The boy longed for . . . and the unwanted girl(s)

Yesterday, there was the news about an unfortunate incident in Afghanistan in which a woman strangled her daughter-in-law to death for giving birth to a third daughter. 

At NJH, it is quite common to be reminded about the preference for girls . . . 

3 instances . . . 

The first one, PD, the mother of four girls was brought last Friday afternoon - unconscious and frothing, almost at the edge . . .  The fact that there were 4 little girls at home waiting for their mother to come back home made our doctor on duty to try the best to save her life. PD had a blood pressure of 200/120 and Urine albumin was 4+. The baby was already dead. And there was no indication of her delivering normally for the next 12 hours. 

Dr Johnson made a decision to deliver the dead baby by surgery. She was already intubated and being mechanically ventilated. The surgery was uneventful - but PD could just not be weaned off the ventilator. Over the last 2 days, she has also gone into renal failure. . . I've discussed with the relatives that we shall keep her in the ventilator for another 24 hours. . .  Kindly pray that PD will make a miraculous recovery. 

The family had been wanting a boy - the reason for PD getting into the present state. And the dead baby was a boy. . . It is unthinkable for 4 little girls to grow up without their mom. . . 

The second one is KD. KD was in her second pregnancy. KD's last baby was born 5 years back. In spite of being only 2.5 kgs, the baby was born by an instrumental delivery. The second baby looked bigger - but then she had an ultrasound which showed that the baby was smaller. But, clinically, the baby looked big. . . 

I explained to the relatives that she could end up with a Cesarian section. The relatives were begging me to somehow ensure that KD delivers normally. We have seen quite a lot of our antenatal patients who beg us to somehow ensure a normal delivery end up with having a girl baby. 

I'm not sure whether it is my prejudice - but I've a gut feeling that most of such families are quite sure that they have a girl child. And, I'm sure that there are many an ultrasound facility to give the sex of the baby to the family. (It is illegal to divulge the sex of the baby in India as quite a lot of girl children are aborted off)

And I've seen the vice versa happening too - families agreeing for Cesarian section at the drop of a hat and even taking all possible efforts to salvage a boy baby who is born moribund sick. 

Now, I've one more lady in the labour room. SA, a primi with nephrolithiasis, severe hydronephrosis and chronic urinary tract infection - we've been advising the family from the very beginning to have her delivery at a tertiary or teaching hospital in Ranchi. The advice has fallen to deaf ears and they want to do the delivery here.  

She came to outpatient today with post dates. And her blood pressure is on the higher side. I made one more effort to convince the family to take SA to Ranchi for the delivery. I've quite sure that they've discovered that the baby is a girl . . . Maybe, I'm wrong . . .  I shall let you know when the delivery happens within the next couple of days. . . 


Well, this line was put in much later . . . What happened with SA? It was hilarious. . . 

Tuberculosis . . . continuing to ravage . . . and helped on . . .

Over the last couple of weeks we've had reports of a new form of tuberculosis which the government refuted within a surprisingly short interval.

Today morning, in OPD, I had three new patients who were all partially treated tuberculosis. All very similar histories which found common ground in an article I read recently. I'm not very sure on whether their sputums will yield acid fast bacilli as almost all of them had been on some form of tuberculosis treatment. And none of them have had any trace of government medicines in them . . .

Well, tuberculosis is not an uncommon diagnosis in NJH. In fact, we are a tuberculosis unit which cater to one third of the district. Today and tomorrow, our Medical Officer is on a training course of diagnosis and management of Multidrug Resistant Tuberculosis. 

The patient I wanted to tell about is TT, a 17 year old young man admitted into our ward. We diagnosed TT to have miliary tuberculosis on the basis of his symptoms and Chest X-Ray. But TT was already on treatment for Tuberculosis from a private practitioner. He was put on a sub-optimal dosage of a combination therapy of Rifampicin, Ethambutol and Isoniazid. No Pyrazinamide . . . 

But, what interested me more was the number of other medicines which TT was on. I've tried to take a photograph of all the medicines put together. 4 of the medicines are multivitamins which totally cost about 30 rupees per day. Then, there is a cough syrup. One strip is Diethylcarbamazine . . . and then he has been on regular daily intravenous injection of Amoxyciline and clavulanic acid as well as on a combination of oral Ampicillin and Cloxacillin. 

