Quackery . . .

Since our tryst with Palamu region for more than a decade, babies such as the one above are not uncommon. We’ve had many such babies brought to NJH during our stint there. However, with the government taking a pro-active approach to treatment of extreme malnutrition, our workload on such babies have come down to quite a large extent.

This baby girl, whose birth date is not known came to us today. Regarding her age, the parents are only sure that she is more than 2 months old. They had already received a referral letter to the Malnutrition Treatment Centre at Sadar Hospital, Latehar. Unfortunately, they just don’t want to take the baby there.

The reason I posted the snap of this child is to let the world know of how quacks and charlatans in rural India con poor people. I hope you can clearly see the reddish dye put on the scalp of this baby. The treatment given by some quack is for ‘khaparphod’ - which means broken head/skull. ‘Khaparphod’ is the local terminology for the open anterior fontanelle which as we all know is a normal feature of infants which close by about a years age.

The quack has told them that all of the child’s problems is because of the open anterior fontanelle. And they had been taking treatment for that from the said quack since the last one month. I spent close to half an hour convincing the family that this is a normal anatomical feature in a newborn.

It’s close to 6 hours since the baby was ‘admitted’ at our place. Meanwhile we also realised that the child was in sepsis. I can only pray that she gets better soon and puts on some flesh over her bones.

I hope it is also significant to mention that this is the family’s seventh child and three of those died before they turned started to walk. 

Untold misery

This is Kunti Kumari. Elder of three girls who lost their father to Naxalite violence. We don’t know the details.

Kunti was brought to us few days back in a confused state by her uncle. Considering that she was having fever since two days and she was from our ‘malaria endemic’ zone, there were no guesses to arrive at a provisional diagnosis. Laboratory report confirmed the diagnosis. Mixed malaria infection with features of impeding complications.

She responded well to treatment. Considering the rush of patients that we had been having, we missed the tragedy that befell the family. We did not know that Kunti had lost her younger sister to high grade fever just the previous day.

It was one of our nurse aides who told us about the sad story. Kunti's younger sister was having fever since few days and was being managed by a quack in the village. She had suddenly become unconscious and died the same morning when Kunti was brought to us. 

The last ten days we saw more than 25 patients with malaria. Except 2, all of them had mixed infections. We were ill equiped to manage four patients whom we had to refer to Ranchi. Two of them have renal failure and are still on dialysis. One little child has unexplained hemolysis needing repeated transfusions. One little boy of twelve years died within one day of admission to our nearest teaching hospital.

From the nearby villages, we’ve heard about 5 deaths so far. No one has been proved to have had malaria. They had high grade fever for couple of days which was managed by the local quack. And they just died.

The interesting thing this year is the total absence of the coverage of malaria deaths and high incidence in the local media, leave alone at the state and national level.

How long shall we cover up the truth? The truth of an India which is still grappling with preventable diseases like malaria and the unnecessary deaths . . . 

PS: Consent was taken from Kunti and her guardians to put her story and snap in public

Monsoon arrives in Barwadih

Monsoon rains have always been welcome relief. It's a photographer's delight. Whether it was NJH or Kachhwa, there were quite a many snaps.

In Barwadih, we had been quite busy. Still, got the time to take few snaps of the rains.

We thank the Lord for the rains. I hope the water table improves.

Perungalam 2017

These are snaps of our visit this year, Summer 2017. Though we were well prepared to do fishing, we did not catch any fish this year. And we took lesser snaps than last year. So, few snaps shared by the previous director, Rev. Mathews of the Retreat Centre is included (the first four).

This time we missed the boat and had to hire a local speed boat. I hope you noticed the Jharkhand origin jhola in the boat. 

That's the boat we arrived in . . . 

The boat arriving for our return journey . . .

Netarhat

Jharkhand has many beautiful places to visit. Netarhat is the highest point in the state. I've never visited the place, though I visit a village quite near once a month.

Today, an acquaintance send me few snaps of the place. He gave me permission to post it in my blog.

By the way, Netarhat is not more than 100 kilometres from our home in Barwadih. Along with other places worth visiting near by, Netarhat is a must visit place. 

Spare a thought

It has been raining all over the country. Friends and relatives from Kerala inform of the non-stop rain. There are floods in the North East. Along with parts of Tamil Nadu, our part of Jharkhand is yet to receive full fledged rains. 

This was a sad sight in our neighbourhood yesterday. 

Almost all the tubewells in the region have dried off. Many families are depending on water-tankers for their daily supply of water. 

