planets. Our Earth is also one of them.” I understand this is far from our modern scientific explanation of creation. But it was good enough to confront us against our beliefs on stories of creation from mythology.

The year was also marked by the year of Bangladesh’s war of liberation. That time the country was called ‘East Pakistan’. After the event of March 26, we were closely following what was going on in that country. That evening my father came grim faced from his office, and told my mother about the brutality of the Government of Pakistan against the Bengalis. Then came the stories of sufferings and sorrows of refugees from the other side of Bengal, who took shelter in this part. Soon the guerilla fight started, and even as a kid, I was keenly following the news broadcast from radios, and also the reports of newspapers. The talk of liberation of East Pakistan was every where. Every night we used to listen to a special radio channel, which broadcast Sheikh Mujibur Rahaman’s famous speech. We had almost memorized it. A part of it even plays in my mind with his distinct thunderous melody, “ ….Our fight is the fight for liberation!  Our struggle is the struggle for independence. None of you can crush us! …”  Some of my friends could recite the full speech mimicking his voice.  Around that time the slogan, “Jai Bangla! (Victory to Bengal!)”, became so popular that people attributed it to every holy or unholy thing, which made a guest appearance in that year. We had “Jai Bangla” Saris (Dresses for Indian Women), “Jai Bangla” shirts, caps, rings – even that year the common eye disease conjunctivitis widely spread in different parts of our state. People named it “Jai Bangla”. I was also not left out from its blessings. For two or three days, I was kept inside with my swollen red eyes.  I also had personal experiences of watching refugee camps in a border town, where my grand parents (from my mother’s side) lived. We had no doubt about the victory of the liberation war. For us kids, then the adult world was painted with black and white only. There were either good fellows or bad demons, and who doesn’t know that the evil will be finally defeated? So we strongly believed that the liberation war would be won, as we also knew that America would be defeated in Vietnam. In our play time, we transformed the hide and seek game into a new form. We made it as a mock-fight between two warring parties, where one had to kill an enemy by shouting against the opponent soldier, as soon as he or she was visible. The shouting slogan was ‘Jai Bangla!’, and the name given to the game? – Naturally, ‘Jai Bangla!’

The formal war between India and Pakistan started after my final examination was over. But by that time, as far as I remember, Pakistani army was almost defeated. The local liberation army had already dealt a vital blow to them. It took only a few days to finish the war. It was a moment of glory and happiness for all of us. I have no particular memory of my examination days. I could remember that my mother used to wait to receive me after the examination. Head Master-mashai also used to visit the center and encourage us to perform well. After my examination, our days were full of excitement with the news from the war front, sensing a possible victory and the birth of a new country, which speaks a language of our own, and where my parents had their roots.   During this exciting period, Master-mashai came to our house in one afternoon, and with a radiant face he congratulated me, “You did it! I knew you would get the scholarship. You proved it. I was waiting for this day.” He was quite emotional. While returning his blessings on my respectful bow to him, he told, “Grow up and make us proud!”  I did not realize then what a tough assignment he was setting for me. The scholarship was much easier!

22.11.11