It is unfortunate. There has much written on unethical and spurious medical prescriptions written by quite a lot of our fellow practitioners. It is not uncommon to see even well qualified and well known doctors write so lengthy prescriptions. Of course, there is a lot of money to be made. But, the ultimate question is about the cost poor people like TT or the other 3 patients whom I had seen in outpatient today pay? ? ? 

Unfortunate . . . and disturbing . . .

I received a letter from the school where my son studies. Below is a scanned copy of the letter. 

And later, we had newspaper reports of the unfortunate incident. 

The concerned person has already made a statement about his not having made any statement or put up a performance as alleged. 

Now, this is a matter of grave concern. It is not quite uncommon that politicians and public servants turn their ire at private and mission institutions especially in the areas of healthcare and education.

I've also had similar situations when small time government functionaries have come and threatened me with dire consequences if I do not heed to their demands. Most of the time, nothing much has happened. 

Once, I remember asking a village elected representative on why they did not attempt to do the same with government facilities. You go to a government healthcare facility and do not find a doctor - they hardly make a wimp and accept it as normal. When there are umpteen number of government schools, almost all these fellows would rather send their children to a convent school or a high end private school rather than demand better facilities in the government run facilities. . . 

Is it because, private institutions such as these are soft targets . . .  Well, so much can be written about this incident, which I do not intend to do since the matter is now subjudice. 

I shall be much obliged if you could facilitate spreading of news of such sad events in well run institutions like the Sacred Heart School, Daltonganj . . . I had searched the national media for this news item - but I did not find anything . . .  I'm sure that this sort of incident is not appropriate to have happened at behest of a member of the legislative assembly . . . 

Poverty . . . And Malnutrition . . .

Well, this is the story which I had told about writing in one of my earlier blogs. This post, similiar to the previous post is about food. 

DR’s life has been full with sufferings. Born with multiple deformities of the upper and lower limbs, he was an outcast within the family. Seen as a burden, many thought that he would not live long.

DR lived on. In fact, he could walk after he got discharged. . . 

It was over the last 2 months that he felt a vague sensation over the abdomen with episodes of pain in between. DR came about a week back with one of the acute episodes of abdominal pain which he had been having of late. On cursory examination, it was evident that DR had severe anemia with quite massive hepatosplenomegaly.

Hemoglobin was 2 gm% and peripheral smear showed severe microcytic hypochromic anemia. The total count was only 1500 with a normal differential count and there was total decrease in all blood cell components. There was no evidence of any infection. The next thing we should have done was a bone marrow. 

We're yet to start any bone marrow aspiration cytology. I'm sure my better half would be yearning much to start it off. . . 

So, I gave them the option of a referral to Ranchi.  The answer was one of the most terrible ones I've heard in my life. The boy's uncle replied, 'Sir, we find it difficult to feed him something. Somehow, we brought him here seeing his pain. None of us have any resources to take this boy any further than here.' 

That dialogue sent my grey cells into action. I caught hold of DR and asked him sometime later in the day about his food habits. Nobody was interested in feeding him within his own home. He got to eat some rice twice a day. There are days when he spends the day without anything. Some tea shop owners give him a biscuit or two on and off. 

Vegetables - he remembers eating some okra couple of years back and once or twice a month, he gets to eat some leftover potato curry from eateries in his village. 

Well, I wondered whether he was suffering from a very severe nutritional anemia. There were features of most of the vitamin deficiencies on his body. We somehow got decent meals for DR to have during his stay in hospital. 

He could still have an malignant infiltration of his bone marrow resulting in the pancytopenia. He left for home yesterday. He was quite cheerful by the time he left. I hope he gets something to eat after he reaches home. I wait for February 13 when I've called him back. I hope to see him better. 

The second incident happened today afternoon. I was called to the emergency sometime today late afternoon to see a baby who was quite sick. As I reached emergency, my theatre staff had already intubated the hapless little one. They were sucking out food material from the trachea. 

Little MD had a seizure sometime early afternoon and was taken to local practitioners before she was brought to us. Her body was so emaciated that I thought that she looked quite immunocompromised. 

MD was hardly breathing. And there was quite a lot of aspiration. After aspirating as much as we could, we started her on mechanical ventilation. The dire need of a pediatric ventilator stared at us. 

As I sat to write the chart, I had the shock of my life to see that MD was nearing 3 years and her weight was only 4.5 kilograms. Then the story came out. 

