Marathon Cesarian Sections . . . Cont'd

Over the last week, I've tried to pull your attention to the poverty of this region. In addition, there was the day when we had to do 7 Cesarian sections on the trot . . . all of them, Maternal Near Misses.

They all got discharged without any sort of complications except for the babies of KD and AF. 

Below is the chart once more. This time, I've added 2 columns . . . which shows the final bill and the charity we ended up giving.

Name	Time and date of surgery	History	Final management and comments	TOTAL BILL (INR)	CHARITY (INR)
RtD	20th july, 11:00 am	Previous LSCS, had come for ANC on 20 june, Hb: 8 gm%, never bothered to arrange blood	Boy baby, apgar 9 and 10. Had waited almost a day for the blood	13162	3979
SMD	20th july, 12:36 pm	Obstructed labour since previous day 8 pm	Boy baby, apgar 6 and 10. Almost a rupture	16101	6851
MD	20th july, 2 pm	Primi at 40+6 with labour pain since previous night. Later obtained history of leaking 4 days. Irregular fetal heart.	Girl baby apgar 8 and 10. Well off patient – did not go to Ranchi.	15658	490
AF	20th July, 3:14 pm	Labour Pains since yest afternoon and leaking, short 136 cm, obstructed labour	Sick girl baby, apgar 1 and 4. Died later, Almost a rupture	16541	3109
KD	20th July, 5:24 pm	Prev LSCS  with iud and Hb 8 gm%	Dead girl, Hysterectomy for placenta percreta	17320	6524
RnD	21st July, 2:17 am	G4P3L2D1, pedal edema 2 weeks, headache followed by seizures 2 pm, 20th july	Baby boy, apgar 6 and 10. IUGR	16498	1053
SrD	21st July, 3:30 am	Short primi, pedal edema > 2 weeks, was having laboru pain since 12 pm on 20th July, BP 140/100. Urine alb 3+	Cervix edematous and head high, inadequate pelvis – lscs, boy baby apgar 3 and 7. Gr 3 Meconium Stained Amniotic Fluid	19235	2438
	TOTAL			114,515	24,444

Well, why do I have to show this . . . When some hospital asks for a small amount and people don't pay, they make into the newspaper. I know of quite a number of healthcare institutions who do quite a lot of charitable work and do not even find a mention anywhere. Just imagine, almost 20% of our costs going into charity . . . This is a fraction of a day's work. 

As I write this, I've 2 patients who are in the ward for whom I would have to give full charity. . . 

The first one, NK, who delivered her first baby and was brought to us about 5 days back with a history of seizures after she delivered a baby about 5 days back. We've not been able to bring down the blood pressure. We tried to refer them the first day. But, to no avail. Today, the father came to me. He requested me to discharge the patient as they did not have any more money with them. He told, 'I will take her home and then we would wait for her to die'. I've told them that we shall continue treatment for 2 more days and they need not pay any more money . . .

The second one, RD was operated 5 days back. Stuck by polio at the age of 3 years, she had got married to a blind young man from her village. She had a pregnancy 3 years back - she had a normal delivery, but the baby was dead. I wonder how she delivered with both legs stuck with polio. When she came to NJH, it was not a classical Rupture Uterus. On operating, it was like someone had done a Cesarian section without opening the abdomen. 

The family does not have even one rupee with them. We'll have to write off the entire bill . . . 

The consequences of such charity work can be terrible on an institution such as ours . . . But, then, there is no other option for most of our patients . . . I wish we had some sort of support .. .. .. 

Requirement . . .Urgent

Today morning, we had something unfortunate happening in our Acute Care Unit.

Our first ventilator went off dead in the middle of ventilating a patient who had come unconscious in the morning. It just refused to function the way it used to. However, it had served its' purpose for quite long.

Our engineer was quick to come down and do few rapid diagnostic tests - and the conclusions were obvious. The motor had given way and we would need to do some major repairing on it. And it will take time and may not give long lasting results.

However, it did not need much of thinking to come to a conclusion that we would do better with couple of more of this type of a ventilators.

Our new ventilator has not been quite cost effective and guzzles quite a lot of oxygen which makes the whole process of ventilating quite expensive for our poor patients and it has not been that user friendly.

A couple of phone calls and manufacturers of the first ventilator tinformed us that they still produce such machines. The cost is Rs. 65,000 and it is only made on order.

We have realised that the new ventilator is more suited for use along with the Boyle's machine and she has performed quite well in the cosy environments of the theatre.

So, all those who has been reading about our work - please do help us. Over the last 3 months, the patients we had been ventilating has gone up quite a lot. And we would do well with couple of such ventilators.

We would need about 150,000 Indian Rupees (approximately 3000 USDs/2250 Euros/2000 GBPs) to cover the costs of buying 2 such ventilators including the transportation. Looking forward to hear from quite a few of you...

Charity - giving, giving and giving . . .

Couple of days back, one of my colleagues questioned me about our policy to going overboard to help patients get their lives back. The specific instance arose when I requested one of my staff to donate blood for SD about whom you can read here. Dinesh, the engineer here, readily donated blood – but I was taken aback when one of my closest confidantes chided me about the decision.

To recap things, SD was brought to our emergency in a quite bad state on 5^th September morning. She had delivered a dead baby at around midnight and her placenta was stuck. She had been bleeding all through the night and into the day. Her hemoglobin was 1 gm% and she was sinking. With a AB positive blood group, the chances of her surviving were remote.

 

 

The fact is that SD is still alive. She has stopped bleeding. Her vitals are all normal. During my attempts of removing the placenta and from the history it was very obvious that the baby had been dead for days and the whole of the uterus was terribly infected. She has received two pints of blood so far of which the first pint was given by my engineer, Mr. Dinesh.

 

 

I clearly understand that volunteering to give blood in such situations is a very personal decision. I’ve known colleagues who weigh in the possibilities of a patient surviving before they donate the blood.

 

 

However, when I look it from the perspective of how Jesus looked at problems and their solutions – I am very much encouraged by the incident of the ‘Feeding of Five Thousand’ – which we read in all the 4 gospels in the Holy Bible (Matthew 14:13-21, Mark 6:31-44, Luke 9:10-17 and John 6:5-15). The most absorbing spectacle in the incident is the readiness of the disciples to tell Jesus on how little they had. And Jesus was looking at their readiness to share the little they had.

 

 

I’m glad that the Lord led us as a team to decide on giving this patient the one pint of blood which was the only thing other than our prayers which we could offer her to sustain her life. She has pulled through so far. We still do not know how things will progress – but we are encouraged by the unseen but the very much felt hand of the Holy Spirit that leads us each day.