The First Rupture Uterus of 2012 . . .

And finally, although we had quite a busy day on my first duty of 2012, we were lucky not to have a rupture uterus.

But, then we had the first rupture uterus of 2012 on my next duty day (9th Jan, 2012).

The duty was not much busy – save for the night, when I had 3 patients with previous Cesarian sections landing up with in a time period of 1 hour. The first two were without much problems.

But, the third one, BD had tried to deliver at home and ended up with a rupture. It was her 4^th pregnancy. The first one was a normal delivery. The second one was the previous cesarian – but she had lost that baby during the surgery. The third one was a normal delivery – which may have prompted her to try to have her fourth one at home.

BD was visiting her parents when the labour pains started – most probably a reason for not trying to access health care. However, by the time she knew that something was amiss, she had called her husband, who was elsewhere. The husband was knowledgable enough to realize that she had ruptured and advised her to go straight to NJH.

 

So, she came straight to us. She was in shock – which she responded well to fluids. And the family arranged for couple of pints of blood.

Shishir did the surgery. By God’s grace, the rupture was clean and we were able to close the rent without much problems. She is making a good recovery.

But the family is quite upset that they lost a baby boy. The second delivery which involved a Cesarian section had also ultimately ended up with a dead baby boy.

Lesson learnt: The importance of finding out the decision maker in the family where a lady is expecting a baby soon and educating the decision maker about institutional delivery.

First working day of the New Year . . .

Today was my first day after the brief vacation and oh...my....it's turning out into a major one.

To start off, as I left chapel and entered the hospital, Dr Johnson requested me to convince MD to undergo a Cesarian section. Johnson was convinced that MD was obstructed - and I was also convinced. I was thankful when Johnson went out for one more round of negotiations and returned victorious.

MD had been in labour at her home since late afternoon of the previous day. She had also recieved 6 intramuscular injections, half of which were oxytocin. She had arrived sometime after midnight, and had not progressed.

And, I was glad we operated. The outer uterine muscle fibres were starting to snap, there was petechia in the lower uterine wall, the bladder was edematous and there was a part of the lower uterine wall through which I could see the flakes in the amniotic fluid. She would have ruptured within the next one hour. The baby girl had a surprising Apgar Score of 9 and 10.

As I was starting off MD's Cesarian Section, word came that there was a Previous Cesarian without any antenatal check up who had come in with labour pains. She was also posted for surgery as soon as MD's was over.

Patients such as KD actually prevent us from readily jumping in for Cesarian Sections even when there is a faint indication for one. It was unbelievable. KD, who had a previous Cesarian 2 years back, did not even have a tetanus toxoid injection leave alone a proper antenatal check up. KD's Cesarian section was also uneventful although we had to arrange blood as her hemoglobin was only 8 gm%.

Well, I forgot about LD - who was wheeled in as we were taking a decision on MD. LD was about 32 weeks and had come in all the way from Ranka - about 60 miles away. LD was hardly conscious , had convulsions the previous day and was being managed elsewhere before they referred her to us. There was no fetal heart and the abdomen looked too big for 32 weeks.

Shishir promptly did an ultrasound and confirmed dead twins in the uterus. Then we found out that her birthcanal was almost fully dilated. But, for some unknown reason, we ended up doing a craniotomy to deliver the first twin and then the other one was pulled out breech. LD is still not fully conscious.

Then, we had two more normal deliveries, one of which was a small for gestational age baby. And another one which was an Intrauterine Death.

I'm glad we do not yet have a case of Rupture Uterus. But, we do have a elderly primi with post dates whom we've induced. I hope she delivers normally - but sometime back, the labour room nurse has informed me of couple of high diastolic blood pressure readings . . .

Well, for all those who want to know about other patients - we had two proven malaria patients today. SK aged about 19 years had been sick since Wednesday. It was quite obvious - he was shivering as he came to OPD. Then we had VS, who just came in very sick. He has been sick since January 2. He was all yellow - I tried my best to refer him - but to no avail.

Rajeev, our lab technician telephoned me VS's blood tests - Falciparum malaria positive, Total Count 21,000/ cu mm, S. Bilirubin 9 mg%, Platelets 30000 / cu mm . . . I am yet to see the full reports.

I've the ventilator ready . . . And another 12 more hours before I hand over to Dr Johnson . . .

And to top it all, two more young ladies with attempted poisioning. One had taken organophosphorus and the other permethrin shampoo . . . Both are doing well . . .

Before I sign off, an X-Ray from OPD today. There was one more good one . . . but I forgot to take a snap . . .

2012 . . . Looking forward . . .

As I sat in the watchnight service yesterday, my thoughts strayed to the dreams I have about 2012. Our time so far at NJH has been quite challenging and demanding. The possibilities in that place are umpteen. However, the challenges we've seen throughout the last year have been daunting. Few of the challenges continue to remain. As was posted in my previous post, there are so many blessings that we are thankful about.

