Eventful Day

Yesterday was eventful in many ways. The 75 odd general hospital beds were 100% occupied for the first time since many people could remember. There was not an inch to move. About 20 deliveries, 18 surgeries, a tubectomy camp which started from Monday and a host of fever patients resulted in that.

However, more significant was Dr Nandamani's first cholecystectomy in NJH. It was not the sort of case any surgeon wants as his first case in a new place. But, that is how it turned out. The clinical and sonological diagnosis was gall stones with infection of the gall bladder. After a course of antibiotics, the patient AM was posted for surgery.

Per-operatively, it turned out the gall bladder was very badly infected and was filled with pus and two large stones. The full excision of the gall bladder was not possible. Only a partial excision and removal of two stones was possible.

Kindly pray that the patient makes a smooth recovery.

THE COSTLY MISS...

The scenario which I'm going write now would be very unfamiliar to most of the people reading this blog. It is unfortunate that this has happened to MS in the 'Shining India' which boasts of nuclear armaments, satellite rockets, the cricket world cup, state of the art health facilities encouraging 'health tourism' etc.

59 year old MS was on his way back after procuring ornaments in bulk for his business when he fell down from the vehicle he was traveling in and had a lacerated injury of his right foot. He was taken to a local doctor by the driver of the tempo vehicle where the wound sutured up. The wound stretches all along the dorsum of his right foot and needed about 20 sutures.

10 days later, MS started feeling very funny - he had difficulty swallowing, which was slowly associated with an inability to open the mouth and a vague back pain. He was taken to the district hospital, where some antibiotics were prescribed. Unfortunately, he was getting worser.

MS landed in our OPD along with his relatives on the 4th of July - The diagnosis was easy, but difficult to imagine an adult having it in this era of high tech medicine - Tetanus.

MS was put on a cocktail of diazepam and phenergan. In addition, as we found out that the wound had become badly infected - the sutures had to be removed, and we had to do a thorough debridement. We are thankful to God that he's made a good recovery from his tetanus. His wound is clean but has a long way to go to completely heal.

Meanwhile, I had a chat with one of his sons, who happens to know quite a lot about medicines - most probably a local practitioner in his village. He was aghast when he came to know that his father is suffering for want to one TT injection. I got hold of the prescription of the place where MS was taken first after the injury.

You can see very clearly that Inj TT was cut off. Most probably, it was out of stock in the place or they were asked to purchase it from outside and give it. A small lapse and the price that MJ and his family had to pay has been costly.

Inj. Tetanus Toxoid has been around for quite a long time - but it is sad that people still suffer for the lack of awareness about this. Years before, neonatal tetanus was quite common in this place - thankfully, the incidence has come down appreciably.

However, patients like MS teach that India has a long way to go when it comes to basic health care to the common man.

NJH diary

Wanted to put in a list of cases which we have ended up managing here. Would appreciate your prayers too.

1. KD - 30 year old came in with pain abdomen and vomitting since 4th of July. We had made a diagnosis of Sigmoid Volvulus and she had improved symptomatically on conservative management, so much so that she took a discharge against medical advise. However, she came back in 2 days time with worser symptoms. We posted for an exploratory laporotomy - and she had a necrosed distal jejenum which needed resection anastomosis. Later we found out that she had gone for abdominal massage - which could have caused the condition. It is 3 days now, since the surgery and she is doing well.

2. SD - 22 year old primi who came with Eclampsia and Twin Pregnancy yesterday night. We delivered her by emergency LSCS. The babies are very small - however doing fine. However, her blood pressure remains quite high. Kindly pray for a quick recovery.

3. JP - 18 year old came with organophosphorus poisoning yesterday evening. He brought in quite sick after almost 4 hours after the poison intake. He had to be intubated - we've already pumped him with about 200 vials of atropine. He was weaned away from the ventilator today evening. However, he would have benefited from mechanically assisted ventilation.

4. MK - 14 year old who was bitten by a krait today early morning. Brought in after 4 hours of the bite with no pulse or blood pressure, she continues to be very sick. She continues to be in ventilator.

5. Today we had one lady with eclampsia who died suddenly after LSCS. We do not know the cause. She was quite sick on arrival. The relatives had made quite a lot of fuss although they were explained about the high risks associated with the condition. Kindly pray that there would not be any more problems.

6. Today, we had 3 patients who needed ventilator simultaneously. We have been planning for a ventilator - now I'm sure we need to accelerate the efforts. Kindly pray as we take a decision tomorrow to purchase a new ventilator.

There are 4 burn patients in the ward now. I would definitely like to share our experiences with their management especially the success that Dr Nandamani is experiencing after doing tangential excision and skin grafting on them. That would be in my next post....

A tragedy revisted

It is after quite a lot of proding from one of my friends that I've restarted the blog. It has been almost a week since I had been trying to think about what I should start on. And then, today afternoon, something happened which I felt should be put in...

I remember the sultry afternoon almost one year back. I was in the office, sorting some matters related to taking responsibility of the hospital I give leadership to now. One of my medical officers called me and told of a lady in labour with a hand prolapse. Usually, when a hand prolapse occurs the baby is dead. But, she thought she heard a heart sound. I went to see the patient. It was one of the many gruesome scenes I had ever seen. The baby's hand was protruding out of the vagina - and it was bluish black and edematous. Since, she was in the OPD, I pushed in for a scan and lo the baby was alive.

We somehow got her posted for an emergency LSCS - the hemoglobin was 6 gm%. The baby was sick - the inside of the uterus was stinking. She was in labour since about 3 days and the hand had been sticking out for almost a day. Unfortunately, the baby succumbed after 12 hours of struggle. Now, the effort was to ensure that the mother did not go into sepsis. We were glad that she made a good recovery. Since, there was no more complications I did not get to hear much about her again.

Fast forward one year - Today, I was in the office, when Dr. Ango rushes in saying that there is a rupture uterus on a previous LSCS. So, what was the great thing? Rupture uteruses are the order of the day in NJH. We get about 20-30 of them every year. Well, the thing was that the subcuticular skin suture was still on the patient.

Dr. Nandamani operated on the patient. The baby was dead and the uterus was sown back. In the meantime, I made discreet enquiries on how it is possible for the skin suture to have remained. It seems that the patient had absconded before she could be discharged. And the skin suture remained on her.

I felt really bad. Here was a patient who ran off most probably because she could not afford the bill - and then later comes back with a rupture uterus within 1 year. Something needs to be done here. Now, the lady has already been twice pregnant and both the time she ended up with complications and dead babies. She would need to become pregnant again if she would want not to be abandoned by her husband.

I'm going to meet this family and talk to them tomorrow. They look really poor and illiterate. Will have to convince them to come for regular antenatal check ups and then if she gets pregnant - to plan for a early elective Cesarian Section.

BPL Cards

I've got a very unenviable seat in our hospital. It is very interesting to sit here and watch the motley of crowd who comes to the administrative office.

The one big group of people are relatives of post-natal women who had delivered at our hospital. They come to claim Rs. 1650 which is given as part of the Janani Suraksha Yojana. The most unfortunate part is that I do not think that even 80% of those who come and claim this amount really deserve it. As is the usual story, it is common to see that the actual needy would not have any sort of papers to claim this money. One of the necessaties is to possess a BPL card.

I had been discussing about this to my colleagues when one of them blurted out that 30% of my local staff in the hospital actually have BPL (Below poverty line) cards and they could claim benefit under the JSY scheme. Amazing.

I do not think I would be justified in making any critical observations on the unknown group of people who have nothing to do with me when mine own staff are making a mockery of the entire system.