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.

The Fourth Estate . . . Quo Vadis

It was quite surprising that Mr. Shashi Tharoor was again on centre-stage all over in almost all media circles yesterday night. The reason . . . he had posted something on Twitter regarding the Delhi rape victim. 

Yesterday night, the way the story was reported, showcased Mr. Tharoor as an uninformed ignorant person with ulterior motive. However today morning, with the family having obviously given it's consent for the same, most of the newspapers have backtracked and have been sort of commending the idea. This is a good article on how the media handled this. 

The whole incident shows how thoughtless are our media and politicians. We under-estimate the capability of a person who was an illustrious diplomat and was in the running for the UN Secretary General whereas we are ready to accept statements of people who end up apologising most of the time that they were misquoted. We would rather get along with people who would state what we want to hear rather than hear someone who talks from one's heart with conviction. 

And the media just waits to pounce on things. Everyone wants masala so that their viewers or readers would increase. The number of newspapers and news channels who publish real news are on the constant decline. 

Well, it's not in the national scenario that media does not behave with responsibility. 

In my routine clinical practice, it is quite often that I hear about patients threatening to call the 'patrakar' (the local journalist). I ask them to go ahead. During my first year here, there were few who tried to publish news against the hospital. However, when I convinced the local patrakars that they could end up in serious trouble if they published baseless news, they've left me alone. 

One of the common practices in this part of the country is 'paid-news'. If you run an NGO, it is very common for you to call the 'patrakar' and give him a 'baksheesh'. The prominence, the news about your program will command is directly proportional to how much you pay. 

I made a conscious effort to ensure that these guys are not called when we have big programs in the hospital. However, there is one problem. When we call some of the big shots in the government or administration, they usually ask where the patrakar is? I politely tell them that we usually don't invite the patrakar separately. However, they end up calling them up and they usually rush to cover the event. 

Even, with this Delhi rape case . . . although I'm quite encouraged by the protests it could muster and the awareness people got after the media coverage. I wonder .. .. .. is it that we never had molestation against women? In fact, 2 young men (Keenan Santos and Reuben Fernandes) were killed in Mumbai when they went to protest against a young lady being molested. To make matters worse, I read that there were about 25 cases of reported molestations against women since the Delhi rape all over the country. However, you were not interested in following them the same way you reported this particular incident. 

My dear friends . . . in the light of such incidents and experiences that we've had with the media, I propose that nobody of us believe much on what they say and publish. 

And my friends in the media . . . there is something called ethics which you need to follow. Please remember that you are not the rule enforcers or the judiciary. Your role is to report what happened . . . and not to report what you think should/would have happened . . . or not to report what you are paid to report. 

And please do remember . . . there is another India, news about which does not make find many takers. Hope you remember the Banwari Devi case. I wonder why much fuss was not made for that poor lady. There are many more which go unreported . . . 

Hope that you would be a voice for the voiceless rather than an amplifier which decides when to switch itself on or how loud and clear one should sound. 

Wish you'll report with sense and responsibility in 2013. Happy New Year . . . 

Heralding the New Year . . .

We celebrated the New Year a bit differently this year . . .  Snaps from the same . . .

As mentioned in one of my previous posts, there are quite a lot of Catholic dispensaries and mission stations serving remote areas of our region. They do yeoman work in the areas of education and healthcare. For many of the communities, they may be only teachers or healthcare workers they would ever see in their work. Most of these places are in remote areas with very scenic views.

Do enjoy and comment . . .

Shalom and Charis had a great time, watching trains from Barwadih Ashram . . .  

We tried to take a family photograph in a guava grove . . . this is the best we could manage. 

That calf is less than 24 hours old . . . Efforts in animal husbandary by the Ashram inmates . . . 

There was this stream through the Ashram area which we had to cross . . . Quite a trek

Duck farming . . . 

Then there was a sumptuous lunch. Shalom and Charis enjoy the food . . . 

The highlight of the trip was a visit to Morewai health centre which is located quite remote.
For many a people, this is the only access to health . . . 

The Morewai clinic . . . place of refuge for quite a large population . . .

Shalom and Charis cutting the New Year cake . . .
The clinic has been serving the local community since almost 35 years

Everybody having a good time . . . 

The Morewai church . . . construction was overseen by Fr. Barry . . .

A memorial for policemen killed in civil unrest . . . Grim reminder of hard times

More trains . . . 

These are all places which are quite cut off from development. The railway line reminds us that there are better places far away (The Ranchi Rajadhani passes through this route . . . most of the people don't see it go as it is late at night, unless the train is late). And even for the local population, the efforts are all aimed at making their way out of this place.

We wish you all a prosperous New Year. We pray that each of you will be a blessing to the people and communities around you. 

Last maternal death of 2012

The sad part was that she was one of our regular antenatal patients and she had delivered her first baby also with us. Interestingly, her first pregnancy was also complicated. She had enteric fever, later viral hemorrhagic fever and ultimately had a premature birth. 

However, for her second pregnancy, she her her regular check ups elsewhere. However, she came with a very bad urinary tract infection with false labour pains more than 2 weeks back. We had to admit her and manage her aggressively to control the infection and the pain. 

She was well controlled and later took a discharge saying that she can continue her treatment in her town. 

She had an institutional delivery at a Primary Health Centre (PHC) on the morning of 31st December. Within half an hour, she had an episode of seizures which was managed at the PHC. She was at the PHC till around 2:30 pm, when the family was told that she appears to become sick. 

We do not know the details. But, she was brought dead at around 4 pm at NJH . . .

The relatives were in a hurry to take the body home. So, I did not get the details.

I've informed the same to the concerned people. However, I'm not sure if there would be any sort of follow-up on this matter . . . 

It was a like a message for us . . . Maternal and child health continues to be a major concern of the region which we serve. It was a bit unbelievable, but year 2013 also started off with a case of maternal near miss for us which I would narrate later. We have a long way to go. I'm sure that year 2013 is also not going to be any different. We would continue to deal with extreme obstetric care. My biggest wish for 2013 is that we would be able to involve ourselves in child survival a bit more than what we are doing now. 

Wish you all choicest blessings for 2013 .. .. ..