tag:blogger.com,1999:blog-45225339792743510922024-03-18T15:17:48.247+05:30The LearnerJeevanhttp://www.blogger.com/profile/14805862105396943161noreply@blogger.comBlogger938125tag:blogger.com,1999:blog-4522533979274351092.post-35867321752217443442017-08-07T22:55:00.000+05:302017-08-07T23:01:38.183+05:30Quackery . . . <div dir="ltr" style="text-align: left;" trbidi="on">
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiSRrjdI7CEGorSFZvTlhUCW131m92qi7mYe9_CH5wBviMZSIbz2zkR6fRZ0k4Jn1li0CraV0JxqzEkKD5HIn_3Vg8qR2IgJyqiGjX-fZoywaxMU8qbk94iFQAVF0z6t3M00eRRNyQ3iLM/s1600/IMG_20170807_120027.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="553" data-original-width="643" height="275" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiSRrjdI7CEGorSFZvTlhUCW131m92qi7mYe9_CH5wBviMZSIbz2zkR6fRZ0k4Jn1li0CraV0JxqzEkKD5HIn_3Vg8qR2IgJyqiGjX-fZoywaxMU8qbk94iFQAVF0z6t3M00eRRNyQ3iLM/s320/IMG_20170807_120027.jpg" width="320" /></a></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: "calibri"; mso-bidi-font-family: 'Times New Roman'; mso-fareast-font-family: SimSun; mso-spacerun: 'yes';"><br /></span></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: "calibri"; mso-bidi-font-family: 'Times New Roman'; mso-fareast-font-family: SimSun; mso-spacerun: 'yes';">Since our tryst with Palamu region for more than a decade, babies such as the one above are not uncommon. We</span><span style="font-family: "calibri"; mso-bidi-font-family: 'Times New Roman'; mso-fareast-font-family: SimSun; mso-spacerun: 'yes';">’ve had many such babies brought to NJH during our stint there. However, with the government taking a pro-active approach to treatment of extreme malnutrition, our workload on such babies have come down to quite a large extent. </span><span style="font-family: "calibri"; mso-bidi-font-family: 'Times New Roman'; mso-fareast-font-family: SimSun; mso-spacerun: 'yes';"><o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: "calibri"; mso-bidi-font-family: 'Times New Roman'; mso-fareast-font-family: SimSun; mso-spacerun: 'yes';"><br /></span></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg92oznLRABiAGFpPnJRIRAJj1Bwxv95Cu1ddhtBQN4JVsGVJMMDlvigkk8oiZj4-TIeMsi9COtWRpF09O-8SwGCVHyyrZeFbQhgZ4KquuBcyEgGZiyfn5LIA2BN-X2fCVn4JjK8luUd4E/s1600/IMG_20170807_120040.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="316" data-original-width="793" height="158" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg92oznLRABiAGFpPnJRIRAJj1Bwxv95Cu1ddhtBQN4JVsGVJMMDlvigkk8oiZj4-TIeMsi9COtWRpF09O-8SwGCVHyyrZeFbQhgZ4KquuBcyEgGZiyfn5LIA2BN-X2fCVn4JjK8luUd4E/s400/IMG_20170807_120040.jpg" width="400" /></a></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: "calibri"; mso-bidi-font-family: 'Times New Roman'; mso-fareast-font-family: SimSun; mso-spacerun: 'yes';">This baby girl, whose birth date is not known came to us today. Regarding her age, the parents are only sure that she is more than 2 months old. They had already received a referral letter to the Malnutrition Treatment Centre at Sadar Hospital, Latehar. Unfortunately, they just don’t want to take the baby there. </span><span style="font-family: "calibri"; mso-bidi-font-family: 'Times New Roman'; mso-fareast-font-family: SimSun; mso-spacerun: 'yes';"><o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: "calibri"; mso-bidi-font-family: 'Times New Roman'; mso-fareast-font-family: SimSun; mso-spacerun: 'yes';">The reason I posted the snap of this child is to let the world know of how quacks and charlatans in rural India con poor people. I hope you can clearly see the reddish dye put on the scalp of this baby. The treatment given by some quack is for ‘khaparphod’ - which means broken head/skull. ‘Khaparphod’ is the local terminology for the open anterior fontanelle which as we all know is a normal feature of infants which close by about a years age. </span><span style="font-family: "calibri"; mso-bidi-font-family: 'Times New Roman'; mso-fareast-font-family: SimSun; mso-spacerun: 'yes';"><o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgYF959GK1IFJS2ggUIY8gp6YcgKBfMTGxP8uYlZzsWbW0wbl_zMZV-roVgJTfso_XX3FMMdbcg3wDM8FbXs0XusdDjHMVr84G3thn-kV-_qEP_vG4RdbxKSXBFnNcaR3JhP70vCpItyZs/s1600/IMG_20170807_120134.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="404" data-original-width="710" height="364" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgYF959GK1IFJS2ggUIY8gp6YcgKBfMTGxP8uYlZzsWbW0wbl_zMZV-roVgJTfso_XX3FMMdbcg3wDM8FbXs0XusdDjHMVr84G3thn-kV-_qEP_vG4RdbxKSXBFnNcaR3JhP70vCpItyZs/s640/IMG_20170807_120134.jpg" width="640" /></a></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: "calibri"; mso-bidi-font-family: 'Times New Roman'; mso-fareast-font-family: SimSun; mso-spacerun: 'yes';">The quack has told them that all of the child’s problems is because of the open anterior fontanelle. And they had been taking treatment for that from the said quack since the last one month. I spent close to half an hour convincing the family that this is a normal anatomical feature in a newborn. </span><span style="font-family: "calibri"; mso-bidi-font-family: 'Times New Roman'; mso-fareast-font-family: SimSun; mso-spacerun: 'yes';"><o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: "calibri"; mso-bidi-font-family: 'Times New Roman'; mso-fareast-font-family: SimSun; mso-spacerun: 'yes';">It’s close to 6 hours since the baby was ‘admitted’ at our place. Meanwhile we also realised that the child was in sepsis. I can only pray that she gets better soon and puts on some flesh over her bones. </span><span style="font-family: "calibri"; mso-bidi-font-family: 'Times New Roman'; mso-fareast-font-family: SimSun; mso-spacerun: 'yes';"><o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: "calibri"; mso-bidi-font-family: 'Times New Roman'; mso-fareast-font-family: SimSun; mso-spacerun: 'yes';">I hope it is also significant to mention that this is the family’s seventh child and three of those died before they turned started to walk. </span></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: "calibri"; mso-bidi-font-family: 'Times New Roman'; mso-fareast-font-family: SimSun; mso-spacerun: 'yes';"><br /></span></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEijxPOhO8SGeqn4GZVWEFYFWR24XdIV9Sc36YxGB83SJoz-eHYVyKOixUedO_IIr3EE8Ked2ASWlF-IvMnk2cDPnw92wXnCAwm7UrR0VxKic7j4VMng8Bhzc_2RqG7kEQQbdquMdlHtPjk/s1600/IMG_20170807_120456.