Friday, December 20, 2013

Lost Pregnancies



Over the last 3 days there were 6 obstetric patients in the Acute Care Unit. All of them of course high risk. 

The first one was PrD, who had been on the ventilator for over 2 weeks. She recovered miraculously and has since been shifted out to the general ward. 

The second one was BaDe a twin pregnancy with eclampsia who had delivered normally. It is very rare for a mother and her twins to have come out alive after few episodes of seizures. Her blood pressure has since been controlled. 

MD was pregnant for the fourth time and had come to us after having been searching around hospitals who were ready to take up a previous Cesarian. When we operated, her previous scar was already giving way. The baby was lucky to have survived. For, MD has lost 2 of her previous babies to early neonatal illness.  

The fourth lady, SumD was delivered elsewhere. She had Post Partum Hemorrhage after the twin delivery. The bleeding was so much that the people where she had her delivered just packed her vagina tight with roller gauze and bandage. We removed that pack only after we got fresh blood. Thankfully, it was only an atonic PPH which had taken care of itself. 

The lady in the fourth bed was ManD. She also had delivered by Cesarian. And of her four pregnancies so far, this was only her second live child. The rest two had died during childbirth. She was also almost rupturing when we operated. She had been going around different hospitals in 2 districts, in labour, before she reached NJH.

The last patient of this story, MarB was the most unlucky. She had already lost 2 babies earlier. The present one was her fourth pregnancy and she had lost that too. As she had a Cesarian for the previous pregnancy elsewhere and there was scar tenderness, we had no option but to do a Cesarian section for the dead baby. Again, the uterus was just giving way. 

All the six ladies could have ended up dead. Some are alive because they were referred at the right time.

If you leave the two twin pregnancies . . . and look at the rest of the four families of PrD, MD, ManD, MarB . . .

Four families . . . 13 pregnancies and 8 dead babies . . . PrD (1 dead baby), MD (2 dead babies), ManD (2 dead babies), MarB (3 dead babies) . . .

Can you believe this? 

It was so difficult to comprehend that all these families had gone through so much of a heartbreak . . . 

At least 2 of the babies would have died if we had not intervened on time when they arrived this time. . .  And as I mentioned earlier, all the six mothers could have ended up as maternal mortality statistics . . .

We write in our consent forms . . . there is no obstetrician, pediatrician, anesthetist or a surgeon in this place . . . there is no blood bank in NJH . . . if we have to operate with a low hemoglobin, we give authorization to do the surgery without blood . . . the responsibility of getting blood is with us and not with the hospital . . . 

Most of our patients sign this without any second thought. Many of our patients are too poor to take a decision to move on to a higher centre . . .

I wish we had some more co-workers join us and be a part of NJH. Yes . . . consultants in all the above four specialties is something we would love. 

Thursday, December 19, 2013

Animals in Ranchi Zoo

Snaps of animals in the Ranchi zoo . . .

The hippo

Monkeys. In India, I wonder why there are kept in the zoo. We get to see quite a lot of them in the open.

A very friendly deer

Tiger

Porcupine

Civet cat

Leopard cat

Wild cat

A board saying that there is a lioness there whose upkeep was sponsored by Ms. Priyanka Chopra, the Bollywood actress. The period of sponsorship is already over. So, I wonder if the lioness is still inside.

Great Himalayan Bear

Deer

Sambhar deer

Jumbos

Gharial

Water monitor lizard

Invitation to a village



After quite some time, I got another opportunity to visit a nearby village. This visit was quite different from most of my previous visits. I went after the Village Headman invited me to visit the village and advise them on how to develop the place. This village, Patna in Manika block of Latehar block was a village where the Project on Community Based Rehabilitation for the Disabled was working. 

The Village Headman was disabled himself. It was quite a sad story on how he got a bad limp. He slipped and fell from a bund when he was studying in the third standard. From his description, it looked as if he had a posterior dislocation of the hip which was never managed properly. 

A meeting was arranged where the villagers could discuss issues with me. However, there was a small hitch. Most of the villagers thought that I would be late like most of the other guys who get invited to the village. 

So, I had time to walk around and see the village. Below are few of the snaps from the walk . . .


The violet colored plants are wild tulsi.

The water body on one end of the village




Recently, there was a government program promoting organic farming using compost. These are compost pits made using government grants. Unfortunately, nobody was sure about how to make the compost.

The dried looking fields. The farmers were trying to plant wheat

The lunch we got in the village. Rice with pigeon pea curry (dhal). Side dishes included mashed pigeon pea leaves made in two different ways.

My jottings after the visit to Patna village –

1. The segregation on the basis of caste within the small village of about 180 families affected the progress of the village.

2. Similar to most of the villages in our region, they had abandoned traditional cropping which included millets. That had spelt doom for them. Members from about 80 families had already migrated to other places in search of work.

3. There were 4 graduates in the villages. They were running pillar to post in search of a job. None of them was even exploring the option of self-employment/enterpreneuing.

4. There was a medium sized lake on one side of the village. The villagers were not able to use it for commercial gains.

5. The villagers had heard about the intervention we were doing in the neighbouring villages of Ghutwa and Ekta under the Climate Change Project. They wanted us to help them out too. There are challenges. Patna village is in Latehar district whereas the Climate Change Project is being implemented in 30 villages of the Satbarwa block, which is in Palamu district. Considering the enthusiasm the village had to see change, I would have to oblige them.

Wednesday, December 18, 2013

Keeping up with the Joneses

A hippo in the Ranchi zoo checking out on what his neighbors are up to . . .


Birds at Ranchi Zoo

Snaps of birds in the Ranchi zoo. 

As soon as we got into the zoo, we had the shock of a very poorly kept parakeet cage. However, things turned out to be better as we went on. 

The poorly maintained parakeet cage

Geese

One type of pheasant

Pariah Kite

Adjutant stork

Ibis