Hospital Information System

Today is one of those days where our energies are being tested to its limits. 

Everything revolved around a computer crash-down after our Hospital Information Software went bust. And to our horror, we realized that we lost data from 11th July to 7th August. Everything, totally wiped off. 

We've been trying to find funds to obtain new software and hardware since about a year. The present arrangement of HMS has been on since 2006. However, things have not been going smooth since quite some time. Things had been kept on hold for long for want of funds. 

One of the major issues in remote and impoverished locations such as ours is the inability to raise capital. With an impending drought in the region, the future for increasing prices etc., thereby raising capital look quite bleak. The non-payment of dues from the government programs have only made matters worse. 

So . . . how much we need to somehow get our systems going once again smoothly? 

My IT manager says that he needs a minimum of 200,000 INR for the hardware and another 400,000 - 500,000 INR for the software. A welcome addition would be an additional 400,000 INR to equip all our officers with laptops. So that makes a total budget of around 1,000,000 INR (

Yes, we've had major plans for the IT department where the budget has been put at around 2,000,000 INR. However, that has not materialized so far. 

Meanwhile, please pray for the whole administrative team along with the nursing team and maintenance team who are working round the clock to ensure that things get back to normal by tomorrow morning with the old software.

Pediatric ICU

It is not even one week since I received a call from a prospective pediatrician for NJH about the pediatric workload at NJH. Well, this post is sort of an answer . . . 

Today's patients in the Acute Care Unit . . .

Bed Nos. 1: 3 year old boy, AA. Admitted with complaints of one day history of fever, multiple episodes of seizures and altered sensorium since today early morning. We had to intubate him and mechanically bag him within minutes of his admission. The diagnosis - Meningoencephalitis with aspiration pneumonia. The boy is quite sick.

Bed Nos. 2: LK, a 9 year old girl, who was sick with fever since 4 days. Since today morning, he had multiple episodes of seizures. The diagnosis - Meningoencephalitis with aspiration pneumonia. Her condition is better than AA, but needs oxygen to maintain saturation although she is not intubated. 

Bed Nos. 3: 9 year old girl, NK, who came on the 3rd August after a krait bite. She has been intubated since. By God's grace, her condition has improved quite a lot. Weaning off the ventilator would take some more time.  

Bed Nos. 4: 20 year old young lady, KK, who had a cobra bite at around 3 pm yesterday and was brought around 8 pm after going through the customary rituals of 'jhad-phuk' and couple of visits to other hospitals. We had to intubate her within minutes of her arrival . . . She continues to be on the ventilator. To make matters worse, she has a bad ischaemia of the site of the bite - Right middle finger - which most probably needs amputation. The only adult patient now in the ACU. 

Bed Nos. 5: 16 year old boy, who was bitten by a krait on 2nd of August. He has also been on the ventilator since admission. Dr. Roshine plans to take him off the ventilator sometime later today. 

Bed Nos. 6: 10 year girl, BK, admitted today morning with the history of fever since 8 days, headache and vomitting since 3 days and couple of episodes of seizures since yesterday. Lumbar puncture is suggestive of a tuberculous meningitis.

So, 4 out of 6 patients in ACU are children, another one is a teenager. That provides the answer to the prospective pediatrician . . . 

The things to be thanked for . . . all the 6 patients are sick and it was such a relief to see all of them hooked onto multipara monitors. Thanks to all those who helped us to get to this state of affairs. 6 multipara monitors, 1 full fledged ventilator, 2 anesthesia ventilators, 2 syringe pumps . . .

The sad thing was to see little AA being manually ventilated . . . However, you know, there are no ventilators of any type other than those we have for a radius of almost 150-200 kilometers. 

Of course, many more things to be done before it would become a full fledged ICU . . . more on that in the next post . . . 

Looting in broad daylight . . .

Today, a poorly built young man come to one of our doctors. He had a contrast enhanced 18F-FDG whole body PET-CT Scan in his hand which he held out to me and told me that the concerned doctor has told him that he has tuberculosis in his blood.