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="417" data-original-width="826" height="322" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEijxPOhO8SGeqn4GZVWEFYFWR24XdIV9Sc36YxGB83SJoz-eHYVyKOixUedO_IIr3EE8Ked2ASWlF-IvMnk2cDPnw92wXnCAwm7UrR0VxKic7j4VMng8Bhzc_2RqG7kEQQbdquMdlHtPjk/s640/IMG_20170807_120456.jpg" width="640" /></a></div>
<br /></div>
Jeevanhttp://www.blogger.com/profile/14805862105396943161noreply@blogger.com82tag:blogger.com,1999:blog-4522533979274351092.post-32618207006755331272017-08-06T22:54:00.000+05:302017-08-07T06:42:14.537+05:30Untold misery<div dir="ltr" style="text-align: left;" trbidi="on">
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhPbYhlHtqSAc4V5FsrYihzJp-C-jGgeh4LQ-IK0xilL-RZAk01j917rlDMChWgjyV5tA7Qi7_KyIMgYIo2Hoptp4fHUt2BzTy-Yt6UJFXA2epMe21CC6A8aHEHFUHg6JhA1msRVoPkChM/s1600/IMG_20170803_153011.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" data-original-height="1173" data-original-width="907" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhPbYhlHtqSAc4V5FsrYihzJp-C-jGgeh4LQ-IK0xilL-RZAk01j917rlDMChWgjyV5tA7Qi7_KyIMgYIo2Hoptp4fHUt2BzTy-Yt6UJFXA2epMe21CC6A8aHEHFUHg6JhA1msRVoPkChM/s320/IMG_20170803_153011.jpg" width="247" /></a></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: "calibri"; mso-bidi-font-family: 'Times New Roman'; mso-fareast-font-family: SimSun; mso-spacerun: 'yes';">This is Kunti Kumari. Elder of three girls who lost their father to Naxalite violence. We don</span><span style="font-family: "calibri"; mso-bidi-font-family: 'Times New Roman'; mso-fareast-font-family: SimSun; mso-spacerun: 'yes';">’t know the details. </span><span style="font-family: "calibri"; mso-bidi-font-family: 'Times New Roman'; mso-fareast-font-family: SimSun; mso-spacerun: 'yes';"><o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: "calibri"; mso-bidi-font-family: 'Times New Roman'; mso-fareast-font-family: SimSun; mso-spacerun: 'yes';">Kunti was brought to us few days back in a confused state by her uncle. Considering that she was having fever since two days and she was from our ‘malaria endemic’ zone, there were no guesses to arrive at a provisional diagnosis. Laboratory report confirmed the diagnosis. Mixed malaria infection with features of impeding complications. </span><span style="font-family: "calibri"; mso-bidi-font-family: 'Times New Roman'; mso-fareast-font-family: SimSun; mso-spacerun: 'yes';"><o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: "calibri"; mso-bidi-font-family: 'Times New Roman'; mso-fareast-font-family: SimSun; mso-spacerun: 'yes';">She responded well to treatment. Considering the rush of patients that we had been having, we missed the tragedy that befell the family. We did not know that Kunti had lost her younger sister to high grade fever just the previous day. </span><span style="font-family: "calibri"; mso-bidi-font-family: 'Times New Roman'; mso-fareast-font-family: SimSun; mso-spacerun: 'yes';"><o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: "calibri"; mso-bidi-font-family: 'Times New Roman'; mso-fareast-font-family: SimSun; mso-spacerun: 'yes';">It was one of our nurse aides who told us about the sad story. Kunti's younger sister was having fever since few days and was being managed by a quack in the village. She had suddenly become unconscious and died the same morning when Kunti was brought to us. </span></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: "calibri"; mso-bidi-font-family: 'Times New Roman'; mso-fareast-font-family: SimSun; mso-spacerun: 'yes';">The last ten days we saw more than 25 patients with malaria. Except 2, all of them had mixed infections. We were ill equiped to manage four patients whom we had to refer to Ranchi. Two of them have renal failure and are still on dialysis. One little child has unexplained hemolysis needing repeated transfusions. One little boy of twelve years died within one day of admission to our nearest teaching hospital. </span><span style="font-family: "calibri"; mso-bidi-font-family: 'Times New Roman'; mso-fareast-font-family: SimSun; mso-spacerun: 'yes';"><o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: "calibri"; mso-bidi-font-family: 'Times New Roman'; mso-fareast-font-family: SimSun; mso-spacerun: 'yes';">From the nearby villages, we’ve heard about 5 deaths so far. No one has been proved to have had malaria. They had high grade fever for couple of days which was managed by the local quack. And they just died. </span><span style="font-family: "calibri"; mso-bidi-font-family: 'Times New Roman'; mso-fareast-font-family: SimSun; mso-spacerun: 'yes';"><o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: "calibri"; mso-bidi-font-family: 'Times New Roman'; mso-fareast-font-family: SimSun; mso-spacerun: 'yes';">The interesting thing this year is the total absence of the coverage of malaria deaths and high incidence in the local media, leave alone at the state and national level. </span><span style="font-family: "calibri"; mso-bidi-font-family: 'Times New Roman'; mso-fareast-font-family: SimSun; mso-spacerun: 'yes';"><o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: "calibri"; mso-bidi-font-family: 'Times New Roman'; mso-fareast-font-family: SimSun; mso-spacerun: 'yes';">How long shall we cover up the truth? The truth of an India which is still grappling with preventable diseases like malaria and the unnecessary deaths . . . </span></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: "calibri"; mso-bidi-font-family: 'Times New Roman'; mso-fareast-font-family: SimSun; mso-spacerun: 'yes';"><br /></span></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgD3FfR3CW_AgOhC9DxVtbqQ_uwMOUKHnWS5oX66FP1ylVAjn3yc2rpCavzzUAdwhBtFIx6XPA502gVHHF1myQoTo0JpR9IgeB0OjGRupH21v-SqFuXukR8cf2TbHcX_o30aG7GW_mV_eA/s1600/IMG_20170801_180835.