Monday, December 31, 2012

Violence against women . . . the paradox

I had been wanting to share this incident which happened with one of our inpatients about a month back . . . much before the Delhi rape case happened. 

What emerged from this incident was one cruel reality which stalks many a women of our country. Read the incident and decide for yourself. 

It was a busy outpatient day when a young lady, a mother of 2, was brought to the emergency. It seems she suffered burn injuries couple of days back. She was being managed elsewhere. From the injuries, it did not need much knowledge to infer that the burns was not accidental. The history was that the stove burst while she was cooking and her clothes caught fire. 

Since it was quite busy and we were short of hands, we did not go much into arguing with the husband. However, within 2 days, we had found out the truth. The husband had thrown kerosene onto his wife and set her on fire in a fit of rage. But, from the way, he was caring for his wife after the incident, it did not seem so. He was so dedicated to helping his wife to survive. 

With good care, the lady survived and improved. But, it was evident that the hospital admission was taking a toll on the family. Their total bill was around 25000 INR. They had hardly 10000 INR after about 3 weeks in hospital. Obviously, the husband was the only bread-winner in the house. 

Promising that they would come back for the skin graft, they got discharged after we wrote off the rest of the bill. 

Why do I write this? During her admission, as with all cases of burns we had sent a police intimation. The primary report was that it was accidental. However, on coming to know that it was homicidal, I called up one of the policemen and told him of this. He already knew that it was homicidal. 

Then he tried to convince me on the futility of making this case into a murder case. 'The husband was very remorseful. Quite a lot of people depended on him for their daily bread. In addition to the wife and 2 children, he also had his parents to take care of. If I file a case against this man, the family would fall into poverty and would be on the street.' 

Yeah, what the police man told me was true. If the husband went to jail, our system does not have any provision to provide for the rest of the family. 

Later, I happened to meet mother of the wife. I asked her if she knew what had happened. She knew. She told me, 'Please do not betray us to the police. My son-in-law did it in a fit of anger. If he goes to the police, my daughter would have to sell her body to earn a living. Please do not allow that to happen. We've forgiven him.' 

We had another lady with burns injuries caused by her husband more than a year back. Here also, the lady described her husband as a good man. And she refused to testify against her husband. The case was dropped. I presume that in that case too, this must have been the reason for the wife not to proceed with the case against her husband. 

In our country, in very few families is the woman empowered to live a life independently. I do not have any easy answers for this sort of a situation in which the woman would prefer to remain imprisoned in an abusive relationship. 

I would encourage you to put in your thoughts on this matter which I'm sure is a common issue in many families of our country. 

Photo Post . . . 31st December, 2012

Well, few more snaps from 2012 . . . Hope you enjoy them . . .

A class in the CH department going on . . .
One of the few EHA units where you can do a class in the open. 

Another example of indigenous toys . . . Chesed with one of her favourite toys. 

Is this Lupus erythematosis? Initial diagnosis was acne with secondary infection

The cho-mohun chowk (Junction of 6 roads) at Daltonganj

The latest view of the burns unit roof. Curing involves water logging so that concrete sets . . . 
Empyema gall-bladder. Notice the pus in the suction tube . . .

The Third Movement . . .

Over the last year, we've seen 2 major peoples movements on the streets . . . The first one - Anna Hazare's crusade against corruption which seems to died a silent death . . . The second one, the embers of which are still burning - the nation's outrage against the Delhi rape case. We are still not sure of what the outcome of the second movement would be. 

What does one make out of these sort of mass protests. We've seen similar protests taking place in other countries too. But, they made much impact. We're all quite familiar with the White Revolution which started off in Tunisia and went on to engulf Egypt in an unthinkable way and later and continues in Yemen, Bahrain, Syria, Lebanon and Jordan. 

The question is whether we could expect such a result in India. My opinion is that we may not. 

The reasons are many. I shall try to put couple of them in this post . . . 

1. Although a single country, we are divided. Divided in terms of language, culture, cuisine, economic power, caste etc. etc. We've all been actively following the Anna's movement against corruption. We all know that corruption has been entrenched in our veins since quite a long time. When a decision needs to be taken against a corrupt person, all the divisions which are amongst us play a very crucial role. 

2. This is with specific reference to the issue of violence against women. Keeping women in subjugation has been a prevalent practice in almost all of the cultures of the country. If there is any difference, it is the tribal communities of the North East where the woman is empowered to quite an extent. I've put many of the instances where the girl is treated inferior to the boy during our clinical practice here at NJH. 

However, I strongly feel that there is a silver lining to both these mass movements. The very fact that the Indian citizens have responded to both these themes is something which needs to be appreciated. However, responses need to be made at the grass root level too. I repeat the same which I made in my post on the Delhi rape case. 

The change we look for needs to be started in our families and communities . . . 