MD's father is presumed dead since the last 2 months. The mother has been bringing up 5 children of which MD was the second last. MD's father even when he was around could not provide enough for the family. MD being a girl was the worst sufferer. The other 4 were boys. One year back MD had fallen severely sick and had taken treatment at NJH. She had recovered well and gone home. 

The family was at the mercy of relatives for their food. The mother went to earn on and off. 

It was a terrible story. . . Difficult to even believe that in this age of iPads and Medical Tourism . . . However, we have enough statistics to show that we have the worst malnutrition status in the world . . . Stories like that of MK and MD makes us think whether the realities are much worse than the data. . . 

MD's little lung could not hold the stress of the mechanical ventilation. Her heart stopped beating after about 4 hours. . . I just returned after declaring her dead . . . Cause of death: Probable meningitis or tetanus resulting in aspiration pneumonia and severe malnutrition . . . Maybe, I should have written only severe malnutrition . . . It could have caused a stir in the government circles . . . Hunger death . . . Something, which nobody wants to acknowledge that we have . . .

Well, before I end this post, just wanted to share a paradox about DR. DR's first name actually stood for the Hindi of 'wealth'. Maybe his poor parents thought that naming him 'wealth' may bring him some luck . . . Unfortunately, that was not how it has turned out to be for DR who is at the mercy of his villagers for at least a meal a day . . . 

Cakes . . . good one . . .

I've been quite encouraged by the response by my earlier post on baking cakes... It was quite funny that people are more interested in such things than the other things I write . . .

Couple of days back, we thought about making a different type of chocolate cake. My better half did not like it much, but both the kids have given the thumbs up. In fact, my daughter ate 3 pieces at one go as soon as it was baked. . .  It is bit bitter, but will be loved by people who like the bitter chocolate taste . . . 

Well, we shall call it the coffee chocolate cake. . . Here's a snap of what it looked like at the end. It looks like it got burnt. It isn't. It is just a very dark chocolate cake. . .  

For a 9 inch pan - 

Refined flour (maida): 1^1/4 cup

Cocoa powder: 200 gms

Milk: ^3/4 cup

Sugar: 1^1/4 cup

Egg: 2

Butter: 250 gms

Baking powder: 1 teaspoon

Baking soda: ^1/2 teaspoon

Vanilla essence: ^1/2 teaspoon

Coffee powder: 1 tablespoon

Preparation Time: 30 minutes

Baking Time: 40-50 minutes

Preparation:

1.   Separate the yolk and white of the egg. Keep the yolk aside. Fluff up the white of the egg with an egg beater.

2.   Sieve the flour and add baking powder, baking soda, cocoa powder to the same.

3.   Mix the sugar and the butter well. We usually powder the sugar before mixing.

5.   Add the yolk of the egg to the sugar-butter batter.

6.   Add the coffee powder to the batter.

7.  Incorporate the flour mixture gradually into the batter alternating with the milk. The batter should look a bit thick.

8.   At last, fold the fluffed up egg whites to the batter. Do not use a cake mixer for it. Take a spoon and just fold it into the cake batter.

9.   Don’t keep the batter outside for long. Bake as soon as possible at 160 degree Celsius (about 300 degree Fahrenheit) for about 40 to 50 minutes. Ensure that the cake is well cooled before you attempt to cut.

Praise and Prayer Bulletin . . .

1. There have been quite a lot of patients who have been healed over the last week. SD1, SD2 and MD who have made good recovery. Both RR and RK, who came with burns have made remarkable recoveries. We’ve also had couple of more eclampsia patients and a young girl with Aluminium Phosphide poisoning who have all recovered. We thank the Lord.

2. We thank the Lord for babies. There have quite a few new arrivals at NJH since the last 3 months which will stretch on for the next 3 months too. We thank the Lord for new arrivals in the families of Dr Johnson and Dr Kumudh, Mr. Immanuel and lastly Mr Malay and Mrs Prabhavathy who had their second child today. We have 3 more expected new arrivals for the next 3 months – the families being Mr and Mrs Manohar, Mr and Mrs John Jeyachandran and the last one being ours.

3. There has been quite an improvement in our patient load after a serious lull in the outpatient and inpatient statistics in December. Kindly pray that the confidence that people have in our services will continue its’ upward trend. Most of our patients look at us as a last resort. We pray that we would be the first point of contact for healthcare in our block.