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="609" data-original-width="605" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgD3FfR3CW_AgOhC9DxVtbqQ_uwMOUKHnWS5oX66FP1ylVAjn3yc2rpCavzzUAdwhBtFIx6XPA502gVHHF1myQoTo0JpR9IgeB0OjGRupH21v-SqFuXukR8cf2TbHcX_o30aG7GW_mV_eA/s320/IMG_20170801_180835.jpg" width="317" /></a></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: "calibri"; mso-bidi-font-family: 'Times New Roman'; mso-fareast-font-family: SimSun; mso-spacerun: 'yes';"><i><br /></i></span></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: "calibri";"><i>PS: Consent was taken from Kunti and her guardians to put her story and snap in public</i></span></div>
</div>
Jeevanhttp://www.blogger.com/profile/14805862105396943161noreply@blogger.com18tag:blogger.com,1999:blog-4522533979274351092.post-292565764719287152017-07-06T00:09:00.000+05:302017-07-06T00:09:03.301+05:30Monsoon arrives in Barwadih<div dir="ltr" style="text-align: left;" trbidi="on">
Monsoon rains have always been welcome relief. It's a photographer's delight. Whether it was <a href="http://jeevankuruvilla.blogspot.in/2012/06/rains-hooray.html">NJH </a>or <a href="http://jeevankuruvilla.blogspot.in/2015/06/the-monsoon-arrives.html">Kachhwa</a>, there were quite a many snaps.<br />
<br />
In Barwadih, we had been quite busy. Still, got the time to take few snaps of the rains.<br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEja3IwW5YjT-b_wRMOWlMcOhRF9GxcU5zL9Crbq8KfO4UtQUWsL6YfwjWbM2ubrpAdgzt1MrvyjbyemWL5YpAiRc6muFrgjvSy-s6dD5Si3_KR0XivKJ1yWtpvLqS0S9nqkUa2wF8-cwkQ/s1600/IMG_20170704_160904.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="936" data-original-width="1248" height="476" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEja3IwW5YjT-b_wRMOWlMcOhRF9GxcU5zL9Crbq8KfO4UtQUWsL6YfwjWbM2ubrpAdgzt1MrvyjbyemWL5YpAiRc6muFrgjvSy-s6dD5Si3_KR0XivKJ1yWtpvLqS0S9nqkUa2wF8-cwkQ/s640/IMG_20170704_160904.jpg" width="640" /></a></div>
<br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiElA6UhkEGZoBZrUGsi7uFdfXQhyphenhyphenz2qokL2aQjb6qUQoA1KPjIQBEDaH3Nfv2R7sYhPjm68ko-cyuUrvUNGsbIFkN6M3MLauLbHZQ9iQ2HQrTSLXd0BYWm-9tVzV6GumG9q30NCxXuDj4/s1600/IMG_20170704_161110.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="936" data-original-width="1248" height="478" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiElA6UhkEGZoBZrUGsi7uFdfXQhyphenhyphenz2qokL2aQjb6qUQoA1KPjIQBEDaH3Nfv2R7sYhPjm68ko-cyuUrvUNGsbIFkN6M3MLauLbHZQ9iQ2HQrTSLXd0BYWm-9tVzV6GumG9q30NCxXuDj4/s640/IMG_20170704_161110.jpg" width="640" /></a></div>
<br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgLrs73PEGwSFckULf3LOxOmJ2uikQ9KKd547gy_gCAanNYlp7NVpum4x4ImQsW3tMich5ANI87ReE_aTMLDjJ4EXR1uo3yRVhPBBMeWB6NszlHVG37HhdeHyJpVyNbKDE__3C3Pt6hxb4/s1600/IMG_20170704_161159.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="936" data-original-width="1248" height="478" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgLrs73PEGwSFckULf3LOxOmJ2uikQ9KKd547gy_gCAanNYlp7NVpum4x4ImQsW3tMich5ANI87ReE_aTMLDjJ4EXR1uo3yRVhPBBMeWB6NszlHVG37HhdeHyJpVyNbKDE__3C3Pt6hxb4/s640/IMG_20170704_161159.jpg" width="640" /></a></div>
<br />
We thank the Lord for the rains. I hope <a href="http://jeevankuruvilla.blogspot.in/2012/06/rains-hooray.html">the water table improves</a>. <br />
<br />
<br /></div>
Jeevanhttp://www.blogger.com/profile/14805862105396943161noreply@blogger.com15tag:blogger.com,1999:blog-4522533979274351092.post-46791080280754735832017-07-01T23:00:00.000+05:302017-07-01T23:00:08.973+05:30Perungalam 2017<div dir="ltr" style="text-align: left;" trbidi="on">
These are snaps of our visit this year, Summer 2017. Though we were well prepared to do fishing, we did not catch any fish this year. And we took lesser snaps than <a href="http://jeevankuruvilla.blogspot.in/2017/06/perungalam-2016.html?m=1">last year</a>. So, few snaps shared by the previous director, Rev. Mathews of the Retreat Centre is included (the first four).<br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhcBpl7E1jVS8W_DEhS_R0ov87d91idB6MjiCaDqvzSngM6u4mxsrAYtGPcLWLJGC_maTZa67Zdk9sXV8oCE8bjyUtl3WZX-_d7xXxnD6rzfr9B8puyXoY71Grgbv_na3fol9au45zncus/s1600/IMG-20160614-WA0005.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="676" data-original-width="1200" height="360" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhcBpl7E1jVS8W_DEhS_R0ov87d91idB6MjiCaDqvzSngM6u4mxsrAYtGPcLWLJGC_maTZa67Zdk9sXV8oCE8bjyUtl3WZX-_d7xXxnD6rzfr9B8puyXoY71Grgbv_na3fol9au45zncus/s640/IMG-20160614-WA0005.jpg" width="640" /></a></div>
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiup33155WNE1kl48ViEo8sscXBeKc9KAp4ALfMZLHpGsSdfG3U9MtqzGcj2NaS93t1aTNnoRsOFRs2lTykg4Z9ShkKcP1c79jTLqWPVDPVyJC52f-AU7uxZ5FKvhichOkLN8BnWsWnqp4/s1600/IMG-20160614-WA0007.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="676" data-original-width="1200" height="360" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiup33155WNE1kl48ViEo8sscXBeKc9KAp4ALfMZLHpGsSdfG3U9MtqzGcj2NaS93t1aTNnoRsOFRs2lTykg4Z9ShkKcP1c79jTLqWPVDPVyJC52f-AU7uxZ5FKvhichOkLN8BnWsWnqp4/s640/IMG-20160614-WA0007.jpg" width="640" /></a></div>
