Quail

As part of the project on Climate Change, I wonder whether we can look at quail farming as a livelihood in this region. The wild variety of quail, locally called 'teethar' is quite a local delicacy. It is illegal to kill it, but it's commonly available in most of the local dhabas (roadside hotels). 

Quail farming is quite a major business in South India. 

Below are snaps of quail egg, which is quite favoured by our children. It's quite commonly available in grocery stores in Trivandrum. 

Would appreciate feedback on whether anybody has tried 'quail farming' in Bihar/Jharkhand region. 

God's Own Country

Snaps of a place I think is the one of the most beautiful in Kerala. Any guesses . . .

I'm sure that very few of you got this right. This is Neyyar Dam, which is about 20 miles from Trivandrum. You can very well see that these snaps were taken in 2006. 

Next week, I'm planning to once more go to this place. Shall definitely post the snaps .. .. ..

Fishing at NJH

As is the tradition at NJH since quite a long time, we started the process of fishing from the hospital pond last week. Below are the snaps from the whole exercise. 

A golden carp

Casting the net . . .

An odd shaped face . . .

The booty being brought for distribution

130 kilograms of fish

The distribution going on in full swing

Every family received 1.5 kilograms of fish at a subsidized cost. And none was wasted. We wait for the next round of fishing next Saturday. 

Warning signs . . . from the sky

I chanced on the snaps below while surfing the net. No doubt, they are really beautiful. But, I also realised that the snaps also show some aspects which the country would need to take care of. 

The above snap was touted as the snap of India on Diwali night. However, that was not the case as the article in The Hindu said. 

Below is a snap of the forest and the mineral wealth of the country.

Now if you look carefully at the composite picture of the night sky of the country, please note where the coloured lights come in. According to the article in The Hindu -

- Blue lights indicate city lights that became visible in 1992

- Green lights indicate city lights that became visible in 1998

- Red lights indicate city lights that became visible in 2003

And please re-look at where our mineral wealth and more importantly forest cover of our country is. Yes, it is in these regions that we've been having population influx and growth as the years pass by, except for the North East part of the country. 

Isn't this something which should be of a concern to us?

You can see the beautiful snaps from space of other countries at IBN Live and Earth at Night: 30 Photos from Space. 

Eye 'Bulldozed' - Please Pray

GP did not have any idea of what would happen to him on the 21st of May. He had been doing quite well over the last 2 months. More so, because the RSBY has enabled him to get cataract surgery done on his right eye.

But, GP's cow had other plans for the day.

While taking his cow back from pasture, the cow charged at him and the next thing he knew was that he has badly injured in his right eye. He had continued to wear his black glasses given after the the cataract surgery.

He was rushed to NJH and he reached us by 6 pm.

For Dr. Pradhan, our ophthalmologist, the first option was to refer to a higher centre in Ranchi. GP had a rupture globe, iris prolapse and blood in the anterior chamber - a nightmare for any doctor. The lens was just spared of any violence.

GP was poor. He had done his cataract because RSBY helped him. He could not afford the transport and stay at Ranchi. The family took the option to do the treatment here.

An extensive repair of the eyeball was done.

Kindly pray that GP will recover well.

His present treatment is also being covered under RSBY.

Tale of 2 Anaemic Patients

Yesterday was my first Sunday first call duty of the year 2013.

Early morning, I was informed of a very complicated patient in the labour room. LD, a 26 year old lady has been in labour since Saturday early morning. She has been running from hospital to hospital trying to get some help. The problem was that she had a hemoglobin of 6 gm% and nobody was willing to take her. To make matters complicated she had been given injection pitocin elsewhere. She had a pregnancy couple of years back. The baby had died just after childbirth after she had attempted a home delivery.

She was O positive. Dr. Johnson tried to arrange some staff to donate when she reached late night on Saturday. Unfortunately, we do not have many staff with O positive blood group. There was only one option. Either the patient had to be referred or we had to do the surgery with a consent to do without blood which was not a easy choice. The family having had visited quite a few  hospitals before entering NJH had already spent quite a lot of money on her ‘treatment’. So, the question of going to Ranchi was totally out of question.

However, we decided to wait for blood to come.

It came . . . by around 11 am on Sunday morning. It had been a full 33 hours since she had been in labour. And she was into obstructed labour.

I opened and found the worst I had feared. The uterus had ruptured. The baby was alive but quite sick. The endometrium and placenta was grossly stained with meconium. The baby died by evening. LD lost quite a lot of blood. She is on the ventilator and fighting for her life.

As we were doing LD’s Cesarian section, rather laparotomy, in came SeD.

Frighteningly, SeD also had a history similar to LD.

SeD was brought by her parents. Her father, a wizened old man who had quite a lot of creases on his face was a sorry figure.