4. The violence in the region has increased. Last week, there was a major attack on the security forces in the nearby Garhwa district where 13 were killed. Kindly pray for lasting peace.

5. There was a criminal case which was filed against the hospital 2 years back. We’ve had a respite from the police as the case has been dismissed after we gave a representation to the police authorities.

6. There are initial reports of our being accredited for Rashtriya Swasthya Bima Yojana (RSBY) programme. We had someone from the insurance agency coming for inspection yesterday. Please do pray that the staff would receive it positively and would support the smooth implementation of the programme. Also pray that the Janani Suraksha Programme would also be restarted at NJH by the government. Both the programmes give quite a lot of relief in healthcare to the poor.

7. The electricity woes of the region remain. However, last week, we came to know that new young sincere officer has taken over charge of our region. Kindly pray that he would facilitate regular electricity supply. A transformer exclusively for our campus has been a longstanding need. We had raised it up many a time. Please do pray that this would be a reality soon.

8. Our burns unit construction is going on quite well. We thank the Lord for the donors. We however need another 2,300,000 Indian Rupees to complete the building and run the programme.

9. We are planning to streamline the supply of water within our campus. The present system is very hap hazardous. There have been initial discussions with like minded organizations and we hope that we would be able to make some progress.

10. We’ve had a number of sick patients in the ward who require portable X-Ray and the poor power supply has necessitated that we have a 100 mA X-Ray machine too, in addition to the present 300 mA machine. The cost of purchase of a new machine is about 250,000 Indian Rupees.

11. The poor power supply requires us to purchase one more generator. This would cost us about 350,000. Kindly pray for the necessary resources.

12. There are a few new staff joining us over the next one week. Kindly pray that the Lord would lead them into being effective leaders who would contribute towards the building of the Lord’s Kingdom in this region.

13. Malnutrition along with severe poverty has been something which has been staring at our face, ever more over the last year. The cold has only made matters worse. Kindly continue to pray that we would continue to be a beacon of hope for the poor and marginalized  and our actions would reflect the love of Christ.

14. Communications (telephone, mobile and internet) have been a major challenge in the region. Kindly pray that we would have fruits of the endeavors which we take.

15. We thank the Lord for quite a lot of visitors who would be in NJH over the next 2 months. Prominent among them are Gerald and Wendy Cowles, who have been facilitating neonatal care in EHA units. Grace Babies, the organization they head pioneered the neonatal unit at NJH. 

TALES OF 3 PREGNANCIES . . . LIVES OF MISERY AND SUFFERING . . .

Over the last 3 days, we’ve had 3 pregnancies – in almost all of them the mother could have died . . . But, they were all lucky and as always, there are lessons to learn – almost all of them with simple solutions.

3 days back, we had a lady with rupture uterus. SD1, aged about 25 years, was in her 4^th pregnancy. And she had just one live child – a girl aged 6 years.

Her first child was born at home and had died after couple of days – this was 8 years ago. The verbal autopsy was indicative of birth asphyxia.

Second child was born at home – and she was the only child who was alive.

The third child was born at a private clinic, but the child was dead by the time they reached the health centre.

The pains started from the night. 4 am she went to a private clinic in Japla who referred her to the nearest district hospital where she was kept for about 2 hours before she was sent to NJH.

On arrival, our duty doctor, Dr Shishir was sure that the uterus had definitely ruptured and it could be a surgeon’s nightmare. He suspected bladder rupture too.

The surgery was uneventful. SD1 is making a slow recovery.

The saddest part was that SD1 took quite a lot of time going from one centre to the other because of poor roads and transportation.

Then, there was SD2, 32 years old who came with her 8^th pregnancy. Her first 4 children were alive. Then she had 3 deliveries where the baby’s head got stuck – and all of them died during birth.

However, they had taken a decision to do a hospital delivery for the next one. They somehow got hold of an ultrasound which confirmed that the present baby was also quite a large one. It was quite surprising that they came straight to NJH without stopping anywhere.

After they reached NJH, for some reason, SD2 had a very bad episode of antepartum hemorrhage. And to post her for Cesarian Section became all the more needed.

The third one happened today. 24 year MD, who had delivered about 3 years at NJH came with a obstructed labour. The family had been trying to deliver her at home since early morning. She was not from very far – maybe about 20 kms away.

MD’s first pregnancy was also obstructed, the baby had died in utero and we had to do a craniotomy to deliver the dead baby. Maybe, the family thought that the first baby would have somehow widened the birth canal – and therefore, the second delivery should not be a major issue.

