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. 

Disability Day Celebrations - Daltonganj

Now, these are snaps I got from the International Day of People with Disability celebrations in our district headquarters which our Community Health team organized . . .

Welcome address

Joint inauguration

One participant singing a song

Chottu and Chintu doing a dance

 

Disabled friendly ramp

The Climate Change Project staff advertising Madwa/Ragi foodstuff

Another view of the audience

A drama in progress

One more view of the audience

Waiting . .. ...

(This post was written on Monday, the 29th July, 2013)

As we wait for rains . . . I’ve been waiting for something else since today early morning.

When I arrived for work today early morning, Titus had news for me about a rupture uterus which has been refusing to go to a higher centre after she arrived her at around 5 am today morning.

This is the second rupture uterus over the last 24 hours.

Dr. Shishir did the first one on Sunday evening.

MD had come sometime early morning on Sunday (28th July). MD had been in labour since 4 am on Saturday (27th July). This was her 3^rd pregnancy. By around 10 am on Saturday, the family realised that there was some problem. She was shifted to the nearby PHC.

The doctor at the PHC was smart enough to realise that there was some complication and she was shifted to the nearby district hospital. At the district hospital, it took some time before the family was told that she appears to have a rupture uterus.

It was late evening. The family was told that the best place for them would be a private hospital in the adjacent district. However, no vehicle was ready to take them to the adjacent district.

They were told that it would be dangerous to be in the district hospital. Therefore, they took refuge in a private hospital for the night.

Very early in the morning, they set out to the Daltonganj. The private hospital they were referred to refused to have anything to do with the patient. It was much beyond their skills. They promptly referred the lady to NJH.

They reached NJH by around 8 am on Sunday. The problem was that she had very high counts and her haemoglobin was just above 7 gm%. It was unthinkable to do anything without blood. We sent the relatives to the nearest blood bank in Daltonganj for 3 pints of blood.

The relatives returned by around 3 pm. Dr. Shishir operated. It was quite tough. She was in severe sepsis and appeared to be going to severe Acute Respiratory Distress Syndrome. She has pulled through the night. 

As I write this (Monday night), MD continues to be on oxygen.

The next maternal near miss, the one I mentioned at the beginning of this post, arrived today morning. RD, had a Cesarian section for her previous delivery. Similar to many of our previous rupture uterus following a Cesarian section, the family was ignorant of the fact that she needed an institutional delivery.

She was better off than MD. Her haemoglobin was 9 gm%. Still considering the time she was in labour and the long period of dehydration, we were definite that there was hemoconcentration.

RD had arrived at 5 am today. It was 5 pm by the time the relatives could arrange blood from Daltonganj. The surgery was uneventful. However, her uterus was quite damaged to conceive another baby.

To top the 2 rupture uterus, we had a severe eclampsia sometime around mid-morning. We kept her for normal delivery as she appears to progress well. However, we realised towards the beginning of her second stage of labour that there was a malrotation and she may not deliver normal.

We ended up doing a Cesarian section for her. As it was a second stage Cesarian section, there was lot of problems. The uterus was in atony for quite some time after delivery of the baby. And she lost quite a lot of blood.

Again, we needed blood. We tried to send the relatives to Daltonganj for blood. But, it was too much of an ask. We have to ensure that she does not bleed more during the night.

The availability of blood is quite a crucial aspect in the smooth running of a centre like ours.

Last year, we’ve had about 1500 deliveries. And with quite a large proportion of them accounting for high risk obstetrics, if we need to develop further, we urgently need to think about setting up of a blood bank.

And not to mention the very high chance that all three of them could have ended up as maternal deaths if NJH was not around. 

However, the big question remains about committed personnel who would be willing to come all the way to a remote location such as ours . . . and continue the good work and look at possibilities of new avenues of quality care. 

A Stray Leopard . . .

I wonder if anybody had read about a stray leopard which entered a house in Daltonganj, our nearest town. It sent quite a shivers down many a spine here, as our hospital is very much in a heavily forested area. I never thought that the news was in the internet till I saw the reports in TOI. Of course, it was big news in the local press. 

There had been quite a lot of deforestation and the very bad drought over the last few years had dwindled the wild animal population. 

However, the recent intrusion of this wild cat is an indication that the wild animals may have returned to the Palamu Tiger Reserve. Newspapers later reported that the foresters estimated that there were over a 100 leopards in the reserve area. There was much joy about a year back, when the forest officials reported rare sightings of the animal in trap cameras set in the reserve. 

Good news for wild-life, but frightening for many of us here. The leopard has been released back into the reserve. 

Now, we would need to be careful about venturing out in the dusk . . . especially going for calls etc. in the night. 

I would definitely like to see one. But, not inside the campus . . . roaming around. 

Schooling at NJH

Whenever one has to serve at remote locations like ours, one of the first questions that people like me with young children usually ask is about a good school in the nearby vicinity. The popular notion was that there was no good school near NJH. And was many a time quoted by people who had worked there as a major challenge to get qualified people there. 

I knew that there was a good Catholic school in Daltonganj during my previous stint at NJH. However, being a bachelor and having had not made much of any plans of coming back, I did not give much thought to this matter. 

However, on reaching back and having a young boy who was almost ready to go to school, I had to take a call. We had to send Shalom a year earlier to school as he was quite insistent that he goes to school. And we also thought that we will get a feel of how good schooling is at Daltonganj. 

The school has been the alma mater of quite a few of our staff kids who have gone to well placed positions in life. I hope that many of them would respond to this post.