The history . . . SeD had also been in labour since the previous day. The family had been to many hospitals. She was also told that her hemoglobin is 6 gm%. And her baby was in an abnormal position. The nurses could not get the fetal heart. I was in a hurry.

I told them to push SeD into the ultrasound. I had a cursory glance at the fetus. The heartbeat was going strong and was a footling breech. No other choice than to do a Cesarian section.

I did not think twice. She was B positive. I send word to 2 of our staff requesting to donate blood. SeD was having very strong uterine contractions. I did not want SeD to end up with the same outcome as LD. Ebez George, our Project Officer and Dr. Basil, our Dentist were were happy to donate.

We did the Cesarian in no time. To my surprise, SeD had a twin pregnancy. Mother and babies are doing well. I had missed that in my ultrasound screening.

I wondered why we did not have a staff with O positive blood who could help LD and her baby. They would have done better. The baby would have been alive.

But, a terrible thing happened later. I went to see SeD’s father. He had narrated to me SeD’s sad story. SeD had also delivered 2 years back, but the baby had died soon after her home birth. When SeD got into her present pregnancy, SeD’s husband took her and left at her parent’s home and told them not to send her back if she did not have a live baby this time.

I was congratulating myself as I saw SeD’s father standing at a distance and was happy that I had good news.

I could only watch with horror the pain that SeD’s father’s voice echoed when he came to know that his daughter had delivered twin girl babies. The creases on his face becoming deeper as he pondered aloud, ‘Doctor saab, I wonder if SeD’s husband would come to take her back with the 2 girl babies’.

Please pray that LD would recover well and SeD’s husband feels proud to be the father of 2 daughters.

It's Lagan Season

Last week, as I travelled from Alleppey to Ranchi, few of my staff called me and told that there were very few buses available from Ranchi to come to NJH as it was 'lagan season'.

'Lagan season' is the season of marriage in this part of the country. The connotation is for the auspicious period when marriages can take place. The present marriage season has started from sometime during the second week of May and will extend to the last week of June. Someone told me that it could go all the way to the middle of July. 

Why the great interest in the 'Lagan season' for NJH?

It's all about the hospital becoming busy. The patient numbers come down to a great extent during this season. The reasons . . . everybody is going to someone's wedding. There are no vehicles to come to hospital as most of them will be booked by marriage parties. 

Soon after I arrived at NJH last Sunday, I had gone for a haircut. The barber and few of the customers were surprised at my decision to come back so soon after I had left for Kerala. One villager quipped, 'Sir, you should have taken a longer break. It's so hot and it's marriage season. There will be hardly any patients'. 

But, we've not been so much derived of patients. There's quite a good number of patients coming to outpatient as well as inpatients. We've been busy. 

Then, we receive patients who just want to get cured just in time for a wedding in the family. Basil is quite used to young men and women who want to have a perfect teeth just in time for the big day. I had a family whose middle aged mother was dying of tuberculous meningitis, who wanted me to keep the lady alive till a wedding in the family was over. But, then that never happened.

2 years back, I had a peculiar request. A father and his son who going to getting married in a couple of days came to Outpatient. The father wanted me to ensure that the son did not cough even once when the wedding ceremony was going on. He just wanted me to prescribe a cough syrup. And the son was totally asymptomatic.  

I sometimes wonder how the concept of the 'Great Indian Wedding' has permeated to the rural areas of the country . . . when the whole world stops, when there is a wedding in the village. 

Or was it always like this since the ancient days ? ? ? 

What a place ? ? ?

It is not more than 5 months since I put up the snaps of a very cold winter in NJH. I even had a snap taken of the temperature measured on that day . . . January 8, 2013. 

But, today was a totally different day. The temperature was so high that our thermometer was not enough to measure the temperature. I wonder if it was at least 55 degrees Celsius. 

Good for all people who are away on vacation. But, the better news is that we've been having good electricity supply since the last month. So, not an intolerable summer . . . so far. 

Of course, we would be happy to have some rains . . . Lord, please send us showers of blessings . . . 

The Unfortunate One .. .. ..

I took first call last Monday after quite a long time. It was quite a busy one and got quite a wide array of cases which would have put a Medical College to shame, especially the newly opened ones. 

But, the best case was the first Cesarian I did for the day. A usual case of 'you know what'. 

It was about 9 pm. I was just planning to go for dinner when CJD, a 35 year old lady arrived in labour room. She had been trying to deliver at home since early morning. With the sort of heat we've been having of late, she was so dehydrated and worn out. To complicate matters, she had undergone a Cesarian section for her last child birth which was 2 years back. 

That was the last thing I wanted after a quite busy day in outpatient. 

And after the details emerged . . . I was sure I was sitting on top of a time-bomb. 