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhjjGFEpKM86r1g4YM7oXOXi8GnEbAeAsbAEtmdrkjpVLrRW0tfv7HHX0m0-hz2f9LS8mNGS0LxJ9522bb5n0aLb0NaK0MBGr6yR4NiEUbJFsnFwiVYM-ac0iZJQtZl5zcYQg-yWGiCtXU/s1600/IMG-20160615-WA0001.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="676" data-original-width="1200" height="360" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhjjGFEpKM86r1g4YM7oXOXi8GnEbAeAsbAEtmdrkjpVLrRW0tfv7HHX0m0-hz2f9LS8mNGS0LxJ9522bb5n0aLb0NaK0MBGr6yR4NiEUbJFsnFwiVYM-ac0iZJQtZl5zcYQg-yWGiCtXU/s640/IMG-20160615-WA0001.jpg" width="640" /></a></div>
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh_5c1EqmRoybDncLBRYymzCCuCrnvrUnjM9vPxvhUI5V1K3rbITJ-3YxAQOWNcaSKwAWeWi5-DBx0pj8UMIXd_iv_DWpB8xJ_2scrt_AgE5R10Yxp_dC6AWZe-uP0oKEqmt9yBEQkiJOI/s1600/IMG-20160615-WA0003.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="676" data-original-width="1200" height="360" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh_5c1EqmRoybDncLBRYymzCCuCrnvrUnjM9vPxvhUI5V1K3rbITJ-3YxAQOWNcaSKwAWeWi5-DBx0pj8UMIXd_iv_DWpB8xJ_2scrt_AgE5R10Yxp_dC6AWZe-uP0oKEqmt9yBEQkiJOI/s640/IMG-20160615-WA0003.jpg" width="640" /></a></div>
<br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi9g23UDPW0mATF0AEV8GheJPoPneoPdy3P04XCyTF17xhYivrrf5EQ8DBV0Fud0blYBe2r09SCMBULe_MSMs_KOfVFsrFN51SQlQ5cEG5f6W40NTw7Er2PYPUblfU6bOjlKQ3ztHkxBVI/s1600/IMG_20170607_093309.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="835" data-original-width="1131" height="472" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi9g23UDPW0mATF0AEV8GheJPoPneoPdy3P04XCyTF17xhYivrrf5EQ8DBV0Fud0blYBe2r09SCMBULe_MSMs_KOfVFsrFN51SQlQ5cEG5f6W40NTw7Er2PYPUblfU6bOjlKQ3ztHkxBVI/s640/IMG_20170607_093309.jpg" width="640" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">This time we missed the boat and had to hire a local speed boat. I hope you noticed the Jharkhand origin jhola in the boat. </td></tr>
</tbody></table>
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhtzLBeTNPasWRKQGUlq9-p3eexcFAsx_NYQW_TYRlItNbDaVzqjHeyTla0JoD_xakWhRcY5brRVFM3R2nSYWzgDiD8gHDAFb0xzv0Vm1ZOBKqyWiquBTJMw34U4to5Oo3X-Vw1EdeDWw8/s1600/IMG_20170608_120713.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="936" data-original-width="1248" height="478" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhtzLBeTNPasWRKQGUlq9-p3eexcFAsx_NYQW_TYRlItNbDaVzqjHeyTla0JoD_xakWhRcY5brRVFM3R2nSYWzgDiD8gHDAFb0xzv0Vm1ZOBKqyWiquBTJMw34U4to5Oo3X-Vw1EdeDWw8/s640/IMG_20170608_120713.jpg" width="640" /></a></div>
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg5bZVmaj9sK2p595QdUXtqAZtrBdFu1wXoHMN5gSOKBZty_Yb1WnWeetucCeevNcGobc3Ei_3O0XbGCi5PbR-EHLedN7BiXYSPCyubbYnUjWU5Rnu8UmcuQqI-OnyEHzwRE-0kQxxD1yQ/s1600/IMG_20170609_140850.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="936" data-original-width="1248" height="478" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg5bZVmaj9sK2p595QdUXtqAZtrBdFu1wXoHMN5gSOKBZty_Yb1WnWeetucCeevNcGobc3Ei_3O0XbGCi5PbR-EHLedN7BiXYSPCyubbYnUjWU5Rnu8UmcuQqI-OnyEHzwRE-0kQxxD1yQ/s640/IMG_20170609_140850.jpg" width="640" /></a></div>
<br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhd_fHDUJ46TINIDNdHBdRk34T5aGpVgLxX5xLm-r6Gz3TMhzCUBsZd285uljk7OfrAww97x-x4HCHY2HQ9vKxa9A6OQCURds0_n2W0DAxYP0Hv1DLJJMsWjzXRC0awZmwTIqaJqXfM6DU/s1600/IMG_20170609_140911.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="936" data-original-width="1248" height="478" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhd_fHDUJ46TINIDNdHBdRk34T5aGpVgLxX5xLm-r6Gz3TMhzCUBsZd285uljk7OfrAww97x-x4HCHY2HQ9vKxa9A6OQCURds0_n2W0DAxYP0Hv1DLJJMsWjzXRC0awZmwTIqaJqXfM6DU/s640/IMG_20170609_140911.jpg" width="640" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">That's the boat we arrived in . . . </td></tr>
</tbody></table>
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhJOkSVVxW2s5lvdrYQ7tBCboaajpnUAZn64F5e9_H3euOE2EwHD-t6edYbyFsKBl1H88GF7PURjiLtRcb1btmI-R40vasymMYYWBUtOSKp-4nyoQQY7mz5R1bGIRc_jVYXbyZ3n9nFCik/s1600/IMG_20170609_140925.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="936" data-original-width="1248" height="478" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhJOkSVVxW2s5lvdrYQ7tBCboaajpnUAZn64F5e9_H3euOE2EwHD-t6edYbyFsKBl1H88GF7PURjiLtRcb1btmI-R40vasymMYYWBUtOSKp-4nyoQQY7mz5R1bGIRc_jVYXbyZ3n9nFCik/s640/IMG_20170609_140925.jpg" width="640" /></a></div>
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjDQsj0aKRQuEFTDEcCNLhLLPbtpU4aIEKIfSSweW4rw4EY3OW1qvAMWFsNvHe0ED8XRrnIDeWxcpmS1j-kUfBJKuO611Xll0F5ZqyEgXpocISe3vvV96Zmz_9StIOxSrfiYbEpdWkNKmI/s1600/IMG_20170609_140939.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="936" data-original-width="1248" height="478" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjDQsj0aKRQuEFTDEcCNLhLLPbtpU4aIEKIfSSweW4rw4EY3OW1qvAMWFsNvHe0ED8XRrnIDeWxcpmS1j-kUfBJKuO611Xll0F5ZqyEgXpocISe3vvV96Zmz_9StIOxSrfiYbEpdWkNKmI/s640/IMG_20170609_140939.jpg" width="640" /></a></div>
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjgtJrCFn0XRzuVjHaAaReu6bBGS1B0chDVtY91k8Pgi0M04tnEJUXAmPb7N0xXVj2mo3q4hJhPSdzcu3iyFJEOuUc0OkdO9VM_ekF_1swZLNx3JRg1u1X0-l5SGQc_OsRE6On4fXhE93A/s1600/IMG_20170609_142307.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="936" data-original-width="1248" height="478" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjgtJrCFn0XRzuVjHaAaReu6bBGS1B0chDVtY91k8Pgi0M04tnEJUXAmPb7N0xXVj2mo3q4hJhPSdzcu3iyFJEOuUc0OkdO9VM_ekF_1swZLNx3JRg1u1X0-l5SGQc_OsRE6On4fXhE93A/s640/IMG_20170609_142307.jpg" width="640" /></a></div>
<br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhBX936ezwyhdgmjgV8Go-TL7Y56NHYc7xWeTjLDDgYIW04QWWjaFltEKMwv4NIGHN9FtFXHxdVwxD1afiYrHubFwBYBcDIezUwFUuyuhCX8HcD129QjDD3wUb02oqk7g5-5PD0lVzFe4s/s1600/IMG_20170609_143329.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="841" data-original-width="1151" height="466" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhBX936ezwyhdgmjgV8Go-TL7Y56NHYc7xWeTjLDDgYIW04QWWjaFltEKMwv4NIGHN9FtFXHxdVwxD1afiYrHubFwBYBcDIezUwFUuyuhCX8HcD129QjDD3wUb02oqk7g5-5PD0lVzFe4s/s640/IMG_20170609_143329.jpg" width="640" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">The boat arriving for our return journey . . .</td></tr>