When MD reached NJH, she was already in a very sorry state. The baby had passed meconium in utero and the heart rate was dipping. I was sure that I could not assure the relatives that this baby would also make it. However, the relatives opted for surgery.

I was glad that we could deliver a healthy baby by Cesarian section, although she had aspirated some meconium.

Later, I found out that all the three ladies had received intramuscular oxytocin injections at some point of time during their labour. 

3 ladies - totaling 14 pregnancies . . . Of the 14, only 6 yielded live babies . . . And as I told earlier, all the 3 ladies could have died delivering their last babies . . . 

Well, considering the trauma all these 3 ladies had undergone during their lifetime, I wonder what you would make of the story of the young man about whom I plan to write within the next couple of days . . . 

Tragedies . . . and Painful . . .

I was on duty yesterday…Sunday….

And the morning rounds was a sad one….

We had 3 children with burns over the last 48 hours.

RR, a 3 year old boy was the first to come. It is quite common in rural India for households to cook on the floor. There is no elevated portion within the kitchen to keep the fire. Usually, there is no kitchen… A portion or corner of the house or many a times the outdoors is used for cooking.

RR’s mother was cooking rice for breakfast on a improvised stove outside the house when RR happened to tip over the boiling pot of rice and fell on it. RR ended up with about 20% burns. I could have been worse if the boiling water had fallen over him while the pot tipped over.

The second patient was RK, another 3 year old who had a history very similar t RR. This time the offending item was boiling milk rather than rice. RK’s father owned a tea shop in front of his shop.

The third patient was KK, a 7 year old girl whose case was a very bad one. KK’s mother was in the kitchen cooking when someone called her outside to the shop which adjoined their home. KK’s mother went to attend the customer and returned back to the kitchen. She lighted the match for the stove and the next thing she knows is that there was a big blast and the bed on which her daughter was sleeping nearby was on fire.

The blast brought her other family members rushing to the scene. Somehow, they pulled out KK from within the debris. Luckily, KK’s mother was not hurt.

The whole house along with the shop was completely gutted… We calculated that 90% of her body was burnt with areas of deep burns including her face, neck and genital regions.

KK’s family was into a major tragedy. They are quite well off. But, within the flash of an eye, they are in a major quandary. It was so sad to see KK’s father sitting beside KK within this head buried deep in his hands and bursting into tears on and off.

We offered them a referral which the family readily accepted. Meanwhile, I took RD to the theatre and did a thorough cleaning up and dressing. He had a circumferential burn of his right hand which needed fasciotomy.

Kindly remember all three children in your prayers.

Meanwhile, do note that all three episodes of burns could have been prevented. In fact, we've had similar episodes before too.

1. I remember during one of the conferences which I had attended on burns, there was a solution provided by one of the participants on putting up barriers made of mud or bricks in households where the cooking was done on the floor. Something which would go a long way in preventing small children from wandering into the fire.
2. It is quite common to see teashops and small hotels function from within houses. The womenfolk also help out in the chores in these eateries. And many a time, children end up wandering into the areas where the food is cooked and end up with accidents including burns. Parents of both RK and KK ran such shops.

I happened to glance through the folder of 20^th National Conference of National Academy of Burns (NABICON 2012) in New Delhi. There is a message in the last cover page which goes – Best Treatment of Burns in Prevention. Of course, we are in the process of putting up a burns unit. I pray that we would be ultimately able to play a key role in interventions which would prevent the occurrence of burns within our communities. 

Communications. . . Cut Off from the outside world . . .

The whole of last week has been a nightmare for us . . . In addition to the challenges we have with electricity, we also have problems with our communication lines . . .

We've been almost cut off from the rest of the civilized world . . . Almost all the cell phone networks had failed and the ensuing road repair going on has ensured that the phone lines and the internet broadband connections are also regular snapped . . . 

And therefore, the drop in the number of posts in my blog. . . The hospital has been quite busy and we've had enough sick patients to write about . . . but, because of no connectivity, nothing has been possible. 

Quite a lot of us depend on the BSNL network for our cell phone connections. . . The network has been dead for almost the last 10 days. . . and we have no clue on when the network will be back. We get Airtel connections from a tower which is about 2 miles away . . . but, the connections are not very strong, but we have identified certain locations within the campus where we get good network. 

