Abandoned . . .

This is the story of a lady with a very bad burns who was brought to us about 2 months back. 

Initially, we did not know why she tried to commit suicide. Now, we know. 

Her husband had another woman and it was difficult for her to accept it. We came to know about it only towards the fag end. 

TD had doused herself with kerosene and set herself aflame. She sustained about 40% deep burns mainly of her face and trunk. It was very difficult

However, she fought valiantly . . . before she gave up. She gave up as she realised that there was no adult to whom she could look up for support. 

For about couple of weeks, her husband came on and off. Then, her constant companion was her daughter. She had a teenage son whom we never say.  

It was a sombre atmosphere during rounds each day when we could not tell much to this little girl. 

The staff eating in the mess shared their food. But, that was not enough. She needed blood . . . more food . . .  someone to hold her when the dressings took place. And there was none. 

The bystanders of her fellow patients said that she better be gone as her life is going to be miserable. 

Another story of the abandoned and uncared woman in the household. 

In another room near to where TD died lies CD, the new mother with 2 girl babies . . . both of them weighing not more than 1.5 kilograms. Every day I visit CD, the gloom pervades the room. It's very obvious that the family looks forward to CD getting pregnant again soon and try to deliver a boy baby. The fact that she went through a difficult pregnancy (twin pregnancy with eclampsia) does not hold any value for the family. 

Yes . . . another example of women being left to fend for themselves in a male dominated world. 

The total cost of treating TD was about 75,000 INR for almost 2 months. Her family had raised about 25,000 INR. We're glad that we've been able to write off the rest. However, this would mean that we need help to subsidise the care of such patients. 

Fibre Crop . . . Any idea . . .

Yesterday, I happened to stumble upon a plant which was used as a source of natural fibre in this part of the country. In the local language, it is called GHUDRUM. Natural fibres such as jute, sunn hemp, mesta etc. are quite popular and a major source of agricultural revenue.

I could not find any more information about ghudrum in spite of searching the net.

Below are the snaps. I would appreciate if anybody could provide additional information. 

Seeds of the plant

Rope made from the fibre . . .

Like the millets, the major advantage of this plant is that it needs less water. In the olden days, it used to widely used for all purposes that we use a coir rope or jute rope. It has fallen into disuse as processing it is quite energy intensive and there is no known mechanised processes as seen with jute or coir. 

I wonder if this could be a good source of income generation for this impoverished region. 

And I'm also yet to receive good information about kodo, the vanishing millet crop. 

I just wonder . .. .

It has been quite a long time since I posted something about the maternal and child health care we do at this place. We do quite high risk obstetric care in spite of all the limitations we have. And it has been some time since we got any sort of high risk patients. 

However, today we had two bad cases. 

The first lady, RB - a primi at term with regular antenatal check ups had been trying to deliver at home since the last 24 hours. The reason for trying to deliver at home - 'she's had a normal antenatal check up' - according to her brother. 

Dr. Johnson was on duty. RB's was dead and was in a face presentation. And she was running a fever. Blood investigations showed sepsis. It was a tough call. Mother in sepsis and a dead baby with a very difficult presentation. We called up Dr. Shalini who is in charge of Obstetric Care in EHA. A craniotomy was the best option. 

I had never done one for a face presentation. However, Dr. Shishir had experience of doing couple of them on a face presentation. I have never liked doing these destructive procedures and to do one for a face presentation was all the more unthinkable. Thankfully, the procedure went well. 

Late evening, we had another of our routine eclampsia patients. With a twin pregnancy and having been having fits since more than 12 hours, CD was a very high risk patient. And being quite well off, it was quite surprising that the family did not want to take her to a higher centre. 

Again, Dr. Titus, our doctor on duty got in touch with Dr. Shalini and she advised to go in for a Cesarian section. The surgery went off uneventfully. The babies needed active resuscitation - but they are doing well for the time being, although both are around 1.5 kilograms. 

Well, what did I wonder? 

As you can see, both the women had received sub-standard care. RB should not have been in labour at home for over 24 hours and CD should have gone ahead to a higher centre. It was quite risky for CD to have given a high risk consent for us to go ahead with the surgery. . . however lengthy the consent was . . . the family even accepted that CD could die on the table. 

All the 3 babies born were G I R L S. I find it difficult to accept that neither RB nor CD's did not know that the babies were girls . . . although I may be wrong . . . Dear Lord, I pray that my hunch is absolutely wrong . . . 

A 'big' snake bite . . .

Yesterday, we had a lady being wheeled into casualty. She had been bitten by a viper about 12 hours back. She had a swollen leg and couple of bite marks. However, she was very cold. And we could not get a pulse on her. She was in shock. 

One of the relatives told me that she was bitten by a baby python. They had brought the snake!

I was sure that there was envenomation. She had difficulty breathing although her saturation was normal. 

I got 2 vials of ASV going into her along with the intravenous fluids and decided to take a look at the snake which was kept outside. 

Thankfully, it was a killed specimen. And what did I find . . . 

Yeah, a really big viper . . . 

So much for people misidentifying snakes . . .

Surprisingly, her clotting time was normal. However, the urine output was on the lesser side. The creatinine was 1.57 mg%. I gave her Anti Snake Venom according to the low dose protocol. 

It's 36 hours now. She's done well so far. The urine output is on the rise. Tomorrow, we shall repeat the S. creatinine. And if that is fine, she should be going home. 

Kept Waiting . . .

Few days back I had a date in a court. I had to give my expert opinion as a witness to a medico-legal case. Something very common in the life of a doctor. 

I reached the court at around 7 early morning. We've made it a routine to route all our medicolegal cases through our lawyer. It's a bit more expensive but saves us all the hassles. So, I was there at the table of our lawyer waiting for the judge to call me. 

To cut the story short, the judge called me at around 9:00 am and he took up my case at around 9:30. The cross examinations and other formalities took around half hour. I was ultimately back at NJH by around 11 am. As I drove back, I wondered about the time I lost waiting for the venerable judge. 

In India, we are quite used to waiting . . . Waiting for trains that are running late, waiting for the bank teller to open his counter, waiting for some shop to open it's shutters, waiting for a traffic jam to clear out . . . the time we spend waiting in our lives are huge. 

And of course, we are always well prepared to wait . . . a book in hand . . . and with the cell phones now, one can always keep one selves entertained. 

It was sad that even at the level of the judiciary one had to wait. The summer timing for the courts in this part of the country is 7:30 am. But, the judge did made his arrival after 2 hours. I can now imagine how we have ended up with quite a large number of pending cases before the judiciary. There has been quite a lot written on it. 

Talking of arriving late and keeping people waiting, I think that it's one way of showing people how important you are. The higher the position, the more you made people to wait. One can remember waiting for the local politician to arrive at a function . . . and even the time one has to wait to see a doctor. 

To see a doctor . . . that reminds me about how we made a small, but major change couple of years back about our approach to patients. Many of my colleagues were quite sceptic about the possible returns. Now, as we analyse our patient load over the last year, we get feedback that the strategy has worked. 

In most hospitals, the outpatient department starts after the doctors finish off the ward rounds and the other work in the wards. Therefore, the patients wait for quite a long time. We made a policy to ensure couple of doctors started off outpatient work sharp at 8:30 in the morning. 

Now, we get almost 50 patients before 10 am . . . 

I presume that we would gain a lot by ensuring that we don't keep people waiting. It wastes resources. It builds up stress. And you can imagine a whole chain of events which impacts many lives and communities. 

So, could I request you not to keep your clients/patients/customers waiting . . . We will end up saving quite a lot . . . time, energy and resources. And that would be part of our nation building efforts . . .