</tbody></table>
<br /></div>
Jeevanhttp://www.blogger.com/profile/14805862105396943161noreply@blogger.com12tag:blogger.com,1999:blog-4522533979274351092.post-41260603905504465102017-06-30T11:21:00.000+05:302017-06-30T11:21:00.822+05:30Netarhat<div dir="ltr" style="text-align: left;" trbidi="on">
Jharkhand has many beautiful places to visit. Netarhat is the highest point in the state. I've never visited the place, though I visit a village quite near once a month.<br />
<br />
Today, an acquaintance send me few snaps of the place. He gave me permission to post it in my blog.<br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgw-KFrANmN5-CESLhj7oHyXcPg6I4s4nBzWxygdK2qPjfFtlDzZLyGIJpRO3C1s30sMRt3uevjtUvTcYvRMA4fZFSbNNOUFHioBzIu5pseloSKJTYEW-df76Z7aq9EzJby1Ci6M9jQ1io/s1600/IMG-20170629-WA0002.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="780" data-original-width="1040" height="480" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgw-KFrANmN5-CESLhj7oHyXcPg6I4s4nBzWxygdK2qPjfFtlDzZLyGIJpRO3C1s30sMRt3uevjtUvTcYvRMA4fZFSbNNOUFHioBzIu5pseloSKJTYEW-df76Z7aq9EzJby1Ci6M9jQ1io/s640/IMG-20170629-WA0002.jpg" width="640" /></a></div>
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgZYDTTkZEHMo3E39Y6EY55WOKhJ0aVO-t6A3C_vYWwipG3AQAF-kaJjMPMTqPB2iWsZUfFcqDFRKn7LWGy18kyN81Jb3EDejJ16c657FidLOFENDWXWiX8AXMVbXTSfq-3xkVgaFzq82Q/s1600/IMG-20170629-WA0003.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="780" data-original-width="1040" height="480" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgZYDTTkZEHMo3E39Y6EY55WOKhJ0aVO-t6A3C_vYWwipG3AQAF-kaJjMPMTqPB2iWsZUfFcqDFRKn7LWGy18kyN81Jb3EDejJ16c657FidLOFENDWXWiX8AXMVbXTSfq-3xkVgaFzq82Q/s640/IMG-20170629-WA0003.jpg" width="640" /></a></div>
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhJ_7r2NEdw11uKOFWXkjAMIEaAZ52nTiDrhz_tNRwe4ffuLodq1VfDK7kPMOpyR9StLroOI20CrvSxcZo0GQd_k36f1QANQoH20Frj2IXqZZcVxPSUVEPP6FAsA65RuT1F7tnmX7FTkmI/s1600/IMG-20170629-WA0007.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="780" data-original-width="1040" height="480" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhJ_7r2NEdw11uKOFWXkjAMIEaAZ52nTiDrhz_tNRwe4ffuLodq1VfDK7kPMOpyR9StLroOI20CrvSxcZo0GQd_k36f1QANQoH20Frj2IXqZZcVxPSUVEPP6FAsA65RuT1F7tnmX7FTkmI/s640/IMG-20170629-WA0007.jpg" width="640" /></a></div>
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgzv_dOr-qQD3lgrfW7jzzvaeRl1mLiJUa50y4vXuqheryBziPFFn2F3SZbMGg6zlIXbMYGkS8PeIiG66VnzSJdUUNYqxwLU9JmWmqHm19X1chdY3qfN01WUiNQ1WMCdZyTyAPztgAsJC8/s1600/IMG-20170629-WA0008.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="780" data-original-width="1040" height="480" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgzv_dOr-qQD3lgrfW7jzzvaeRl1mLiJUa50y4vXuqheryBziPFFn2F3SZbMGg6zlIXbMYGkS8PeIiG66VnzSJdUUNYqxwLU9JmWmqHm19X1chdY3qfN01WUiNQ1WMCdZyTyAPztgAsJC8/s640/IMG-20170629-WA0008.jpg" width="640" /></a></div>
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiSzJwJaS3rrn95xdcOyjxhLa0m-O2q0t8jTVpP_zVaho1GfluTmOgleYVyGM8wp7VOtJ1PLVWLFSkulYXrfDgm94I2eJM-2gjY_4nO8UpGyGV82lY66iX8LU14G1Be1hp0B1-eXe3XbaA/s1600/IMG-20170629-WA0009.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1040" data-original-width="780" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiSzJwJaS3rrn95xdcOyjxhLa0m-O2q0t8jTVpP_zVaho1GfluTmOgleYVyGM8wp7VOtJ1PLVWLFSkulYXrfDgm94I2eJM-2gjY_4nO8UpGyGV82lY66iX8LU14G1Be1hp0B1-eXe3XbaA/s640/IMG-20170629-WA0009.jpg" width="480" /></a></div>
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgwNzswtWRaFPl3Z-NuS7uxDPodxKM-MfiLl2xGGIF4jt_6IYCXcmVbGTneAaOenUya5D954xwZzbgAY6EzIDaGcJYlO2qU4MRbRvhD9PB4HJwcKePmpUWWB_2Rag7iY3RbmEdIuMz2W-s/s1600/IMG-20170629-WA0010.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1040" data-original-width="780" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgwNzswtWRaFPl3Z-NuS7uxDPodxKM-MfiLl2xGGIF4jt_6IYCXcmVbGTneAaOenUya5D954xwZzbgAY6EzIDaGcJYlO2qU4MRbRvhD9PB4HJwcKePmpUWWB_2Rag7iY3RbmEdIuMz2W-s/s640/IMG-20170629-WA0010.jpg" width="480" /></a></div>
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjWti6mOz6c5riJT2NgZgd7PBmYoGDTirx02_OLqIFDIG_tv76y_ELYlE3oM-Ak1ZSjS6wJMZRVDTNvi1unp2UXzPuD_bdXKs_Mr2S3UT7VLFJQohebBQrZjSnZFCMW0owaw5w6xWVBFeg/s1600/IMG-20170629-WA0011.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="780" data-original-width="1040" height="480" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjWti6mOz6c5riJT2NgZgd7PBmYoGDTirx02_OLqIFDIG_tv76y_ELYlE3oM-Ak1ZSjS6wJMZRVDTNvi1unp2UXzPuD_bdXKs_Mr2S3UT7VLFJQohebBQrZjSnZFCMW0owaw5w6xWVBFeg/s640/IMG-20170629-WA0011.jpg" width="640" /></a></div>
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgMkMAEYcQf2CWFQdR7pWzE79yJ4jfEovyOcnpnsS6lIGm9xFXGxX5i_1SYNiYTcURxf59xwuDLV8pmosRZRkknJZaBb4F8f_4-5e6igrb4Dy91EEHMozNxnPsoZ3dqP2iANwVGNTkBHBA/s1600/IMG-20170629-WA0012.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="780" data-original-width="1040" height="480" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgMkMAEYcQf2CWFQdR7pWzE79yJ4jfEovyOcnpnsS6lIGm9xFXGxX5i_1SYNiYTcURxf59xwuDLV8pmosRZRkknJZaBb4F8f_4-5e6igrb4Dy91EEHMozNxnPsoZ3dqP2iANwVGNTkBHBA/s640/IMG-20170629-WA0012.jpg" width="640" /></a></div>
<br />
By the way, Netarhat is not more than 100 kilometres from our home in Barwadih. Along with <a href="http://jeevankuruvilla.blogspot.in/2012/08/satbarwas-niagara.html">other places</a> worth visiting near by, Netarhat is a must visit place. </div>
Jeevanhttp://www.blogger.com/profile/14805862105396943161noreply@blogger.com20tag:blogger.com,1999:blog-4522533979274351092.post-84627055964984849282017-06-29T18:48:00.000+05:302017-06-29T18:48:00.531+05:30Spare a thought<div dir="ltr" style="text-align: left;" trbidi="on">
