Monday, March 11, 2013

IWD . . . News item.

On the International Woman's Day, I found the following news item in our local vernacular daily. Another sad state of affairs . . . The clip and the translated prose . . .

The headline says -
KUNTI DEVI GOES AROUND THE STREETS
with human excreta on her head
There is so much a hue and cry regarding women's empowerment in our nation.  There are many programs from the government aimed to achieve this objective. There has been quite a number of changes. The government and many non-governmental organisations are working towards women's rights, empowerment, equality and freedom. However, in the midst of all these, certain regions are still in darkness. Mrs. Kunti Devi, a resident of Deori Kala village of Hussainabad block is in such darkness. Mrs. Kunti carries human excreta on her head and that is her occupation. She does this job from the very early morning every day. 
Inspite of doing this demeaning job, Mrs. Kunti does not earn more than 50-60 INR per day.  She does this job as she has no other choice. There is no work. She used to work in a presently defunct cement factory in Japla. Till the factory closed down in 1992, she had a good job. She had been knocking high and low to become beneficiary of government schemes. Her son who is a graduate is yet to get a stable job. 
You can read more about human/manual scavenging in the articles below . . .

1. Wikipedia
2. Times of India
3. The Hindu
4. IBNLive

Saturday, March 9, 2013

IWD . . . 3 stories . . . No, 4

(This post was done yesterday. But, I was too busy to post it)


Today is International Women's Day. We had quite a few programs lined up for the week.

Like many of my previous mails, stories of 3 women I saw in the hospital today which epitomises the state of the nation's women.

The first one, A. A 50 year old lady who had come to me about a week back with vague complaints. She attributed everything to her high blood pressure. I thought that there was more than hypertension in the diagnosis. I had asked her relatives to get her admitted for a day or two so that we could observe her.

Her vague complaints varied from feeling fearful, perception of something trying to attack her, someone trying to squeeze her head. She attributed everything to the high blood pressure. 

We admitted her and found out that she did not have any major problem with her blood pressures. Today morning, I got her relatives and talked about something more than blood pressure that she could be having. 

They agreed to allow me to start psychiatric treatment and counselling. As she was getting discharged, the husband came to me and asked whether he could take her to a psychiatrist. I had already given them the option. Then I suggested one of the psychiatry institutes in any of the nearby cities. 

To my horror, he told me that she was on treatment 10 years back in a psychiatric institute and now he did not want to have the stigma of being attached to a psychiatric institute. However, he never thought about revealing the same to us even after we had enquired about such a history many a time. 

The second patient, B. Diagnosed to have Pulmonary Tuberculosis at NJH 4 years back, we had referred her to her nearest DOTS Centre. She had come to us about a month back. It was a hopeless case. Her lungs were quite eaten off. My colleagues wanted me to take a second look. Below is her Chest X-Ray.


There was nothing we could offer. The history was horrible. She claimed that she never got regular medicines from the DOTS Centre that we referred her. Later, she went to another place from where she took irregular medications. The sequence went on for 4 years before she thought about coming back to us. 

Pulmonary tuberculosis continues to be a big killer in our part of the country. And women are no exception. 

The third patient, C. We first saw C about 2 months back. She had come with very high blood pressure and seizures. We tried to refer her. But she never went. And she refused to terminate her pregnancy . . .  Rather her husband refused permission. She was discharged with anti-hypertensives . . . and she had improved quite a lot. 

Patient C came again . . . she had stopped her medicines. And she had one more episode of seizures. Again the same sequence of events repeated. I felt we could not do anything. To make matters worse, the husband got a discharge against medical advice and left. 

And she came yesterday . . . in full fledged HELLP. And anuria . . . This time, it was a bit different. She was accompanied by her father rather than the husband. As my colleague explained the situation, the poor father was aghast. It seems that he was totally in the dark about her daughter's condition. 

The patient went referred to Ranchi . . . Do pray that she will make it . . . 

3 stories . . . 3 instances where the women was left in the lurch one way or the other. The consequences are terrible and something which cannot be fathomed in a civilised society. 

However, towards the end of the day, I had another patient . . . Patient D . . . She was in labour for more than 36 hours in one of our neighbouring district headquarters hospital. 

The issue here is that the healthcare personnel left the family down. 

To make the story short, the baby was obstructed in the birth canal. We had to rush her in for Cesarian. The baby's head looked as if it was put in a tube press. He was lucky to be alive. 

However, the parting shot was that of one of the relatives' of patient D . . . 'We're glad that the baby is a boy and not a girl. We feel that our efforts were not wasted'. 

Speaks volumes . . . Don't they? 

Hope my readers would values the women in their life . . . mothers, daughters, sisters and of course their wives . . . I cherish them. May you do the same too . . .

Sunday, March 3, 2013

3 adverse maternal events . . .

Today, I'm on first call after quite a long long time. Necessitated as we are just 3 of us running the hospital from Friday last. Many a time, I wonder about how long I shall shout about adverse maternal events in this part of the country. And every time, I get an answer about what to do . . . Yes, continue to shout about it till something happens. 


We had 3 mothers today . . . all of them had gone through adverse events. Of the three mothers, one was already dead by the time she reached us. The second one was . . .  from a medical point of view . . . a gone case . . . it would need a miracle for her to live. The third one came to us on time . . . she should live. 

Their stories . . . 

