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

Blackwater fever . . .

(This post was drafted on 15th Dec, 2011)

We have been having quite a lot of patients with malaria over the last 2 months and it seems that they would continue to come all through the winter. We have some sort of a cold wave going on here with temperatures around 5-10 degree celsius in the night and it is a bit unnerving that we continue to get very sick malaria patients.

The latest two patients whom we have are quite sick. ND, a young housewife who is 7 months pregnant came today afternoon with long standing fever. She was being treated in Daltonganj for the last 1 week. 50% of her red blood cells were infested by the malarial parasite. And her liver enzymes were mildly elevated. We offered her a referral as we thought that the family looked well off, she was pregnant and her platelet counts were 41,000/cu mm.

Her family ultimately decided to treat her here after much deliberations.

Sometime late in the evening came MS, a middle aged man with history almost very similiar to ND. However, he looked more sick. 20% of his red blood cells were infested by the malarial parasite, but he had a platelet count of only 15,000/cu mm. The worst was his urine. Although his creatinine levels were on the higher side of normal, the colour of the urine was very frightening.

In the earlier days, I understand that this used to be called blackwater fever. And I've read somewhere that Dr Paul Brand's father died of this condition.

I hope that both MS and ND will pull through. As we discussed about these patients, Nandu was quite apprehensive about having to manage such patients alone from Saturday. Shishir has already left for his vacation and I would also be going off south to home from Saturday.