Wednesday, November 30, 2011

Praise and Prayers - 7 Dec, 2011

(Please go straight to point nos. 10. That has been one of our best praise points for the whole year)

1. Over the last week, the electricity situation in the region had improved. However, since last Saturday we have again started to have long durations of no electricity and we incur quite a large additional expense in running the generator. Kindly pray that we would be able to reach a point where we do not spent unnecessarily on running the generator.

2. Regular bandhs continue to very badly affect the functioning of the hospital. Over the last 15 days we've had 7 days of not much work happening on account of bandhs. Kindly pray that we do not have interruptions of our normal work days.

3. We suspect that unethical practices such as bonded labour aimed towards the suppression of the oppressed minority people groups especially the tribals happen in our region. We do not know how to go ahead in this. Kindly pray that justice will prevail.

4. We are thankful for LO, a 8 year old boy who was admitted with quite bad tetanus. He made a remarkable recovery and was discharged today. We thank the Lord for his recovery. As we discharged LO, we recieved in another young girl with tetanus. Kindly pray that she will make an uneventful recovery like all the others.

5. Last week we had a very bad case of endosulphan poisoning. He was quite sick, but has made quite a remarkable recovery. We are thankful that he is alive and discharged.

6. Kindly remember SD in your prayers - SD, a mother of 5, had a rupture uterus and she reached us 2 days later. After surgery, she remained in the ventilator for about 5 days, before she could be weaned off it. However, we are almost sure that her urinary bladder has most probably sloughed off. She would need more invasive procedures.

7. We thank the Lord that we could almost complete making our hospital environmental friendly by changing over incandescent bulbs to energy saving Flourescent Lamps. Now, our maintenance department is involved in putting in fluorescent street lights - all the efforts ultimately saving quite a lot of energy. We are thankful to EHA-United States who partially financed the efforts. May the Lord bless each of the individual donors.

8. KDA, the mother with pre-eclampsia who delivered a baby weighing 1.3 kilogram has done well. The baby is also doing well and putting on weight. SDA, who also delivered a preterm baby weighing 1.4 kg - the baby has done well, although he struggled the first couple of days. KD, the mother who was in her third pregnancy after 2 previous intrauterine deaths at term, who also had severe Pregnancy Induced Hypertension also delivered a 1.3 kg baby who has since been discharged. As I finished typing this off, I recieved a consultation from Labour Room for a newborn who is 5.5 kgs (12 lbs 12 ozs). Kindly pray for this baby as the family is quite poor to afford for a specialist consultation.

9. Please continue to pray for CD, the 65 year old with one of the worst cases of self-poisoning I've ever seen. She continues to be on Atropine - we have already pumped in about 150 vials of Atropine - and I suspect that she would need more. Yesterday, I had the initial discussions with her on her poisoning. It seems that she was fed up with her insomnia. There was no other reason for her being depressed. And she is glad that she is alive. We thank the Lord for her amazing recovery. Please continue to pray for her as we manage her to a total recovery and especially heal her of her possible depression and insomia.

10. And the ultimate praise point. Yesterday, Dr. Nandamani and Dr. Ango had left to Delhi for Ango to write her DipNB theory exams. We were concerned that Ango had not got her admit card for the examination. Both of them went to the DipNB administrative office in Delhi today morning and found out that Dr Ango had cleared her examination during her last attempt. I'm still not sure of the details. But, we are ecstatic about this news. Please pray as she prepares for her practical examinations.

Tuesday, November 29, 2011

Unusual Poison . . .

Just now, we had MY, a 25 year old man who was brought in by his parents with the history of poison ingestion. On examination, he was frothing, had an almost pin point pupil and pulse was around 45 per minute.

As is the usual diagnosis with poisoning in a rural area, we started him off on a bolus of Injection Atropine in response to Organophosphorus poisoning.

He responded well but then he started shivering. As I sat to write the inpatient chart - I casually asked them if they knew the exact name of the poison. The father told me 'Endosulphan'. He was absolutely sure. It seems that it is very much used as an insectide in vegetable cultivation around us.

I searched quite a lot for any literature on the management of 'Endosulphan Poisoning'. I even called up my colleague in Madhepura Christian Hospital. I got some reading material which has almost helped me in planning the furthur treatment.

However, considering into fact that endosulphan is quite a dangerous poison and is in the process of being banned all over the world, it is a bit concerning that it is very freely available even now. Interestingly, Sr. Deepti who is managing MY comes from that part of Kerala, which has witnessed the horrific effects of endosulphan poisoning.

