Back at NJH . . . The Saga Continues . . .

Well, I had to somehow put in this post as there was quite a lot happening at NJH when I was away . . . 

How do I start . . . It's 2 days since I arrived . . . It seems we had 3 maternal deaths . . .all brought quite late after labor had started . . . I'm yet to go into the details. But on preliminary investigations - all of them had been cases of eclampsia. As I write this, I've one more lady in Acute Care on the ventilator. . . Humanly speaking, there is not much of a hope. . . She is into a HELLP syndrome . . . We had requested the relatives for platelets for which they've gone to Ranchi . . . and it's General Strike all over the country today. . . 

It has been quite hot here at NJH . . .Local newspapers have reported temperatures as high as 50 degree celsius (122 degree F) in some parts of the district. . . I wished I had stayed on in Kerala. Well, I've hope. The weathermen have predicted rains by June 10. We earnestly pray that it would happen. And there has been another major development - we've had electricity somewhat more regularly since today . . .So, a bit of a relief after one of our generators had crashed unexpectedly. We still are on the lookout for someone to help with funds towards a new 100 KV generator. 

Today being Thursday, I was trying to get some amount of sleep when our chowkidar came knocking. Titus had sent me a chart. The patient's relatives could not pay the total bill. . . Well - the diagnosis. Obstructed labour caused by hydrocephalus resulting in a rupture uterus and a rupture bladder. The bladder rupture was too bad that Nandamani had to put in an patch of omentum to give some sort of structural integrity to the bladder. . . 

Armed with my camera, I was off to the hospital with the hope of getting a good snap for a 'Human Interest Story'. You know, funders always like those - a smiling lady, happy to be alive and to be photographed for probably the first time in her life. And then the story of how their funds helped to give this lady life . . . quite good publicity material for a power point presentation on what all we do at NJH . . . 

Before I went to the patient, I met the husband and brother of the lady. Wearing torn clothes, both of them appeared not to have decent food in the recent times . . . The husband looked forlorn. I was dressed casually. So, he did not recognise me as a doctor. I explained to him that the treatment had been quite expensive. The ventilator, the anesthesia, the monitors, the surgery, the prolonged admission, 5 pints of blood, antibiotics etc etc all resulting in a total bill of about 28,000 INR. He had paid about 11,000 INR so far. He had only 8000 INR more. . . I did not want to haggle the family any more. . . 

I thought of seeing this lady, whom we shall call RD. She was so young. She did not look the 30 years. If she had changed into a salwar kurta and put some make-up, she could any day be mistaken for a 12th standard student. I shelved my plans to take a snap of her. For her age, her faced looked so much in pain and distress.

One can only imagine. Married for 6 years. Her husband had no land to cultivate in. He was dependent on the other landed farmers for labour. In addition, he went as migrant labour to distant lands. There was nothing much to eat at home. Worse was her obstetric history. The present pregnancy was her third pregnancy. Both the previous deliveries were home deliveries. The first one, a boy of about 5 years was alive. Really, she did not know how old he was. Her second pregnancy - the baby died after 3 days. And the third pregnancy was a real tragedy . . . 

I pondered over all the possibilities. . . The family was obviously poor. How did they managed to pay our bill. Maybe they sold off some land . . . but, they did not have land. Or they must have got into some sort of bonded labour . . .quite a big possibility. I asked the husband . . . He has pledged some of his mother's gold and some brass utensils . . . Well, I do not know. But, the fact remains that the family has become poorer. 

We do not have a choice. There were expenses involved and they were not small . . . 

As I walked back . . . I saw the almost dried up pond. 

RD had come quite a long way and like most of our stories of maternal near misses and maternal deaths, she had been kept at other centres. She has been lucky to escape death . . . The dried up pond sort of reminded me of the life she was going back into. . . The family would have to up all those from whom they had taken loans to pay for her treatment . . . I wondered if she would even have a decent dinner tonight.

With quite a confused heart, I reached back home. . . I sometimes wonder what could bring committed people to this place where basic healthcare is lacking. Do remember, I'm not speaking about a village or a block . . .I'm talking of entire districts, regions . . . 

