Domestic Violence . . . Bizzare and Cruel

(Warning: The photograph is this blog is very disturbing.)

Today sometime around afternoon, we had a patient with burns all over the face.

It was a bit unnerving as the burns was only limited to the face and just extending to the scalp. Not even a centimetre of burns anywhere else in the body.

Initially, I thought that it looked like an acid attack - I had seen photographs and few victims during my visit to Bangladesh. But, there were no marks of acid having flown down the body. Dr Nandamani noticed that she was smelling kerosene over the burnt area - but this was not a typical case of burns where the kerosene is poured on the head and the victim trying to set it on fire.

Then it dawned to me. There was only a chance for this sort of burn. She or somebody had forcefully dipped her head in a fire. The relatives who had brought her was not forthcoming. After consoling her - we found out the truth.

Her own words - 'My husband tried to burn me after pouring kerosene on me. I tried to run away. Then he caught me on my hair and dipped my face onto a vessel of boiling oil which was being heated up for cooking. Then he ran off'. The reason - She was upset with him for the way he was spending it and she had asked him for some money.

It is going to be long haul for her. However, the manner in which she got burnt is something unfathomable. The paradox was that later she described her husband as a good man without any vices. Maybe it was done in a rush of anger.

Domestic violence as a major aspect of public health needs to be further re-examined especially in the light of violent incidents such as these. Prevention of such incidents is possible if there is good family and community support.

THE LORD IN CONTROL . . . Trusting HIM

We were in a very peculiar situation since the last week.

Our hospital is in a very high snake-bite prone area. Therefore, we keep about 40 vials of the Anti-Snake Venom separately for our staff use. Unfortunately, since the last 2 weeks, we faced difficulty procuring the ASV. And to make matters worse there was no dearth in the the number of our admissions of patients with venomous snake bites.

About 5 days back, I was relieved to know that one of our suppliers agreed to give us about 120 vials of ASV. He promised to come on Friday last. Unfortunately, he did not come. And on Thursday night, there was a snake bite victim on whom I ended up using 16 of the 40 vials kept of our staff. I was in a fix and I prayed that there should not be any snake bite victims over the weekend.

Meanwhile, the supplier phoned up and confirmed that he would arrive surely on Monday. I somehow got hold of 5 more vials of ASV from the local retail pharmacies – most of them had none or at the most 1 or 2. And we had one more snake bite victim on Sunday night – and I used up 8 of the vials.

I was in for trouble – the supplier’s train got cancelled on Monday. So, I was looking like a fool with 11 vials of ASV and I knew that I could only pray hard. And that’s what I did. The supplier called me and confirmed that he had got a ticket for Wednesday, the 12th October.

But, I had almost 48 hours to get through with only 11 ASV vials with me. Then, out of the blue – the good Lord gave me a thought. Dinesh, our engineer had gone along with Sr. Rita, the Nursing School Principal to Ranchi. I asked Dinesh if he could just try to scout for some vials of ASV. I was glad when he could get a total of 15 vials from different places.

And today, I knew that the thought of getting some more vials happened only for a little girl who came at around 11 am today with absolutely no respiratory effort. She was apparently bitten by a cobra. Later we found that the hematological parameters were also awry – so conclusion that it must have been a large krait.

We intubated and mechanically ventilated her. 8 vials of ASV were flowing into her veins in no time and 8 more went in over the next 4 hours. It was good to see her conscious and sitting up comfortably when I left hospital in the evening.

The incident had a very simple message to me – on whom I should be trusting. There is a verse in Psalms 20 – v7. Some trust in chariots and some in horses, but we trust in the name of the Lord our God.

The supplier confirmed just now that he is finally in the train on his way to NJH. I’ve asked Dr Nandamani to go ahead and use the remaining 15 ASVs if there is a need in the night. I sleep peacefully in full faith that the Lord is trustworthy.

Tetanus - help from a Good Samaritan

CD who was with us for almost a month got discharged couple of days back. He was quite in a bad shape when he had come in.

It was a matter of concern for us on how he will make his way back home. He came from almost 100 kms away and it was not on the main highway. With great difficulty he arranged for food. We were quite sure that the family did not have any money.

