Strokes - blocked/burst arteries

Other than tuberculosis, the next disease group that has sort of overwhelmed us at Kachhwa is Non-communicable diseases. 2 things stand out – stroke and diabetes.

First, I shall narrate about strokes as it has sort of overwhelmed us. Since the last 2 months, we’ve had only two patients with myocardial infarction (heart attack), but over a dozen stroke patients. Quite a high number for a small hospital like ours considering into fact that we have quite good quality healthcare facilities in the nearby towns and cities.

It is a bit concerning that when it comes to strokes, it is the hemorrhagic variety that predominates. Now, when it comes to strokes, there are 2 aspects that have stuck me.

The first one is the stark poverty that many a family is in that prevents them from taking the patient to a higher centre when there is a complication like a stroke. The definitive management starts only once you have a CT Scan.

Even, when they take to a higher centre, the costs are too high that they return early with a discharge against medical advice. Although, Kachhwa is only about 40 kilometers from Banaras where there are quite a few private and government healthcare facilities, the cost of seeking care for a diagnosis of stroke is quite high. The cost is all the more considering into fact that the 40 kilometer journey costs nothing less than 1500 INR.

The second aspect that we remember when we see strokes is the number of diabetes and hypertension patients that we see who don’t have faith in the medicine we give them. I hardly find even one patient who does not have some sort of belief in some root or fruit which they think will heal their disease in one go.

I had the experience of telling a new diabetic about his condition. He was accompanied by his elder brother. As soon as I told the patient that he was a diabetic, the elder brother started a babble on how easy it is to treat both diabetes and hypertension by special diets of juice extracts of gooseberry, jamun and jujube (ber). He told me that he was diagnosed hypertensive few years back and his hypertension was well controlled with regular consumption of these juices.

However, he was gracious enough not to stop me from helping his brother understand a diabetic diet as well as get prescriptions for some medicines.

As both of brothers stood up to leave, the elder one (supposedly hypertensive) requested if I could check his blood pressure. I obliged. It was 200/120. I assured him that so high a value could be because of the stress he must be in of knowing that his brother has diabetes. He was quick to agree. I told him that maybe he lies down for sometime before I took his pressures again.

A repeat after a 20 minute rest showed 180/110. He mumbled that he will go back to his doctor and he left.

I’m sure that lot of my colleagues can identify with me of having such conversations.

There is enough evidence that control of hypertension decreases incidence of stroke.

However, I still struggle with the first issue that we face - - - about poverty. The best bet for the poor is to prevent stroke. Availability of affordable drugs to treat hypertension and diabetes should be a priority.

The other option would be to look at a set of criteria that will help us to distinguish between ischemic stroke and a hemorrhagic stroke. Many have been proposed but none are foolproof.

As for diabetes, I shall write in detail in my next post. We explore options of starting a diabetic clinic soon. Pray for our team . . . 

Jonah and the Whale

Couple of days back, I found one letter pad with few cartoons scribbled by Charis. As I saw at the pictures, Shalom told me that it was the story of 'Jonah and the Whale'. Then, Charis came and narrated to me about each picture. I thought it was a fantastic effort to warrant a post . . . 

God speaks to Jonah

Jonah got into a boat going the opposite direction. However, he was thrown out of the boat only to be swallowed by a big fish.

God ordered the fish to spit out Jonah into dry land. 

Jonah reaches Nineveh and he goes around the city . . . and preaches

God sends a vine to give shade to Jonah . . . 

The plant is eaten up by a worm and Jonah is disappointed . . .

Limes of Kachhwa

During winter, lemons are a common sight in the Kachhwa Christian Hospital campus. So far, in addition to the Grapefruit, I've sort of identified 4 types of them. 

We start with the grapefruit. There's so much of them that quite a lot goes waste and eaten by the birds and squirrels . . .

That's grapefruit . . . 

Grapefruits . . . 

The next is Pomelos . . .

A close up of a pomelo . . . 

Then, there are the large lemons . . . Similar to the Pomelos, nobody knows what to do with them. Someone told how the mess tried to make pickles out of them and nobody wanted to eat it . . . There's so much of them and it's a real spectacle. The untrained eye can mistake them for orange . . . 

Then, there are some good for nothing limes, which tastes like water. Mr. Barsati, our gardener says that it is the stalk which was used for budding and unwittingly was allowed to grow when the graft dried out. Everybody calls it 'musambi'. But I'm sure it is not 'musambi'. 

The last one, is a little member of the family. The snap is below, but I shall tell more about it in my next post . . . Any guesses . . . it makes great marmalade . . . 

Trip to Sarnath

Last week, we went as a family to Sarnath. This is the place where the Ashoka pillar was put up by Emperor Ashoka. It's also a pilgrim centre for the Buddhists. 

Snaps from the visit.

Huddled in front of the Buddhist temple (Mulagandhakuti Vihara)

Was trying to walk to the Dhamek Stupa. But this entrance was blocked ..  .. ..

In front of the broken pillar of the Ashoka Lion Head. The Lion Head can be seen at a nearby Sarnath Archeological Museum.

At last we got a snap of the Dhamek Stupa

Leaving the park. The archeological remains of Buddhist monasteries

Tuberculosis . . . The Affair Continues

It’s been couple of months since we started to serve at Kachhwa.

One of the things that that has followed us here from NJH is the high prevalence of Tuberculosis. I only wonder if the prevalence is a bit more higher than Palamu region as the density of health care institutions including tertiary centres are more here. 

I personally saw 4 pulmonary tuberculosis patients, 2 abdominal tuberculosis, 1 tuberculous lymphadenitis and 2 tuberculous meningitis. The experience in NJH has been such that we have the diagnosis of tuberculosis in the back of our mind once the patient complains of cough or comes with vague complaints. I’m sure many would echo my view.

Couple of interesting cases . . .

DES, a 45 year old lady came to us about couple of weeks back with pain on passing urine and vague abdominal pain. We sent her for routine urine examination which showed a bad urinary tract infection. She was started on oral antibiotics, but did not respond to treatment. She came back. Ultrasound showed features of early pyelonephritis. She was admitted and started on intravenous antibiotics.

She did not improve. Rather, after admission, she started to complain of breathlessness at night. Later, on probing, she told us she has been breathless since the abdominal pain started. We took a Chest X-Ray.

Miliary tuberculosis was the diagnosis. She was started on treatment. And the recovery was dramatic. DES is at home now.

The second story is that of a little boy and his grandmother. MS, a 2 year old boy was brought with history of long standing cough. MS weighed just about 5 kilograms and on probing gave a history of exposure to probable tuberculosis. His grandmother was a chronic cough patient and had taken 2 months of tuberculosis treatment.

Meanwhile, in another cubicle of our hospital, another doctor was examining his grandmother and had made the diagnosis of tuberculosis. The parents did not think it wise to tell to the doctor who examined MS, that his grandmother had also come and was being examined at another cubicle.

Below is MS’s X-ray. We were quite taken aback at the extent of the disease.

Meanwhile, MS’s grandmother also got her X-Ray. Later, her sputum was also positive.  

It took some time before we realised that both MS and his grandmother was diagnosed to have tuberculosis the same time in our hospital without the knowledge of either doctors.

When, we told the family that MS should have got the disease from his grandmother, the family was not willing to believe stating that MS visits his grandmother only once a month.

This is nothing uncommon that we see when we try to educate people about the spread of the disease. 

There is one more patient whose story I wanted to narrate. That would be in another post . . .