He had come to NJH as we had a reputation for treating tuberculosis patients. 

One look on his face and his history was enough to make a very strong suspicion of Sickle Cell Anemia. He had a huge file with him. Our doctor was hopeful that there would be something in there about the diagnosis. The names of the hospitals he had gone through were huge enough to have their own websites and online fixing of appointment etc.

Other than the PET-CT Scan, he had a complete hemogram (4 times), liver function tests (4 times), serum iron studies, detailed stool examination (3 times), ASO titres, echocardiogram, HIV, ultrasound abdomen, widal tests, couple of chest X-Rays. He has been admitted and on multiple intravenous antibiotics for quite some time. 

The total costs of the latest treatment for him has come to something around 70,000 INR.

The poor guy had gone to one of the metropolitan cities in the country for job. And then he fell very sick with severe body pain and fever.

He was always sick since childhood. He had been to many places. Nobody has told him anything till he took the PET-CT Scan when the concerned doctor told him that he appeared to have tuberculosis in the blood. 

However, the reason for me to put up this post was because of the absence of a peripheral smear report in his treatment file. Nobody had told him about the possibility of sickle cell anemia. 

I wait for the reports of the sickling test and peripheral smear . . .

Obstetrics . . . still on . . .

Couple of hours back, someone messaged me asking the reason for stories of high risk obstetric care vanishing from my blog. It's not that they have vanished . . . the fact is that the numbers almost remain the same although there has been a fall in the number of deliveries. 

I just returned from the labour room after being called for a lady who had come to deliver her first baby after she started to have pains since afternoon today. 

RD was from one of the nearby villages. In fact, married to someone in the nearby village. She was away at her mother's house which was more far away. The family had been waiting for her to deliver. 

They knew that she had completed her term almost a month back. We calculated her gestation age as 45 weeks and one day. The poor family also wondered aloud to me that it has been quite some time since she crossed term. 

I hope she has wrong dates. 

But, there was more to come. Blood pressure showed 160/110 mm Hg with a Urine albumin of 3+. She was blessed not to have thrown a seizure. On examining the abdomen, the uterine size just about corresponded to 28 weeks size. She was contracting. 

On per vaginal examination, she was in full blown labour. There was grade 2 meconium. 

Teenager with her first pregnancy, post-dated, severe intrauterine growth retardation, with meconium stained amniotic fluid . . . not an uncommon story that we've seen. 

RD was away at her mother's house till today morning. Her husband sighed that it would have been better for her to remain with him. But then, he had go far for work as a migrant laborer. 

She delivered within couple of hours. The baby weighed a measly 1400 gms, had meconium bubbling from the oral cavity and the nasal cavity. The heart rate was too slow . . . And while getting ready for resuscitation, we noticed that the pupils were already dilated . . . 

As RD was shifted to the ward, we had our next bad obstetric patient . . . a 24 year old mother of one who had delivered couple of days back at home, coming with severe lower abdominal pain and no urine output. She was in shock . . . no pulse or measurable blood pressure. She is in acute renal failure and she's pouring out pus from her uterine cavity . . . 

More on SD, if I find time . . . 

Land of milk, and . . .

When we joined NJH in 2010, one of the major issues we faced was the scarce availability of milk. There was not even an ounce of cow’s milk to be brought. Buffalo milk was available,  but in very small quantities. Providing milk to the children was always a challenge and most of the time, we were dependent on packaged milk.

Well, things have changed a lot.

As most of you have read in the news media, we are in the middle of a bad drought.

However, there is no scarcity of milk nowadays. We get cows’ milk for giving the kids. And there is quite an abundance of buffalo milk.

Such good milk that we get approximately 100 gms of butter every day. Recently, we had so much butter stored up in the refrigerator that we made ghee (clarified butter) out of it.

It’s so amazing. Poor availability of milk was something we put before the Lord when we reached here in 2010.

With the sort of agriculture work that is happening (in spite of a drought), I’m sure that the Lord will bless us with honey also in no time.

All praises to God, Jehovah Jireh, the provider of all things good for his children.