For me, I also do possess an Airtel connection and I get the best network when I keep the phone dangling on a cloth-hook and now I am connected to the internet through Airtel. Another place where I get a good connection is under the Banyan tree near the mess . . . and many a time, as I try to walk up and down while talking to someone I need to be careful that the network stays good. . .and I do not stray beyond the area of good connectivity.  

Of late, Reliance has good network and I've got a connection for my wife. But, again, we've realized that there are quite a lot of areas within the campus where the connectivity becomes zero. I continue to depend on the BSNL and Airtel connections. . . 

Now, you can imagine how difficult it is going to keep multiple connections . . . However, the cell phone manufacturers have also kept themselves in business by manufacturing phones which can carry multiple SIM Cards. . . I carry one which provides space for 2 SIM Cards. Recently, my engineer has got hold of a machine which provides space for 4 SIM Cards. . .  

It was only couple of days back, a dear friend of mine suggested that I talk with one of the Cell Phone companies who could provide some sort of a low cost equipment which would give us uninterrupted connectivity to us within the hospital campus. Of course, our neighbours would also benefit from the same. I'm not sure on where to start . . . 

Later, as I discussed this with few of my staff, I understood that there had been some efforts made earlier. . . but had not yielded much results . . . 

Therefore, I would like to invite anybody with the right connections to help us get in touch with any of the mobile companies . . . What I can assure you is at least 100 connections from within our institution . . .  So, guys from Vodafone, Tata Indicom and Idea, do you want to be part of the little good that we try to do in this part of rural India ? ? ? 

Malnutrition . . . A perspective . . .

Of late, there has been quite a lot of news items including reports on the honorable Prime Minister commenting on malnutrition among Indian children.

I know that all of us can give umpteen reasons for the predicament of our children.

In the light of couple of incidents that happened today in the hospital, I wonder whether 'the perspective' which I want to raise is another very significant determinant of the poor state of healthcare  in our country.

I was on my rounds today morning, where I came across RA who had delivered by Cesarian Section couple of days back. RA told me that she was not secreting enough breastmilk. I asked RA's mother nearby on how often the baby is passing urine. RA's mother told me that she has lost count. In fact, she was cleaning up the baby when we reached RA's bedside, and she looked quite exhausted, which was quite explainable...

Then I suggested to RA that if the baby was passing urine, then the baby must be getting something to feed. RA replied that when she squeezes her breasts, there is not much milk coming. I told her not to worry and to only ensure that the baby is put to the breast at least once in hour hours and then if she demands.

RA did not look very happy . . .Then, to my horror, as I left the ward, the accompanying staff suggested that I write a prescription for a popular breast milk substitute. So much for promoting breastfeeding . . .

Unfortunately, this is not the first time I had a incident similar to this . . . and I had taken the pains to teach my colleagues on the importance of ensuring breastfeeding . . .

4 hours later, I had a patient in OPD . . . Unfortunately, I did not recognize her. She was RK, who had delivered exactly 35 days back at NJH. The complaint was that her baby was very lethargic . . . RK served as a Auxiliary Nurse and Midwife (ANM) in one of the Primary Health Centers in the district . . .

On a cursory glance, it was obvious that RK's month old baby looked small. . . Her weight was a measly 2.8 kg . . . And her birth weight was 2.5 kg . . . . And her weight today was measured with quite a good amount of clothing on as it was quite cold . . .

RK was a trained ANM from one of the reputed institutions of the state and she held quite a senior position within the public healthcare system of the region . . . 

And she had not recognized that her baby was not gaining enough weight . . . RK was responsible for the well being of mothers and children within quite a large area . . . I can very well imagine how much knowledge she has to impart to her target community . . . 

I had a incident which echoed the same sentiment couple of months back. . .  Which was a bit more sad as the SD, the patient died of complications . . .

What I'm concerned about is the knowledge element of quite a lot of staff in the healthcare services. . .  It is very well known that many of them get into the job by unscrupulous means . . . But, at whose expense??? 

Of course, there are other factors which ultimately contribute to malnutrition . . . But, incidents such as these show that many of our  babies start their lives with a severe disadvantage on account of poor knowledge imparted by healthcare staff who themselves are not very sure of basics . . .

It is high time that, concerned authorities in medical education seriously look at principles which ensure that the right concepts are passed onto students of all healthcare disciplines and market dynamics such as a powerful lobby for breastfeed substitues do not rule the roost and force us into unethical decisions  and practices . . . 