A bit more concerning was the circumstances of the poisoning. It seems MY and his father was threshing wheat with the help of bullocks. In between the bullocks were not behaving well and the father pulled up MY for not keeping the bullocks under control.

Off went MY in a huff into his house and drank the contents of the pesticide bottle. Later in the day they came with the bottle of the pesticide and so we were ultimately sure.

The next 12 hours is going to be critical. It is not even one year since MY got married. Kindly pray that MY will recover well. None of us have any experience of managing 'Endosulphan poisoning'. We welcome suggestions and advice. . .

Monday, November 28, 2011

Another hand-prolapse . . . but luckier . . .

SB never thought that she would end up in this state. It was her second baby. She had an uneventful home delivery 3 years back.

SB's pains had started on Friday early morning and she was from near the hospital. She realised that something was amiss by late evening. However, her relatives insisted that she wait for some more time before going to hospital. And to supplant the patient's efforts, one intramuscular injection of oxytocin was also given.

It could have been a dangerous wait - at around 10 pm, plopped out the hand from her birthcanal. Her relatives understood that this was quite dangerous. They knew that she had to rush straight to NJH. Although her house was not much far from hospital, they could reach only at around 12:30 pm.

As usual, after a quite busy day I was getting into sleep mode when the call came. The nurse informed me that she was not sure about the fetal heartbeat. After the last patient who had come with hand prolapse I was sure that this was also not going to be much different. I was wrong. As I kept my hand on the abdomen of the patient, I felt I got a kick from the fetus.

Yeah, the fetal heart beat was present. And quite well. Everything happened so fast after that. The baby had a poor APGAR score but the theatre staff did a good job with resuscitation. This was the second baby over the last 3 months who came out alive after a hand prolapse. In fact, the previous one was quite fresh in my mind. As was expected, the hand was quite edematous. But, it has settled over time.

We did quite a good job with using the improvised CPAP for this baby too. And we thank the Lord that he has done good.

Bonded Labour . . . Do we still have it . . .

(Kindly note that this post is written on the basis of an incident which happened in hospital today. I have enough reasons to believe that what I think has happened is true - but I do not have any solid evidence to prove anything)

SD had delivered about a week back by Cesarian section for a dead baby with a hand prolapse. We had discharged her today. We knew that she was quite poor. Unfortunately, we had sent the chart for billing and the family was informed about the bill.

Sometime around mid-morning I had a local well off person who came in saying that he was helping out to pay off her bill and that he would need some charity. Dr. Nandamani asked him why he is interested in paying the bill. He replied that the family works in his house and therefore he wants to foot the bill. Dr Nandu smelt something fishy and told that unless a male member of the house comes, he would not do anything.

The well off guy came to me and I sent off for the chart. The chart was in Dr. Nandamani's hands. Nandu called me and told me what he is suspecting. It was then that I realised that there is something major happening here which has missed our attention. The patient was from quite a far off place (Leslieganj). The fact that one of the relatives mentioned that the family works at the house of the well off guy sent alarm bells ringing in both of us.

It is quite a common practice that we see at NJH where well off local people pay off part of the very poor's bills and comes on their behalf to get some charity. Many times, we had ignored it and we were also told that such payments were made with the help of donations taken from local people.

I called a male relative of the patient who told me that whatever payment was being made is wholely from the side of the patient. I asked the relative where the money was. He told me that it was with the well off person. I asked him how they were able to mobilise such an amount. They told me that they pawned a cycle, few jewellery and some of it was given by relatives.

The bill was 11,0000 Indian Rupees. The family told us that they will pay 8,000 Rupees. I told them to pay Rs. 4000 Rupees and wrote in the chart. Later, as I asked the cashier on how much was paid -  I was astounded to find that the well off guy had insisted that he takes Rs. 8000. It was obvious. There was more to the payment that was done than a mere help to a needy patient.

Or is it just wild and wishful thoughts ? ? ?

Friday, November 25, 2011

Praise and Prayers - 26 Nov, 2011

1. Today was Chain Prayer and Revival Meeting day for the hospital. Quite a lot of staff and students actively participated.

2. We've had quite a number of very sick patients over the weekend. We thank the Lord for KB, who had septicemia and a dead baby in her womb - she underwent a normal delivery. PD and SD had quite complicated pregnancies, - although they lost their babies, they made remarkable recoveries and were discharged.

3. The very preterm baby born to the eclamptic mother who died is doing quite good. Kindly continue to pray that he will put on weight and we would be able to discharge him soon.

