Mulberries

I wonder how many people know about the mulberry tree inside the NJH campus. 

I had snapped the berries while they were raw last year. 

I remembered them only this year when they had become quite ripe and juicy. 

Making childbirth a horror

(The snaps in this post could be repulsive to many. Viewer discretion advised)

Last week, we had one of the worst rupture uteri we've ever seen. Worst in the sense that it was quite repulsive when we got the history. 

SS, a 30 year old lady with no living issue had become pregnant the third time. As with her previous two pregnancies, she had thought that she would deliver without any problem at home. Her previous two babies were born at home but died before they attained the ages of five.

However, the progress of labour in the third pregnancy was eventful. The baby just refused to come down as the previous two had come. The family sensing that something was wrong took her to the nearby government health centre. There was no doctor or nurse at the place. 

Someone suggested a 'reliable quack'. 

The quack gave her two injection and started to applied pressure with his bare hands on her bulging tummy. He was trying to somehow push the baby out of the uterus. He had not even done a per vaginal examination. After about half an hour of applying pressure on the abdomen, she felt something give way. 

But, there was no baby. The tummy still looked swollen. The labour pain had disappeared. But she started to feel quite nauseated and sick. By this time, one of her relatives who was a Sahiya had turned up. She realised that something had gone wrong. 

It was around evening when the family reached NJH with SS. As always, the diagnosis was quite easy . . . a rupture uterus . . . 

Snaps of the surgery and how it looked . . . A grim reminder of how archaic obstetric care remains for quite a lot of our fellow citizens . . .

Tried to get a snap of the abdominal contour in a rupture uterus.
There is fullness of the suprapubic and the epigastric regions. 

The surgical team led by Dr. Shishir . . . 

The baby appears like he's sleeping . . . 

The aftermath of the violent abdominal massage . . . 

The uterine rent well sutured . . .

Comparing costs

Recently, Isaw a website which showed cost of foodstuff in different parts of the world.

Sometime last week, I happened to buy some vegetables in a nearby village market. After I came come, I realized that it may be a good thing to put up the below snap of whatever I brought and request my blog readers to put up here the cost of the same amount of vegetables in their town.

The amount of different vegetables and their costs are put up in the table below - - -

Item	Cost per kilogram	Nos. of kilograms	Total cost
Tomato	10.00	2	20
Cauliflower	8.00	1.250	9
Greens	5	2	10
Carrot	10.00	2	20
Capsicum	20.00	0.50	10
Beans	10.00	2	20
Grand total		9.75	89

1 kilogram (kg) equals about 2.2 pounds (lbs). 

Unbelievable . . . but true. When I called one of my friends and made a comment about this, he volunteered to check the costs in his place and get back. The costs totaled approximately 250 INR.

Would like readers to get back regarding this post and tell the cost of vegetables kept in the snap, in their town or city . . . 

Oh . . . the suffering

One of the major changes that we've seen in our patient profile over the last one year after the roads have been repaired is the huge increase in road traffic accidents. I suppose, we get almost 20 patients a week who get into some sort of an accident in our region. 

And all this, when it is quite common knowledge that we do not have the necessary infrastructure both in terms of facilities and personnel to manage such cases. 

Of course, poverty is the major reason that many patients come to us for treatment after accidents. It is quite heart-wrenching to see them explore alternate ways of treatment especially when there are broken bones or head injuries. I've lost track of the number of head injuries who just could not afford to go ahead. The same with fractures. 

However, today, I had one of the most pathetic story of a family involved in an accident. 

One extended family was taking one of their young men who had become mentally unstable and got a wild predisposition over the last 2 days to show a doctor in the nearby town. The young man was so uncontrollable that he was bound up and held by couple of his cousins in the tempo. 

As fate would have it, the cousins had dozed off or they had thought that the patient had settled when all of a sudden, the young man become violent, loosened his restraints and pounced on to the driver. The driver lost control of the vehicle and went off the road and overturned. 

Both the cousins who were holding the patient had serious fractures. One of them had a complex open fracture in the elbow region with distal neurovascular injury. The other had a bad comminuted supracondylar fracture of the left humerus. There was one more cousin who had a fracture of the clavicle All the others including the driver and the psychiatric patient escaped unhurt. 

We had to refer both the cousins. I am quite doubtful if the doctors at Ranchi would be able to save the forearm of the young man with the complex fracture. 

And I was quite interested to know about what happened to the mentally unstable patient. It seems that the family had got so terrified of the whole episode that they have put him under lock and key in a nearby house. 

I'm sure it's not quite often that we find such an interesting association between psychiatry and orthopaedics . . . although the story was a grim reminder of how bad things can turn out in the absence of knowledge and in the absence of easily accessible facilities. 

Mistaken Identity - a fishy affair

Last Saturday, we started to fish from the pond. Along with the usual fish, we also had a fish locally called 'Tengra' 

Now, none of us had expected the 'tengra' to be there in our catch, as we had not put 'Tengra' fingerlings. Now, there was a chance that someone had contaminated our pond with 'tengra'. Unless . . . what we knew scientifically as Pangasius was locally called 'tengra'. 

Yes . . . we had put about a hundred fish fry of Pangasius in July 2013.

'Tengra' was a cheap fish which was commonly seen in the local fish markets, but quite unpopular. Cheap it was, and quite a blessing for families like ours where the children loved fish. The reason - - 'It had only a single bone and no small bones'. 

According to my staff, it was not as tasty as the 'rohu' or the umpteen number of carps, which according to me were all full of little bones. 

So off we are on a research on the 'tengra'. On googling 'tengra', it was obvious that what is commonly called the 'tengra/tingra' was a totally different variety. The common agreement was that what is commonly called 'tengra/tangra/tingra' is of a genus called Mystus - common varieties being 'Mystus bleekeri' and 'Mystus vittatus'. 

So, I've sort of come to the conclusion that what is locally caleed the 'tengra' is actually Pangasius . . . to zero in further - - Pangasius bocourti. 

I would like to hear from the experts. 

If I'm sure that this is 'Pangasius bocourti', it means quite a lot for us as we had put the fingerlings sometime in the first half of July, 2013. It's not even 9 months and we got 2 of them weighing above 1500 gms. We did not give them any special feed as is recommended.

They say that this fish is quite strong and therefore is quite difficult to catch. Maybe we would be getting more of this fish in the next catch . . . which should happen in two week's time.

The pale flesh of the fish. The only disadvantage is that the meat is quite soft . . .