For corruption . . .  how many of us would resist giving that extra 100 rupees for a berth in our trains, or the extra 100 rupees for chai-pani to the government clerk who has to issue us a certificate or the 500 rupees to speed up the process of obtaining the driving licence. I'm afraid that this is going to take some time . . . but unless this sort of a resistance to corruption builds up the grass root level, we would not go much distance in eradicating the evil of corruption. 

With regard to the violence against women . . . we need to bring up our daughters with the same love and care that we give our sons. As of now, the birth of a daughter brings a pall of gloom in most of the Indian homes. I can tell you instances where the daughter in the family is illiterate whereas the son has gone on to become an engineer. Recently, one of my acquintances was telling me that he was finding it difficult to find a suitable match for himself as none of the prospective brides from his own caste had any education beyond Class X. In fact, it was reported that there were about 25 reported cases of molestation of women while the nation was protesting the Delhi rape. 

As we go on the the New Year 2013, I wonder what are the other issues on which we would need a people's movement . . . another issue which would bring out the crowd into the streets of Delhi . . . 

I strongly feel that the issue of the Caste System is something that is playing havoc in our country. Of course, we've already have had the Mandal commission protests way back in 1990. But, to be very honest, the caste system thoroughly divides our society . . . Villages, communities, colleges .. .. .. it is very sad to see this division causing so much of mistrust and antagonism.

A national integration with respect to language and culture is a distant dream . . . However, there is a crying need for a eradication of the caste based mindset among our communities which is many a time worse than apartheid. 

Wish you all a better India in 2013. I pray that each of us will strive to work together for making our lives enriched and our nation a better place to live in. May each of us be a blessing to our neighbours and communities .. .. .. 

Sunday, December 30, 2012

Cultural Evening . . .

It is customary at NJH to have a cultural program involving staff and their families towards the end of the year. I was not very sure about having this program this year as quite a lot of staff were still on holidays. Below are few snaps from the event . . . 

The opening song . . . 

The drama . . . 

Dance by staff kids . . . 

The silent wedding . . . 

The silent wedding . . .

Another staff kid's dance

A drama by staff children . . . 

Action song by Anubhav and Abhinav

Drama by staff nurses . . . 

One more dance . . . 

Shalom singing a song. Charis brought her bucket to play as drums but backed off the last minute . . . 

The final dance . . . 

Saturday, December 29, 2012

Sharing information . . .

Sorry, this is not the story of the very bad case of eclampsia which I had been promising to share about. 

Today late morning, I got a frantic call to the Acute Care Unit from Dr Nandamani, our surgeon. I was surprised to find SKS, a patient on whom we had done surgery for duodenal perforation more than a week back. He was quite sick when he had come. And he was in acute care for quite a few days with ionotropic support. 

I was under the impression that he was discharged. 

Of course, he was discharged yesterday. But, being a general strike, the family could not go home. 

Today morning, he was feeling a bit uncomfortable. We attributed it to the very bad cold weather that we had been having over the last week. 

He suddenly collapsed around 10 am. No pulse, no measurable blood pressure. And his respiration had stopped. We had him intubated in no time and hooked him onto the ventilator. With intravenous fluids and ionotropic support, he was resuscitated. The unfortunate part was that we could not pin point a diagnosis. 

Even after being on the ventilator, we were having difficulty getting his saturation to rise. Which, prompted me to think along the lines of pulmonary embolism. But the ECG was not convincing. 

I narrated the case of Dr Philip Finny, the Internal Medicine consultant in our sister unit at Raxaul. Later, I sent him the X-Ray. He suggested that it could be a case of steroid abuse. 

I remembered that he had a very barrel shaped chest. In addition, he had been having severe joint pains for which he was on over the counter medication. Dr Nandamani had concluded that the duodenal perforation has been due to NSAIDs he was taking for joint pain. 

Later, I realised that he may well have been taking steroids for the joint pains. We did not know about the steroids. And in a peri-operative setting, he could have gone into a hypoadrenal crisis after we had inadvertently stopped his steroids abruptly. 

I thought that I will take a proper drug history once more with the relatives. I talked to his wife and two sons. They had no clue on what disease he suffered from. He used to regularly take some medicines and on and off injections. His medical condition was always a secret for the rest of the family. The only information that they had that he was regularly popping down pills. 

With no documentation as the treatment was being supervised by quacks in the village, there was no way that we could find out his complete drug history. 

SKS continues to be on the ventilator. I've started him on low molecular weight heparin as well as hydrocortisone. He is much better. I hope he recovers . . . 

The incident has taught us that a previous drug history needs to be properly asked for . . . and for the general public who is reading this post . . .  Please share with your close relatives your medical history as well as the medications you're on. It may save your life. 

Simple living . . .

Yesterday, I was reading a book on bringing up children.

2 things which stuck me . . . the author was telling about how children cherish times spend with parents and how they value simple things to play with rather than costly toys . . . One more thing I would add is they cherish unusual food available locally as much as occasional treats from KFC or MacDonald’s  . .  . rather more.

It has been very true with the trio in our home.