The first patient, AA, was a known case of pregnancy induced hypertension. She was supposedly under treatment. However, I did not see any records. Therefore, not sure. She had started to have convulsions today early morning. They had taken her to some hospital in the nearby district headquarters. From where they were asked to go to NJH. It was too late for her. She was dead by the time she arrived. 

The second patient, BB, a primi mother had been having contractions since the last 3 days. When she did not deliver by today morning, they took her to a hospital nearby where she delivered a macerated baby. But, then her abdomen started to distend. She was given a letter to go to Ranchi. 

Her relatives brought her to us. The family was too poor. And her blood group was O Negative. She was putting out blood from her bladder. And then to our horror, found out that she was leaking urine. And on putting a nasogastric tube, there was pus coming out. Most probably, she had undergone abdominal massage when she was trying to deliver at home. 

My provisional diagnosis - Rupture uterus with bladder involvement and intestinal necrosis following abdominal massage. 

Thanks to a new fund we created following a donation from a well wisher in Australia, we paid for her travel to Ranchi. I can only pray that she survives. 

The last patient, CC. Into her 2nd pregnancy, she had a cord prolapse. And her baby was dead for almost 2 days. There was pus pouring out from the uterus. The last thing I wanted to do was a surgery to deliver a dead baby which was stuck in the uterus. But, that is what the doctor who first saw her elsewhere wanted us to do. 

I was not sure about how friable was the uterus. She was in full blown septicemia.

We took a decision to try to do a craniotomy and keep her ready for laparotomy if the uterus ruptures in the process. It's a difficult thing to do a craniotomy and I always pray that I do not end up doing one. 

As we were explaining to the relatives about all possible complications, the fortunate lady suddenly started to have contractions. And she miraculously delivered normally. It was a relief. 

It was very unfortunate . . . for the first two ladies . . . 

Next week, it is International Women's Day on the 8th. 

I pray that we would continue to make a difference in the lives of women in our surrounding communities especially when it comes to managing their pregnancies . . . 

Friday, March 1, 2013

Praise and Prayers . . . March 1, 2013


Our praise and prayer bulletin for the fortnight . . .

1. We praise God that we were accredited to treat patients under RSBY in Palamu since the last one year. The scheme for Palamu for the second year got expired yesterday. Kindly pray that we would continue to remain accredited for the next year. 

2. We have been praying for creating a fund to subsidize treatment for our really serious obstetric patients. We thank one of our regular readers from Australia who has made a kind donation to kick start this fund. I'm sure quite a lot of our patients with complications like eclampsia, rupture uterus etc. would benefit. 

3. Meanwhile the obstetric care in the region remain pathetic. Women continue to die. Families are much affected. Kindly pray that we would be an agent of change in the area of maternal and child health in the region.  

4. We thank the Lord for our staff nurse, Sr. Hiramani. Sr. Hira, a known case of Rheumatic Heart Disease had delivered a healthy baby last week. She went into pulmonary edema following which she was subject to an emergency procedure. She was in the ventilator for around 4 days. Yesterday, the ventilator has been removed. Kindly pray that she would make a complete recovery. 

5. Our brick machine turns one year this week. We were quite apprehensive about how useful it would be be. We thank the Lord that He enabled us to purchase it. Special thanks to the Burns unit team who agreed to fund the purchase it. It has been a blessing. 

6. Over the next month we are looking at ways and means to attract more poor to come to NJH in the absence of competent centres at the public health level. Kindly pray as we deliberate and take decisions.

7. We need to build new residences for our staff. Kindly pray for Dinesh, our engineer and Mr. Shovit from Central Office as they make the final designs. 

8. The short summer vacation for children in our campus starts from today. Kindly pray for staff and families who plan to take a break and travel.

9. Next week, we celebrate International Women's Day. We've one week long celebrations where we would be having a special focus on women in the Bible. On the 8th evening, we've a special time of fellowship with Rev. James Panavila giving leadership. 

10. We are part of a snake bite study facilitated by the Christian Medical College, Vellore. We thank the Lord for this privilege. Do pray for this as NJH would be part of a multi-centric study of such importance most probably for the first time. 

Residences . . . requests ideas

NJH has been witnessing quite a lot of changes. And the biggest need now is better residential facilities for staff. As I mentioned in many of my previous posts, the condition of most of our buildings are quite bad. 

Leaking roofs, plaster falling off the walls and roof, dingy rooms etc. are quite common features of our homes. Rats, bandicoots and snakes keeping us company is quite an accepted feature. Not to mention about monkeys having a competition of breaking the asbestos roofing. 

We've come to a stage that much of our future development can remain just a dream if we do not develop good residential facilities for our staff. 

And as part of the same we are looking at good plans to construct a housing complex. I would prefer time tested plans which save space and construction costs. 

I'm looking at each home measuring not more than 900 square feet. 2 bedrooms, 1 bath, 1 toilet and a kitchenette in addition to the living cum dining room. 

The expected cost for a block of 8 units of 900 square feet homes each is about 7,200,000 INR (131,000 AUDs or USDs/ 103,000 Euros/ 88,000 GBPs). 

Kindly remember this need in your prayers. Please do remember to refer us any good construction plans or sites. 

The costs look astronomical . . . but these are minimum requirements for any average family. 

If we get this done, 8 families can move into these new homes . . . Please do spread the word around.