To come back to an empty house is a terrible experience. I hope that this month will go fast soon. Usually, when I come back, I come back to a loud chorus of welcome from Charis and Shalom . . . and Angel who would be patiently asking about all that happened. . . Many a day, I would be too tired to talk much . . . 

Well, a parting shot of what I've got to beat the summer heat . . . And they come cheap this year . . . 

Summer vacation . . . Part 1

Well, ultimately, we got to take a vacation . . . although a short one. We've promised to take a longer version during Autumn this year.


I've not been an enthusiastic photographer during the trip . . .however, below are few good ones . . .


Below are couple of snaps which I took of the Burns Unit construction which I took before I started off.

The brick making machine had come out really well . . . It looks like a good investment . . . 

The upcoming burns unit . . . 

Couple of snaps from the train journey to Alappuzha . . . We travelled by the Dhanbad-Alappuzha express - the only option we really have . . .

We had packed enough food . . . But, Shalom had to have  Potato Bondas from the pantry as soon as he got into the train . . . A scene 5 minutes into the journey . . . Of course, Charis is also turning out into one great train fan . . .

10 cups of tea . . . 5 cups, the ones further away - the milk had split. . .
The pantry guys were gracious to replace is as soon as the problem was diagnosed . . . 

Charis keeping Chesed in good spirits . . . 

Shalom also joining in the act . . . 

Came Andhra and we had mangoes coming in . . . and Charis was right into it . . . 

Chesed sleeping off in Ammachi's arms . . . 

Charis taking a walk in the Chengannur railway station . . . 

Waiting at Trivandrum Pettah railway station . . .and having hot vadas . . . 

Well, this blog has turned out into a long one . . . Rest of the snaps in a later post . . . especially those from Trivandrum . . . 

Enjoying Summer . . .

It has been about 10 days since I left for a short vacation. Something waited for after all the busy times we had been having at my place of work. It is almost one year since I seriously started to blog . . .  and the rewards have been multiple. There are enough happening at my workplace that I've unusual things to write about almost every weekend. 

In the process of trying to find a wider audience for my writing . . . I ended up writing a bit more than an average blogger. My dear wife has already started to call me an 'internet addict'. However, when I got a announcement for a contest from The Lakme group through Indiblogger, I just could not resist the urge to put in one more post. 

And more the reason to put it as I had observed one of my very high risk patients who somehow pulled through a difficult childbirth put makeup on her face in the ward and my colleague made a passing comment on how better things would have been if she, rather her family had taken the same care during her antenatal period with regard to her health. I've not much a clue about all the different cosmetics available to get ones face made up. But, oh my, that pretty lass had a little cute box full of all those . . .

I had been wondering on how to combat maternal mortality and near maternal misses . . . I deal with them so many a time. 

I had a very much relaxed time over the last 10 days. . . Well, I would like to take Kyra back with me to the place and ask her to give me ideas on how to improve maternal health in the region. 

Statistics say that India accounts for 20% of the world's total maternal mortality. Do remember mothers die young . . .and many a time leaving children orphans.Well, one aspect which maternal mortality does not represent is the untold suffering, which we call 'morbidity', which many a woman undergoes during the physiological process of giving birth. 

Couple of major causes of maternal mortality in NJH is Eclampsia and Obstructed Labour, both of which can be prevented and easily managed. I have had many experiences of husbands and fathers showing me the snaps of their dead wife or daughter after the tragedy of a maternal death. Most of them took a late decision to bring the patient to the hospital even after realizing that there is some problem with the delivery.

Pretty, painted, dainty faces . . . lost in a ethereal bliss . . .stare back at me. It is difficult to imagine that those are the faces of the same young lady, whose life I had been trying to save couple of hours back.Faces twisted and contorted . . . swollen feet . . .and stiff abdomens . . . dark circles around the eyes . . . exhausted beyond imagination . . . having lost the desire to live . . .

