Left in the lurch

Once a while, we get patients who remind us about how pathetic can healthcare in the country be. 

SSB, a 55 year old lady was wheeled into our emergency with a history of backpain followed by paralysis of her lower half of the body since the last 2 months. She had very bad bed sores . . . and that was the reason her relatives brought her. 

It was Titus who saw the patient. They had quite a lot of papers relating to some treatment SSB received at a big hospital in one of the metros. 

Titus could not believe what he read. The lady had been diagnosed to have follicular carcinoma thyroid sometime in April 2013 and she had a hemithyroidectomy done for the same. And the relatives did not have a clue that it was cancer. 

It was not difficult to come to a diagnosis about her backpain and the paralysis. Some quack had taken few X-Rays of the spine and the mets were so clearly seen and there were compression fractures of the body of couple of vertebrae. 

2 things, I could not understand. The reason why only a hemithyroidectomy was done after a diagnosis of follicular carcinoma thyroid. And the second, how come the relatives did not have a clue about what the patient had. 

Titus started to explain about what all we could do the maximum for her. It was difficult. It has been quite a  few days since we wanted to start off a formal palliative care program. I'm still not sure on how we could take on this. I still remember KD who did fantastically well under our care. There are quite a few units in EHA under the leadership of Dr. Ann Thyle who's doing fantastic work in palliative care in rural North India. 

SSB's relatives could have none of it. Titus called few of us too to put across things. The family was just not willing to understand. They just wanted some medicines to cure the bed-sores. 

This is not the first time we encountered such a case. 

We had a young man from one of our nearby villages who was diagnosed to have nasopharyngeal cancer about a year back. Unknown to us, he had gone and done surgery from one of the premier institutes in the country. The diagnosis was well written in the papers. 

However, the family had no clue about it. Until he had a recurrence and he came to us. We took a CT Scan and found out that it had spread out too much. 

He passed away within a month. 

I don't know whether the families had bluffed to me regarding their ignorance of such a serious diagnosis. However, I don't think one can find any excuse for doing only a hemithyroidectomy after a diagnosis of follicular carcinoma thyroid has been made. 

I would stand corrected if there is any change in management processes of late . . .

Ragi Idli Recipe

I had quite a few people asking me about the ragi idli recipe. 

Here it is . . .

Ingredients:

- Ragi (finger millet flour): 2 cups

- Raw rice (arwa chawal): 1/2 cup

- Bengal gram (urad dal): 1 cup

- Salt to taste

- Lukewarm water

Method:

- Soak the bengal gram and the raw rice separately for about 6 hours.

- Grind the bengal gram to fine paste. Keep aside.

- Grind the raw rice to a rough batter. It should not be very smooth, but should have enough water to mix the ragi flour in. 

- Mix the rice batter to the bengal gram paste. 

- Fold the ragi flour to the batter. It should not be mixed too much. Add enough water to get a smooth batter.  

- Pour the batter into idli moulds and keep in the idli cooker for 10 minutes. 

- The recipe makes about 24 medium sized idlis.

Finger Millet (Ragi)

That is the snap of a plate of Ragi (finger millet) idli with chicken curry. 

The item is part of a effort from our CH team to re-introduce and popularize finger millet (ragi) cropping in our part of the country. 

Finger millet is known by the following names in different parts of the country. 

We had found out that millets had been the backbone of the food security of quite a large part of this region of the country for ages. Till the green revolution forced rice and wheat cultivation onto the population. It was furthered pushed on by construction of dams to ensure sustained irrigation.

However, with the reality of climate change, people have slowly started to realize the significance of alternate cropping in which millets play a vital part. 

There are quite a lot of websites which glory the use of millets in our regular diet, but I found quite a good blog which describes things in detail. It is very well recognized as on of the best food items that can be given to babies during weaning.

More than all these are the facts about the cultivation of millets . . . I had mentioned about them in my previous post . . .

- These crops are hardy and require less water. 

- They can be grown in low fertile soils.

- Millets grow better with biofertilizers.

