The Determinants

Public health believes very much in the socio-economic determinants of health.

Many a time, we find it quite common to very good clinicians treating their patients with hardly any regard to these determinants of health. One of my teachers told me that if a clinician, however good he is, if he/she does not heed to the socio-economic factors related to his patient, he is never a good doctor.

The unfortunate part of this is that in an impoverished place like ours, although we know about socio-economic issues related to a patient, there is hardly much we can do in many cases. I’m not sure how many will remember Sabita Devi (SD). SD graced the inside cover page of our Annual Report 2012-13 (after page 16). SD’s story was one of our Human Interest Stories.

SD along with her husband turned up yesterday. It seems that SD’s condition had suddenly turned for the worse. She had skin growing over almost the whole of her burnt area. She was doing good. 

The family had some amount of land where they cultivated grain. The produce was quite good this year. But, that was not enough to sustain the family as there was added burden of SD’s treatment. The husband decided that he could make some extra money and therefore went as a migrant labour. But, that was a terrible decision.

The absence of her husband ensured that SD was not well taken care of. There was nobody to ensure that she got her dressings on time. And more than that, there was no one to buy food and coax her to eat well.

SD’s husband came home after about a fortnight to check out on her. SD had lost weight. The skin which covered her burnt parts of the body had started to fall off. He called Dr. Nandamani who advised them to bring her to NJH.

It was obvious. She was terribly malnourished. Investigations confirmed it. Hemoglobin of 7 gm% and Serum Albumin of 2 mg%.

We requested her to get admitted. But the family would not have any of that. I told them that they’ll need to pay only for the dressings. But, the family had worked it out. The indirect costs were too much. There was a crop to be harvested . . .

I don’t know whether SD will return back . . . If she returns, that would be another miracle . . .