Marathon Cesarian Sections . . . Cont'd

Over the last week, I've tried to pull your attention to the poverty of this region. In addition, there was the day when we had to do 7 Cesarian sections on the trot . . . all of them, Maternal Near Misses.

They all got discharged without any sort of complications except for the babies of KD and AF. 

Below is the chart once more. This time, I've added 2 columns . . . which shows the final bill and the charity we ended up giving.

Name	Time and date of surgery	History	Final management and comments	TOTAL BILL (INR)	CHARITY (INR)
RtD	20th july, 11:00 am	Previous LSCS, had come for ANC on 20 june, Hb: 8 gm%, never bothered to arrange blood	Boy baby, apgar 9 and 10. Had waited almost a day for the blood	13162	3979
SMD	20th july, 12:36 pm	Obstructed labour since previous day 8 pm	Boy baby, apgar 6 and 10. Almost a rupture	16101	6851
MD	20th july, 2 pm	Primi at 40+6 with labour pain since previous night. Later obtained history of leaking 4 days. Irregular fetal heart.	Girl baby apgar 8 and 10. Well off patient – did not go to Ranchi.	15658	490
AF	20th July, 3:14 pm	Labour Pains since yest afternoon and leaking, short 136 cm, obstructed labour	Sick girl baby, apgar 1 and 4. Died later, Almost a rupture	16541	3109
KD	20th July, 5:24 pm	Prev LSCS  with iud and Hb 8 gm%	Dead girl, Hysterectomy for placenta percreta	17320	6524
RnD	21st July, 2:17 am	G4P3L2D1, pedal edema 2 weeks, headache followed by seizures 2 pm, 20th july	Baby boy, apgar 6 and 10. IUGR	16498	1053
SrD	21st July, 3:30 am	Short primi, pedal edema > 2 weeks, was having laboru pain since 12 pm on 20th July, BP 140/100. Urine alb 3+	Cervix edematous and head high, inadequate pelvis – lscs, boy baby apgar 3 and 7. Gr 3 Meconium Stained Amniotic Fluid	19235	2438
	TOTAL			114,515	24,444

Well, why do I have to show this . . . When some hospital asks for a small amount and people don't pay, they make into the newspaper. I know of quite a number of healthcare institutions who do quite a lot of charitable work and do not even find a mention anywhere. Just imagine, almost 20% of our costs going into charity . . . This is a fraction of a day's work. 

As I write this, I've 2 patients who are in the ward for whom I would have to give full charity. . . 

The first one, NK, who delivered her first baby and was brought to us about 5 days back with a history of seizures after she delivered a baby about 5 days back. We've not been able to bring down the blood pressure. We tried to refer them the first day. But, to no avail. Today, the father came to me. He requested me to discharge the patient as they did not have any more money with them. He told, 'I will take her home and then we would wait for her to die'. I've told them that we shall continue treatment for 2 more days and they need not pay any more money . . .

The second one, RD was operated 5 days back. Stuck by polio at the age of 3 years, she had got married to a blind young man from her village. She had a pregnancy 3 years back - she had a normal delivery, but the baby was dead. I wonder how she delivered with both legs stuck with polio. When she came to NJH, it was not a classical Rupture Uterus. On operating, it was like someone had done a Cesarian section without opening the abdomen. 

The family does not have even one rupee with them. We'll have to write off the entire bill . . . 

The consequences of such charity work can be terrible on an institution such as ours . . . But, then, there is no other option for most of our patients . . . I wish we had some sort of support .. .. ..