In fact, I started to blog determined to bring the untold stories of these women out into the open. The first 3 women about whom I posted epitomized the challenges maternal care faces in this country. 

However, with relation to the cosmetics - I wondered if there is a paradox in the whole affair. 

As I looked at the family snaps of many of our patients who died - I used to wonder at the pain that each of them might have taken to make themselves look pretty rather presentable to the outside world and be the pride of their parents and husband. But, when it came to antenatal care - they seemed hardly bothered . . . 

I had patients who never had even a single antenatal check up . . . another lady who in fact of being a care-provider in her village, failed to recognize danger signs of her own pregnancy and paid it with her life. . . . Sometimes, things are beyond our control . . . Sometimes, I've wondered if the brightly painted lips camouflage the anemia which also accounts for maternal deaths . . .  I can go on and on . . . 

What I would like Kyra to do is to come along with me to the place where I work . . . She has been quite successful in promoting beauty enhancing products all around the world. . . Maybe she can explore on how to use her skills to bringing down maternal mortality and morbidity in places such as ours . . .I heard from my colleagues that while I was away on vacation, there were 2 maternal deaths . . .

Maternal healthcare is only the tip of the iceberg of problems we deal with. One more facet of life in NJH which we would expect from Kyra is for expert suggestions on how to tackle the issue of preference of boys over girls so much to an extent that my clients end up killing girl babies expecting to get boy babies . . .

Of course, Kyra can take her cosmetic kit containing the range of Lakme products along as it would help her bond fast with the young women and their caregivers.

Photo Post . . . 21st May . . .

1. The first two snaps of this photo post are hilarious. As you can see, this is a Barium meal follow-through film taken of a patient with an episode of acute abdominal pain. And the radiologist has diagnosed appendicitis from the investigation. Well, if somebody could tell me if this is part of the investigation for an acute abdomen . . . I just can't believe that this guy has diagnosed a 'tender appendix' by ultrasound. . .

2. Few snaps of a common scene when you travel between Kuru and Ranchi especially in the morning. The region around Kuru is quite favorable for vegetable cultivation. 

It is only quite recently I found out that the local farmers cultivate seperately for local consumption and commerce. For local marketting and consumption, they use the traditional seeds without much of pesticides and fertilizers. For those being grown commercially, they go all out with all the latest technology - high yielding varieties, pesticides, fertilizers, growth hormones . . . One farmer even told me about injections being given to cauliflowers and cabbages to increase their size and give a fresh look . . .

I asked few of the locals on why they did not prefer the newer varieties - all of them had the same answer - 'They don't taste that good'. Well, those of you in cities getting fresh looking and large sized vegetales . . . be careful . . . I'm sure you won't be able to wash off injected chemicals with all the soaking and scrubbing . . .

3. This is the per-operative picture of Mrs. AD's uterus after we had put a B-Lynch suture to make the uterus contract. Well, it is sort of a modified B-Lynch suture . . . as the uterus was of a funny shape and the traditional one did not hold well. 

AD had been through regular antenatal care in one of the private hospitals in the district headquarters. 

She had gone into labor and had been admitted since morning in the same hospital where she did her antenatal care. Over the day, her blood pressures rose and she was referred. Dr Titus was on duty and I was called. She was in severe pre-eclampsia and the baby was in an occipitoposterior position and there was hardly any pelvic space - obstructed labour.

The problem was that the family was quite well off. . . Severe pre-eclampsia with obstructed labour . . . Recipe for real trouble . . . I explained to the relatives my predicament . . . To complicate matters, came her hemoglobin report - 7.9 gms%. Since she had come from outside, I had done the counts too - Total count was 28,000 with 90% neutrophils . . .

With all the required consents, I opened . . . The uterus was in a terrible state. From the outside itself, it appeared quite unhealthy. On opening, it was obvious - chorioamnionitis at its' worst.

The uterus just refused to contract. There were 2 pints of blood readily available at hand. It gave me time to start off with the B-Lynch and ask help from Nandamani too.So far, she has done fine . . . till I left on vacation. . .I was glad that she made it - otherwise we would have had the second maternal death of the month . . .

