Tuesday, June 11, 2013

Best Posts on RCH

I mentioned in my previous post that, over the last month, I had been searching for the best story in Maternal and Child Healthcare over the last financial year to write up a Human Interest Story for our Annual Report 2012-13. 

Around the same time, one of my friends suggested that I should make a list of the best incidents/posts in my blog worth reading in the realm of Reproductive and Child Health and sort of tabulate them. 

So, here is my selection. The period covered is April 2012 - March 2013. 

1. This is the story of a miracle we had in the hospital. 40 year old MD, a grand multipara had come to us with antepartum hemorrhage. With a hemoglobin of 4 gm% and no blood, only God could intervene. We thank the Lord that He intervened. MD lives to be a blessing to her family. 

2. The curse of anemia in pregnancy is something we've not taken seriously. Unavailability of blood and reluctance of relatives to donate blood deteriorate the scene. One of our biggest killers in the labour room is undiagnosed anemia. 

3. Many of our patients come in and die within minutes. This patient died within 15 minutes of admission. An obvious rupture uterus with severe anemia, there was nothing much for us to do. However, around the same time, someone had asked about tabulating the causes of maternal deaths during 2011 and 2012. 

4. However, there are others who take a long time to develop complications and then die. Most of the time, it's quite painful. And then you start wondered if you should have intervened this much in a situation where finances, specialist care and time are a premium. 

5. A narration of 3 adverse maternal events, all on the same day. And a worse spate of events on a fateful day in August . . . 3 maternal deaths . . . yes, one . . . two and . . . three.  

6. We knew this lady who was brought dead. She had become quite sick during her first delivery. Although she had her regular antenatals elsewhere for her present pregnancy, she was admitted about 2 weeks back with a very bad urinary tract infection. It was a shock to see her rolled into emergency with no sign of life. It looked like a case of post-partum eclampsia.

7. Many a time we become so busy to even note down about our patients. No time to even pause and think about the horror that many of the pregnant women go through. Some of them are so young to be even pregnant . . . leave alone have a rupture uterus

8. We have been actively managing severe eclampsia patients . .. ... going to the extent of elective mechanical ventilation. This appears to be yielding quite good results. A description of 2 such cases. 

9. A primi rupture uterus is not something which is common. However, last year we had an unfortunate lady with the condition . . . thanks to her lazy and ignorant family. 

10. Quite a lot of maternal near misses occur due to neglect. Poor infrastructure like bad roads complicate things. A typical case study. And ignorance makes things all the more worse. It is sad when healthcare fails people by not explaining potential risks. 

11. And worst, when patients are mismanaged by the medical fraternity on whom they have put their utmost trust. We also have instances where civil unrest in the form of general strikes result in maternal deaths. And to top it all there is corruption . .. .. blood bags with low hemoglobin values. And there appears to be no hope when they have no money to spend for their womenfolk in labour. 

12. Many people think that Magnesium Sulphate is a magic drug. However, our experience says that you need to have basic skills of stabilising a patient's airway and circulation if you want to manage your eclampsia patients well. And not to forget good skills in neonatal resuscitation if you want a healthy baby. 

13. Many healthcare professionals have requested us to share photographs especially of rupture uterus. This post (with snaps of the surgery) is about a rupture uterus where the baby turned out to be alive although sick. However, she did well in our Neonatal Intensive Care Unit. And there was one more lady who had a rupture uterus, but was blessed to have a live baby.

14. To showcase the seriousness of the obstetric cases we take up, I had put a post with a typical list of Cesarian cases and later the costs we had to write off. Thanks to this post, we have a well wisher from Australia who's helped us with more than a 200,000 INR to subside high risk obstetric care.

We've slowly realised that we need consultants in obstetrics and pediatrics to share our burden. Please pass on this exhaustive post with links to those who may be interested. And of course, pray for us . . .  

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