4. FD who turned up quite late passed away couple of days back. It was sad that she did not know about the facilities we provide for burns patients. Kindly pray that the local communities would know more about the work we do and would come fast if there is a burn accident.

5. The construction of the burns unit is progressing well. Kindly pray for all the efforts going on to mobilise more funds.

6. Over the last year we have realised that there is a major gap in cancer care in the region. I wish the Lord would raise up people who would have a burden for involvement in this area of healthcare.

7. Since the last 2 months we have been witnessing a major epidemic of malaria and quite a few young lives being lost. We know that we can respond - but we need people with expertise. 

8. Yesterday, one case which was foisted against the hospital has come up again. There is no iota of truth in the case which has been filed. Kindly pray for the Lord's mercies on the people who have filed the case and the police officers who have raised it up again. We need wisdom and good guidance as we deal with it. 

9. SR, who came to us with a very severe case of pyopneumothorax has responded well to our intervention. Kindly pray that he would be fully healed. 

10. Over the last one week, we have not been having electricity. We end up spending almost 200 litres of diesel everyday to run the unit. Kindly pray that we would get regular electricity from the Electricity Board. 

11. The roads from NJH to Daltonganj continue to be in a very bad state. However, we've got news that the Chief Minister is visiting Daltonganj by road and therefore road repairs is being hurriedly carried out. Kindly pray that we would have good roads soon. 

12. Over the last 10 days, there were 3 days of bandhs/strikes which has affected the flow of patients to the hospital. A bandh has been called tomorrow also in response to the killing of a leader of the naxalite movement. 

Thursday, November 24, 2011

Pyopneumothorax. . .and Massive

SR, worked as a daily wage labourer in umpteen number of brick kilns near the town of Balumath. Rather than a town, it is more of an overgrown village. Balumath is famous for the umpteen number of proposals for coal fields by umpteen number of multinationals. However, it is also one of the most impoverished regions of the state.

One may remember about the tetanus patient whom we had who was in terrible state of poverty when he came down to NJH. It was a miracle that he survived.

When SR came down to NJH, he was in a terrible state. Having been diagnosed to have tuberculosis about 5 months back and also having been on treatment on a daily regime, he was not getting better. Rather he was worsening.

And this was his X-Ray when he came.

 We knew that we had to put in a tube and there it was – I had never seen this much pus together in a person’s body so far. After he had drained about 4 litres, we clamped the drain as we feared that he will go into pulmonary edema because of the quick release of so much of material from within the chest cavity. Over the next 2 days we had drained almost a total of 6 litres of pus.

SR also needed blood. When we told his father that he would do good with a pint of blood, he expressed all helplessness. But SR was lucky. He had my same blood group. And the pint of blood I donated for NS was still in the fridge. 

SR is making a quick recovery. We praise God. Kindly continue to pray for SR as he has quite a long way to go.

NS – story of ignorance and apathy

NS, a 4 year old boy came the next day after the 2 sisters were admitted. NS was quite sick. The history was more suggestive of acute intestinal obstruction with severe anemia. And interestingly his mother was also quite sick. The only difference being that NS looked very sick and was almost unconscious.

NS’s blood tests were terrible. Hemoglobin of 4 gm%, 40% of the RBCs filled with the falciparum parasite and a platelet count of 20,000/cu mm. We needed blood fast. A peripheral smear showed all signs of hemolysis. NS reminded of Shalom, my son. He was almost of the same age.

NS was from Phulwaria – a village along with banks of the river nearby. Phulwaria is a common name for villages in this part of the country. The basic characteristic of all Phulwarias I know of is that they are usually the name given to the outer neglected part of the country side. And it is the same with the Phulwaria that NS’s family came from.

Families living in utter poverty and neglect. The only attraction for them to live there is the river that flows nearby. Most of the families live on some odd labourer jobs and most of them are at the mercy of the local landlords. The women live collect wood from the forest part of  which is sold and the rest used to cook whatever they can afford to buy. The perennial river ensures that there are collections of pools of water at many places away from the area of water which flows constantly. And this supposedly is the place for breeding of mosquitoes spreading all diseases which the mosquito spreads.

I told the relatives that if we need to save him, we needed blood. Off the 3 male relatives went off to get blood. It was then I realized that I was fit for my next donation and our blood groups matched. And I did not have to give much for a 10 kg child. Off went the donation and the blood was being transfused in no time.

