The Learner: June 2013

Saturday, June 29, 2013

A Moth

Last week, as I reached home late evening after it was quite dark, I found a large moth outside the window of my home. The insect measured about 3 inches from one end to the other. I wish someone can help me find it's name.

Annual Report 2012-13

Below are the pages of our annual report for the last financial year. Please let me know if you could like to have a hard copy of the same.

Wednesday, June 19, 2013

Glimpse of the Western Ghats

We are on our way back from Kerala.

I got some good snaps of the cloud covered Western Ghats as we travelled by the Alleppey-Dhanbad Express. The snaps were taken in the section between Palakkad and Coimbatore.

Monday, June 17, 2013

Glimpses of possibilities

Yesterday, Titus called me to say that they ran out of ventilators for patients.

There were 4 patients who needed a ventilator at the same time. And with the the nearest ventilator 80 miles away, there was no other choice than to manually ventilate using a bag.

Patient A, a 25 year old lady who came with unknown poisoning. She came with seizures and later had a respiratory arrest. She was on the ventilator for almost a day before she was weaned out.

Patient B, a 17 year old young man with organophosphorus poisoning. He was gasping when he came in. He obviously took the second ventilator.

Patient C, a 48 year old man who came in with a krait bite. In spite of being started on a high dose ASV, he went into respiratory arrest. When Mr. C came in, B and C were already in the ventilator. Mr. C was manually bagged for around 12 hours, when we felt that Patient A could be weaned out.

Patient D, a 9 year old girl who came in gasping after a krait bite. She was intubated immediately and was bagged till Mr. B was out of the ventilator.

Then, there was a patient E, a 12 year old girl who was rushed in from the local village after a krait bite. We gave her an option to go to a higher centre. They have rushed her to Ranchi.

We did not have a bag to ventilate her if she had a respiratory arrest. Even, we were not sure of starting ASV as we did not have a bag to ventilate (2 patients were being manually ventilated) if she had an anaphylaxis.

Such a situation puts us in a position where we need to seriously ask questions about expanding our resources - - both in terms of infrastructure and qualified personnel.

To start off things, we eagerly wait for Dr. Roshine, the medicine consultant who'll join us on the 22nd, the coming Saturday.

Healthcare . . . Quo Vadis

I've been in Kerala for about 10 days. And one of the major thing I've noted is the explicit business that healthcare has become.

I'm not sure about how much of what I heard is true . . . I would love to hear that all of this is mere gossip.

One of my friends, who was working in the paramedical wing of a major hospital in the south of Kerala was narrating to me how expensive doctors have become. He was trying to facilitate a Internal Medicine consultant to shift from his previous place of work to the hospital he was presently working.

The compensation the young doctor was demanding was a whopping 200,000 per month. It seems that he was making about 150,000 per month.

I wondered how the hospital made up this much of a money to pay the doctor. And I've been asking questions to anybody who has anything to do with healthcare whom I meet. The answers are very disturbing.

It's easy. Every doctor is given a target of the number of blood investigations, ECGs, EEGs and CT Scans they are supposed to give. Obstetricians are given target of the number of Cesarian sections to be done in a month. Interventional cardiologists are given the target of the number of angioplasties for a month . . . The list goes on and on.

I could only feel sorry for all those of our teachers who were quite keen to drill into us the aspect of cost effective medical practice. Leave alone those who try to teach us evidence based medicine.

The question is about how many of us doctors would take a stand against this sort of healthcare practice.

Another side of this story is that almost every patient is happy to comply to any investigation or procedure that his/her doctor prescribes without a whimper questioning about the need of the test/procedure. The more complicated and latest the investigation or intervention, the lesser the chance of a patient not complying.

And the pharmaceutical companies and their ploys to increase their sales make the scenario all the more enticing for unscrupulous business practices.

Here also, I noticed that the patients also loved to have the latest antibiotic and the latest drug . . . many of which did not even have complete safety profiling.

Sad . . . but true. No wonder, there is a big lobby against public healthcare all over the country. And with the rapidly increasing upper middle class with massive paying capabilities with a liking for all the latest, the future appears quite bleak.

Blogger's Dilemma

It's not quite long since I started to blog seriously. Although I had put my first post sometime in 2009, my serious blogging started from July 2011. Started off as a means to put across healthcare in a rural Indian healthcare and the challenges we faced in an environment which was quite different from what most of the other colleagues in the healthcare faced, I soon found myself getting quite a large audience.

My friends told me that 500 readers in a month would be a good number for the sort of topics I plan to cover.

But, I found out that things can be different.

I was averaging 300 pageviews everyday. And of course, I was overjoyed . . .

Till today . . .

Around afternoon today, I noticed that I crossed 1000 pageviews in a single day. The previous maximum pageviews in a single day was not more than 600.

I was really happy. But, to my horror, I found out that by late evening, my pageviews for the day had crossed a whopping 3000. At the point of my posting this, my ticker shows 3200 pageviews for the day.

I wonder if there is some problem or is this sudden increase genuine.

Appreciate help and advice. I've no clue on how I got such sudden increase in pageviews.