Cold . . . Solutions . . .

Over the last 2 weeks, it has been really cold. So cold that we had problems with patient care. . . We lost a preterm baby in the ward . . . 

Of course, we have heaters and warmers. But, the problem has been with electricity too. Most of the time, we have problems with electricity and even when we have electricity, the voltage is too low that the warmers do not work. . .

To give you an idea . . . the following two snaps would help. The first one is taken with a flash and the second one is taken without the flash. The dim light you see is the filament of the 60 Watt bulb burning.

And the next picture shows you the same bulb when the voltage is a bit more better. Well, the above sort of a picture is not so uncommon in most parts of rural India. For our state, it is a shame - as we are a treasure trove of coal and power plants . . .

There has been quite a lot of work on electricity connections which have been aimed at saving energy. We've achieved quite a lot - but the severe cold and the need for heating equipment has put us in a tight spot. . .

We look forward for ideas on how we could use non-conventional energy to warm up our wards and other facilities. . . Of course, one of the major needs are solar water heaters for providing warm water to patients, students and if possible to staff . . .



For those who are not very familiar with our place, there are very few days when we do not have good sunlight during the daytime . . . . which should actually help us to look at solutions which could trap the daytime heat and use it later in the night . . .



Or is it too wishfull thinking ? ? ? 




You may have some query on how the baby died. The baby was born at 29 weeks with a birth weight of 1.4 kgs. He had done well for about a week. He was kept in the warmer. The parents and the staff had been taught to move the baby into 'kangaroo care' if there was a blackout. 




Unfortunately, there was no blackout. The voltage had gone quite down. Nobody noticed it - as many of the bulbs had been recently changed to Compact Flourescent Lamps - they continued to burn well even in the low voltage whereas the warmer did not have enough current to generate enough temperature . . .




I've got hold of a stabiliser for the warmer for the time being thanks to a kind donation from one of our friends. . .  But for the baby, the decision had come too late . . . 




However, we look for more stable solutions . . .

Of traditional remedies for balding hair and potbellies . . .

As we sit in outpatient departments, it is quite common to see patients come for the complaints of balding and pot belly. As your sincerely has a bit of both in quite a significant amount, of late, I've not had much patients asking me about remedies for the same. 

Last week, I happened to see a youtube video about very popular remedies very much available in my home state of Kerala - and I was quite relieved. Unfortunately, the narration is in Malayalam. 

Relief because - I've quite a number of dear friends and relatives who had been bugging me to try out these remedies. And, I actually tried some for the receding hairline - which I'm sure did not do much good. However, few of my friends think otherwise. 

The business involved is in crores and if the video is to be believed the whole business is a unethical, unscrupulous and criminal. 




So, if you have a receding hairline, just take it from the Lord that you have a beautiful scalp worth public display and if you happen to have a paunch, it's a warning that you need to careful about what you eat. . . .




Well, for those who had been looking earnestly for clinical stuff, we are quite busy in hospital. There is quite a lot of action. But, I thought that this matter needs to be given a bit of publicity so that you don't waste your money on these remedies . . . 

Remembering Andamans . . .

There was something unfortunate in our vernacular daily today. Later, I found out that it was all over in the international press. 

A significant shift in a stand leaning more towards primary healthcare and public health happened in me during a 6 month posting in Andaman soon after the Tsunami in December 2004. I was part of the initial disaster response team sent from EHA. 

Well, the first reaction you have of that place is the amazing beauty of the islands. I hope to share few of the snaps I took during the 6 months. I know that the snaps are too assorted. Unfortunately, I'm sure that I'll take quite a lot of time to sort them out . . .  So, kindly excuse . . . 

Snap taken to send home . . . 

One of the umpteen snaps taken of the rock formations along the sea . . .

Reminder of the independence struggle... Gallows at the cellular jail...

Cellular Jail . . . 

Reminder of the earthquake . . . 

Road to Mount Harriet

Ferry crossing at Baratang . . . On the way to Rangat . . . 

Again reminders of the earthquake . . . 

Tents at the relief camps . . . 

Our clinic in progress . . . 

Hutbay . . . 

Destruction at Hutbay . . . 

School in progress at Hutbay

The team . . . 

Crab Poo . . . 

Photo response to a friend who sent me a snap of his posh office . . . 

Mud volcano . . .