Something good . . . from a tragedy

I'm sure quite a few of my readers would have become envious of my alarm clocks. 

Tragedy stuck us last week when all the 4 of our roosters succumbed to disease. I was busy in hospital and a trip to our sister hospital in Fatehpur. The onset of disease was quite fast and they were dead within 48 hours. 

Phone calls to our newly acquired friends in the field of veterinary science confirmed the diagnosis as Newcastle disease, called Ranikhet disease in India. 

Yes, we knew about it . . . but was not very serious about getting them vaccinated. The major reason - you don't get single dose vaccination vials. The minimum you get is 500 dosage vials . . .

Later on casual talk with staff, I found out that almost all of my staff who had kept poultry lost their flocks to disease over the last month. And the clinical features fit in well with Ranikhet disease. 

Now, there was something else happening over the last couple of weeks. Before I leave on a 3 week break to Kerala, our Community Health team had arranged meetings with all the 46 Self Help Groups that our CH team had facilitated to discuss and throw up ideas on Income Generation Programs. 

Almost all the groups were doing well with the set standards of running Self Help Groups and it was good time to engage them in discussions about IGPs. 

So far, I've met 10 groups . . . We've had major discussions on various possible means of income generation that our groups could focus on . . . handloom weaving, food packaging, pickle making, small scale grocery stores, goat rearing, pig rearing, poultry . . . there was quite healthy discussion. 

The challenges we had was mainly of 500 odd women most of whom who had not seen the outside world and has been dependent much on their menfolk for their day to day existence. We were giving them ideas about making a bit of extra income. There were odd ones who stood out. One lady who had some idea about large scale poultry farming, another one who had worked in a carpet factory before she got married to someone in our neighbouring village. 

It was obvious that it was better for us to start small . . . 

Our staff did quite a lot of research . . . It was in the fourth or the fifth group I met that the issue of backyard poultry was brought up. No one was quite serious about it. But, later as we researched on the net, we found out that there were quite a number of aspects about backyard birds that made it quite a good thing for women to try out for additional income. 

Most of us knew, heard about and had eaten more broiler chicken. There was quite a little knowledge on country chicken and backyard poultry. 

We went back to the earlier groups and had further discussions . . . And oh man . . . they were all so sad with the 'tunki bimari' the local term for Ranikhet disease. They loved to keep birds, but the disease was doing so much harm.

Chicken at home was really an advantage . .. ... the local chicken fetched quite a good rate. 200 to 300 INR per kilogram. A sudden guest could be well taken care off; a sudden need for money was not a problem with few chicken around; with vast tracts of agriculture land, there was food for the chicken all the time; there was no additional work involved, and there was a bird on the table at a regular interval . . . all came to an end with huge losses as soon as the birds got the disease.

Now, the question was about what we could do for the disease. We knew that there was a vaccine. 

After quite a lot of discussions . . . we took a decision to look at facilitating vaccination of the remaining healthy birds of the groups we met so far. A rough calculation told us that the 10 groups (about 120 members) we met so far had lost a total of about 2000 birds over the last month to Ranikhet disease. The loss was much much more if one took the entire village. 

Now, we have taken a decision to vaccinate birds in 2 villages where the groups have put up a specific request for vaccinating birds. Considering into fact the birds have never been vaccinated before, after discussions with expert veterinarians, we have zeroed in on the LaSota strain vaccine which was be put into the eyes of the bird. 

I brought the vaccines today. 2 vials of 500 dosages each. 

Do pray for us as we get into this business . . . quite an unexpected thing for me to do . . . I have a hunch that this could get us into bigger things . . . after we started discussions on this, I've got inquiries on if I had some idea on diseases in goat . . . It seems that word has traveled around fast . . . 

My reading over the last two weeks was more on chicken and goats rather than on maternal health, child health or tuberculosis which I usually prefer to read. 

Maybe soon, I would be forced to put out an advertisement for a committed missionary veterinarian . . . 

An unusual presentation

JO was a 15 year old jovial boy who suddenly took up sick with fever about a month back. He was sick for almost 2 weeks and was treated successfully elsewhere. After discharge, JO’s father noticed that his son was not his former self. He suspected something was wrong.

His suspicion turned out to be true within a couple of days, when JO became unconscious gradually. Even his family did not take the way he became unconscious seriously as it looked more of JO becoming more and more sleepy over the day.

When JO was wheeled into our Acute Care, he was hardly breathing. JO had something very bad in his brain. He was running a high fever and had anisocoria. We had to do a CT Scan. But, JO was hardly breathing on his own.

After almost 2 days of mechanical ventilation, we could wean out JO from the ventilator. Considering the sort of diagnoses that a young boy with anisocoria can have, we were anxious for the CT Scan Brain. With a backup for ventilation, we rushed him to the nearest town for the CT Scan.

The CT Scan showed a hypodense area in the periventricular white matter of the right temporal region.

