Winter Rains . . . ? Climate Change

Today, late in the afternoon, we had very heavy rains. It was as if monsoon had arrived very early. 

It was very unusual. But, this should ensure that the campus pond will remain full throughout the summer. 

Few snaps . . . 

Disappointment . . .

Someone asked me what was our setbacks in the last couple of weeks.

The first one, was a maternal death.

And the second one, a very terrible complication which succeeded one of the surgeries we did towards the end of  last year.

First, the maternal death.

SRD delivered sometime in middle January at home and was not keeping well. She came to us 20 days after her delivery. From the history, the delivery was quite a difficult one and baby was dead.

On investigating we found out that she had about a litre of pus inside the peritoneal cavity. Hemoglobin was 8 gm% and she was in profound sepsis. No blood could be arranged. 

Therefore, we did a peritoneal tap and removed as much pus (about a litre) as possible.

However, she had become more toxic on day 2. After much persuasion, 2 of our staff donated blood. Ultrasound shows more pus with loculations. We had to clear her peritoneum.

The surgery was uneventful. We removed about 1.5 litres of pus. The intestines and uterus were all caked. Most probably she had a massage of her abdomen during the delivery which would have caused necrosis of the intestines.

She did well for about 36 hours after the surgery. Suddenly, without any warning, she developed a cardiac arrest and could not be revived. We were not sure of the cause. Either the sepsis was too much for her body to cope with or she had a pulmonary embolism. We don’t know.

The other case was that of GD, who had eclampsia  on whom we had done a Cesarian section and later put a B-Lynch.

She had a wound infection which was quite expected. We had pumped her with the strongest antibiotics.

However, she was discharged with daily dressing of her wound.

She was doing well.

Last week, she came with a prolapsed uterus and it was gangrenous. Her general condition also was not good.

Most probably, she was not getting the good food and care after she went home. Our nurses had also been quite concerned about her general hygiene.

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With a surgeon not around, we somehow convinced her to go to a higher centre.

I’ve my doubt that they’ve taken her back home to die.

It was sad, but in the absence of specialist care, that was the maximum I could do. And nutritious food and good hygiene are issues which we have not much control upon. 

Unwanted Hysterectomies . . .

Over the last 4 days, our local newspapers are on a reporting spree on allegedly unwanted hysterectomies being done by couple of hospitals in our neighbouring district, Garhwa.

About couple of months back, we had a similar news in our own district. I don’t know about what was the outcome of the investigations and enquiries that came after that.

In fact, we at NJH receive quite a lot o patients who come to us after they had been advised to have a hysterectomy elsewhere. The reason would most of the time would be one irregular cycle or a vaginal infection. And in 80% of the cases, there would not be an indication or the surgery. The ultrasound reports it as 'edematous uterus' or 'enlarged uterus'. 

I remember a patient who was pestering me to get her uterus taken out. I could not find any reason to do the surgery. The family saw the uterus as a unwanted organ once the function of childbearing was done with.

It is not uncommon for requests for hysterectomies from patients when they are subject to abdominal surgeries which have no relation to the uterus. Appendicectomy . . . Cholecystectomy . . . Perforation peritonitis . . . there's always a query on whether the uterus can also be done away with. 

When the news about unwanted hysterectomies being done was first reported, I remember having a conversation with one of the local village leaders.

He wondered why the all fuss about the uteri being removed. He narrated to me how difficult and useless it was for a village woman to have a uterus once the function of child-birth was over. He was referring to the 'menstrual cycles which torment the lady' till she attains menopause.

And mind you, he knew the medical science. He told me how irregular and heavy bleeding during menstrual cycles could keep the lady anemic and malnourished.

He narrated, ‘First of all there is so much of poverty and malnourishment. To top that, there is the monthly loss of blood which is well averted if the uterus is taken out. Then, if she has a problem with her cycles, she’s too tired to work for almost a week. Therefore, why all the fuss about removal of few extra uteruses? And the treatment you people give for irregular bleeding is also quite expensive . . . he knew the costs that hormonal therapy involved . . . the drugs and multiple visits involved.’

A typical example of how developments in healthcare can be utilised in a twisted manner by people who are out for a profit and beneficiaries who assume that they have a good deal.

Then why the fuss .. .. .. my friend has the answer.

‘You cannot allow anybody to get their uterus out without a genuine reason. The reason why everybody joins the bandwagon of blaming the doctor and the hospital is because someone must have told them that there is the possibility of some sort of compensation involved. Nothing less, nothing more’

I could buy his reasoning . . . not about the reason for hysterectomies. The reason for the fuss being made after the surgery has been done. 

It was not difficult to imagine  . . . the hype after all the damage is done . . . nothing short of media sensationalism . . . the question on who got the scoop . . . and then, a glimmer of hope among the rural poor about getting some amount of 'compensation' for the 'wrong' done. 

Nothing concrete to change practice. That is what we learnt from similar 'revelations' elsewhere. 

I shall be much relieved to see some amount of responsible decisions being taken in the healthcare sector in this region after this incident. 

Praise and Prayer Bulletin . . .

Please join us in praise and prayers . . .

1.       2 of our bachelor staff are getting married soon. Dr. Titus and Mr. Dinesh. We praise God for finding life partners who agreed to become part of the adventure they’re in. Please pray for both the young ladies who are going to commit a lifetime with these guys.

2.       We thank the Lord that the lamp lighting and capping ceremony our NursingSchool for the year 2013 was held last week. Please remember the needs of the nursing school and the staff in your prayers. We pray that the students from our school would be a blessing in the places and to the people they serve.

3.       We thank the Lord for the miraculous healing that many a patient gets at NJH.

4.       Praise God for the Grace Babies team who spent about a week with us. Please pray that they would continue to be a blessing.

5.       The healthcare profession is bereft of compassion and care as days pass by. Please pray that we at EHA would be examples of excellence in compassionate care.

6.       We’ve had positive responses for the vacant positions of Information Technology Manager and a Physiotherapist. Kindly pray that the Lord would work in their lives and they would be a blessing to NJH.

7.       Material needs of the hospital continue. We need to invest about 2.5 million INR (50,000 USD/Euros) as an emergency – a school bus and couple of generators. Kindly pray that we would have somebody to fund this need.

8.       Our children (about 40 of them) are giving their year end examinations. Please pray that the Lord will grant them success.

9.       The winter crops have yielded a bumper harvest. But, it pains to see that quite alot of harvest is wasted as there is no mechanism of food processing or storage. Please pray that we can do something about this.

1.      A surgeon, pediatrician and medicine consultant continue to be dire requirements. We trust the Lord for these staff requirements. 

Flowers . . .

I've always admired people who have a good garden. Many a time, I used to plan to have a good garden in our home. But, the very much demanding work schedule and the monkey menace we have in the campus prevents me from having one. 

As part of our work, we visit quite a lot of health dispensaries in remote villages usually managed by various congregations . . . Few snaps of flowers in the gardens of these places. It's quite a feast to the eyes . . .