Very sick patients - request prayers

There has been lot of Community Health work going on over the last 3 weeks. The Lord has been gracious to us after we got some very favorable responses from few of the government departments. I just returned from a technical week celebrations by the local Krishi Vigyan Kendra and the Zonal Research Centre, Daltonganj who asked us to facilitate one day of farmer training. 

As I reached hospital, Roshine and the ACU staff were struggling and baffled by a 9 month old baby who had turned up yesterday late night very sick. She had kept almost Roshine and the Critical Care staff awake last night and it seems that she would continue to do today also. MK had been having diarrhoea over the last 4 days and she was being managed at home. She had suddenly become unconscious yesterday. 

She was gasping and badly desaturating when she reached NJH. The staff had to intubate her as soon as she reached. This 9 month baby weighed 14 kilograms. She was so chubby and in shock too. Roshine had to put an intraosseous line. She was improving over the day. But, she became worse towards evening. 

She continues to be on manual mechanical ventilation. 

Please pray for her. 

One more person we request prayers. AA, who came about 2 days back. AA had fallen from a height and ended up a paraplegic. Due to lackadaisical care, he developed a bad bed sore which was also neglected. He was brought in a very bad state and with probable pulmonary tuberculosis. 

We were very sure that he needed a miracle to recovery. We told of our limitations. 

They requested a referral to a higher centre. He had already been treated in Ranchi. 

Kindly pray that he would get good treatment in Ranchi and he would get healed. 

Our CBR program has already identified that falling from heights is one of the major causes of acquired disabilities in the countryside. And most of such villagefolk live miserable lives. 

As we explore further avenues of facilitating Community Based Rehabilitation, we pray for more skilled and committed hands . . . Do also remember Dr. Titus, who recently was accepted for post-graduate training in ENT at the Christian Medical College, Vellore would leave us in a couple of days along with his wife, Dr. Grace . . .  

Diarrhoea

We were one of centers who were requested to be part of the Rotavirus Vaccine study,of which initial research answers have started to appear. Unfortunately, we do not get many cases of children with acute diarrhoeal disease. It's not that there are not much cases in the community.

The reason is that quite a lot of the community knows that we do not give much medicines.

ORS . . . that's the only thing you get when you go to NJH.

Now, if you go to a quack . . . I've had pictures of what they end up getting.

I got a one year old child with diarrhoea about a week back. The medicines which the quack had already prescribed.

The family expected me to prescribe more drugs.

When I told them that all these drugs are not needed, they left in a huff claiming that they know better doctors elsewhere. Of course, I've had worse cases before . . . And also similar cases who had gone to qualified doctors who got same type of treatment.

So, who's going to come to us ? ? ?

So much for our participation in the study . . . 

Mismanaged Diarrhoea . . . How quacks do it . . .

Yesterday, I had a post on how medical school educated graduates manage diarrhoea. 

Today, in outpatient, I had a 18 month old child who was being managed by a quack . . .  And below is the snap of the medicines, he has been on. 

And this is his prescription . . . 

For those who could not understand the writing - 

1. Ondansetron Syrup

2. Dexamethasone Injection

3. Ofloxacin plus Ornidazole Suspension

4. Ceftriaxone Injection

5. Aristozyme digestive enzymes. 

The parents claimed that the baby was also prescribed Oral Rehydration Solution . . . But, there was no sachet to be seen . . . They claim that the baby was initially better, but later started to have diarrhoea and vomiting since last night. 

And the most interesting aspect . . . Similar to yesterday's patient, this young boy weighed 6 kilograms . . . instead of at least 10 kilograms which a healthy child of this age should have. 

Mismanaged Diarrhoea . . .