I’m yet to see the total bill. It should be something around at least 20,000 Indian rupees excluding the medicines which also we helped him to buy. Tetanus is not a great disease to have. He took almost a month to recover, of which he was heavily sedated for about 20 days.

I come to the story on how the good Lord arranged for people to arrange for his travel back home.

I was in my office when a middle aged gentleman walked in. He did not look that rich though he could have been even poor. He told me that he was the father of a lady who had come for delivering.

I was very dismissive of him thinking that he has come to ask for some charity. Meanwhile I asked him to sit. He asked me how CD was doing. I told him he is fine but would need some more physiotherapy before he could be fully back to his normal routine.

The gentleman told me that CD was his neighbor. And also that during normal days, CD’s family had struggled for food. CD getting tetanus had made things worse. He requested me if he could allow CD to come back with him when his daughter was discharged. Thus, CD could have a comfortable ride back home.

CD (seated) with the good Samaritan (on the extreme right)

I was thrilled. It was so good to see a caring neighbor. I wish we have more people in our villages, who would care for each other especially when it came to issues of healthcare and food security. I wondered how long it has been since I’ve seen somebody offer help without being enticed for the same.

Hard working and over worked . . .

We have been always hearing about the less number of healthcare personnel especially doctors available to work in the rural and remote areas of our country. It is no secret that even public health facilities at the district level run with skeleton staff and inadequate infrastructure.

Yesterday morning, our local newspaper carried out a front page article on the lesser number of doctors available to serve the nation.

'No doctors, how will there be treatment'

There were statistics given about the statistics of shortage at the state (Jharkhand)level and the national level.

However, more interesting was a small article within the main article narrating the story of one of the senior doctors in Latehar district hospital who apparently fainting during his duty following severe exhaustion caused by continuous work.

I've heard about the goodness and sincerety shown by Dr Harold Hansda in his work. The question remains on how much people like him get appreciated. I will certainly run into him some day. And I shall tell him that I appreciate the work ethics shown by him. Hope that there will be more doctors who can work at least selflessly to some extent, if not to the extent shown by Dr Hansda.

Encephalitis around - SOS

Yesterday, sometime around 3 in the afternoon, I had a patient in the outpatient department with a history of fever since the last 5 days and illegible conversations since yesterday morning. He was being managed elsewhere for malaria. The family was well off and our wards were quite full. I gave them the option of going ahead. They were not very forthcoming. Later, one of the relative turned up and asked me what I think about the diagnosis. I told him it is some fever which is affecting his brain. Then he told me that he was already on treatment for malaria and typhoid.

We had been having quite non-specific fevers over the last month and we've been suspecting viral encephalitis. Some of them seemed to have done good and improved. There are couple of them who did not make it and I had few children who has neurological sequelae.

I told the doctor about my suspicion of encephalitis. Later, there was one of the local leader who came in for discussions. I was thankful that they ultimately took the decision to move ahead to Ranchi. However, I had sent for blood tests before the results had come. After they left, I was more relieved when the blood tests came. His platelet count was just 50,000.

I bumped into the village leader today afternoon. He updated me about the patient. It seemed that he was diagnosed to have viral encephalitis in Ranchi. Overnight, his condition deteriorated. He is in the ventilator. The doctors have told him that he has brain edema and the chances of survival is quite bleak.

So, we are in the midst of an epidemic of encephalitis. It is very surprising that I'm yet to recieve any intimation from the government machinery. I had called the Civil Surgeon couple of weeks back and told him about my suspicion.

I still have about 5 patients in the ward whom I suspect encephalitis. I've asked my store manager to get intravenous acyclovir. Without a medicine consultant it is very exhausting to manage these patients. And to make things complicated, we had been suspecting other causes of fever for quite long.

One of the 5 patients, 7 year old IK was doing good and improving with oral acyclovir. I wanted to refer him - but the family was too poor. He developed seizures yesterday and has become unconscious again. Today evening, he shows signs of improvement. I praise God. I pray that he does not have any neurological sequelae.

I'm concerned about the surrounding poor villages and our staff families. I pray that this epidemic will move on without causing much more damage. I wonder where the government machinery is. I wonder when shall we grow out of the 'malaria and typhoid 'malaria and typhoid only' attitude. It is high time we plan to explore more on what causes fevers in many areas of the country.