Friday, August 15, 2014

Searching for help . . .

The country celebrated it's 68th Independence Day today. Over the day, we had stark reminders of how languished many of our fellow countrymen are. 

The first reminder we had today. 

Around 4:30 pm today, we had a young boy being wheeled in. He was dead. 

Although brought in a Maruti Dezire by a well off guy, it was very evident that the boy hailed from a impoverished background. The history - - he was bitten by a krait at around 4 am today morning. For quite some time, they were doing witchcraft (jaad-phuk). Then someone suggested that they take the boy to a hospital. 

Someone told of the good hospital that was at Tumbagara village, in Palamu who offers good treatment for snake bite. Off they set from Tilouthu town searching for our hospital. 

Do search in google maps. Tilauthu is how it is spelt in google maps. Tilauthu to Satbarwa is whooping 165 kilometers. For those of my friends from Kerala, that is more than the distance from Kottayam to Trivandrum

I wonder how they missed the fact that Tilauthu to Varanasi was the same distance and the road was much better. Varanasi has big hospitals and the famous Banaras Hindu University which has a Medical College. Nearer is Gaya which also boasts of a Medical College. 

When the group drove from Tilauthu to Satbarwa, they traveled through 3 districts. They had started off at around 8 am today morning. On the way, someone advised them of a more powerful wizard in a place called Japla. So they went to Japla. They left Japla at around 2 pm to reach NJH at 4:30 pm. 

Now, if you look at the map, you see that Tilauthu and Japla are on either side of the Sone river. Initially I thought that that the family somehow crossed the Sone river to Japla. But, that was not the case. The family had reached Chattarpur at around 10 am on the way to NJH, when someone gave the advice about the wizard in Japla. 

So, they actually took a detour to go to Japla. The family claimed that when they left Japla at 2 pm the boy was breathing. 

If the family had straightaway come to NJH, maybe we could have saved the boy. 

But, the incident brings to the fore the sad state of healthcare available to many of the communities around us. And of course, the ignorance about snake bite and its treatment. 

Hope at least by next year's independence day, lesser lives will be lost to snake bites . . . 

Friday, August 8, 2014

Hospital Information System

Today is one of those days where our energies are being tested to its limits. 

Everything revolved around a computer crash-down after our Hospital Information Software went bust. And to our horror, we realized that we lost data from 11th July to 7th August. Everything, totally wiped off. 

We've been trying to find funds to obtain new software and hardware since about a year. The present arrangement of HMS has been on since 2006. However, things have not been going smooth since quite some time. Things had been kept on hold for long for want of funds. 

One of the major issues in remote and impoverished locations such as ours is the inability to raise capital. With an impending drought in the region, the future for increasing prices etc., thereby raising capital look quite bleak. The non-payment of dues from the government programs have only made matters worse. 

So . . . how much we need to somehow get our systems going once again smoothly? 

My IT manager says that he needs a minimum of 200,000 INR for the hardware and another 400,000 - 500,000 INR for the software. A welcome addition would be an additional 400,000 INR to equip all our officers with laptops. So that makes a total budget of around 1,000,000 INR (

Yes, we've had major plans for the IT department where the budget has been put at around 2,000,000 INR. However, that has not materialized so far. 

Meanwhile, please pray for the whole administrative team along with the nursing team and maintenance team who are working round the clock to ensure that things get back to normal by tomorrow morning with the old software.

Thursday, August 7, 2014

Pediatric ICU

It is not even one week since I received a call from a prospective pediatrician for NJH about the pediatric workload at NJH. Well, this post is sort of an answer . . . 

Today's patients in the Acute Care Unit . . .

Bed Nos. 1: 3 year old boy, AA. Admitted with complaints of one day history of fever, multiple episodes of seizures and altered sensorium since today early morning. We had to intubate him and mechanically bag him within minutes of his admission. The diagnosis - Meningoencephalitis with aspiration pneumonia. The boy is quite sick.

Bed Nos. 2: LK, a 9 year old girl, who was sick with fever since 4 days. Since today morning, he had multiple episodes of seizures. The diagnosis - Meningoencephalitis with aspiration pneumonia. Her condition is better than AA, but needs oxygen to maintain saturation although she is not intubated. 

Bed Nos. 3: 9 year old girl, NK, who came on the 3rd August after a krait bite. She has been intubated since. By God's grace, her condition has improved quite a lot. Weaning off the ventilator would take some more time.  

Bed Nos. 4: 20 year old young lady, KK, who had a cobra bite at around 3 pm yesterday and was brought around 8 pm after going through the customary rituals of 'jhad-phuk' and couple of visits to other hospitals. We had to intubate her within minutes of her arrival . . . She continues to be on the ventilator. To make matters worse, she has a bad ischaemia of the site of the bite - Right middle finger - which most probably needs amputation. The only adult patient now in the ACU. 

Bed Nos. 5: 16 year old boy, who was bitten by a krait on 2nd of August. He has also been on the ventilator since admission. Dr. Roshine plans to take him off the ventilator sometime later today. 

Bed Nos. 6: 10 year girl, BK, admitted today morning with the history of fever since 8 days, headache and vomitting since 3 days and couple of episodes of seizures since yesterday. Lumbar puncture is suggestive of a tuberculous meningitis.

So, 4 out of 6 patients in ACU are children, another one is a teenager. That provides the answer to the prospective pediatrician . . . 

The things to be thanked for . . . all the 6 patients are sick and it was such a relief to see all of them hooked onto multipara monitors. Thanks to all those who helped us to get to this state of affairs. 6 multipara monitors, 1 full fledged ventilator, 2 anesthesia ventilators, 2 syringe pumps . . .

The sad thing was to see little AA being manually ventilated . . . However, you know, there are no ventilators of any type other than those we have for a radius of almost 150-200 kilometers. 

Of course, many more things to be done before it would become a full fledged ICU . . . more on that in the next post . . .