This is a guest blog from our Physician at NJH. She responded to my request for a post after she completed 100 days of selfless service at NJH. We had been praying for her for quite a long time and it was a dream come true for me when she joined NJH.
Dr. Roshine Mary Koshy completed her graduation and post-graduation in Internal Medical from the Christian Medical College, Vellore. She hails from Kerala and was a topper in the State MBBS Entrance Examinations. Her father, Rev. George Koshy pastors the Marthoma Church, Krishnarajapuram, Bangalore. I hope her former school mates from the Marthoma Residential School, Tiruvalla and Mathews Mar Athanasius School, Chengannur will appreciate her work.
After her graduation she had also served at Marthoma Hospital, Chungathara and the Fellowship Hospital, Kumbanad.
Over 3 months into working as a consultant physician
in NJH has been an eye opener for me. This write up is an attempt on my part,
as someone new in this field, to share my experiences and observations/musings
over the past 3 months in the hope that anyone who might be interested in
getting involved in improving health care in North India might have something
to ponder about and those who intend to be spectators might want to take a
closer look.
I feel that a great challenge as a health care
provider is being able to identify the population with greatest need and to
constantly focus on allocating all available resources within our constraints
for their benefit. Just a few months experience and I know this is easier said
than done.
Who are the poor that this hospital takes care
of? It is a heterogeneous group and the
two distinctions I make are purely based on my observations as I care my
patients and talk to their families in a hospital setting.
There are the real poor. They are hardly seen in the
hospital because the hospital is their last resort to which they often don’t
reach on time. But I remember a few of them who did come to us. They come
really sick, treated by traditional healers, wanting their loved one’s life
saved. If I were to tell them the critical condition of the patient and paint
the obvious bleak outcome, they would rather take the patient home than get
treated. But if they do decide to get treated and the patient gets relatively
well in a day or two, they want to be discharged immediately because they can’t
bear the expenses of the remaining days. They get better, go home very happy
and never beg for charity.
I learnt this the hard way. 8 year old Reena came to
us with GTCS for almost half an hour. There were no beds in the ICU. We
controlled her seizures and I explained that they would need to take her to a
higher centre. It seemed reasonable enough to me. It never dawned on me that
the nearest higher center is Ranchi, a 5 hr journey with an expense of 6000 Rs
if the family makes it both ways with additional expenses in Ranchi. I was
happy to see them arranging a vehicle with the referral letter in hand. I am
grateful for one of my colleagues who happened to notice the scene and told me
that they were taking the child home. It took only a little extra effort to
arrange a bed and manage her medical problems. She turned out to have TB
meningitis, developed partial lateral rectus palsy while in the ward which
resolved with treatment and she went home a happy little girl.
The thought that if this health service had not been
available for her, that she would not have lived was a hard truth for me to
swallow. After seeing the health status of the poor here, having been able to
save a life does not appear heroic to me. It just speaks volumes of the complacency
of my profession in fulfilling its solemn duty to society.
The not so
poor patients, I have grouped together because though their socio economic
status varies, they have something in common. Their health issues have not been
properly evaluated; they have been extensively and unnecessarily investigated
and treated. I find this to be one of the greatest challenges while working in
this part of the country, the fact that the practice of medicine is not a
science but a trade. I sensed it during my first month when my patients were
very offended because i seemed to be ‘probing’ into the history of their
clinical complaints. Listening to their history and examining them before
ordering an investigation was unusual. It was more frustrating to me when
healthy patients came asking purely for investigations because they wanted to
confirm if they had ‘typhoid’.
Working in a
rural area and ensuring that the practice of medicine is both science and art
is challenging but extremely rewarding. I am grateful for my training in the
Christian Medical College, Vellore, for the privilege of being mentored by
excellent clinicians. For those young doctors who think that working in a
secondary set up in a rural area is dull, I thought I would just give you a
list of a few of the medical problems that we encountered in the past 3 months.
Snake bites both poisonous and non-poisonous,
Organophosphorus poisonings, meninigitis, strokes, tetanus, neurocysticercosis,
pneumothorax, staphylococcus empyema, rheumatic heart diseases, tuberculosis,
connective tissue disorders, apart from malaria, rickettsial infections and the
like. Being able to clinically diagnose them with basic supporting
investigations and manage them is very satisfying. As for scope for
improvement, the area of critical care has great potential in our area and we
are focusing on it.
Working in rural areas which have been neglected and
among communities that have often been exploited can be very frustrating
because good intentions can be looked upon with suspicion and appreciation for
the work that one does is often hard to come by. The advice that my colleague
gave me is something worth contemplating and I end my ramblings with the wise
words of Oswald Chambers.
“If we are devoted to the cause of humanity, we
shall soon be crushed and broken hearted, for we shall often meet with more
ingratitude from men than we would from a dog; but if our motive is to love God;
no ingratitude can hinder us from serving our fellow men”.