I was with the child for about half an hour as the blood was being transfused. I was looking at the possibility of intubating NS and ventilating him. The other option was to put him on CPAP. But his saturation was maintaining well.

I thought of rushing home and getting freshened up. I had just reached home when I got a call from Acute Care that NS had arrested. Nandamani was in the next room doing a cut down on FD. He had NS intubated but he was not responding to any resuscitation.

By the time I reached ACU, there was nothing we could do. It was not surprising that NS collapsed so fast considering his hematological parameters.

The next day, Angel reviewed the peripheral smear of NS where she found out evidence of severe hemolysis. Most probably, NS had gone in a state of auto-immune hemolysis which is commonly seen in severe malaria.

The saddest part of the story was that the male relatives came almost 3 hours after NS had died. I told them that we had tried our best. As I was conversing with them, I realized that all 3 of them very stinking alcohol and I was talking to 3 fully intoxicated men. I realized the futility of my talking and left them to take the dead boy home.

It was sad. NS was the only child of his parents. As with almost every family in Phulwaria, NS’s family also had a hand to mouth existence. Everybody drowned their sorrows in alcohol which was available plentiful. If the local women did not make the country brew, it could be brought in the nearby Satbarwa village or they could always buy a bottle of ‘English liquor’ which was a bit more expensive. The story about alcohol use would distract you from the objective of my post.

Malaria continues to ravage in parts of Jharkhand in an almost vengeful manner. There are multiple factors which would continue to ensure that the parasite would remain in the communities we serve. Unqualified medical practitioners also compound the problem.

I could only watch helplessly as the nurses removed the almost full pint of blood. They asked me what to do with the rest of the pint. I told them to keep it in the fridge. Maybe, if I got someone else with a A positive group, I could transfuse the rest of the blood. I wish I waited to donate blood for another patient who had a better chance of surviving.

Malaria Galore. . .

It all started yesterday with 2 sisters, both below 5 years coming to Emergency with quite high grade fever associated with chills and rigors. Both of them were grandchildren of one of our watchmen, Mr. Jithen. They were being managed in the village.

However, the parents or rather the grandparent realised that both of them need serious medications.

When they came in on Sunday morning, both of them were partly conscious, one of them had falciparum plenty within her red blood cells whereas the other one did not have obvious parasitemia. Both were terribly anemic with haemoglobins of half the normal values.

As I had written in my previous blogs, there has been quite a lot of malaria in this part of the country since the last month. Even, the local newspapers have been reporting increase in the number of deaths as well as large number of villages being terribly affected by the malady.

Both of them have been started on quinine and the relatives were able to arrange blood transfusion for both the children. They have improved quite well and should be fit enough for discharge in a couple of days.

However, it is very evident that both these little girls are quite lucky compared to NS, a little boy who came with very severe anemia yesterday, about whom I shall write in my next post.

Maternal near misses continued . . .

My last duty was a bit stressful. I had to do 3 Cesarian sections back to back. And to make things quite difficult there were the 3 malaria patients in the ACU and the terribly burnt patient which Nandamani kindly agreed to manage.

The first one was SD who came in at around 10:00 pm with a hand prolapse per vagina. I somehow hoped to do an internal version. However, she being a primi – it was quite a tough ask. And when I examined her, it was obvious that I would not be able to do the internal version. The uterus was in a state of tonic contraction without any moment of relaxation.

Per operatively, I was glad that I did not try the internal version. The lower segment was on the verge of a rupture. Later I found out that she had recieved intramuscular pitocin injections from her village.

However, what I wanted to bring to your attention was the fact that SD had been diagnosed to have breech presentation on arrival in the Leslieganj PHC and she had a referral letter dated the same day at 5:00 pm. But, the relatives decided to stay on whatever the consequence is. There was a high risk consent absolving the PHC doctor of any complication if she did not go ahead to a higher centre.

The hand prolapsed occurred on the way. The baby was freshly dead. Maybe, we would have got a live baby if she had turned up early.

The second one was AD, who came in sometime late morning. It was AD’s first pregnancy and she lived adjacent to the District Hospital at Daltonganj. Interestingly, till the day of admission her family never thought about taking her to the District Hospital for an Ante-Natal Check Up.

On the day of her admission to NJH last Monday, sometime in the early hours of the morning, AD threw a fit out of the blue. There were no warning signs. No swelling up of the body or no blackouts. Taken straight to the neighbouring district hospital, she was referred to NJH. Unfortunately, on arrival at NJH, AD was quite groggy and had 5 episodes of seizures.