Today morning's Sunday service really lifted up my soul. Angel's dad preached on the wedding at Cana (John 2: 1-11). Among the many other things he preached, what touched me was the challenge to unwaveringly pursue fulfilling the Lord's will in our lives during 2012.

 

Once more, I would like to quote one of the good old Malayalam gospel songs which has always enthralled and inspired me. The translation goes something like this.

- Oh Father in heaven, your Holy Will

- Be done in earth, as it is in heaven

- As your Son who did Your Will on earth

- I surrender myself to do your Holy Will

- Oh, My Lord, To do Your desires

- I gladly come to Thee

- My dear Lord, I do not want anything of my desires

- May I be fulfilled/content in Your desires of me

I should say that many of the newer songs would hardly stand the time nor convey the meaning that many such songs of old.

V5 is very significant. I consider it as one of the greatest statements on faith in the Bible. 'Do WHATEVER He tells you.'

We have quite a lot of dreams. Our wishlist for 2012 conveys quite a lot. Well, if there are 10 things which I would pray earnestly to happen at NJH for 2012, they would be the following -

1. A group of leaders at NJH who would see the potential of that place, be willing to go down on their knees to intercede for the Chottanagpur region and work selflessly towards the mission and vision of NJH. This process would require newer staff including consultants for Internal Medicine and Pediatrics.

2. Completion of the burns unit and operationalising it. We need approximately 2.5 million Indian Rupees (48,000 USDs/Euros/AUDs, 30,000 GBPs) more for completion. One of my friends has started the initial process of fund raising.

3. Upgradation of the Acute Care Unit and the theatre for laparoscopy facilities.

4. External funding for our Community Health work is drawing to a close. My dream is to synchronise the clinical work with the community health work with our own funds. It is a tough ask but I'm quite sure that this would give more ownership towards CH work from the side of the hospital as well as the community.

5. Construction of newer residential buildings including major renovation in electrical and water connections is a major need.

6. Lasting peace in the region is something we would really want.

7. A newer school bus and the roads to become better would definitely encourage more qualified staff to explore the option of staying on at NJH.

8. Construction of a 'sarai' for our patients who come from far away is a big need.

9. There is a need for extra space for the Nursing School and Hostel.

10. There has been inital discussions about the possibility of operationalising a Community College. There is a huge potential for such an effort.

There are many many more. . . Our prayer as a family and as a community is that we do not end up doing anything which is outside the will of God in 2012.

We look towards a year which is devoted to prayer. A post by Jonathan Parnell has challenged me. I hope I will live up to this New Year resolution . . . And of course there are quite a lot of people who remember us in their prayers and continue to encourage us.  We are thankful . . .    

Remembering 2011 . . . .

Its a tradition as we pass on to a new year to remember the major events of our lives and be thankful that we are blessed to see yet another year.

2011  - the major points of thanksgiving . . .

1. For me and my family, we thank the Lord that we were able to be there for the whole year which witnessed quite a lot of happenings at NJH. A violent society around us has been the biggest challenge. Life has not been smooth with quite a number of bandhs around. We thank the Lord that he kept us and all the staff and their families safe and healthy in 2011. 

2. Obstetric care at NJH has been quite busy. We had patients like KB, PD and SD who survived in very adverse situations in spite of losing their babies. Then we had quite miraculous escapes for babies, AB, SD, KD and SB - all of them were blessed with live babies.Unfortunately, we witnessed quite a number of maternal deaths, the last of them being RD. In fact, I started off this blog to a certain extent to highlight the poor obstetric care in the region. The post on the stories about LD, SD and MD is the most read post of my blog. We are thankful for the mothers and babies we saved. We look forward to the day, when pregnant women in this region would get basic antenatal care without much hiccups and there are facilities in place for complicated cases. We are thankful that government health authorities along with UNICEF has already started to take steps in the right direction.

3. We've had a 100% survival rates with regard to tetanus patient care. Starting off with MS who in fact made it into the 2012 NJH calendar to LO and SK - all of them did well. We thank the Lord for all of them as well as for the superb nursing care.

4. We are thankful for Dr Nandamani who has been giving great leadership in surgical care at NJH. We've had few open prostatectomies. All of them did well. The first cholecystectomy which Nandu did was quite a complicated one. Subsequent to that, he did few more. All the patients have done well. We've had quite a number of burns patients - many of them have been healed. VM, MI and LD were few of our successfully managed patients. We thank the Lord for each of them.

5. In addition to routine surgical work, Dr Nandamani also initiated the burns unit construction. - which has progressed well. The presence of Dinesh with his sound experience of engineering has been a blessing. We are thankful for Dr Ron Hiles, Dr Colin Binks and Ms RuthAnn, who have been steadfastly working towards this dream for quite a long time. There have been amazing developments over the last month which has encouraged us quite a lot. We thank the Lord that we are part of this amazing process.