Pray that rains will arrive soon. 

Doubtful benefits

A major group of patients who come to us are those with non- communicable diseases being treated elsewhere who just cannot bear the cost of treatment. Of course, most of the extra expenses are a result of multivitamins and latest combination drugs which are expensive.

However, I was quite surprised to meet a well off gentleman who came to me last week. He was diagnosed to have diabetes and hyperthyroidism elsewhere. He was incurring a cost of 7000 INR every month just to purchase the medicines. Doctor consultation costs and blood tests were extra. He had met another doctor who told him that there was no need for so many medicines.

He came for a second opinion.

His original treating doctor was no small man. He was a senior cardiologist in a NABH accredited hospital in a state capital city of our country.

The best I could do was to call up one of my friends in the respective speciality.

The below snap shows the medicines he had with him. In the foreground is the medicines he absolutely needs and behind it are the medicines he could do without, which has not much evidence of significant benefit.

A close up of the medicines we stopped. The protein powder and the sucralfate syrup is included.

Now, this is a patient who can afford to spend 7000 INR. One can only imagine the plight of the poor who are given a similar prescription . . .

Well, I hope you looked at the second snap, which shows the medicines he stopped a bit close . . . In that bunch of medicines, I hope you noticed Tab. Faropenem 200 mg. The gentleman was having it twice a day since the last 10 days. I could not find any evidence of any sort of infection in the papers he had nor did he give any history of the same. 

So much for evidence based medicine and the dangers of antibiotic resistance that we talk about . . . 

Heights of Ignorance

If you search my blog, there is a post with a similar title written on September 3, 2013.

I was aghast at finding a similar report in our local newspaper few days back.

Below is the clip.

The headline screams - Superstition: Buried dead body of girl exhumed on instructions from traditional medicine-man. Medicine-man claims that dead girl will live. 

The news report is about a family who lost their 6 year old daughter after a snakebite. After the dead body of the girl was buried, a traditional medicine-man turned up who claimed that the girl is not dead, but alive. The family readily exhumed the dead body. However, when the family shifted the body for witchcraft, the local temple priest declared that the girl was dead. 

The incident happened in Kankari village, which is 11 kilometers from the Palamu district headquarters of Medhininagar, previously called Daltonganj. 

Perungalam 2016

Last year, during our summer vacations, my dad suggested us to spend couple of days at the Marthoma Retreat Centre in Perungalam, Kollam District, Kerala. The experience was too good that we decided to spend couple of days at the Dhyanatheeram this year too. 

I had thought of putting up few snaps of our visit to this place last year itself, which never materialised. So, better late than never. 

Waiting for the boat. It is cheaper to get the public transport boat from Ashtamudi Vallakkadavu boat jetty

You can see the boat approaching . . . 

Getting ready to board the boat along with the regular commuters

Scenery from the boat

Approaching the retreat centre

The view of the backwaters from the balcony of our room

A selfie with the pet emu of the retreat centre

A view of the entrance from the inside

Children's play area . . .

Arpit enjoying a merry go round with Ammachy

The highlight of the trip - hooking a pearl spot fish (karimeen), the local delicacy,
This made the children look forward to another trip the following year

How much poor ?

As health care professionals, Angel and me get exposed to horrible levels of poverty almost every day. There have been many many stories. Few days back, I was reminded once again on how bad the poverty can be. 

6 months back, we had an elderly man walk into our clinic with a retention of urine. He needed catherisation of the urinary bladder, which ultimately ended up with a permanent indwelling catheter. Leave alone the option of undergoing a surgery to open up his prostatic urethra, he could not afford the trip to meet the surgeon. 

The maximum we could offer was a permanent indwelling catheter, which is not exactly the ideal option of treatment. He needed to get it changed once a month. 

We also told him about the better options that he has. He laughed them off saying that unless someone does it on him for free, our treatment is what he preferred. In addition, he also had high blood pressure. 

He came regularly till January 2017. Then we did not see him. In fact, we remembered him. Maybe he died. Or, someone gave him some money to undergo the surgery. 

Today, he turned up. He was in severe pain. And his catheter had blocked. He had kept his catheter for a full 3 months.

It was a nightmare. There was skin enveloping over the catheter. It was dry and was very dirty. The attending nurse could not deflate the bulb. I could only shudder on what we will do if the catheter had become stuck. He would have to visit a urologist. The nearest one was 200 kilometers away. The maximum money he usually has with him has never crossed 200 INR, not even enough to cover the travelling cost of one person to the urologist. 