The problem was that according to her dates, she was just in the middle of 32 weeks of gestation. Her blood pressure was 160/100, and Urine Albumin was 2+. As always is the case, we explained the limitations we had in terms of not having an obstetrician, a paediatrician, anesthetist, medicine consultant, ventilator, blood bank…everything I could think of. Armed with a high risk consent, I told them that I shall try for a normal delivery – without any sort of guarantee for the mother/child.

Over the next two hours, her blood pressure had become controlled and I was sort of confident of somehow getting the steroids to act on the baby’s lung tissue by waiting for 24 hours before we acted. I also induced her with Misoprostol.

As evening progressed, with the malaria patients and hand prolapsed, my thoughts were on how AD is doing. In between the surgery for SD who came in with the hand prolapsed, the nurse in the Labour Room informed me that there was a rise in AD’s blood pressure and her Urine Albumin is 4+. I knew that I had to act.

I posted her for Cesarian section immediately after SD’s surgery. AD delivered a healthy boy more of a Small for Gestation Age baby rather than premature weighing about 2 kgs. The mother and baby have done well so far.

It was quite a paradox that within a week of my post about non-availability of proper medical facilities, here was a patient who totally ignored getting herself at least one ante-natal check up and ended up with a complication and another one who ignored an advice to go to a higher centre.  

Monday, November 21, 2011

We need a miracle . . .

On the 21st evening, I had a peculiar patient in emergency.

It was a bit difficult to believe about the history, but that was how the husband put it.

FD was making tea about 10 days back, when her clothes caught fire and she ended up with quite a very bad burn injury of her body. Treated initially in Daltonganj, she was referred to Ranchi where she was in the Government Medical College for about a week.

Today afternoon, the doctors at Ranchi decided that they were fighting a losing battle and decided to take the patient back home to die. The patient was also quite listless and the relatives had also given up home.

The patient was from Rehla, Garhwa district and NJH was on the way from Ranchi to her home. It seemed that they had some relatives who lived in our nearby village.

FD is quite sick. I presume that she must have started with a burns of about 40% but after infection setting in, the burns has increased to about 65%. The relatives just cannot accept that she will die. They want to give it a try.

After explaining about all the pros and cons of trying to manage such an extensive burns at NJH, we took a decision to take her in. We’ve promised that we shall try to intervene once we have at least 5 pints of blood.

I know that humanely speaking we are fighting against all odds. But, we’ve been seeing miracles here. We request you to stand with us and pray for this lady and her family. We want His Name to be glorified.

Group snaps . . . Jubilee

The Jubilee gave us an occassion to take few groups snaps including a snap of the whole hospital staff which has been done after quite a long time. If anybody likes to have a original copy of the snaps please let me know.

This is the first one - the whole of the hospital. I counted 85 of the 100 odd staff we have.

The we had the committees . . . Starting with the Unit Management Committee

The Nursing School Committee

The Burns Committee

We also had few more snaps which I shall put in my next post . . . .

Friday, November 18, 2011

Praise and Prayers . . .18 Nov . . .

I always hope that friends of NJH who keep us in prayers would benefit from my postings and would uphold us in their regular prayers.

Recently, one of my very close friends requested that I be very specific and put in the praise and prayer points regularly.

So, here is it. I hope to put it on once a week.

Praise Points . . .

1. Today morning, we had a sort of surprise inspection from the Income Tax Department. They were paying such a visit after quite a long time because of which there was a bit of anxiety at the administration level. But, the inspection went off quite smoothly and the officers were quite happy with our papers. They were so happy that they insisted on having a group photograph with all the doctors and office staff.

2. We have got one of my friends getting interested in further helping us with the construction of the burns unit. There is quite a lot of homework for us to do before it can be taken forward. We thank the Lord for this friend of mine who has shown interest in our work among burns patients.

3. The Daltonganj State Bank of India has promised to look into donating us medical equipment worth about 250,000 Indian Rupees. We thank the Lord for this initiative from the SBI authorities. The quotations have already been given to them. Kindly pray that the Lord will give us success.

4. We had some very sick patients come to us especially over the last week. KB, who had been in obstructed labour with a dead baby for about a week has done well and has been discharged. SD, who was quite a complicated case is slowly making a recovery although she has a long way to go. PD, whose baby had hydrocephalus in a breech presentation has also gone home well.

5. The baby born to KD is gaining weight quite well. The family is quite delighted to have a live baby after 2 intrauterine deaths. Please continue to remember this family who is quite poor.

