Thursday, March 16, 2017

Nowhere to go . . .

It was the festival of colors early this week. The whole country was in celebration. With our Prime Minister getting a major boost to his 'make India great again', the celebratory mood was well felt in every nook and corner of our communities. There were major things coming for the poor . . . the rich will be taken to task . . . there will be no more corruption . . . no-one will ever go hungry . . . there will be no more deprivation . . . there will be no more need for charity . . . 

I'm encouraged . . . I see a glimmer of hope for the marginalized and the poor in our communities. 

On the day of the Holi festivalI had just the sort of patient, who I feel should not exist in 2022, when the country celebrates it's 75th Independence Day. 

Mrs. A was not an unknown face. In fact, quite a many members of her family comes to us when there is a serious medical issue. In fact, it was just few weeks back that her nephew was brought to us with clinical meningitis and he made a miraculous recovery. I've known Mrs. A since the day we reached here. She was a known hypertensive and had been on irregular treatment. But, the last time we saw her was in October, when we diagnosed her to also have quite severe Ischaemic Heart Disease with some amount of cardiac failure and a bad pneumonia. 

As with the majority of our patients, she did not want to be taken to a higher centre. The maximum we could do to evaluate her was a Peripheral Smear and an ECG. Yes, not even an X-Ray. She made a miraculous recovery. 

But, she never returned for treatment. Alas, we also did not notice that she had not turned up for her regular medications. 

Her husband brought her in a miserable state sometime late morning last Monday (Holi). She was coughing with quite a lot of phlegm. Clinically, she got a bad pneumonia again which was causing quite a lot of stress on her badly damaged heart. I told the family that she needs evaluation. They told me that the maximum they could spare today was 500 INR. As usual they were not willing to take her ahead.

Over two days with some medicines to treat her lower respiratory infection and support her flailing heart, she made a miraculous recovery.

Reasons for her not coming for regular treatment for her high blood pressure and cardiac failure - they are very poor. There is one son who goes to work in the nearby town. He cannot go far as he has to look after his aged parents. There are couple of other sons who are earning a living in faraway places. They hardly come.

Now, it would be a great thing if such patients are taken care of. There are two ways to do it. The first is to ensure that the public health care system is robust.

And the other is to imagine that they don't exist. If the latter is the solution, people like me remain busy. 

Thursday, March 9, 2017

Misinformed

It's been a long time since I blogged in this one. It's almost an year since we got back to Palamu region, in a smaller place than before, where I'm much more accessible to those who could benefit from my skills.

I thought an incident which happened few days back in one of the peripheral dispensaries that I serve deserves a documentation.

At around noon, a group of villagers reached this place with an middle aged lady who apparently had a snakebite early in the morning. It was already 6 hours past. She showed no symptoms nor signs of any envenomation.

To make things easier, they had brought the snake along.


It was an easy identification. A Common Kukhri.

After the bite the patient had tingling sensation at the bite site, by which the villagers concluded that it was a venomous snake bite. A 'snake expert' in the village confirmed the same explaining that snakes with bands are poisonous and all the more colorful the snake, all the more venomous.

A 'jhad phuk' was called. He agreed to flush out the poison for a princely sum of 5000 INR, which the family readily agreed on.

So, here was a family who had already spent 5K INR and wanted me to treat her for envenomation.

I told the family that there was no symptoms and signs of envenomation, which I don't expect from a non-venomous snake. The family was absolutely sure that the snake they brought was the culprit.

I told them to throw off the dead snake into the heavily forested area nearby and go back home.

Couple of them appeared not much convinced. There was talk on taking her to another 'jhad phuk'. They carefully packed the snake into a bottle and was off for a second opinion. 

Wednesday, January 6, 2016

Sabbatical . . .

The last 100 days, I thought of taking a break from my blog . . . I hope the break is over. Part of the reason for the break was laziness.


Now, as I mull over what caused my laziness, part of the answer was that I did not seem to get a break from the routine work. Considering into fact that blogging was taking quite a lot of my time after the change in my work environment, I came to the conclusion that the first thing that I should forego was blogging.

While at NJH, my friends used to ask me when I got the time to blog. And the answer was in between the surgeries. There would not be time to go home and take a break, but there would be time to write a blog. Outpatient was not as busy with a better doctor patient ratio.

However, Kachhwa has been different. We see the same number of patients, but has a poor doctor patient ratio - which makes things different. 

So, major issues we had to grapple with over the last year at Kachhwa - 

1. Tuberculosis
2. Malaria
3. Systemic Hypertension and Diabetes
4. Care of the Elderly
5. Snakes bites which is of course coming down since winter is on . . . 

Shall write in detail about each of them . . . 

Well, the ultimate reason on why I took back to blogging. One of my friends retorted that the reason for my silence seems to be the perceptible change in environment within the country on putting across opinions and facts . . . 

As doctors, we are scientists and to voice out facts and our opinions on issues pertaining to healthcare is our mandate. Well, one could stifle them, but that would be at a heavy price . . .  

I hope I get the time to write . . .

Before I sign off, a small prayer sent to me by one of my seniors, with a small addition from my father in law -

May God bless us with discomfort at easy answers, half-truths and superficial relationships, so that we may live deep within our hearts.

May God bless us with anger at injustice, oppression and exploitation of people, so that we may work for justice, freedom and peace.

May God bless us with tears to shed for those who suffer from pain, rejection, hunger and war, so that we may reach out our hands to comfort them and turn their pain into joy. 

And may God bless us with enough foolishness to believe that we can make a difference in this world, so that we can do what others claim cannot be done, to bring justice and kindness to all our children and the poor. 

And we pray for the gift of endurance to withstand all the above, such that inner transformation will happen to us all. 

Wishing you all a blessed 2016  - - -