Monday, August 15, 2011


Well, it turned out that I was on duty for a third weekend running. The reason I could not pen the happenings on the blog was non-co-operation from our telephone department. It had been raining quite hard over the last week and our communications have gone for a six. As we are quite corruption unfriendly, the telephone department takes least interest in repairing our lines. The lines are still dead. You can read my accounts of the other two weekends at and

I could put this on to the web as I'm travelling - going to Delhi to get a better half for our ventilator The company was planning to send it to us by truck parcel - but later had double thoughts because of heavy rains and bad rains which had been lashing most of North India over the last week. They asked us to take personal delivery of the same.

I penned part of this in Daltonganj station. As I sit and write this, there is quite a swarm of mosquitoes trying to suck my blood and if possible inject malaria or dengue into me. But, I have this local application material called the 'Mosbar' - basically diethyltoluamide put in a soapy base. Initially when someone told me about it, I was quite sceptic about how this works. However, once I started using it, I was determined to promote it's usage and therefore I thought that I shall put a word about this here. It is made by Maheshmunda Holy Cross Sisters of Belatani, Giridih district, Jharkhand. It costs Rs.8

When I talk about mosquitoes, I need to tell you about 2 very sick malaria patients whom we had over the weekend. Both of them are over 60 years old. One of them whom I shall call PD has improved after Artesunate injections. He was not as sick as SD when he arrived. SD continues to remain unconscious - though not on the ventilator. Both of them had Falciparum malaria teeming in their blood.

Obstetric wise, we had a rupture uterus and couple of Cesarian sections on Saturday. Two eclampsias and one more cesarian section on Sunday. CF, who had the rupture uterus was quite a sad case. CF had a cesarian section 3 years back. She reached the local district hospital on a wrong day - it being Rakshabandan (Indian festival where brothers take the vow to protect their sisters - symbolised by the tying of a sacred thread around the hand of the brother by the sister), there must not have been many qualified hands to deal with her. Her pains had started on Saturday early morning. She reached the district hospital some time late morning. God only knows what they were trying to do with her over the whole day. Sometime around midnight, the family was told that it seemed that CF would need more expert medical care. They rushed CF to the private hospital nearby where they were told that things were quite bad and they would need to go to Thumbagara.

I recieved CF at around 6 am on Sunday. The diagnosis was obvious. Far worse, CF was in shock. She was very pale. She needed to be operated on fast and she needed quite a lot of blood. 3 male relatives readily volunteered to donate blood. But they had different blood groups. I decided to call on one of our staff to donate blood as we were quite concerned of her hemodynamics. Consequent to few extra number of surgeries on Saturday and the incessant rain we were running short of theatre gowns. So, I decided to call on Dr Nandamani since I could end up calling him for help if the rupture was a complicated one. And thus, we could save one theatre gown. Per operative it was not a very clean rupture. I was glad that Nandamani was doing the surgery.

I saw CF just before I started today's journey. The journey towards parenthood had been quite traumatic for the family. We had given the option to the relatives to try to have a second child. But, they would have had nothing of it. The first child, a girl was born by cesarian section and it had been very expensive for the family. Now, the second pregnancy has given more trauma. It was so unfortunate that the delightful physiological experience of pregnancy and delivery of a child has been transformed to a nightmare partly due to lack of health education and quite a lot due to apathy from health delivery professionals like me.

The other two cesarian sections on Saturday were uneventful. The first one was for BD, whose mother was being regularly seen by us for her depression BD was post dates. We had tried to induce her but she had not responded even after about almost a day. We did not have much choice. The second one was CD, who had been seen by couple of senior obstetricians in Daltonganj and was advised Cesarian section. The problem with CD was that she could not percieve fetal movements since 2 days. We could hear her fetal heart. I screened her by ultrasound and suspected that the umblical cord was wound over the fetus. In addition, the baby looked quite large. With no qualified obstetrician around, I could not offer the family anything less than a Cesarian section.

I was glad that we did surgery. The baby was 4 kgs and the cord was wound quite tight twice around the baby's body.

The highlights of the week were that both ZB and UD have made amazing recoveries. We praise God.

As I came out of the hospital, I could see little Naveen waiting for admission for his second round of skin grafting. Other than obstetrics, Dr Nandamani has been having quite a lot of success with his surgeries and especially with management of burns. I wish I will be able to put it soon in the blog.

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