Little joys

Many a time, readers have written to me asking about how patients have fared. I’ve found it difficult to follow-up my patients in the blog.

Couple of days back the boy depicted in Snap 3 of Photo Post came back for follow up. He had improved quite a lot. He was quite happy and posed for a photograph.

This sort of smile makes our day. This boy had come to us after having been to many doctors and they were quite relieved when he was healed at last.

We thank the Lord for the small joys we see.

Opportunity to be a part of us

Today morning, as I reached ACU, I was suddenly overwhelmed by the fact that unless we have more qualified, dedicated and sincere staff, we could be getting burnt out any day. The forthcoming Golden Jubilee celebrations make things all the more tough.

So, whom do we need?

1. Lady medical officers: Preferably freshly passed out MBBS graduates who are willing to learn to rough it out. Preference would be for people from the North Indian or North East India who are looking forward to do a post-graduation in Pediatrics or Obstetrics.
2. Consultant in Medicine: Preferably a MD/DipNB/FRCP/MRCP/Certificate from the American Board in Internal Medicine with exposure to the Indian environment in clinical management.
3. Consultant in Pediatrics: Preferably a DCH/MD/DipNB/FRCP/MRCP/Certificate from the American Board in Pediatrics with exposure to the Indian environment in clinical management.
4. Consultant in      Surgery: Preferably a DCH/MD/DipNB/FRCS/Certificate from the American Board in Surgery with exposure to the Indian environment in clinical management.
5. General Nursing and Midwifery: Preferably a fresher in the GNM course from an accredited Nursing School. There are positions vacant for both men and women. Preference would be given to those who show specific interest in burns management, obstetrics and neonatal care.
6. Store Assistant: A graduate in any discipline with exposure to basic mathematics. However, preference would be given to people with experience or a degree in material management.

For graduates from countries abroad, please note that you will need to take the necessary clearance from the corresponding Indian councils before you plan to join us.

What can I assure you? I can assure you a time of hard work with opportunities to influence the lives of thousands of the most poor and marginalized in our part of the country. Of course, we pay enough to make a good living. There is an organizational pay structure which we follow.

For further information, please contact me either at jeevan@eha-health.org or jeevan53@gmail.com. Since we belong to the organization - Emmanuel Hospital Association (EHA), appointments would happen only through the Central Office. You may wonder why I did not put the number of required posts. EHA has a total of 20 units spread out all over the country and quite a number of them are in situations which are very similar to ours.

Baking Cakes

Baking was a new thing for my wife. She got the bug of baking cakes while as part of her post-graduate studies she spend 6 months in the Pathology Department where couple of consultants gave her quite vivid and juicy descriptions about the joy of baking cakes. My taste buds prayed quite a bit that she would take up this as a serious routine in our home.

So, one of the first new possessions that we brought after we shifted from Vellore to NJH was the Murphy Richard’s OTG (oven, toaster, griller). With internet around, it was not so difficult to find good recipes. Being quite away from town was a bit difficult especially when it came to procuring the baking ingredients especially butter. Occasionally, we used to get Amul butter – but it was not recommended because of the additives and the salt.

There is a good shop in Ranchi where we could get fresh butter. So, when someone made the long trip to Ranchi, at least a kilogram of butter was a constant order.

It did not take long for our kids to develop a liking for cakes. Considering the fact that we could not make cakes often because of butter not being available regularly – cakes were always in good demand when they were made. Both of them particularly took a liking for the eggless variety of chocolate cake which Angel modified quite well even with the addition of eggs.

Our first challenge was Shalom’s birthday party last September. The problem was about trying to decorate the cake. We wanted to make the cake as well as decorate it. That was when we found out that we could use colour coated chocolate bits marketed under the trade name ‘Gems’ could very well be used. It has become a favourite with both the kids. When Charis had her birthday celebrations in April, Shalom was quite clear about what type of cake we should have.

However, the kids have discovered that the joy of baking cakes is actually in waiting to lick the batter before the cake is baked.

Shalom discovered it on his own. Charis needed a bit of introduction from Angel. However, now Charis is the dominant player as you can see from this picture.

Initially, baking cakes used to be a family event. Unfortunately, of late, I’ve not been able to take part because of the workload in the hospital. I look forward to a day when I can be part again of the fun of baking cakes.

Fever, fever and fever. . . .

Over the last couple of weeks, we have been having patients galore with fever of all types. Of course, most of them have already had treatment elsewhere, especially with the quacks about whom you can read here.

The majority of them do not test positive for anything except for a few who will have features suggestive of septicemia in their blood picture. Very few of them show the malaria parasite in their smear - and most of them who have a falciparum positive picture would have come straight to us.

Over the last many years I know of this place – there have been only two diagnosis – malaria or enteric fever. One of my colleagues here has the following different diagnosis for all sorts of fever. Malaria, probable malaria, chronic malaria, resistant malaria, recurrent malaria etc. He does not believe that there can be any other diagnosis.

We are looking at the options of being part of looking at the various causes of fever in this part of the country. Couple of weeks ago we had an epidemic of fever of which couple of them had tested to be CSF positive for bacterial meningitis. Almost all of them were only responding to either erythromycin or azithromycin and we had assumed that H.influeza must have been the cause.

I’m sure that if we do a study, we’ll find quite a number of new viruses and there is high possibilities of finding leptospirosis. Dengue has already been documented last year. Chikungunya has already been documented in our nearby districts. We had one typical case in the OPD last week. However, unless we do a systematic study we would not able to find the cause.

Maternal near miss and a miracle

DD, was pregnant for the 9^th time in her life. To compound the problem, her blood group was O Negative. Her first 3 children were alive and the next 5 had died soon after childbirth. DD came to our Outpatient department for the first time yesterday. It was very obvious from the history that her children had all died because of Rh incompatibility. And she had hemoglobin of 7 gm%.

After having had a couple of bad experiences with patients who had a negative blood group, I made it very firm to the relatives that it would be better for them to go to Ranchi and have the delivery. The family was of the lower middle class, and not very poor. Our Outpatient department and the in-patient wing were bursting to the seams. We did not want another potential crisis in our labour room. In addition, we had an appraisal visit from the Central Tuberculosis Division exploring our preparedness for the start of the DOTS Plus programme. And Tuesday was Dr Nandamani’s operating day.

The relatives did not buy any of our arguments for referring the patient. They forced us to admit her to our labour room. She was in very early labour. Dr Nandmani was on duty on Monday. By around 4 am early today morning, she was about 4 cm dilated. I came in at around 8:00 am – she had progressed to only about 6 cm dilatation. The head seemed to be in an occipitoposterior position. I feared the worst. However, since she was a grand multipara, there was a chance that the head may somehow come out – but there was also a chance of rupture of the uterus.

We decided to take our chances. The relatives somehow wanted to deliver normally. We waited till 12:00 pm – not because we had to wait, but because the theatre was too busy. By around 12:30, we took her in – with no blood and very high consent of even death on the table. We also had explained to the relatives earlier about this baby also not making it because of the problem of Rh incompatibility.

Dr Nandamani did the surgery. The baby was well – he was in fact an occipitoposterior position and had failed to descend well. There was a bit extra bleeding from the uterus and we took up quite a lot of carboprostin for arresting the bleeding.

The miracle was that the baby’s blood group turned out to be O negative – the same as that of the mother. So, he will not have the problem with incompatibility.

After couple of hours of the operation, we were quite encouraged that the husband got hold of one pint of blood. Kindly pray that DD will recover fast and that we would get at least more pint of blood.