4. A scene from one of the Primary Health Centres we visited on our Tuberculosis Unit supervisory visit. The snap shows bundles of 'Bal Swasthya Card' (Student Health Card). Distributed from the government, the staff were not sure on how to go about with these documents. A well thought out program on paper, it's a waste when it comes to implementation at the grass root level.

These cards are supposed to be filled up for each student to be used as a tool to monitor their health over the entire year.

As I discussed about this with a friend of mine . . . he told me that these cards should have arrived sometime in June-July . . .they arrived sometime in January and then no-body has much clue on what to do with them. And it is already April . . .

5. Railway line construction going on between Lohardaga and Tori which is expected to make it easier for us to connect to Ranchi by rail. 

RSBY Medical Camp . . .

Couple of weeks back, I was informed about the program of holding a medical camp in Satbarwa by RSBY. I had been quite vary of medical camps since I had been part of quite a lot of them. They are quite good for bringing in publicity. From a public health point of view, I'm not sure of how useful they are except for a chance for screening populations for chronic diseases like hypertension or diabetes. 

On asking the concerned staff on what the objectives are - I was informed that it is basically to screen patients for elective surgeries. I was not much impressed. However, did not want to discourage the RSBY staff. And it was first one I was doing in the name of RSBY and also after I came back after my post-grad. And I thought of giving it a good try - with all inputs from the hospital put in. The Community Health Department made quite an effort.

Following are the snaps from the camp. We got quite a lot of patients - totalled about 150. We had 3 doctors at the place including Dr Isac Jebaraj, an orthopedic consultant from the Christian Medical College, Vellore who was visiting us along with a batch of 2nd year Medical Students.

Getting the place ready

The ophthalmology team

Registration

Everybody . . .

Drs. Isac Jebaraj (white shirt), Nandamani (blue shirt) and Titus (yellow shirt)

Lessons learnt at the end - 

1. Medical camps are a waste of time especially for hospitals like us which have quite a regular crowd.  At least when they are arranged like this without much of a targeted approach. Lately, I realized that even hospitals such as Apollo has dropped their camp approach for valvular heart diseases.

2. Providing constant and regular service is more important in healthcare rather than mass efforts such as medical camps. 

3. We never got any surgical patients. Most the patients were those with backaches and vague complaints. Like most medical camps I've been to, most of the patients appeared to have come because there was a doctor available for free consultations and some free medicines.

Well, this post would not be complete without the mention of some small drama that happened. We had been told about the camp for almost a week. The venue was all decided and we were given the responsibility of publicity, which we did quite well. However, on the day before the camp, I received a phone call from the RSBY DPM saying that they were thinking of changing the venue. 

The venue surprised us - a newly opened private hospital about 1 km beyond Satbarwa. It was outrageous. I wondered what they were up to. I expressed our unwillingness to go and sit at a private hospital. I told them that I would not have any problem having the camp in the local government subcentre or the new primary health centre almost nearing construction. 

After being stubborn about this, they finally relented and agreed for the original venue.


Well, for a status update, since we were empaneled (March 2012), we've already treated 100 odd patients as in-patients and 570 patients in out-patients under the scheme. And do remember, we must be one of the very few hospitals in Jharkhand who does not charge registration and consultation fees for outpatient care for RSBY card-holders.


The challenge remains payments from the insurance provider - so far we've only received about 120,000 INR out of the 250,000 claimed (only claims submitted 21 days back) . . .  We hope that payments would be a bit more fast . . .We're already making extra investments for the poor - but payback is becoming tough. Do remember the 50,000 INR we lost because of free outpatient registration and consultation. And expenses for medical camps such as the one I described . . .And all these in a space of not even 3 months . . .

Prayer Bulletin . . . 20 May . . .

1. We thank the Lord that the progress of the burns building. Over the last week, we had the new Brick Making Machine arriving all the way from Coimbatore. We've already started making the bricks. 