Managed by the sisters of the Sacred Heart congregation, the school completed 43 years of it's service to at least 2 budding generations of Daltonganj and it's surroundings. As has been the major contribution of the church in education throughout the country, the school has lived up to the standards and is a prestigious institution to get admitted into. 

We are thankful that the school has been a blessing to many of our staff over the years. 

The reason I thought about putting this post was the quite impressive performance the teachers and students under the able leadership of Sr. Jossy Mathew, put up in their recent Annual Function. 

The theme of the program was 'Sangam' - a portrayal of religions in India . . . Below are the snaps . . . 

Sr. Jossy Mathew, Principal accompanying the Chief Guest, Bishop Gabriel Kujur to the dias

Lighting of the lamp

The first dance . . .  Quite a spectacle

Creation story by the tiny tots . . . Note Adam and Eve standing on the right  side

Jharkhand tribal dance . . .

Dandiya dance .. .. ..

Jain dance . . . 

Showcasing the Budha

Sr. Jossy addressing the gathering . . . 

The English choir . . . 

Bioscope . . . which I thought was the best program

Another dance . . .

Quwwali . . . 

The Hindi choir . . . 

English drama . . . Merchant of Venice. 

The Christmas story . . . 

Western dance . . .

Another one . . . 

The Bhangra dance . . . 

Closing program . . . the sangam

Overall, it was a very a nice and well arranged program. 

One more anecdote about schooling for staff at NJH. I was quite concerned about Shalom travelling about 50 kilometers every day to attend school. About a year back, I was narrating this to one of my friends. He told me that I was lucky. Why? His son was travelling about 10 kilometers one-way by bus everyday through the dusty roads of Delhi every day . . . but the journey took more than a hour due to traffic. And that was almost two and a half hours of travel everyday through a very polluted environment. 

Kids at NJH do the journey in about 40 minutes . . . and the journey through a very pristine environment. 

So, that's for people who are resisting from joining us on account of poor educational opportunities . . . 

Golden Jubilee CME

One of the new ventures we attempted as part of the Golden Jubilee was a Continuing Medical Education programme for doctors in Daltonganj. All the credit for suggesting the same goes to Dr Philip Finny, Consultant Endocrinologist from our sister hospital in Raxaul, Bihar State. 

We were quite encouraged by the enthusiastic response from the Indian Medical Association officebearers at Daltonganj. A total of about 40 doctors attended the CME which was on Diabetes Mellitus.

We look forward to more sessions of CMEs along with the doctors at Daltonganj.

THE COSTLY DELAY - 1

You may have read this statement somewhere –

‘If you want to know the value of one year, just ask a student who failed a course.

If you want to know the value of one month, ask a mother who gave birth to a premature baby.

If you want to know the value of one hour, ask the lovers waiting to meet.

If you want to know the value of one minute, ask the person who just missed the bus.

If you want to know the value of one second, ask the person who just escaped death in a car accident.

And if you want to know the value of one-hundredth of a second, ask the athlete who won a silver medal in the Olympics.'

Couple of days back, I had two patients who would have done better if they had not delayed coming to us on time. I shall narrate the story of the first patient in this post and in a later post, the story of the second one.

LR is a 55 year old man from a nearby village, Rankikala. Since the last 1 month LR has been sick with vague symptoms. It started off with fever on and off in the evening. He went to the local practitioner (RMP) in our market village, Satbarwa who prescribed him some tablets. He improved for couple of days, after which the fever had come back. In addition, he developed something new – he had episodes of seizures of his right leg alone.

Satbarwa is famous for a Vaid (traditional healer) who is specialized in neurological ailments. I’m told that he uses the extract of garlic to make a concoction which is given as an intramuscular injection. I’ve had quite a lot of patients who vouch for this remedy in the treatment of neurological ailments. However, I’ve noticed that the recovery mainly occurs in patients who had ischemic strokes – which would have healed otherwise too. Since LR felt that having seizures is something related to the nerves, he straightaway went to the vaid at Satbarwa.

Unfortunately, nothing much happened. He still had a fever and cough was worsening. However, he felt that those symptoms are secondary and he needed to get treatment for his seizures. The seizures continued to occur. The Vaid decided that this needed further evaluation and send him to one of the physicians in Daltonganj. The doctor of Daltonganj also treated him for about 2 weeks – before LR decided that there was not much improvement.

LR came to NJH OPD couple of days back – He was frail and it was obvious that he had lost quite a lot weight recently. His pulse was feeble and Blood Pressure was just 80/50. His chart came to my table – as he entered my room, the diagnosis was obvious - Lung abscess. The stink from his breath was unbearable. It was difficult to fathom how one could miss the stink. And from his blood pressure and history of seizures  - possibilities narrowed down to either a disseminated malignancy or disseminated tuberculosis. Sputum AFB turned out positive for tuberculosis. I did an X-Ray which is put up here.

LR's Chest X-Ray

LR had spent almost 10,000 rupees by the time he came to us. He would have done better with a CT Scan Brain. But, he just did not have the money to make a trip to Ranchi leave alone the CT Scan. In addition to the Anti-Tuberculosis treatment, we have also started him on Steroids and Anti-seizure medications.

LR waits with his son for his anti-tuberculosis medicines

I’m confident that he will do well. However, things would have been easier had he turned to us early – which brings us to question on why people avoid coming to people like me in the first place. Money is obviously the major issue is institutions such as ours. However, he would not have had to spent this much if he had come to us straightaway. But, I did not understand why this does not happen, until I heard about ‘agents’ about whom I shall post soon.

My only prayer is that the delay would not turn out to too costly for LR whereby he may lose his life – unlike RD about whom I shall write in my next post (http://jeevankuruvilla.blogspot.com/2011/09/costly-delay-2.html).