Prayer points -

1. Dr. Srijit Pradhan, our ophthalmologist has left today for his daughter's wedding. Kindly pray for the family as they travel to Cuttack today, preparations for the wedding and the ceremony including the reception arranged at Nagercoil.

2. Sr. Rita Pradhan, our Nursing School Principal is on travel to various nursing schools as part of MIBE inspection. Kindly pray as she travels.

3. One of the social activitist nuns from the Catholic church, Sr. Valsa John who had been working for the upliftment of the tribal community has been murdered. in our state of Jharkhand. The funeral was yesterday at Dumka. Please pray that we would not be discouraged by incidents such as this.

4. Please pray for PD who had come to us about 4 days back with severe post-partum eclampsia. Her blood pressure is yet to be fully control. Kindly pray for her complete recovery.

5. We have a very preterm baby born to a mother with severe eclampsia. The mother died after couple of days of the delivery of  pulmonary edema and cardiac failure.

6. LO is a young boy with tetanus. He has done well so far. Kindly pray for his completely recovery.  

Please do share this post with friends who will spent one minute of prayer for us. I hope I shall be able to post 'Praise and Prayer' posts on a regular basis.

Wednesday, November 16, 2011

Golden Jubilee - the Finale

We had been quite busy and with the sort of sick patients we had been having through the Golden Jubilee programme and a shortage of doctors, I could not find enough time to post the rest of the pictures of the Golden Jubilee celebrations. And later I lost count of whatever I had posted. I realised only last week that I did not put in the final day's programmes.

The finale started with the prompt arrival of the chief guest, Mr. Harikishan, the honourable MLA of our region.

The programme began with lighting of the lamp by the chief guest, the former MLA, Ramchandar Singh and Dr. Mark Kniss.

As in most of the meetings, quite a lot of people spoke. Here is a snap of Dr Santosh Mathew, the Executive Director of EHA addressing the meeting.

The Chief Guest, the honourable MLA, Mr. Harikishan addressing the audience.

Previous leaders of the unit as well as staff who completed 25 years of service were felicitated. Below is a snap of Dr Kniss felicitating Dr Manohar Paul.

EHA honoured Dr Kniss by presenting a silver plaque.

Dr Kniss thanked everyone for the programme as well as exhorted us to carry on the good work.

Quite a sizeable crowd turned up to witness the final proceedings.

Acute Abdomen . . . Unusual cause

The acute abdomen is has always been a favorite question with examiners in under-graduate and post-graduate examinations.

Just wanted to share one of our patients, RD, pregnant for about 8 months who came in with severe abdominal pain. She had already been in couple of places where a diagnosis of preterm labour and was made and she was started on all sorts of medications to stop uterine contractions.

We had already been burdened with quite a number of patients which has stayed put since the Golden Jubilee. RD came in sometime between SD's and PD's arrival in hospital.

I just could not make heads or tails of the diagnosis as the patient appeared to be writhing in pain, but had a very soft abdomen and the uterus was far from any sort of contractions. So, I asked Nandu to take a relook at RD. Nandu was also quite baffled. But he had picked up some chest findings and he asked me to look at the possibility of a pneumonia.

Yes, it was pneumonia. There was an area of bronchial breathing with fine crepitations in the left basal region. And the X-Ray chest confirmed it. In addition, she had a total count of 28500 with predominantly neutrophilia with toxic changes.  

RD responded quite well to antibiotics. As quite commonly seen in antenatals in this part of the world, she was also anemic and after we did a blood transfusion, RD's road to recovery was quite fast.

We thank God that RD reminded us to go through our text-books once in a while so that our grey cells remain active and refreshed.

Working in resource poor settings . . .

It was about a week ago that one of our visitors initiated a discussion on innovative methods to get things done especially in settings like ours. Of course, one of the best examples which has been used is the Newmon ventilator which has served us quite well.

In my previous stinct, my colleagues had somehow improvised an airway circuit to give continuous positive airway pressure for sick babies. It was quite a simple circuit and had worked wonders in saving quite a number of premature and sick babies.

The thought lingered on for about couple of days before a preterm baby was delivered at NJH. To make matters worse, the baby was not keeping saturation well. We got a circuit ready in no-time and presto, it worked. I was quite encouraged.

2 days back, we had one more preterm born to a mother with severe eclampsia and he has also done well with the contraption.

Of course, you may say that cheap CPAP machines are now available. But with all the problems with electricity especially voltage fluctuations, simpler solutions such as these are a real blessing...