2. Couple of weeks back, a major fire within the campus was averted. We thank the Lord that we were able to detect the fire on time and fire-extinguishers purchased quite recently were available on hand to put out the fire. In addition, we also had a major fire in the local telephone exchange following which our telephone connections had gone off for about a week. Couple of days back, our mobile connections were restored. The internet and landlines are still to be restored. 

The clump of bamboo trees that caught fire behind the mess

Smoke billowing from the burning telephone exchange . . . 

3. I hope that you read about my post about a particular incident published in paper couple of weeks back. Kindly pray for this country. The amount of occult and evil practices continue to hold a stranglehold in our society. Many of these practices which is aimed at the poorer and marginalized sections of the society continue in the name of traditions and customs. Please pray that people will see the futility of practices such as these. 

4. The need for a medicine consultant in the hospital is becoming all the more evident. In addition, we need a pediatrician and nursing personnel. We pray that the Lord will move the hearts of people to serve alongside us. 

5. The beginning of the hot and fiery summer came up with major financial liabilities for the hospital. To start with 2 of our generators crashed. By God's grace, we could repair one without much problems. Unfortunately, the second one which is actually the newer one was found to have a major fault which needs expensive repairs. To make matters worse, we realized that the newer one had some sort of technology which was not in use anymore and therefore is of no resale value. Which ultimately means that we should be planning to buy a new 100 KV generator which would cost about 700,000 INR (approx 14,000 USD/Euros or 9000 GBP). We had also been planning for a smaller 30 KV generator which would cost an additional 350,000 INR (approx 7,000 USD/Euros or 4500 GBP).

6. The urgent need for the purchase of new school bus remains, which would cost approximately 1,300,000 INR (approx 26,000 USD/Euros or 13500 GBPs). 

Our old school bus. When I had put this snap few weeks back someone suggested that the bus looks new.
Well, our engineer has kept it going on for some time now.  But the engine and interiors are quite worn out. 

7. Kindly pray as the minimum standards for the Clinical Establishment Act is formulated.


8. We thank the Lord for the students from CMC, Vellore and senior consultants, Dr Isac Jebaraj and Dr Prasanna who gave us company for about 2 weeks last month. We hope that this experience would widen their outlook to healthcare scenario in the Indian subcontinent and play a role when they determine their choice of service. 

The students at a teaching session

A visit to the nearby dam.

9. Quite a lot of of our staff would be away travelling during the next one month on holiday. Kindly pray for journey mercies as well as time of relaxation and rest during the holiday season. Please also remember those who are staying behind in the harsh summer (I heard that it is 46 degree Celsius today) to serve our patients.


10. We start the admissions for the Nursing School from next week. Kindly remember the entire process in your prayers.  

Tuberculosis Unit . . . Supervisory Visit . . .

As part of our responsibilities of a Tuberculosis Unit catering to a population of about 650,000 (each TU usually caters to 500,000 population), we need to make supervisory visits to the different Primary Health Centres and Microscopy Centres in our area. 

It has been quite some time since I had visited the areas after Dr Johnson took over charge of the TU. Over the last week, it has been obvious that Dr Johnson may not be continuing with us and I thought it would be good to accompany the TU staff while they supplied the drugs. 

It turned out that there was a new MDRTB (Multi-drug Resistant Tuberculosis) patient in our area - in fact the first one in Palamu district to be started on DOTS Plus anti-tuberculosis treatment regimen. I had to visit him. 

Being summer, I was relieved that the air-conditioned Bolero was at my disposal. Along desolate, dry and depressing landscape, I made my way to each of the Primary Health Centres under us. For confidentiality's sake I do not wish to mention the names of any of the places I went to. Of course, there are photographs . . . 

The first place of my visit was a Community Health Centre. It operated from a new building since the last time I had visited it. Quite spacious and well planned, it was an administrator's dream. Well, I was told there were 10 doctors posted. About 2-4 of them visited the Outpatient every day. There was no resident doctor although there was a shabby quarters for them at the entrance of the CHC. 