6. The Golden Jubilee celebrations was something we looked forward. We thank the Lord that the celebrations went on quite smoothly. We were quite privileged to have had Mark Kniss for the celebrations. We are thankful that the Lord gave him the health to fly all the way from the US to be part of us.

7. The purchase of a new ventilator, couple of multipara monitors, a Nycocard reader for HbA1C along with the necessary electrical back-up and a non-contact tonometer is a major thanksgiving point for the year 2011.

8. During the second half of 2011, we had quite a lot of patients with severe malaria. We thank the Lord for patients like MS and Jithen's grand-daughters whom we could save.

9. We had a very bad epidemic of viral encephalitis in our region in 2011. We had few patients who were too poor to go to a higher centre. We thank the Lord that we could manage these patients especially because of the availability of one more ventilator.

10. The last weeks of 2011 brought about more good tidings - I've had initial reports of a Pediatrician willing to join us soon. We pray for this person as a decision is taken - we pray that the Lord will lead. There appears to be solutions appearing for water security for NJH as well as surrounding regions. Many of our friends and wellwishers have started to respond positively towards our future requirements. We are so thankful for this.

We've a very popular Gospel song in Malayalam (Tamil translation) the translation of which goes something like -

- To thank Thee counting each blessing

- For the countless blessing You've bestowed

- You've kept us safe in your palms so far

- You've carried me, O Lord . . . 

(All those with better literary skills, kindly excuse)

Similiar to the song, for us at NJH, the blessings have been countless...We've tried to count them.... But they are endless and we acknowledge that... I shall put in a seperate points on our dreams for 2012.  I wish to share with you the Kingdom Bible Reading Plan which I plan to follow next year . . .  Wish each one of you a blessed 2012.

Thoughts on Christmas Day . . .

Couple of days back, I happened to go to the Christmas carol service of my home parish, the Immanuel Mar Thoma Church, Paruthippara, Trivandrum. As I sat listening to the songs, my thoughts raced back to the days when my brother and me were active members of the church choir and the Youth Group. It was quite encouraging to see quite a lot of new young faces in the choir as well the Youth Group.

The church choir has been a major place where I learnt the basics of Christian discipline and practice. The songs we sang over and over made quite an imprint on my mind. I remember someone telling us to chew over the words of the songs we sang over and over again. As I look back, I cannot deny that the singing did quite a lot of good to us.

The choir had always been quite an influence in our childhood and youth days.

I remember the story told by one of our choirmasters about a practice somewhere on Handel's I know that my Redeemer lives where the choirmaster stopped the practice and stepped upto to the soloist if she believed what she was singing. The story goes on that the singer burst into tears and wished that she could make Christ a reality in her life.

As I saw on the pews, I was very much encouraged by our vicar's presidential address where he commented that in the olden days, there was quite a lot of emphasis given on spiritual renewal during Christmas time which has diminished over time. In it's place, arose the tremendous amount of spending on decorations, fun and frolick.

The first song I remember singing in the choir was a song called 'Manger Boy'. It was a sweet song which I sang around for quite a long time. However, it was quite a long time later that I found out the meaning of 'manger'. But, when we first sang it, the term 'manger' seemed very romantic. The corresponding word used in Greek denotes a feeding trough used in cattlesheds. I got this picture from a blog when I searched the net. No, it hardly resembles the pictures we see on Christmas cards and Nativity Plays.

I do not think that one can go any more lower than this. The king of kings to be laid in a manger after he's born. And something more - nowhere in the Bible is it told that he was born in the cowshed/stable/manger. I remember someone suggesting that Jesus may have been born on the wayside, some kind heart had suggested that they rest in the cowshed before proceeding further and Mary improvising the manger into a comfortable crib for baby Jesus. Not improbable. 

What a contrast from the celebrations we see today? 

We've thoroughly missed the message of Christmas. 

There are already quite a movement within believers, on the pagan origins of Christmas and why we should be moving away from many of the outward signs of Christmas like Santa Claus, Christmas Tree etc. You can read about them here. And a bit more stronger message here. 

I'm not sure what the cause is. Of recent, many of the things which we associate with Christmas, even the carol singing pales in camparison to the events associated with the Christ birth. Maybe, I'm becoming old. 

However, I've to convince myself to be part of all the festivities because I've realised that even my present beliefs and affirmations about the lordship of Jesus Christ in my life evolved and were firmed through participation in many of these celebrations especially the choir. I cannot deny that there is a voice deep down somewhere in me urging me to get into some four part singing. Oh...How I used to love those sessions. It was affirmed as we drove back when my sweetheart also expressed a desire to sing in a choir next Christmas...

As for my choristers in my parish, they did a fantastic job. However, do remember that the ultimate aim for the believer in Christ is to know Christ Jesus as Lord of each of our lives Philippians 3:8). Well, do not feel much disturbed about whether to celebrate or not to celebrate Christmas. I've found this article quite useful.

Hope you had a blessed time of Christmas celebrations with friends and family. We pray that you will have a Christ filled 2012...