Too Poor . . .

This is another of my experience with poverty in the region we live.

This incident happened last Saturday. Although it was not busy, there were enough patients in the outpatient to keep us happily engaged.

It was just around lunch time, when Sr. Sanjeetha came running to my cubicle. She could hardly contain her excitement as she told about a lady who just came in. The cause of her excitement - The lady had been carrying her baby for the 11^th month. Her last menstrual cycle was on the 5^th of November, 2012. It was past her 11 months.

I asked Sr. Sanjeetha to bring the family in. There was poverty written all over the couple. 

The lady was bloated up. The pregnant tummy was the only flesh which protruded out. There was quite a bit of edema to make her appear plump. The husband looked a little waif. It was all bone and thin muscles. Not an inch of fat.

The husband and his uncle who came along narrated how they had been thinking over the last 2 months on why the baby was not getting delivered. Yes, it took them 2 months to make a decision to access care. I got an ultrasound done on her. There was very less amniotic fluid. There were some thick calcified areas on her placenta.

As I tried to help them, the only query they had was on what I was planning to do. The answer was obvious . . . to try to deliver her as soon as possible. The risks were well explained.

I did not believe my ears when I heard their reply. They had asked me on how much a delivery would cost. I told them that a complicated one could end up costing up 5000 INR. However, I told them that I’m willing to give them ample concession to ensure that she delivered at a hospital. I promised to do everything for 2000 INR if it was a normal delivery.

The uncle told me that they would arrange at least 2000 INR and then get the lady admitted for delivery. All my arguments fell into deaf ears. They were gone before I could make up any new reasons. As they left, one of them told the nurses that they will back in 2 days time.

Yes, the cost of even 2000 INR for a normal delivery was too much for them. They did not have any RSBY card. And I wondered if they found it too hurting that I was ready to treat them for a lesser charge.

Learning from the poor . . . they are honest, they are people with self-respect and they are more in touch with reality than the rich. And we have quite a lot of people like this family out there. You'll not even hear about them . . . they cannot afford to see us. 

The rich . . . most of them are dishonest, they would stoop to any extent to get some concession and they expect everybody to stoop in front of their riches. And it’s obvious that quite a lot of the rich get their wealth at the expense of the poor.

No wonder . . . our Lord had a soft corner for the poor . . .

And of course, if our Lord had the partiality towards the poor, we better have the same . . . 

Of treasures on earth

It was quite encouraging to see a news item about the pope taking a stand for the poor and putting on record about the idolatry of money being responsible for the recession which has resulted in unemployment and increasing poverty. He also made efforts to reach out to the poor and the most marginal and priority of his pontificate.

Over the last 3 weeks, while I was in Kerala, one of the harsh realities that smash onto us the major influence that money has wielded in the Christian community of the state.

3 instances to just put across on the treasures we value. I know this can be harsh on some of my own very close friends and maybe you will tell me that there are instances worse than these.

-          I was told of a wedding reception in a church where the cost of each plate of food was 600 INR. That was the first time I heard of such a high cost per plate. Later when I discussed about this with a friend, I was told that he had heard about a wedding reception where per plate food was 1200 INR. And it seems that 600 INR per plate was not quite an an uncommon affair for a wedding reception.

-          One of the churches I frequented long back was doing an extensive revamping of its sound systems. The cost – a whopping 800,000 INR. I could not help but think that we could have brought a ventilator if we had that amount.

-          The worst of them all – I know of a church building which was made with a total cost of approximately 20 million INR. The issue was that the church was in a debt of 10 million INR after the construction was over.

I’ve heard quite a lot of statements from the pulpit about the opposition of the church towards extravagant spending. However, that was the maximum anybody has done about it.

Don’t you think that it is high time for us, especially believers of the Lordship of Jesus Christ in our lives to take a stand for simplicity and against extravagance?

I firmly believe that opulent living and spending within our country is a crime and very much against the ethos of the Christian faith.

Could I go one step ahead?

One of the serious issues in the Christian church is about the poor in churches not been heeded to nor given any sort of pastoral care. I repeatedly hear about pastors and clergy who are not interested to visit the poor and the not so rich in their pastorate/parish.

Could each of us take a pledge to make the poor and the marginalised in our communities and churches an active part of our fellowships? 

100 days at NJH

This is a guest blog from our Physician at NJH. She responded to my request for a post after she completed 100 days of selfless service at NJH. We had been praying for her for quite a long time and it was a dream come true for me when she joined NJH. 

Dr. Roshine Mary Koshy completed her graduation and post-graduation in Internal Medical from the Christian Medical College, Vellore. She hails from Kerala and was a topper in the State MBBS Entrance Examinations. Her father, Rev. George Koshy pastors the Marthoma Church, Krishnarajapuram, Bangalore. I hope her former school mates from the Marthoma Residential School, Tiruvalla and Mathews Mar Athanasius School, Chengannur will appreciate her work. 