From the staff, I came to know that there were about 30-40 deliveries every month. However, there were hardly any facilities to manage complications. This is was the CHC for our target area of around 600,000 population. 

The TB facilities were as expected. Lower number of sputum examination rates of chest symptomatics. 

We could not meet any of the Medical Officers or other staff as it was too early. But, late enough for the private lab run by the laboratory technician to have opened and started business. 

On the way to the next place, a Primary Health Centre, we met AD - supposed to be our first Multidrug Resistant Tuberculosis patient to have been started on DOTS-Plus.

We reached the PHC as the daily business was on full swing. Old buildings doted the compound. I was introduced to the Medical Officer in charge - I was quite surprised the way he was talking. He appeared quite incoherent and confused. I thought that he is old - nearing retirement - some amount of senile dementia setting in . . . 

As I came out after meeting the old doctor, one of the staff asked me if I understood anything he spoke. It seems that he was a die hard ganja (local name for cannabis) addict. It was sad . . . The situation about tuberculosis was the same at this PHC too. The best part was a very enthusiastic laboratory technician, RK who kept the numbers coming in a good pace. . . 

Then, was a long drive through some badly Naxalite infested areas to our third place. The PHC which caters to a population of around 120,000 did not have any doctors visiting the place for ages.

The PHC . . . No takers . . .

The labour room . . . Nobody had an idea about the number of deliveries per month. One staff told me it was about 5-10 per month . . .Remember that the served population is about 120,000.
A rough calculation says that there would be 3000 deliveries per year in the target area . . .

 

Indication of better times. The old dilapidated doctor's quarters

Poor electricity facilities, necessitating devices like this solar powered mobile phone charger

The staff appeared quite protective about the status of doctors visiting the place. Once more, we had a very enthusiastic laboratory technician who was very pro-active. 

We were quite tired by the time we finished the third place. 

In between the next visit, we visited one Catholic mission centre where they were trying for the upliftment of the tribal community. It had been 12 years since the work had started - but it seems that the community was hardly interested in any sort of development or progress. The mission centre was running a school for the local community. Of recent, they have sort of taken an foray into healthcare too - and we had been supporting them technically. A very potential place for virgin public healthcare work to start. . . 

By the time, we reached our last PHC, it was late afternoon. The outpatient was over and most of the staff had left. The lab technician was waiting for us to arrive. We were also in a hurry . . . 

It was around late evening by the time we reached back to NJH. . . 

Lessons learnt at the end of the visit - 

1. Rural public healthcare is a neglected area in our country.

2. There is a need for committed healthcare personnel in such places. 

3. We're not going to achieve much in terms of vital statistics if there is no drastic improvement of public healthcare facilities. 

4. Committed staff such as the two lab technicians we met do not receive any sort of accolades for the service they render to such difficult communities. Which of course prevents others from coming to serve in such areas.

5. There were many more patients like AD all over our communities. The challenge is to reach out and find them.   

MDRTB . . . Our first patient on DOTS Plus . . .

Last week, I had to do the fortnightly supervisory visit of our Tuberculosis Unit. In between the visits to the different PHCs,  we stopped to visit AD - supposedly the first MDRTB patient to be put on DOT Plus in the district as well as under our Tuberculosis Unit.

The drive . . . Desolate and dusty roads . . .

A young man, unmarried, looking emaciated but quite high on enthusiasm met us as we reached the village. He had been on Anti-tuberculosis medicines for quite some time. Unlike many of our regular tuberculosis patients, AD came from a high caste family. And we found something which we find in many of the upper caste tuberculosis patients - an aversion to free medicines available from the government. 

The street where AD lives . . . AD can be seen sitting in front of his home . . .

On detailed question, it was very obvious that this aversion to free medicines is what gave him away. AD, who was a very outgoing and fun-loving guy just did not have the discipline to stick to medications which he was supposed to take on a regular basis and his upper caste status discouraged him from getting himself free medicines for treatment. He had felt better many a time and had stopped treatment himself . . . 