The above snap is of medicines that this 18 month old baby had been having since the last 3 days. The list includes - - -

1.       Cefixime with Lactic Acid Bacillus Dry Syrup

2.       Ofloxacin with Ornidazole Syrup

3.       Nutrolin B Syrup

4.       Furazolidone and Metronidazole Oral Suspension

5.       Nitazoxanide and Ofloxacin Oral Suspension

6.       Ondansetron HCl Syrup

7.       Acetaminophen Oral Suspension.

The worst part was that there was no Oral Rehydration Salts prescribed. So much for all the awareness being spread about this intervention, which has been proved to have been one of the most effective life saving interventions ever invented.

And to complicate matters, the child weighs a measely 7 kilograms. And therefore, she is malnourished like the 54% of under fives of this state.

If a doctor with a graduate degree does not know how to manage a case of diarrhoea properly, you cannot blame them going to quacks . . . However, part of the blame is also with patients who believe that more the medicines prescribed, better thedoctor and faster the recovery.

However, this is much better than the last one which I had posted aboutmismanaging diarrhoea.

Managing diarrhoea . . . Complicating things

Yesterday, I was taking rounds when I came to a little boy, 11 months. He looked irritable and took my presence with much protest. I wondered why he should be admitted. 

The case sheet showed - 'Loose stools: 3 days. Being managed elsewhere. Baby has no relief'. 

There is no history of fever or any difficulty in feeding. There was couple of episodes of vomiting which has since settled . . .

I was interested in the 'management elsewhere' - 

And these were the list of medicines the little child was on - - -

1. A combination syrup of Salbutamol and Guiphenasin: 5 ml three times a day. 

2. Inj Ceftriaxone and Tazobactum - twice a day

3. Resicadrotil drops - 20 drops twice a day

4. Syr. Colistin Sulphate - 3 ml thrice a day

5. Inj Amikacin - one injection a day since the last 3 days

6. Neopeptine drops - 20 drops at night

7. Promethazine + Paracetamol syrup: 5 ml thrice a day

8. Ofloxacin + Metrogyl syrup: 5 ml thrice a day

9. Probiotic powder (Lactobacillus)

10. Dicyclomine drops: 5 drops thrice a day

11. Syrup Loperamide: 2 ml when needed

Well, I wonder if the little boy needs food at all . . . There would be no space in his little tummy after he's taken all those syrups . . .

This is the knowledge many of our doctors have about managing diarrhoea. 

You don't want to miss anything - so hit all the bacteria you've heard about or use all the antibiotics whose name you've heard of . . . I'm sure that if they had heard about any anti-virals, that would have also been started. . .

Below is a snap of all the medicines . . .

The worst part of the prescription. There was no Oral Rehydration Solution at all. . . If the doctor had added ORS to the prescription, that would have made it 12 medicines to treat a case of diarrhoea. . . 

We've stopped all medications. The baby's doing well . . . 

Near death experience of a young man with diarrhoea

DD, a 20 year old young man hailed from the nearby village. DD earns a living by selling off wood which he brings from the forest.

DD was suddenly taken sick yesterday afternoon, when he developed severe vomiting and loose stools. DD’s parents got hold of the local 'jhola chap' (travelling quack) who gave him a prescription of intravenous fluids, Injection Amikacin, Injection Dexamethasone along with some more medicines. I had managed to get hold of his prescription which is put here.

DD was brought to NJH at around midnight yesterday. He was very very sick. He had a thread pulse and we could not record his blood pressure. The symptoms were very much typical of cholera. Since it was midnight, we had to wait till day time for a ‘hanging drop test of stool’ for cholera bacteria.

 

Later I found out that DD had not put out any urine since yesterday morning. We put him on a catheter and there was hardly any urine.

DD responded quite well to intravenous fluids and Tablet Doxycycline. By morning, he had started to put out urine in small amounts. Although the frequency of passing stool had decreased, we managed to get a sample for the ‘Hanging Drop’ and it tested positive for cholera.

He had come to NJH on time. If he had waited some more time, we could have lost him. The management of the quack continues to be the same as that of what used to happen 20 years back. I wonder if we could train some of these quacks to provide life saving treatment.