<div style="text-align: justify;">
It has been raining all over the country. Friends and relatives from Kerala inform of the non-stop rain. There are floods in the North East. Along with parts of Tamil Nadu, our part of Jharkhand is yet to receive full fledged rains. </div>
<div style="text-align: justify;">
<br /></div>
<div style="text-align: justify;">
This was a sad sight in our neighbourhood yesterday. </div>
<div style="text-align: justify;">
<br /></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh_MtaS1mKz3zlM26bbHlHY_fbyPOn6izJ1GbMInkmjnvzuFytxgnerXu3dWaplukFZdaSBsfSRUgqLVdPcdeaYJ1waCrIhu5t_DBSs7UjZkJKFkhUM-V4h7S6GzhoYwGxOtNbOz2-gegA/s1600/IMG_20170628_170145.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="936" data-original-width="1248" height="478" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh_MtaS1mKz3zlM26bbHlHY_fbyPOn6izJ1GbMInkmjnvzuFytxgnerXu3dWaplukFZdaSBsfSRUgqLVdPcdeaYJ1waCrIhu5t_DBSs7UjZkJKFkhUM-V4h7S6GzhoYwGxOtNbOz2-gegA/s640/IMG_20170628_170145.jpg" width="640" /></a></div>
<br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjhT-MEOd_MXI3lnxL0RAJAOJO5rLSGSd50j8ELTcetRyFtPODpDfP6LEOg9ZSZz5cfhpuDd59JAv6d5rD2lopXPHAC6hhU-px2FWGXIGXdXyJtyrf8LgJGDSJJmVk77YEzvbRu7Tth5Sk/s1600/IMG_20170628_170211.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="936" data-original-width="1248" height="479" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjhT-MEOd_MXI3lnxL0RAJAOJO5rLSGSd50j8ELTcetRyFtPODpDfP6LEOg9ZSZz5cfhpuDd59JAv6d5rD2lopXPHAC6hhU-px2FWGXIGXdXyJtyrf8LgJGDSJJmVk77YEzvbRu7Tth5Sk/s640/IMG_20170628_170211.jpg" width="640" /></a></div>
<div style="text-align: justify;">
<br /></div>
<div style="text-align: justify;">
Almost all the tubewells in the region have dried off. Many families are depending on water-tankers for their daily supply of water. </div>
<div style="text-align: justify;">
<br /></div>
<div style="text-align: justify;">
Pray that rains will arrive soon. </div>
</div>
Jeevanhttp://www.blogger.com/profile/14805862105396943161noreply@blogger.com1tag:blogger.com,1999:blog-4522533979274351092.post-14410080212691023272017-06-29T03:00:00.000+05:302017-06-29T03:00:05.013+05:30Doubtful benefits<div dir="ltr" style="text-align: left;" trbidi="on">
<div style="text-align: justify;">
A major group of patients who come to us are those with non- communicable diseases being treated elsewhere who just cannot bear the cost of treatment. Of course, most of the extra expenses are a result of multivitamins and latest combination drugs which are expensive.</div>
<div style="text-align: justify;">
<br /></div>
<div style="text-align: justify;">
However, I was quite surprised to meet a well off gentleman who came to me last week. He was diagnosed to have diabetes and hyperthyroidism elsewhere. He was incurring a cost of 7000 INR every month just to purchase the medicines. Doctor consultation costs and blood tests were extra. He had met another doctor who told him that there was no need for so many medicines.</div>
<div style="text-align: justify;">
<br /></div>
<div style="text-align: justify;">
He came for a second opinion.</div>
<div style="text-align: justify;">
<br /></div>
<div style="text-align: justify;">
His original treating doctor was no small man. He was a senior cardiologist in a NABH accredited hospital in a state capital city of our country.</div>
<div style="text-align: justify;">
<br /></div>
<div style="text-align: justify;">
The best I could do was to call up one of my friends in the respective speciality.</div>
<div style="text-align: justify;">
<br /></div>
<div style="text-align: justify;">
The below snap shows the medicines he had with him. In the foreground is the medicines he absolutely needs and behind it are the medicines he could do without, which has not much evidence of significant benefit.</div>
<div style="text-align: justify;">
<br /></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjS-2aCPRAxhHprk1G7CZ-TEBAPqYjBTVcvRlKT_3AMiZpNVYKPHohxI4FLDXmIl3CBVrWJ60UXKI55gcu7MHa2bBPXeUj_XyHokZeT6jBW8m4EbHDpqjTkZiu5SQq-MSkvGHkeKFT6ULs/s1600/IMG_20170618_162902.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="851" data-original-width="1053" height="516" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjS-2aCPRAxhHprk1G7CZ-TEBAPqYjBTVcvRlKT_3AMiZpNVYKPHohxI4FLDXmIl3CBVrWJ60UXKI55gcu7MHa2bBPXeUj_XyHokZeT6jBW8m4EbHDpqjTkZiu5SQq-MSkvGHkeKFT6ULs/s640/IMG_20170618_162902.jpg" width="640" /></a></div>
<div style="text-align: justify;">
<br /></div>
<div style="text-align: justify;">
<br /></div>
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgKdMSf7d2igTdhiH5xH4jov6bsM8EREIlBpT9LE8NCcBtaAXXtv5e2biPlK5hoCKad5rIvnLdhdtWAFNsUQUsmDIDu6mqfH7bWyCS8yaiUACO7xwYumiPfc5gIZvlS5TByFgAikx6gjcA/s1600/IMG_20170618_162954.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="868" data-original-width="1600" height="346" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgKdMSf7d2igTdhiH5xH4jov6bsM8EREIlBpT9LE8NCcBtaAXXtv5e2biPlK5hoCKad5rIvnLdhdtWAFNsUQUsmDIDu6mqfH7bWyCS8yaiUACO7xwYumiPfc5gIZvlS5TByFgAikx6gjcA/s640/IMG_20170618_162954.jpg" width="640" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">A close up of the medicines we stopped. The protein powder and the sucralfate syrup is included.</td></tr>
</tbody></table>
<div style="text-align: justify;">
Now, this is a patient who can afford to spend 7000 INR. One can only imagine the plight of the poor who are given a similar prescription . . .</div>
<div style="text-align: justify;">
<br /></div>
<div style="text-align: justify;">