Cesarian done 2 years back while she was preterm. The baby was a girl who was just 1800 gms. The family was of course quite anxious for a boy. And her blood group was A negative. 

Per vaginal examination revealed that the labour was obstructed. I initially thought about doing a instrumental delivery, but I was not confident about the outcome, especially the chance of a rupture uterus. 

From the onset, I tried to refer CJD to Ranchi. But, the family looked hardly bothered. We have a protocol of not doing a repeat Cesarian section without the provision of at least one unit blood. And it was difficult to get a pint of A negative blood. And the family had made no effort to even think about it, leave alone arrange it. 

I had to take a decision and go ahead with some intervention. After much dialogue, I agreed to take her for a Cesarian section. The hemoglobin was 10 gm%.

The Cesarian was a mess. There was too much adhesions. 

The baby was sick. And continues to be sick. And it was a girl. 

We asked the mother whether the family knew that the baby was a girl. 

However, considering the attention the family never gave to CJD, I wonder if they knew well in ahead that the fetus was a girl. 

The baby is very sick. We've been telling them to take the baby to a higher centre. But, they are hardly bothered. 

And CJD was the first patient of the night. I became free only at 5 am the next day. There were 2 more complicated labour patients, who needed Cesarian section and then one elderly man with a myocardial infarction. But, then the list of patients with the varied hue of diagnoses of the day, in another post. 

Proud School

Today morning, I met the Principal of Sacred Heart School, Daltonganj where quite a many of the children of our staff study. She was quite elated over the success that her wards achieved in the tenth standard exams.

Situated in Chianki which is approximately 30 kilometers from NJH, the school has been a blessing to the Palamu region in spite of very trying situations. 

And a big relief to me as one major concern for families like us is about schooling our kids end up doing when parents such as us respond to a challenge to serve in a rural area.

I get quite a few queries from potential colleagues about schooling in NJH. I hope this would encourage them.

Of the 100 students who enrolled in the 10^th standard during the last academic year, the following are the marks that they received. Of course, all of them passed.

Total percentile	Number of students
90% and above	15
80% to 89%	29
70% to 79%	35
60% to 69%	17
50% to 59%	4

The highest percentage was 95.4%. And of the subjects, the following are the highest marks obtained by students of the school.

Subject	Highest mark
Mathematics	100%
History	94%
Economics& Commerce	99%
English	92%
Hindi	95%

I’m sure that the above two tables give a good description of the blessing we have in the form of the Sacred Heart School for our kids. Please spread the word. 

More waves

Progressive snaps of the waves hitting the breakwaters in Vizhinjam Harbour, taken from a different position. 

Praise and Prayer Bulletin, May 2013

Below are our praise and prayer points for the month. 

1. Dr. Roshine Mary Koshy, our new Internal Medicine consultant has passed her MD exams. We praise the Lord. And we request prayers as she makes the transition to NJH.

2. I was away for about 2 weeks. I thank Lord for the leadership given by Ms. Meghala and Dr. Shishir in my absence.

3. Please pray for Dr. Titus and Dr. Grace who’ll be getting married on May 20^th and Mr. Dinesh and Sr. Priscilla who gets married on May 30^th.

4. We are in the process of consolidating the achievements of the previous years. We thank the Lord that the auditing went about without much hitches.

5. We continue to remain empanelled under RSBY. However, there are major issues with compensations which is a major deterrant for the smooth functioning of the program. Please pray that all problems will be ironed out.

6. Drs. Nandamani and Ango plan to be with us at NJH from the 22^nd June to 2^nd July. Please pray for their travel and other arrangements.

7. There is a small window period in the first 2 weeks of June, when we are going to be really short of doctors. Kindly pray for this time. Please encourage doctors who can help out to contact us.

8. At EHA, we’ve making an effort to remind ourselves that we are primarily here as spiritual leaders. At NJH too, we are well aware of the need for us to lean more on the Lordship of Jesus Christ. We request you for prayers that we will grow in the Lord, our fellowship will be an offering of sweet fragrance to the Lord and we will be a blessing to each person whom we deal with, staff and patient.

9. Quite  a lot of our staff are on summer holidays. Kindly pray that they would have a good time of rest and refreshment. Do uphold the team who’s taking the extra burden in the absence of the staff.

10. There is need for more staff in the Community Health Projects. Kindly pray for the need.

11. We continue to dream about the presence of a Pediatrician, Surgeon, Orthopaedician and an Anesthetist in our team. Please pray. Specialists become all the more necessary because of laws like the Clinical Establishment Act and the continuing danger of litigations in this era.

12. We’re into a major phase of investing into our Hospital Information System. Kindly pray for Mr. Jonathan who’s giving the leadership. There is a need for quite a lot of funds. 

Patient who taught me - 2

Anotherpatient who taught me something important.

This again happened during my previous stinct at NJH.

