Dispatches

By JEFFERSON PENBERTHY/IN SURAT

Bipinchandra D. Darmar, professor of medicine at Surat's medical college, was a worried man when he sat down to breakfast one morning last month with his wife Indira, a pediatrician. The previous evening, two patients had died at the 800-bed New Civil Hospital where the couple work, and Parmar did not understand why. Two young men from the city slums had developed bilateral lung infections and died anguished deaths -- fevered, coughing blood, rolling and clawing at oxygen masks as acute apnea robbed them of breath. Standard cardiorespiratory treatment had proved futile. As he was discussing the cases, Parmar's attention was caught by the Times of India: It reported an outbreak of bubonic plague in the neighboring western state of Maharashtra. Parmar went cold. "Oh, my God," he said to his wife. "This may be it."

Hurrying to the New Civil Hospital, where he heads the department of medicine, Parmar, 44, gave his staff two urgent instructions: Read the literature on the age-old scourge, and start treating every lung patient for pneumonic plague, the secondary but most infectious form of the disease. By , that afternoon a third sufferer was responding to antibiotics, strengthening Parmar's suspicions. With the hospital's superintendent, he began warning health officials that an exceedingly dangerous epidemic was about to break in Surat, home to 2 million and known as "the dirtiest city in India." Authorities in far-away New Delhi were cool to the alarm raised by the provincial physicians; thus no one was prepared for the nightmare that engulfed Surat that evening.

Around 8:30 p.m., hundreds of people from the Ved Road and Katargam slums began descending on the hospital, carrying distressed victims into the dingy wards. "The atmosphere was terrible," says Parmar. "Relatives were pushing, wailing and grieving while patients rolled in agony, facing impending death." Nine died within hours of admission, yet many were saved. "Without Dr. Parmar's warning, many, many more people would have died here that night," says physician Jayesh Solanki. "At least we knew how to begin treatment." It was fortunate that Parmar's New Civil Hospital had been forewarned, because it took the brunt of the cases. Ashoktashram Hospital reported 10 dead; Mahavir and Surat General, three each.

Next day no one could prevent the panic that swept Surat. Almost half a million residents fled, incited, Parmar alleges, by the cowardice of the scores of private doctors and paramedics who led the exodus. "When the people see their doctors run away, how can you expect them not to be frightened?" he asks. Parmar and his staff stayed on; seven doctors and four nurses would become infected. In the first horror, 110 patients also fled the hospital's death wards, creating the risk of an epidemiological explosion. Ultimately, 52 people died. Though Surat was recovering last week, Parmar -- after 16 days of duty -- was still at the hospital. "Two more deaths," he said wearily, scanning a daily report. "Sputum tests positive."