Which ultimately landed him in this state of affairs . . .What surprised me was that he was still a bit careless. He was not very careful with what he ate and he loved roaming the village roads on his bike. 

Later we went to visit his DOTS provider. A quack who is very much sought out - I thought I should pay a visit to him and give him some encouragement for the work he was doing. The village was so remote and he was an obvious messiah to all those who fell sick in the villages near by. 

RS, the quack who's DOTS provider to AD . . .

He was quite proud of his clinical achievements and the succor he has been to the multitude of poor and sick villagers who were very much dependent on his skills. . . We did not have much of a time, but it was quite an entertainment listening to him. 

After, seeing AD one more time and reiterating about the need to stick on to his medications, we were on our way to the PHC.


As I drove, it was very obvious that there were many like AD in the villages I was whizzing through - it would take a herculean effort to treatment them and more so to detect as well as prevent such cases . . . Sometime during the next week, I would post on my visit . . . and you would realize a major reason TB is going to stay on with us . . .


Well, I almost forgot, AD's brother is also a defaulter who's sick with persistent cough and fever for almost a year and is awaiting his culture . . . He was away visiting when we met AD . . .  

The Occult . . . And Worse . . .

Below, is a clip of a news item published in our vernacular daily last week.

The translation is as follows -

It has been reported that a certain Mr. Mukhan Ram (55 years), a resident of Dharuwa village under Kanti Police Station was paraded in the village after having his hair tonsured. Mr. Mukhan Ram is a witch doctor by profession since the last 10 years.

The Panchayat had decided that Mr Mukhan should be punished in social, economic and psychological terms. In relation to the incident, villagers reported that the wedding of the daughter of a certain Umesh Ram took place on 23rd April. Mr. Mukhan had done a certain ritual during the wedding. After the ceremony, when the girl was leaving her house to her husband’s place, she had become unconscious. The girl’s father, Mr. Umesh Ram brought a new witch doctor for further ceremonies from Belchampa, Palamu. The new witch doctor proved by his magic powers that Mr. Mukhan Ram was responsible for the girl becoming unconscious after the wedding ceremony.

Mr. Mukhan Ram’s wife got into a fight with the family of the girl after hearing this. Mr. Umesh has demanded that Mr. Mukhan Ram pay up 25,000 INR which he had to spend towards getting his daughter alright after she had swooned during after the wedding ceremony. The Panchayat has given a time frame to Mr. Mukhan to pay up this amount.

Amazing, for two reasons -

1. First and foremost – the newspaper deciding to put this into print.

2. Second – to note that we continue to incidents like these in our country. Most probably, the girl would have too tired and probably hypoglycemic after the ‘long Indian wedding’ – and that was enough for a witch doctor to extract 25,000 INR from the family towards healing her . . .

My countrymen, we can only weep for our fellow brothers and sisters who are caught up in this mire of ignorance and sorcery . . . 

2 Eclampsias - Different endings . . .

Last week, we had 2 patients come in with very bad eclampsia. We managed one very much pro-actively whereas the other we could not do much as her blood parameters were already quite bad. The first made it and the latter died within 4 hours of arrival to the hospital.

SD, had suddenly thrown off fits sometime mid-morning and had come through couple of other hospitals before she landed up here. SD was very sick - her bladder was empty - rather there was some amount of darkish red fluid coming in the urobag, her creatinine levels elevated, Glasgow Coma Scale of 3 and Platelet Count of 59,000. And the baby was dead. And the birth canal was tightly closed. 

I was in a half mind to operate but the low platelets prevented me. The fact that operating rooms were not free made the decision easier. Unfortunately, she had a cardiac arrest sometime late evening and we could not resuscitate her. She was dead.  

However, there was another patient, UD couple of days before SD arrived. In fact, when SD had arrived, we showed UD who was on the adjoining bed. 

UD came to us after having been to couple of hospitals. She also came sometime late evening. We had done an emergency Cesarian to deliver a pair of undiagnosed twins. Both the babies were sick initially, but recovered over couple of days. UD had been having seizures over the whole day before she reached here. To make matters worse, when UD came in, she had a Glasgow Coma Scale of 3 and suffered a respiratory arrest in the labour room. 