After her graduation she had also served at Marthoma Hospital, Chungathara and the Fellowship Hospital, Kumbanad. 

Over 3 months into working as a consultant physician in NJH has been an eye opener for me. This write up is an attempt on my part, as someone new in this field, to share my experiences and observations/musings over the past 3 months in the hope that anyone who might be interested in getting involved in improving health care in North India might have something to ponder about and those who intend to be spectators might want to take a closer look.

I feel that a great challenge as a health care provider is being able to identify the population with greatest need and to constantly focus on allocating all available resources within our constraints for their benefit. Just a few months experience and I know this is easier said than done.

Who are the poor that this hospital takes care of?  It is a heterogeneous group and the two distinctions I make are purely based on my observations as I care my patients and talk to their families in a hospital setting.

There are the real poor. They are hardly seen in the hospital because the hospital is their last resort to which they often don’t reach on time. But I remember a few of them who did come to us. They come really sick, treated by traditional healers, wanting their loved one’s life saved. If I were to tell them the critical condition of the patient and paint the obvious bleak outcome, they would rather take the patient home than get treated. But if they do decide to get treated and the patient gets relatively well in a day or two, they want to be discharged immediately because they can’t bear the expenses of the remaining days. They get better, go home very happy and never beg for charity.

I learnt this the hard way. 8 year old Reena came to us with GTCS for almost half an hour. There were no beds in the ICU. We controlled her seizures and I explained that they would need to take her to a higher centre. It seemed reasonable enough to me. It never dawned on me that the nearest higher center is Ranchi, a 5 hr journey with an expense of 6000 Rs if the family makes it both ways with additional expenses in Ranchi. I was happy to see them arranging a vehicle with the referral letter in hand. I am grateful for one of my colleagues who happened to notice the scene and told me that they were taking the child home. It took only a little extra effort to arrange a bed and manage her medical problems. She turned out to have TB meningitis, developed partial lateral rectus palsy while in the ward which resolved with treatment and she went home a happy little girl.

The thought that if this health service had not been available for her, that she would not have lived was a hard truth for me to swallow. After seeing the health status of the poor here, having been able to save a life does not appear heroic to me. It just speaks volumes of the complacency of my profession in fulfilling its solemn duty to society.

The not so poor patients, I have grouped together because though their socio economic status varies, they have something in common. Their health issues have not been properly evaluated; they have been extensively and unnecessarily investigated and treated. I find this to be one of the greatest challenges while working in this part of the country, the fact that the practice of medicine is not a science but a trade. I sensed it during my first month when my patients were very offended because i seemed to be ‘probing’ into the history of their clinical complaints. Listening to their history and examining them before ordering an investigation was unusual. It was more frustrating to me when healthy patients came asking purely for investigations because they wanted to confirm if they had ‘typhoid’. 

Working in a rural area and ensuring that the practice of medicine is both science and art is challenging but extremely rewarding. I am grateful for my training in the Christian Medical College, Vellore, for the privilege of being mentored by excellent clinicians. For those young doctors who think that working in a secondary set up in a rural area is dull, I thought I would just give you a list of a few of the medical problems that we encountered in the past 3 months.

Snake bites both poisonous and non-poisonous, Organophosphorus poisonings, meninigitis, strokes, tetanus, neurocysticercosis, pneumothorax, staphylococcus empyema, rheumatic heart diseases, tuberculosis, connective tissue disorders, apart from malaria, rickettsial infections and the like. Being able to clinically diagnose them with basic supporting investigations and manage them is very satisfying. As for scope for improvement, the area of critical care has great potential in our area and we are focusing on it.

Working in rural areas which have been neglected and among communities that have often been exploited can be very frustrating because good intentions can be looked upon with suspicion and appreciation for the work that one does is often hard to come by. The advice that my colleague gave me is something worth contemplating and I end my ramblings with the wise words of Oswald Chambers.

“If we are devoted to the cause of humanity, we shall soon be crushed and broken hearted, for we shall often meet with more ingratitude from men than we would from a dog; but if our motive is to love God; no ingratitude can hinder us from serving our fellow men”.

Children (2)

More snaps of our triumvirate in action .. .. ..

A scene while we were away from home. Dangerous . . .

Brushing teeth . . .

That's a simulated traffic jam caused by a cow on the road . . .

Training in rolling chappatties . . .

The faithful soldier . . . with helmet and the Bible in her hand . . .

Photo Post, 2nd Oct, 2013

Miscellaneous snaps from NJH . . . 

A baby with a undeveloped bladder (ectopia vesicae). He also had few more anomalies.
The family brought to show the baby to Dr. Nandamani for surgery.

We had diagnosed this to be a neurofibroma.
However, per operatively, we found out that it was a hemangioma arising from the external jugular vein.

Recently, we brought half a dozen mopeds for our Community Health projects.
Dedication service of these two wheelers in progress.

Over the last month, we started to enforce use of seat belts in four wheelers.
Jonathan and Anurag on a journey to Daltonganj . . .