About a month back, I had gone to attend the funeral of one of our staff’s mother. This was in a village quite remote. On the way back, we had stopped at a village market. My driver forced one long stick of sugarcane in my hand. The whole journey back, I was wondering of the different ways I could finish off the 6 feet long sugarcane once I reached home.

Images of me and my better half chewing on the whole stick did not look much realistic. 

However, one reaching home, things all changed. Shalom and Charis had never seen a sugarcane in their life. With quite a bit difficulty I cut the thing into small little pieces. The pieces were chewed with the same gusto as when they gobbled chicken nuggets at the KFC outlet couple of months back.

Over the next week, sugarcane ‘nuggets’ were one of the preferred choice of dessert after the end of a meal or a reward for homework done or vegetables eaten.

The other aspect is that of toys. We’ve tried getting all the three kids some good toys. Some of their uncles have also gifted them very good and expensive toys. Of course, they cherish them.

But, when it comes to pure enjoyment . . . here is one snap.

I get the same feedback from quite a lot of my friends. Yesterday, one of my colleagues was narrating how his son loves to play with empty cardboard boxes more than anything else.

So, my friends, don’t worry about purchasing expensive toys and food for your kids. Do try out the local stuff you find near your homes. They could surprise them the same way as toys from Fischer Price or food from MacDonalds.

And last of all, the time we spend with them is the most valued. The best reward our children cherish is an ‘elephant ride’ at the end of the day. 

Schooling at NJH

Whenever one has to serve at remote locations like ours, one of the first questions that people like me with young children usually ask is about a good school in the nearby vicinity. The popular notion was that there was no good school near NJH. And was many a time quoted by people who had worked there as a major challenge to get qualified people there. 

I knew that there was a good Catholic school in Daltonganj during my previous stint at NJH. However, being a bachelor and having had not made much of any plans of coming back, I did not give much thought to this matter. 

However, on reaching back and having a young boy who was almost ready to go to school, I had to take a call. We had to send Shalom a year earlier to school as he was quite insistent that he goes to school. And we also thought that we will get a feel of how good schooling is at Daltonganj. 

The school has been the alma mater of quite a few of our staff kids who have gone to well placed positions in life. I hope that many of them would respond to this post.

Managed by the sisters of the Sacred Heart congregation, the school completed 43 years of it's service to at least 2 budding generations of Daltonganj and it's surroundings. As has been the major contribution of the church in education throughout the country, the school has lived up to the standards and is a prestigious institution to get admitted into. 

We are thankful that the school has been a blessing to many of our staff over the years. 

The reason I thought about putting this post was the quite impressive performance the teachers and students under the able leadership of Sr. Jossy Mathew, put up in their recent Annual Function. 

The theme of the program was 'Sangam' - a portrayal of religions in India . . . Below are the snaps . . . 

Sr. Jossy Mathew, Principal accompanying the Chief Guest, Bishop Gabriel Kujur to the dias

Lighting of the lamp

The first dance . . .  Quite a spectacle

Creation story by the tiny tots . . . Note Adam and Eve standing on the right  side

Jharkhand tribal dance . . .

Dandiya dance .. .. ..

Jain dance . . . 

Showcasing the Budha

Sr. Jossy addressing the gathering . . . 

The English choir . . . 

Bioscope . . . which I thought was the best program

Another dance . . .

Quwwali . . . 

The Hindi choir . . . 

English drama . . . Merchant of Venice. 

The Christmas story . . . 

Western dance . . .

Another one . . . 

The Bhangra dance . . . 

Closing program . . . the sangam
Overall, it was a very a nice and well arranged program. 

One more anecdote about schooling for staff at NJH. I was quite concerned about Shalom travelling about 50 kilometers every day to attend school. About a year back, I was narrating this to one of my friends. He told me that I was lucky. Why? His son was travelling about 10 kilometers one-way by bus everyday through the dusty roads of Delhi every day . . . but the journey took more than a hour due to traffic. And that was almost two and a half hours of travel everyday through a very polluted environment. 

Kids at NJH do the journey in about 40 minutes . . . and the journey through a very pristine environment. 

So, that's for people who are resisting from joining us on account of poor educational opportunities . . . 

Friday, December 28, 2012

Photo Post . . . 28 Dec 2013

Miscellaneous snaps taken by our staff . . .

Recently few of our staff spotted Bison at the Betla National Park (courtesy: Mr. Abinash Biswal)

Another couple seen by the same group (courtesy: Mr. Abinash Biswal)

Dentition of one of our patients . . . Believe me, this is his normal look (courtesy: Dr Nandamani)
Another snap with the fog in the background (courtesy: Dr Nandamani)

Oral cancer with extensive spread (courtesy: Dr Nandamani)

Snap taken when the roof of the burns unit was being laid . . . (courtesy: Dr Nandamani)

Skin graft which has well taken up . . . (courtesy: Dr Nandamani)

Christmas celebrations in Community Health Department