Photos Post . . .Snake Bites

The cobra which had bitten a lady. I insisted on seeing the snake after the relatives told me that a viper had bitten her. And I was sure it was either a krait or a cobra. I was not surprised when they brought the snake in. The 10 cc syringe was put in to show the actual size. Amazing . . . .isn't it? That people find it quite difficult to identify snakes . . . 

Well, here the relatives had identified the snake correctly. A common krait . . .

A viper bite of the hand. We had to do extensive fasciotomy of the hand.
The young girl has recovered well . . . 

Fascination for the 'phoren'

Last month, we had taken a decision to do cataract surgeries at a reduced cost for our poor patients as well as do some amount of publicity work to do cataract surgeries under RSBY. We used all our contacts to disseminate the information. 

Its been 10 days today . . . Today morning, we were reviewing how the whole thing was going as today was the last day for registration for this special scheme. The patient response has been very good. 

However, what my ophthalmologist told me was baffling. Very few people wanted to do the surgery under the reduced rate or under the Rashtriya Swasthya Bima Yojana. The reason . . . Almost all the patients wanted to put an imported lens. We had taken a decision that we would only use a intraocular lens made in India unless someone asked specifically for an imported lens, for which normal rates would be applicable . . . 

But, after all the developments that we have had in our country, folk prefer to have an imported intraocular lens . . . As far as I understand, India produces intraocular lens which are as good as imported lens . . . I hope to hear from ophthalmologists who differ . . . 

For all the swadeshi movement stalwarts . . . isn't it intriguing that our countrymen still prefer foreign goods even when we produce quite a lot of stuff which are commonly used. 

Well, I don't think the village folk here are exceptions . . . I remember how my folk back home used to flash imported saris. It was quite later that I realised that how come there are saris made abroad when the sari was an Indian dress. 

Many of us would really like to get imported chocolates, pens etc as gifts. So, I don't find anything wrong about preferring imported things . . . 

But, do remember, we in India produce stuff which are quite good to compete with those made abroad . . . And when it came to healthcare, I do not think that things like intraocular lens made abroad are any better than Indian made ones . . . Hope that we could feel proud of things that are produced in India . . . 

The First Maternal Death . . .

This is an account of the first of the three maternal deaths which came through NJH over 24 hours of last Sunday-Monday. This lady, SD was brought dead. We did not know till yesterday that she was from one of our nearby villages, Piperakala. 

Later, we had 2 more maternal deaths which have been mentioned in my previous posts. 

We found some time today afternoon to visit the family. 

It was a very depressing time. The house was in the middle of the village. Quite in the middle of filth and rubbish, the house was quite a symbol of severe poverty and despair. 

An old woman and a below 2 year old boy was sitting in a charpoy inside the house. The air smelt of rotting cow dung. Houseflies hovered all around the place. The old woman started to cry as we entered the house.

After introductions, we asked about SD. The old woman who turned out to be SD's mother told us that this was SD's fifth pregnancy. She had lost her second and third babies. The first child, a girl was about 7 years old. She came into the house weeping in the middle of our visit. The second child, another girl died at 10 months age. No one knew how she died. She had fever and then died. The third child was still born. The fourth child, a boy had just turned two. 

SD had come to us sometime back for her antenatal check up. For some reason, we had given her a referral to Ranchi. I would need to get hold of the out patient chart some time.

Her contractions had started sometime on Sunday morning. It was quite uneventful. Sometime in the evening, since nothing much was happening, the family had summoned the Auxiliary Nurse and Midwife of the area. She had given her couple of intramuscular injections, following which she had collapsed and the family rushed her to NJH. 

The interesting aspect was many people in the village did not know about SD becoming serious and ultimately dying. Many people came to know of the news when our team went visiting. 

Dr Johnson who had seen SD's lifeless body told us it looked very much like a Rupture Uterus. 

Later, we had some discussions with some of the villagers. There was much anger against the Auxiliary Nurse who came to help with the delivery. It seems that she gave quite a few intramuscular injections and demanded money. 

Well, ultimately, what mattered was that there was a maternal death in the block after almost a year. 

There are unanswered questions - - - 

1. How come many of the villagers did not know about SD's complicated labour. Was the family ostracised?

2. Was it intramuscular pitocin that SD recieved? It is quite common even for someone as qualified as an Auxiliary Nurse to give intramuscular pitocin for delivery in most of rural India. 

3. Why do patients not prefer to come to hospital for delivery but have no problems in paying up quacks as well as other persons who come and try to do the delivery at home. There is an allegation that the concerned Auxiliary Nurse demands speed money from those she helps to deliver at home. And the rates being quoted are not small . . .

There are major issues which need to be sorted out if deaths such as that of SD has to be avoided. The question remains about our political will to bring about healthcare reforms . . . 