Sunday, June 16, 2013

View from our home

The monsoon has been quite strong all over country. And in Kerala, it's been raining almost everyday.

And the greenery which has enveloped the place cannot be described . . .

The view from the window of my bedroom in Othera today early morning . . .

Physiotherapy at NJH

This is a guest post by Ms. Sheron Mathew, our physiotherapist. Sheron completed her graduation in Physiotherapy from the Christian Medical College, Vellore.

I was sponsored by Emmanuel Hospital Association for my graduate studies in Physiotherapy at the Christian Medical College, Vellore. As I was the fag end of my internship, I got information that my 2 year service obligation would be at Nav Jivan Hospital, Satbarwa. I wondered where exactly this place was?

To my horror I found that this was in the middle of Naxalite infested territory. I was scared in the beginning, but the realisation that God has called me to serve at NJH with a purpose strenghtened me.

I was elated to find out that NJH never ever had a Physiotherapy Department.

Yes! Finally I get to be the Boss. And I get to choose how to keep the department. What colours the walls should be ? I get to choose what type of things should be kept in dept. A big awesome physiotherapy dept which has all the new equipments – standing table, tilt table, IFT machine, Ultrasound machine, electrical stimulation, new plinths for patients, lots of toys for cerebral palsy kids, different gym balls.

That was me thinking as a fresh graduate from the Christian Medical College, Vellore, where everything was provided well; - doctors, physios, occupational therapist, speech therapist, psychologist, implements, exercise machines, special rooms - without which I thought I won’t be able to run physiotherapy department.

All these thoughts lasted till march 31^st 2013, when I had an opportunity to visit NJH for 1 week along with Ms. Ruth Ann, Physiotherapist who had extensive experience abroad and in mission hospital set-ups including other EHA Hospitals.

Sheron along with (from Right to Left) - Mr. Dinesh, Dr. Nandamani, Dr. Ron Hiles, Ms RuthAnn

All my dreams appeared to vanish off when I saw the hospital for the first time. I couldn’t see anything to build up the Physiotherapy Department. This was the first time I saw a really rural mission hospital and that too in one of the most impoverished regions of the country. Miss. Ruth Ann gave me ideas as to how I can start the dept. I went back to my department in CMC, Vellore the next week and was making frantic enquiries with my colleagues, seniors and friends who had served in mission hospitals. I was surprised to hear about creative ideas of different treatments used in the absence of hi-fi and latest technology, innovative methods of using pipes for splints, or AFO (ankle foot orthosis) made out of wood and plastics.

When I was there in NJH in March, during rounds one of the doctors mentioned me that when doctors come to hospitals like this they have to re-learn their medicines. I was not sure of what he meant at that point of time. But now I can see the clear picture.

I realised that setting up a new department is not about buying new things, or putting new colours on the wall or contructing and designing a special room. It’s all about finally trying to explore new ideas which is cost effective without any compromise of the quality of treatment.

One of the problems at present I face is perceptions of staff and people about the discipline of physiotherapy. Most them believe that it is only medicines, injections and surgery which can cure a person. Which of course, stands true in lot of cases but not in all. In conditions such as stroke, cerebral palsy, spinal cord injury they need more than medicines or injections to make them walk, stand or even lift their hands.

Then, there is another group of people here who think physiotherapy is all about massage or “KHASART” to be fit, and physios are the people who treat only back pain, neck pain and shoulder pain.

During the past 3 weeks in the hospital and after few village visits, I found that though there are quite a lot of patients who need physiotherapy, most of them are unaware of services they can avail, and end up being in their house on a bed or in a corner of the house for their lifetime.

I’m excited about the Community Based Rehabilitation Project for People with Disabilities in the surrounding communities. It is a blessing for me to be of service to the community through this project. It’s a long way to go but I hope one day people with disabilities would be finally be able to live with maximum independence possible.

Then, there are stories of ignorance fueled by unscrupulous practitioners and quacks.

In last 2 weeks I had 3 cerebral palsy children who came for physiotherapy. The father of one child told me that doctors elsewhere told him that his child is floppy because her muscles aren’t strong and she needs medicines to make it strong. The mother of the second child told me that the doctor they saw last told her that her son needs a surgery so that left Side starts working.

The family of the third patient knew the condition of their daughter. But before they left the department the father queried, “What is the life span of children with such problems? We are old now. Once we die, no one will be there to take care of her or feed her. Even her own sister won’t look after her because she has her own family to look after. We wish her time (to die) is much before ours.” This question is something I don’t know how to answer.

Before coming to NJH, I wondered at what sort of a job a physiotherapist would do without an orthopedician or a neurologist or a PMR (Physical Medicine and Rehabilitation) doctor. Till now I got to see patients in almost all those fields - Respiratory problems including patients on the ventilator, Snakebite patients who has nerve damage due to compartment sydrome or those who require fasciotomies, acute Cerebral events, Cerebral Palsy and Musculoskeletal pains of all types.

Well I think that’s what serving in mission hospital means, where Jesus is the Great Physician, consultant in all fields, rather the main consultant who guides His children to provide the best service in the middle of all limitations to fellow beings created in God’s own image.