Vegetable Garden

Over the last 2 months, Shalom had been quite inquisitive about how vegetables come into being.

When we had first arrived at NJH, we had started off a vegetable garden. However, because of Simian menace, we did not continue our enthusiasm. 

However, over the last 2 weeks, our farmer genes kicked on and we were into some serious amount of backyard vegetable gardening. Snaps of the efforts . . .

Our only prayer is that the monkeys will spare us this time . . .

Potatoes in empty cement bags

The first tomato plant. We found this growing wild and transplanted it to our backyard.
If you look carefully, you can see the first fruit . . .

A close up of the first fruit . . .

Cauliflower . . .

A seed bed . . . 

Other forms of seed beds . . . made from discarded medicine cartons

Broccoli plants coming up . . .

And we thought we knew everything (2)

It was last year that the world found out that there was one more layer of cornea than what is described in ophthalmology textbooks. 

Couple of days back, I read this article in Huffington post which says that another ligament has been discovered in the human knee. It appears that this ligament could play a vital part in the understanding and treatment of the ACL (anterior cruciate ligament) injury, a common sports injury. 

Amazing, isn't it. 

True it is, when the Psalmist says in 139:14 - 

'I praise you because I'm fearfully and wonderfully made; 

Your works are wonderful, I know that fully well'. 

Lucky us . . .

Today morning, I read an article about cost of medical graduate studies in the United States. 

That was the time, I thought about calculating how much I had spent for my studies in Medical College, Trivandrum. I was a day-scholar. The total costs did not cross 40,000 INR (approximately 1000 USD according to exchange rates at that time). 

That was 1995-2001. 

I thought about looking at latest costs. My colleague, Dr. Titus had done his MBBS during 2005-11. The total costs just crossed 100,000 INR (approximately 2000 USD according to exchange rates then).

Well, I need not voice it out. 

One can only think about the umpteen number of MBBS graduates from third world countries such as India who have enriched healthcare in countries such as the US. And of course, the umpteen come from the sparse numbers who pass out of Medical Colleges in such countries. 

The sad question is - 'At whose expense?' 

And considering the article, the graduates from the developing countries have a head start to the American graduates who are deep in debt when they start their career in medicine. 

I could be prejudiced by the article I mentioned. Would value enlightenment if I'm wrong. 

The Precious Baby

Today Shahana Khatun got discharged. SK was a high risk pregnancy under our care.

SK and her husband, Mr. Khudoos Ansari were married 5 years back. They had got married against the wishes of Mr. Ansari’s parents. The major reason – Shahana was an orphan and had no-one to take care of her.

SK had first come to us in 2010. She was having non-stop seizures towards the fag end of her pregnancy. We had to ventilate her and there was no progress of her labour after we had induced her. As a last option we had offered to operate on her to remove the dead baby – something we don’t do often.

By God’s grace, Shahana did well after surgery and got discharged in about a week’s time. Unfortunately, the neglect of the family to Shahana and her husband continued.

The second time Shahana became pregnant was sometime towards the latter half of 2011. Mr. Khudoos was away in Chennai. He had made up plans to come towards the last weeks of the pregnancy. Unfortunately, Shahana went into labour a bit earlier. The in-laws did not seem it cost-effective to take her to hospital. They tried a home delivery. In fact, during her first pregnancy, it was only two days since Shahana came with her husband from Chennai that she went into eclampsia.

The end result – Shahana’s uterus ruptured and she ended up with a dead baby. Thankfully, she was brought in time before she developed further complications.

We had advised the couple to wait for couple of years before a pregnancy. However, they started coming for ante-natal care from the beginning of 2013. We tried our best to refer them to a higher centre.

The family was poor and there was no way they could even think of a journey to Ranchi for safe confinement.

After getting all the necessary consent, we made a decision to do elective surgery on her at 37 weeks. Towards the middle, she was admitted twice for pre-term labour. Ultimately, she came for elective surgery last week.

By God’s grace, the surgery was quite uneventful and the family was blessed with a baby boy. 

We thank the Lord that we could successfully manage SK's high risk pregnancy. 

Avoidable Maternal Death

We had a maternal death today at NJH. 

The major aspect was that the death could have been avoided if somebody had identified risk factors, taken extra precautions and had been a bit more careful.

FmB, 22 year old mother of two came to us about 3 hours after delivering a healthy baby in a health facility about 5 miles from our place. She was gasping with a feeble heart as she was wheeled it. In addition, she was papery pale. There was nothing left for us to do. There was no blood in her veins. All of it had bled out. 

Although we had her intubated and pumped her with ionotropes, she did not respond.

FmB had been bleeding after the delivery. The care-givers had been giving her some injections to stop the bleeding. 

Unfortunately, by the time they realized that it could be fatal, it was too late. 

FmB had come to us couple of times for ante-natal care. Her hemoglobin was 8 gm% about a month back. I can't find much reason that it would have increased much although she was on regular Iron tablets. 

I'm sure that her care provider during the delivery had much idea about her anemia. There was no documentation of hemoglobin having been done elsewhere. 

Of course, if she had come to NJH, she would have ended up getting a repeat hemoglobin and a request to arrange one pint blood if the hemoglobin was below 9 gm%. 

Of course, I've had one of my dear colleagues in a sister hospital debating upon how one could manage conservatively without blood transfusion. In a situation where there is readily available blood, I may not arrange the one pint blood. 

And if UDBT was legal, this would be one classic case which would have made it if she had come in about half an hour earlier. 

To sum it up . . . FmB's death was a wake-up call for quite a few of us attending to her. A very normal process of delivering a baby ending up in a tragedy . . .

No eclampsia or rupture uterus . . . maybe, the uterus refused to contract . . . or a bad birth canal injury . . .

But, at the end of the day, a preventable maternal death . . . 

I feel sad for the husband and two very young daughters, the first one, just completing 2 years of age and the second one, born today . . .