We got her intubated and shifted her to Acute Care. After some amount of mechanical ventilation, we took a decision to do a Cesarian and deliver the baby. 

After the Cesarian, we were surprised to find out that she could be easily weaned out of the ventilator - but later found out that she had developed a focal neurological deficit - a left side lower limb hemiplegia which has since improved. 

We never expected UD nor SD to make it. We sometimes wonder what was the difference between the 2 ladies. Regarding SD, the facts that stood against her was the overt edema, sudden onset of symptoms, total renal shutdown and thrombocytopenia. UD did not have edema and all her blood parameters were normal. The blood pressure was high with a Urine Albumin of 3+. 

Now, the saddest part of the whole narration. UD's relatives were very upset with us after the surgery. The twins turned out to be girls. And UD already had a little girl of 3 years at home. After UD had become fully conscious, she was also psyched out by one of her relatives for her 3 children being girls . . .We had a tough time convincing UD that it is perfectly fine to have 3 girls and is possible to bring them up to be responsible citizens of the country . . . However, she is going to have a tough time doing that . . . I feel happy that the 3 girls will have their mother to be with them alive and well and raising them . . . I wonder, whether the family agrees with me . . . They may have wished that the mother and 2 girl babies had died rather than lived . . . How sad ? ? ? Most probably, UD will be under pressure to have one more baby . . . to try to get a boy . . . 

Praise and Prayer Bulletin . . . May 1

1. Dr Johnson's father passed away last week. Kindly pray for the family as they go through a difficult phase in their lives.

2. We had been busy over the last couple of weeks. We thank for the patients whom we could save. Please pray for families who lost their loved ones especially the family of the boy who died after 3 members of the family got burnt.

3. The last financial year has been a mixed experience for us. Although our statistics has been on a constant rise, we've had quite a lot of expenses which has kept us in the red. We pray that we would be of help to the surrounding poor communities and shall be witnesses of the love of Christ in the year ahead.

4. We thank the Lord for the safe deliveries of Dr Angel, Sr. Chandrakala and Sr. Kanchan. All the mothers and babies are doing fine. 

5. We praise God that there has been quite a major improvement in the quality of the road to Daltonganj. In light of this, we look forward towards purchase of a school bus for the children. Kindly pray for this need. It would cost us about 1,300,000 INR (26,000 USD/AUDs, 15,300 GBPs). The present vehicle is almost 12 years old. 

6. The public electricity supply in this region continues to be quite pathetic. We spend about 150 litres of Diesel per day to run the generator, which is a major expense to the hospital. We look forward towards exploring alternate sources of energy. Kindly pray that we would make some sort of progress in this area.

7. Obstetric care continues to be on the rise here. We thank the Lord for the joys we have had over the last couple of weeks. However, we have felt that we need to train more of our staff in obstetric care. It would be wonderful to have a full time neonatologist to help us in the work.

8. In addition to the pediatrician, we also look forward to have a medicine consultant. Cases of fever and complicated cases needing intensive care has been a major challenge for us. We pray for a pediatric consultant.

9. Summer has started. It looks like it is going to be quite a harsh one. Please pray that our water reserves would see us through. Do pray that the staff will be protected from sickness during the harsh weather. And that we would receive timely and enough rain once monsoon sets in.

10. After a gap of 3 years, we had a plentiful harvest of fish (112 kilograms) from our pond. We thank the Lord for this encouraging sign.

11. RSBY has been well received by the local community. We had over 350 outpatients and about 80 in-patients since its inception. Please pray that we would receive funds from the insurance agencies in a time-bound manner. On May 4th, the District RSBY Office has organised a Medical Camp at Satbarwa to mobilise surgery patients. We pray that we would have enough learnings in the process. 

12. Please pray for our lawyer, Mr. BK Pandey. He lost his wife couple of months back and had gone into a bad depression. We had been managing him. Thankfully, he has recovered well.