We could only pray. And reattempt to deflate the bulb. It just did not budge. As we attempted again, the valve at the balloon port, broke off. To our relief, as that happened, water started to drip from the broken balloon port and with a bit of a pull, the catheter was out. The balloon end of the catheter was covered with clotted blood for about 10 cms. Thankfully, there was no bleeding from the urethra. 

After everything was over,  I asked the elderly man for the reason for the long delay. He told me that his son reasoned to him that it would be cheaper to wait longer before the catheter is changed. And there was no money in the family. The elderly man and his wife were non-performing assets for his son. His son was away in Kerala now. 

The bill for today totaled about 400 INR. And there was a outstanding due of about 200 INR from his previous visits. I asked him how much he could pay today. He told 250 INR. We took 200 INR and wrote off the rest. 

For such a patient, I cannot see how he can afford a surgical procedure even if I could offer one. Unless, we wrote off the entire amount. 

There has been many a debate on how the poor can be treated. I believe there is only one way until full-fledged public healthcare becomes a reality in the country - teach them to prevent diseases, access treatment at the earliest and offer them options which they can afford. 

Of course, there are always better ways of treatment. Someone could fund it out. But, the question remains about how long . . . about how sustainable are many of the healthcare options we have today . . .

To do list

Few weeks back, I had a unique experience.

Early morning at around 7 am, a man was rushed into our clinic with complaints of chest pain since the last 2 days. He was taking some local treatment elsewhere when the pain became unbearable since midnight. He had a feeling that his life was coming to an end.

We made him comfortable, gave some analgesics and went ahead with an ECG. It was obviously a heart attack in progress.

He asked me if he was having a heart attack which he knew could be fatal. I told him that he appears to be having a heart attack. Although in severe pain, he asked one of the bystanders, who seemed to be his son to bring him a paper and a pen. We provided him with one.

He was in too much distress to write. He told his son to write as he dictated. It was basically names of people along with amounts of money which they owed him. It took some time for him to remember, but he thought he had all names. The total was quite a bit of an amount .. .. ..

As I witnessed this exercise, I remembered about how people like Moses, Joseph, Abraham etc. of the Old Testament in the Bible called all his children and blessed them as they lay dying.

I wondered what I will have to tell my children and grandchildren as I reach my last days on earth . . .

My prayer is that it would only be to tell my family about how good the Lord has been and how good is it to trust and follow the Lordship of Jesus Christ . . .

Misleading . . .

One of the major group of patients whom we serve at Barwadih are those who present with diarrhoea. Since last few months, quite a many of the patients tell us not to prescribe Oral Rehydration Solution powder as there is a ready to drink ORS preparation available in the market. 

I did not care much as this drink called ORSL was quite commonly available in the market and patients especially children preferred it over the ORS powder which we prescribed. On and off, we used to get patients who said that they did not feel better and requested for the ORS powder. 

However, I was in for a shock today, when a patient with diarrhoea walked in with this packaged drink. The snaps of the tetrapack are self-explanatory. 

The manufacturer has very clearly stated that IT IS NOT TO BE USED FOR DIARRHOEA and there is no mention of the WHO accepted formulation for ORS. 

For those who don't know the formula for the current WHO oral rehydration solution (also known as low-osmolar ORS or reduced-osmolarity ORS) is 2.6 grams (0.092 oz) salt (NaCl), 2.9 grams (0.10 oz) trisodium citrate dihydrate , 1.5 grams (0.053 oz) potassium chloride (KCl), 13.5 grams (0.48 oz) anhydrous glucose per litre of fluid. This fruit drink has a whopping 12 gms of sugar per 200 ml. 

So, why the name - ORSL - which appears to stand for ORS Liquid. 

I've seen patients buy this drink in cartons from local pharmacy shops. 

Now, for the shocker . . . The below snap shows the price for this 200 ml drink which misleads people to think that it is a medicine. 

32 INR . . . when the ORS sachets are available free in public healthcare facilities and the maximum cost of a ORS sachet which makes 1 litre of the fluid is about 16 INR. So, a misled patient could end up spending 160 INR per one litre of ORSL instead of 16 INR. 

Quite misleading marketing strategy to make a quick buck . . . Can't someone take this company to task for misleading people into buying this sugary drink, which is in fact harmful to health. At least they should print 'Do not use during diarrhoea' in larger print and the local vernacular language. Instead they have printed ORSL in Hindi to mislead the unsuspecting poor and the half literate Indian. 

A typical example of how crony capitalism makes it's profits . . .