Well, I hope you looked at the second snap, which shows the medicines he stopped a bit close . . . In that bunch of medicines, I hope you noticed Tab. Faropenem 200 mg. The gentleman was having it twice a day since the last 10 days. I could not find any evidence of any sort of infection in the papers he had nor did he give any history of the same. </div>
<div style="text-align: justify;">
<br /></div>
<div style="text-align: justify;">
So much for evidence based medicine and the dangers of antibiotic resistance that we talk about . . . </div>
</div>
Jeevanhttp://www.blogger.com/profile/14805862105396943161noreply@blogger.com1tag:blogger.com,1999:blog-4522533979274351092.post-51274190155869147822017-06-28T15:15:00.000+05:302017-06-28T15:15:05.802+05:30Heights of Ignorance<div dir="ltr" style="text-align: left;" trbidi="on">
If you search my blog, there is a <a href="http://jeevankuruvilla.blogspot.in/2013/09/heights-of-ignorance.html">post with a similar title written on September 3, 2013</a>.<br />
<br />
I was aghast at finding a similar report in our local newspaper few days back.<br />
<br />
Below is the clip.<br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjdG8WkY0GMqBUPvBuO4ydDFPL39RKPJGc9VforU_CHd2cR0k64qkX2RjqeFntmTed4dtIHLu3FhlHr2WdKD_NvH7MW8Iq9Ca9UCNVgmfC7rY1gZPxCWQBVIAdAMu5EHrMBezr5YY530j8/s1600/IMG_20170624_140500.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1600" data-original-width="675" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjdG8WkY0GMqBUPvBuO4ydDFPL39RKPJGc9VforU_CHd2cR0k64qkX2RjqeFntmTed4dtIHLu3FhlHr2WdKD_NvH7MW8Iq9Ca9UCNVgmfC7rY1gZPxCWQBVIAdAMu5EHrMBezr5YY530j8/s1600/IMG_20170624_140500.jpg" /></a></div>
<div class="separator" style="clear: both; text-align: center;">
</div>
<br />
<div style="text-align: justify;">
The headline screams - Superstition: Buried dead body of girl exhumed on instructions from traditional medicine-man. Medicine-man claims that dead girl will live. </div>
<div style="text-align: justify;">
<br /></div>
<div style="text-align: justify;">
The news report is about a family who lost their 6 year old daughter after a snakebite. After the dead body of the girl was buried, a traditional medicine-man turned up who claimed that the girl is not dead, but alive. The family readily exhumed the dead body. However, when the family shifted the body for witchcraft, the local temple priest declared that the girl was dead. </div>
<div style="text-align: justify;">
<br /></div>
<div style="text-align: justify;">
The incident happened in Kankari village, which is 11 kilometers from the Palamu district headquarters of Medhininagar, previously called Daltonganj. </div>
</div>
Jeevanhttp://www.blogger.com/profile/14805862105396943161noreply@blogger.com1tag:blogger.com,1999:blog-4522533979274351092.post-7021430599861063472017-06-27T22:52:00.000+05:302017-06-28T09:05:24.602+05:30Perungalam 2016<div dir="ltr" style="text-align: left;" trbidi="on">
<div style="text-align: justify;">
Last year, during our summer vacations, my dad suggested us to spend couple of days at the Marthoma Retreat Centre in Perungalam, Kollam District, Kerala. The experience was too good that we decided to spend couple of days at the Dhyanatheeram this year too. </div>
<div style="text-align: justify;">
<br /></div>
<div style="text-align: justify;">
I had thought of putting up few snaps of our visit to this place last year itself, which never materialised. So, better late than never. </div>
<div class="separator" style="clear: both; text-align: center;">
</div>
<br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi7GyVtwu4AquSrgWpzV9lIAuzVSHqwYKtBfFOhrEC32zXnZHncEOB5QeN47pO4wX3e_7_d31WWHknnUBU2PIAMes-KLKf1R1Mu-WvbK3uH4QYHw1A_YFFRGL8J7snqQitK2Z0nLQaKxMk/s1600/IMG_20160602_151832.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="735" data-original-width="980" height="476" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi7GyVtwu4AquSrgWpzV9lIAuzVSHqwYKtBfFOhrEC32zXnZHncEOB5QeN47pO4wX3e_7_d31WWHknnUBU2PIAMes-KLKf1R1Mu-WvbK3uH4QYHw1A_YFFRGL8J7snqQitK2Z0nLQaKxMk/s640/IMG_20160602_151832.jpg" width="640" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Waiting for the boat. It is cheaper to get the public transport boat from Ashtamudi Vallakkadavu boat jetty</td></tr>
</tbody></table>
<br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEieG2P49A4FlBDQ9-hkjX745gTJq4s6NRJm1SirYVn75StcYTwRewluzNzWJPI3sV6j54myECDrYH2vMWe9sH_43BTw7MGuwJUNfVMMDpzCqpjCMaSabAjMOyHBXBbwnjdrIl5IYMM3J0M/s1600/IMG_20160602_153900.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="735" data-original-width="980" height="478" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEieG2P49A4FlBDQ9-hkjX745gTJq4s6NRJm1SirYVn75StcYTwRewluzNzWJPI3sV6j54myECDrYH2vMWe9sH_43BTw7MGuwJUNfVMMDpzCqpjCMaSabAjMOyHBXBbwnjdrIl5IYMM3J0M/s640/IMG_20160602_153900.jpg" width="640" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">You can see the boat approaching . . . </td></tr>
</tbody></table>
<br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg8-l4kEzjkbm50GY7lCow58w59Gsw8I9-_VLXp3Z5eDeOCwxLgOR2z4qPyoZqYAmuThl98OnBSt4s5VXN_W_kCwiX8I_-HnJWemqmiWRH5LvQ5PffqHyJyURPMqQASkesnXZ_GzSiuWkM/s1600/IMG_20160602_154019.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="735" data-original-width="980" height="478" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg8-l4kEzjkbm50GY7lCow58w59Gsw8I9-_VLXp3Z5eDeOCwxLgOR2z4qPyoZqYAmuThl98OnBSt4s5VXN_W_kCwiX8I_-HnJWemqmiWRH5LvQ5PffqHyJyURPMqQASkesnXZ_GzSiuWkM/s640/IMG_20160602_154019.jpg" width="640" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Getting ready to board the boat along with the regular commuters</td></tr>
</tbody></table>
