Monday, December 9, 2013

Non-clinicals in a rural mission hospital

This is the second guest post by Dr Angeline Zachariah, my better half. Trained as a Clinical Pathologist (DCP, 2008 Batch, Christian Medical College, Vellore), she is a big help in outpatient department and the Laboratory. Angel, as she is popularly  known, belongs to the MBBS Batch of 2000, of Medical College, Trivandrum.

I have been frequented by queries on how useful is my qualification of a Diploma in Clinical Pathology in a remote mission hospital setting. It had send me into episodes of deep contemplation about my role, rather usefulness at NJH. Even my examiners for my DCP final exams had asked me about ‘what I would do’ and I had replied that I was not sure. Having been a part of NJH for more than 3 years (although officially I was an active participant in clinical activity only for about 8 months), I thought that it is time I pen down my thoughts on the role of a clinical pathologist in a secondary mission hospital settings.

Many a time, mission hospitals have come up in regions which are backward and amidst marginalised communities. There was an era when all febrile patients were treated with a  course of antibiotics or anti-malarials and send home. Even, in the olden times, maternal health involved only in the delivery of the patient and had nothing to do with basic blood tests like haemoglobin, blood group, Hepatitis B screening etc.

The scene has changed quite a lot. Clinicians depend quite a lot on the laboratory for zeroing in on a diagnosis. Emmanuel Hospital Association, the parent organisation of Nav Jivan Hospital has been harping on ensuring ‘quality care’ to the patients. I’m proud of this endeavour from the organisation and was thrilled to be a minor part of this process through my involved in the laboratory.

As I had already mentioned, when I joined NJH, I had no clue on where to start. The best thing to do was to sit in the outpatient department. However, I was soon sucked into the processes in the laboratory. We were already doing quite a lot in malaria treatment. However, our clinicians were quite concerned about the number of febrile cases which had a negative malaria smear. The traditional treatment was to start the patient on anti-enteric fever treatment when malaria management failed.

We started to do peripheral smears seriously. And suddenly the whole issue of thrombocytopenia propped up. The diagnosis of probable viral hemorrhagic fevers and rickettsial infections started to appear in our case-sheets. There was confirmation as patients responded to the respective treatments. Soon, we had enough reason to purchase a 3 part cell counter.

Then was the whole gamut of probable meningitis cases coming to us. We started off slowly and with the arrival of Dr. Roshine, the number of cases with a positive diagnosis for meningitis in all its forms just shot up.

The best part of the last 3 years was seeing very poor patients who could not afford to go to higher centres walking back home after having arrived on a stretcher, near death. There was a time when we had children coming unconscious after a bout of fever. It was a joy to see them get discharged alive and active.

From the Holy Bible, I’m often reminded of Mordecai’s words to Queen Esther . . . (Esther 4:4b): And who knows whether you have not come to the kingdom for such a time as this.
Now, being a lady doctor, I get to see many cases of persistent Pelvic Inflammatory Disease and unhealthy cervices leaving me guilty of the fact that a cervical smear program for screening for Carcinoma Cervix is lacking at NJH. In addition to this, we’ve ended up referring quite a many ante-natal care patients to Ranchi for an Indirect Coomb Test. The poor women who cannot manage to go to Ranchi carry on without these tests trusting that we do the best for them.

There is much more to be done . . . Cultures, especially urine culture is something our antenatal patients would benefit from as we see quite a few of them succumb to a pre-term labour and intra-uterine deaths, persistent urinary tract infections being one of the common risk factor. A blood bank, facilities for bone marrow biopsies, Fine Needle Aspiration Cytology facilities are all dreams . . .

Laboratory services are an indispensable support system for patient management. Of course, a good clinician requests an investigation to confirm a diagnosis, to rule out a diagnosis and to monitor treatment. Medical practitioners of the present age are expected to practice evidence based medicine making the development of laboratory services an essential part of hospital development.

As I write this, I am well aware of the fact the work implies willingness and commitment to toil behind the curtains. I might have never seen the patients or the patients may never know that I’m an integral part of their clinical care. The greatest assurance is only that I’m grateful that I’ve been used by the Lord to bring a difference in the lives of patients who come to NJH.

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