- Most of the millets are pest-free. In traditional societies, they used to be used as used as anti-pest agents to store pulses etc. 

- Nutrient to nutrient, most of the millets are much superior to rice and wheat.  

Well, for all the food pundits, here is the nutritive value of finger millets when we compare to rice and wheat.

	Protein (gm)	Fibres (gm)	Minerals (gms)	Iron (mg)	Calcium (mg)
Rice	6.8	0.2	0.6	0.7	10
Wheat	11.8	1.2	1.5	5.3	41
Finger millet	7.3	3.6	2.7	3.9	344

I'm sure this will impress you. And one can very well conclude that one cannot address malnutrition without seriously looking into issue of popularizing millets. 

More on what our Community Health department is doing with regard to popularising Ragi cultivation and usage in my next post . . . 

By the way, I'm yet to find someone to help out with getting Kodo seeds . . .

In case you did not know

I found a pamphlet advertising a newly opened residential school in our nearby town.

One side of the pamphlet had a table describing advantages of putting your kid in the hostel in comparison to his/her going to school from home.  

I thought it was quite hilarious . . .

The English translation . . . 

STAYING IN HOSTEL	STAYING AT HOME AND GOING TO SCHOOL
Discipline of rising up from bed between 4:30 to 5:30 am, washing hand-face and taking bath	Undisciplined rising up from bed
Exercise between 5:30 to 6:30 am	Nil
Tuition from 6:30 to 8 am	Nil
Breakfast between 8 to 8:30 am	Undisciplined time for breakfast
Regular schooling	Undisciplined schooling
Lunch between 2 to 2:30 pm	Undisciplined time for lunch
Playtime between 4:00 to 5:00 pm	Undisciplined playtime, sometimes stretches the whole day
Computer between 5:00 to 6:00 pm	Nil
Spoken English classes from 6:00 to 8:00 pm	Nil
Dinner between 8 to 8:30 pm	Undisciplined timing for dinner
TV viewing 8:30 to 9 pm	Increased TV viewing
Self study from 9 to 10 pm	Nil

From the above table it can very well be told that by living in our hostel children will be good in studies and discipline. Because of which their future would be better and there would be overall development of the children. 

Waiting . . . for no reason

(I started to pen this post on 12th evening)

Sorry for the little gap in my posts. 

We've been quite busy here over the last 2 days. Only 2 of us (Johnson and myself) to take duties and Roshine away for her convocation. Of course, outpatient care was helped by our better halves too . . . Titus would be back on the 13th. 

We've been preparing for our Regional Administrative Council meetings.

And then, it slowly dawned to me that I may not be able to make it. Mainly because of the sudden increase in patient numbers after all the holidays. The holiday season for the local community culminate with the Chatt festival after having starting sometime early October with Durga Puja.

I write this as I wait . . .

I wait to stop the ventilator of a young lady, MD who came to us yesterday afternoon. She came to us yesterday afternoon (11th Nov) after having umpteen number of seizures since almost a day.

As soon as she was wheeled in, it was obvious that there was nothing much we could be doing. She was in shock and her pupils were mid-dilated with no reaction to light. But her heart was beating and she was gasping. We got her into the ventilator.

She was fully dilated and within half an hour, she had delivered. We got her blood pressure up using dopamine. However, it needed the maximum allowed dosage . . .

There was not much we could offer the family for her survival. But, the family wanted everything possible to be done. They even went to the extent of arranging a pint of blood. 

Today evening, as I went to disconnect the ventilator, the family wanted me to transfuse the blood. It was odd. But, I had to do what they requested. 

The next part was written on 13th night (today).

MD continued to be in the same state of affairs till the family realized by today afternoon that things looked bleak. They came with a request to turn off the ventilator. 

MD died at around 3 in the afternoon. 

Another maternal death which could have been avoided if the husband had decided to bring her early to hospital. The family had waited for about 16 hours before taking a decision to take MD to hospital. They had thought that MD was possessed. 

The saddest part was that MD and her husband lived just 3 miles from the district hospital.

One of the rare incidents in a place like ours where availability of technology puts us in dilemmas.