After he returned, the anisocoria stayed. However, a fundoscopy did not show any features of a raised Intracranial Tension. With a guarded prognosis, we took a decision for a lumbar puncture. The family readily agreed . . . in fact, we had not given them even a day for their JO to survive.

Lumbar puncture was suggestive of a partially treated bacterial meningitis with a higher protein levels than usual. Considering the long history of the illness, we took a decision to come to a diagnosis of Tuberculous Meningitis.

JO has responded well to anti-tuberculosis treatment. However, he’s yet to be completed fit for discharge.

We’re blessed to be a blessing in the life of JO and his family. Kindly pray that this young boy will be completely healed. 

Long haul ahead . . .

It’s been more than a month. BY, a 28 year old young man with a young family was brought to us for care after he had been in a tertiary hospital for a condition which did not have a diagnosis. He’s had couple of brain surgeries including the placement of a ventriculoperintoneal shunt was made.

BY is quite dependent. He has a tracheostomy, a very badly infected pressure sore on his back and badly wasted muscles of his limbs. He was being fed through a nasogastric tube . . . The family had spent about 800,000 for his treatment. They had sold quite a lot of their land for his treatment.

Before BY’s admission, his father came and talked to us. He told us of his predicament. 

BY had gone for giving an final exams for his graduation. In the exam hall, he had become unconscious. He was brought to NJH from where he was sent for a CT Scan. The CT Scan was normal. But, they did not come back to NJH as his condition was deteriorating. 

Someone suggested that he be taken to Ranchi. They went to the best hospital possible. 

After spending so much for the treatment, there was a danger of the family losing all their possessions if they continued treatment in the tertiary hospital.

However, we've also been at a loss to come to a conclusion about his diagnosis. 

By God’s grace, BY made quite amazing progress for the state he was in when he was brought in. He’s since been shifted to the general ward from Acute Care. Even the pressure sore looks much better than how it was when he got admitted at NJH.

There is quite a lot more for him to progress before the family can think about taking him home. The family’s expectations are quite high. We’re a loss when the family enquires about how things will turn up. Couple of weeks back, while BY was in Acute Care, his wife delivered their second child few metres away in our Labour Room.

Everytime I see BY, I’m reminded of how helpless we are in spite of all the amazing amount of medical research that’s happened so far. However, I’m assured of a Saviour who always heeds the call of the helpless and voiceless. We at NJH can only show the family the nail pierced hands of our Saviour who is the Master Healer. In fact, that’s the best that we can do for BY and his family.

We’re absolutely sure that BY and his family needs a divine intervention . . . and for that, we request prayers. 

Bringing in the sheaves

Today, on Easter morning, we harvested the wheat crop . . .

Snaps of the harvest . . 

We wait to thresh it and find the quantum of harvest . . . 

Maybe, we should have send her home . . .

Couple of days back, we had a very sick pregnant lady being wheeled in.

As DD was wheeled in, we were quite sure that we were dealing with a very sick patient. She had been in labour for more than 4 days. It was very obvious that she had been through a tough time. She was in a terrible shape; all bloated up; the birth canal was so edematous. The baby was obviously dead. The head was so high up and appeared to be stuck. The abdomen had a very abnormal contour which is quite commonly seen with those who sustained a rupture uterus.

There was a high chance that the bowel and the bladder were all ischaemic because of the abdominal massage she had over the last 4 days. There was only a 4-5 centimeter diameter of the birth canal. Even if we tried a craniotomy, there was high chance of severe birth canal injuries. There was also a chance of a rupture uterus.

She was also in severe sepsis.

There was only one thing that we could think about . . . to operate and remove the dead baby. The family were very very poor. They had not even a single rupee to take. They had been to couple of other places. The travel from their home to the various centres and lastly to NJH had taken up all the money they had.

Considering the chance of a rupture uterus and bowel injury, we decided to operate. On hindsight, the decision was a ill thought one. The uterus was not ruptured. But, the lower segment was like mincemeat. Putrefaction had set on the baby. On opening the uterus, there was a gush of pus and foul smelling gases.

The bladder was distended and edematous. So was the bowel. There was no necrosis or ischemia . . . but it was obviously unhealthy to look at.

I somehow closed the uterus and came out of surgery.

She did well for the first 24 hours. Then, her condition just deteriorated. She was running high grade fever round the clock. We had to hook her to the ventilator. There was foul smelling material coming out of the uterus. Her urine output was fine, but it was getting bloody and brownish. Her creatinine is about 6.

Today evening, she is all puffed up.

The costs of the treatment has been on the house. However, we will not be able to give her high end antibiotics like Piperacillin-Tazobactum. We helped the family arrange one pint of blood. We’re quite sure that we would not get any payment for this patient. The family had a RSBY card. We’ve blocked her under the scheme.

Please remember DD in your prayers . . .