I shall reserve more comments on this till I hear from those who read about these unnecessary deaths. . . However, what is going to haunt me is the helpless frightened look on the faces of SD's first two children. I'm not sure how secure their future, especially that of the daughter, is going to be . . . 

Maternal Death . . . The Third One

This is the account of the 3^rd maternal death we had over the last 24 hours.

RKD was brought just in as we were doing the final and last attempts of resuscitation onMD. RKD looked dead except for the faint gasps. We intubated her and had her hooked to the ventilator. Her blood pressure was a whooping 280/175 mm Hg. Urine albumin was 4+.

RKD’s history was mindboggling and spoke volumes of the care available for women as well as about how expensive we were to the common man.

RKD who was about 7 months pregnant with her third child suffered her first bout of seizures sometime on the 29^th of July. As is common, they summoned the local wizard to do the needful. The seizures were controlled and she did well.

She had another episode of seizures sometime on Wednesday, the 1^st of August. Someone advised them to come to NJH, but someone else dissuaded them saying that it is expensive. Instead they went to one of the private hospitals in Daltonganj, where they were asked to come to NJH.

Instead, they went to the local district hospital. The doctors at the local district hospital asked them to go to NJH. They could not make up their mind. On 2^nd August morning, someone told them about a ‘famous practitioner’ in the neighboring district.

The relatives promptly took her to the ‘famous practitioner’ who did his treatment. She did not have any more seizures and she looked better. After that, they took her to the wizard in her village again - just to ensure that she would not become sick again. She looked better.

On Saturday, the 4^th August, sometime in the evening, she suffered another episode of multiple seizures which continued over the night. The witch doctor was again summoned who told them that it was beyond his powers. She was unconscious by morning. They took her again to the ‘famous practioner’ in the neighboring district on Monday morning.

The ‘famous practioner’ also told them that the disease was something he did not have much control on. He recommended NJH.

Thus after all the efforts of running all around the district and the neighbouring district, they decided to come to NJH . . . just 10 kms away from their house.

It was around 2 PM on Monday, the 6^th of August, when they finally reached us.

There was hardly any urine coming out. Her lungs were all clogged out. The conjunctiva was congested and edematous. It was only a matter of time. . . before the rest of her organs collapsed. 

She arrested sometime during the midnight . . .

I don’t know what to say . . . please draw your own conclusions. .. … ….

By the way, I’m going to the nearby village of Piperakala where there was a maternal death couple of days back. .. … They had brought the dead body to us. Shall post a report as soon as I return. . . 

Maternal Death . . . The second one

I came from Ranchi after a meeting on Maternal Mortality . . . I made a promise of writing up about all the maternal deaths I come across. Something that I'm seriously thinking about doing is to find out maternal deaths which occur in the community through our volunteers who are involved in other projects through NJH. Who knows . . . we may come up with quite a lot of revelations. 

It was not even an hour after I had arrived, when a patient was brought dead to casualty. She was pregnant. It was busy otherwise. So, not much of a thought was given and relatives took the body home. 

Later, today morning, Johnson called me up to say that the dead pregnant lady had come from Piprakala, one of our neighbouring villages. It's a shame.  

Sometime around mid-day, there was one more very sick pregnant lady who was brought in. There was nothing much to do. She was gasping. Titus told them to go ahead to Ranchi . . . which they really agreed for.

But, the relatives made a beeline to my office and was soon pleading to do the best that we could. I was caught up with work, but somehow made to Acute Care. 

MD looked hardly 20. She was puffing and huffing. Papery white, with a tint of yellow. There could be only one diagnosis. . . Malaria.

I explained everything to the relatives. We had to get her ventilated. She could collapse any minute. We got a sample of blood for the baselines. And had her hooked to the ventilator in no time. Then, she suffered a cardiac arrest. . . we got her heart working. From the look of her eyes, it was obvious that it was going to be tough. Tough it was as she got into another cardiac arrest. . . And her pupils had started to become unequal.  

Meanwhile the results from the lab came in. Platelets of 14,000/cu mm. And 90% of her Red Blood Cells infested with Plasmodium Falciparum. 

She hardly had a chance. . . 

We declared her clinically dead at 2:30 pm, about 2 hours after she had come in. 

She was being treated elsewhere for the last 3 days. . . Nobody had diagnosed malaria. I wonder how even a quack would have missed out on the diagnosis. 

Thoughts on this maternal death . . . 

- A failure to diagnose malaria. She had been to hospital, but the malaria smear is put as negative. 

- Who knows she may have been treated with anti-malarials. It is very difficult to imagine quacks not giving anti-malarials in fever cases. Maybe, we are having resistant cases. 

Talking about malaria, we are having quite a number of fever patients coming in. As we had suspected last year, we still have a hunch that it's not only malaria that we are dealing with.

Well, today afternoon I plan to visit the house of the lady who was brought in dead. Shall put up a post as soon as we come back. . .