It was midnight of a really hot summer. The hospital was not very busy. I was called to attend to a girl, about 12-13 years old who presented to emergency with severe breathlessness.

On attending to this girl whom we shall call AK, I realised that I was dealing with a long term cardiac condition,  most probably a congenital cardiac disease with end stage cardiac failure.

The X-ray confirmed it. Her heart occupied almost the whole of her chest. The veins in her throat were all bulged up. Her eyes were bulging and was very congested. She had central as well as peripheral cyanosis. I could not record her blood pressure.

I put her on the bed in the acute care. I called one of my colleagues who confirmed that nothing much can be done other than make her feel comfortable.

I talked to her parents. In fact, AK had been sick from the day she celebrated her first birthday. They had not shown her to a proper doctor. Only quacks (jhola chaps) and faith-healers (ojhas) had seen her. The family appeared to understand that there was nothing much to do other than pray.

I went to talk with AK. To my surprise, AK also was sure that she was dying. As I told her that I shall see her in the morning and was leaving, she clinged to my hand.

In between her breathlessness she told me, ‘Please ensure that I die here in this place.’ I told her that my nurses will take care of her well. Then she continued, ‘Doctor, I’ve never slept on a bed. I never knew that it is so comfortable. Please let me die on this bed’.

AK died early morning, before I reached for rounds. Her face was so peaceful. Not the contorted faces that I’ve seen in many of my patients who die a horrible death after being breathless.

All she wanted was to remain in the bed on which she ultimately died.

Tells a lot about basic human needs and wants, especially those of the poor. 

Patients who taught me - 1

Patients teach us a lot about life. And I’m sure that they are not one-off incidents. I’m thankful for these patients who instilled qualities in me which I value very much.

The first incident occurred during my previous stinct at NJH. Ms. RK was a 9 year old girl who came to us with a perforated intestine, most probably following enteric fever. The family did not look poor to not afford surgery at our place.

The treatment which included surgery went on without any hitches. Their total bill had come to around 12000 INR. Since there was not any complications and the admission period was uneventful, we did not remember much about RK and her family.

Not until about 6 months later.

I had been part of setting up a TB Clinic at another hospital about 100 miles away from our place. I usually travelled to this place by jeep early morning.

In one of the trips, I stopped at a wayside shack for tea early in the morning, when this middle aged man who was making the tea came out of his shop and touched my feet. He told me that we had saved his daughter’s life some time back.

I could not place the identity of the family till RK came running out from behind the shack.

The shack comprised mainly of 4 heavy pieces of wood in the corners and plastic sheets and sack cloth dividing the space into 3 rooms. Bricks were arranged in a very haphazardous manner to make the outer walls.

It took me some time to recognise RK.

I was surprised at the severe poverty in which the family lived. The father was ready with the tea.

As I sipped the tea on that cold winter morning, I asked the father how he was able to pay our bill 6 months back, considering the poverty he was in. I was in for a shock.

The father replied, ‘We had seen better times till RK fell sick. By the time, we reached your hospital, we had already spent about 20,000 for RK’s treatment. It was just after planting our crops that RK fell sick. So, I did not have any money with me. Therefore, we had to take a loan from the local money lender. Unfortunately, the crops failed because of a poor monsoon. We had to sell our home and the little land that we had to repay the money lender. After that, our life has been this shack.’

He took me about 50 metres down the road and pointed to a hut, much better than their present residence and told me that they used to live there before RK fell sick. 

The winter appeared to sort of envelope me in a terrible chill when I heard this.

We had not even bothered to ask the family about their resources when they came to pay their bill.

The family was very thankful that their little girl did well after our treatment. There was no hint of any remorse in the father’s or the family’s conversation with us about the poverty they were dragged into because of their daughter’s illness.

But, I learnt a very important lesson. I’ve heard only about statistics of how 40% of poverty was caused by ill-health in the family. I was seeing a real life story of one of our patients.

From then on, I make it a point to enquire if our patients our selling their only possessions to pay their healthcare bills. Yeah, the situation has occurred because of a poor public healthcare system.

I’m sure that I may be taken for a ride by many of my patients when they know about my attitude towards patients who have to sell their land or homes to pay for their treatment.

However, I believe that there will be genuine patients who’ll be benefited for life if we enquire about where their resources come from.

The ultimate answer would be to push for a well oiled and competent public healthcare system.

But till that happens, mission hospitals like ours can make a difference in the lives of at least few of such families.

The Aquarium

Outside the Trivandrum Zoo, is a small aquarium which has a decent collection of fish. 

Below are few snaps .. .. .. I could not get the names of most of them. 

Clown fish . . . trying to hide

Well, talking about aquariums, there is a very good aquarium in Vizhinjam. Unfortunately, they do not allow photography. A new building is coming up to house this aquarium.