<br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiWobxe9YR1kW2AQz7dc_ux17Y9OE_noSJ8SjiCqaKTvGw1klweOZH8aVwN3TtZJ6POrFji3bPJVcpZUz3Ru1AJSDPcSivIyg54tyUBShLbigBXl-cvnK-yNilA6bKxuMLkxx1pLf89MZ0/s1600/IMG_20160602_155424.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="735" data-original-width="980" height="478" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiWobxe9YR1kW2AQz7dc_ux17Y9OE_noSJ8SjiCqaKTvGw1klweOZH8aVwN3TtZJ6POrFji3bPJVcpZUz3Ru1AJSDPcSivIyg54tyUBShLbigBXl-cvnK-yNilA6bKxuMLkxx1pLf89MZ0/s640/IMG_20160602_155424.jpg" width="640" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Scenery from the boat</td></tr>
</tbody></table>
<br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgA-Ng7w8NRldHHReFXyqeinI6ooIK-ZuwExSkk6-XFY26o7YAoCHZYdTwxWA8FauKO-F76Z6dYE1Jgysq2XY-OiZF40AFSk6gMbT_xL30OqtblEniH5IZxyAyHO16wCPLEmI4AzXAVR5c/s1600/IMG_20160602_155544.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="735" data-original-width="980" height="478" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgA-Ng7w8NRldHHReFXyqeinI6ooIK-ZuwExSkk6-XFY26o7YAoCHZYdTwxWA8FauKO-F76Z6dYE1Jgysq2XY-OiZF40AFSk6gMbT_xL30OqtblEniH5IZxyAyHO16wCPLEmI4AzXAVR5c/s640/IMG_20160602_155544.jpg" width="640" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Approaching the retreat centre</td></tr>
</tbody></table>
<br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgYXlP7RnjtQ3Zk5Bp-fAjpKFq6gjjIyoiF4BrZwe1QsqTmXFtkpDttc5qGdtYt-XuBzu7RqH6dhOsOfdwDdsnRUWWZh81rxonzAkkEd72AGEIZ_xsqMhz1OnLHgh8hW2DTPD0zRGNh7Dw/s1600/IMG_20160602_160257.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="735" data-original-width="980" height="478" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgYXlP7RnjtQ3Zk5Bp-fAjpKFq6gjjIyoiF4BrZwe1QsqTmXFtkpDttc5qGdtYt-XuBzu7RqH6dhOsOfdwDdsnRUWWZh81rxonzAkkEd72AGEIZ_xsqMhz1OnLHgh8hW2DTPD0zRGNh7Dw/s640/IMG_20160602_160257.jpg" width="640" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">The view of the backwaters from the balcony of our room</td></tr>
</tbody></table>
<br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjblDQ5h25bTM0dQHr427YLB5CCdShMwi43joaJj4EVb9kwHtmiBnCmLYCC3wgpLzMim9Zq6Kgx5E7STtNpGlgRGj2Jja2kStyyAV0tkqPgTesm3KIXtzuoG0BuXxBOBWCjNZ20iy-wcHA/s1600/IMG_20160602_182015.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="720" data-original-width="960" height="480" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjblDQ5h25bTM0dQHr427YLB5CCdShMwi43joaJj4EVb9kwHtmiBnCmLYCC3wgpLzMim9Zq6Kgx5E7STtNpGlgRGj2Jja2kStyyAV0tkqPgTesm3KIXtzuoG0BuXxBOBWCjNZ20iy-wcHA/s640/IMG_20160602_182015.jpg" width="640" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">A selfie with the pet emu of the retreat centre</td></tr>
</tbody></table>
<br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEizEVnyzCwn4tKIQXVqLBBaPu4J16ylmX47mROsx9aNQxFX4CsRqe5-wGnxmrhQFznDDCQzMBKs0Z02unXLWiDFYKoDq6HWtXzjkJ0w4MJFa1sm0jYIzt95PU-UfVpuH0iqAI3H2NMhkyk/s1600/IMG_20160603_092242.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="735" data-original-width="980" height="478" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEizEVnyzCwn4tKIQXVqLBBaPu4J16ylmX47mROsx9aNQxFX4CsRqe5-wGnxmrhQFznDDCQzMBKs0Z02unXLWiDFYKoDq6HWtXzjkJ0w4MJFa1sm0jYIzt95PU-UfVpuH0iqAI3H2NMhkyk/s640/IMG_20160603_092242.jpg" width="640" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">A view of the entrance from the inside</td></tr>
</tbody></table>
<br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj0zbGTZaTd2dgbqQ60Vb2bpObmue0JyN3-KZj018gbqBG49XeAvM0xpzQXWI9lzqD96q673YEnIxzML_mykyQvWrDn3lCKFLA3JB5U4OfVB0Hr5MxzydKcaZaWbOpp9uAThsJGiYEZTUA/s1600/IMG_20160603_094216.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="735" data-original-width="980" height="478" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj0zbGTZaTd2dgbqQ60Vb2bpObmue0JyN3-KZj018gbqBG49XeAvM0xpzQXWI9lzqD96q673YEnIxzML_mykyQvWrDn3lCKFLA3JB5U4OfVB0Hr5MxzydKcaZaWbOpp9uAThsJGiYEZTUA/s640/IMG_20160603_094216.jpg" width="640" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Children's play area . . .</td></tr>
</tbody></table>
<br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjCisGj5EX5dRVr7LUWa3ZXphiSgFv98_kPVrFvDYdkcSEVoSrOq_83DPaGxtwbuafSjwrPBwuOhFCHKATBQOGh9g9f1YIg_Hkh3lOIwxyLS6qir03xtMstfPBpMyZW5tT3ToFBZWZcwTs/s1600/IMG_20160603_094247.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="735" data-original-width="980" height="478" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjCisGj5EX5dRVr7LUWa3ZXphiSgFv98_kPVrFvDYdkcSEVoSrOq_83DPaGxtwbuafSjwrPBwuOhFCHKATBQOGh9g9f1YIg_Hkh3lOIwxyLS6qir03xtMstfPBpMyZW5tT3ToFBZWZcwTs/s640/IMG_20160603_094247.jpg" width="640" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Arpit enjoying a merry go round with Ammachy</td></tr>
</tbody></table>
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg35prEiOlshdgq12uTZVk7YEpaIx47St8XUv-PJGBRLq8wiMX1NTW3aaBXOphslUKLDY9LV5D8FQSm1nBpvEDMTNB-DS5UWyKnClJKu9vL_pamomGbjnKclx1iJo4Hu2SG7iahMma0ug8/s1600/IMG-20160603-WA0006.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="676" data-original-width="1200" height="360" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg35prEiOlshdgq12uTZVk7YEpaIx47St8XUv-PJGBRLq8wiMX1NTW3aaBXOphslUKLDY9LV5D8FQSm1nBpvEDMTNB-DS5UWyKnClJKu9vL_pamomGbjnKclx1iJo4Hu2SG7iahMma0ug8/s640/IMG-20160603-WA0006.jpg" width="640" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">The highlight of the trip - hooking a pearl spot fish (karimeen), the local delicacy,<br />
This made the children look forward to another trip the following year</td></tr>
</tbody></table>
<div style="text-align: justify;">
<br /></div>
</div>
Jeevanhttp://www.blogger.com/profile/14805862105396943161noreply@blogger.com1tag:blogger.com,1999:blog-4522533979274351092.post-60169477445550507462017-06-24T02:30:00.000+05:302017-06-24T02:30:29.982+05:30How much poor ? <div dir="ltr" style="text-align: left;" trbidi="on">
<div style="text-align: justify;">
As health care professionals, Angel and me get exposed to horrible levels of poverty almost every day. There have been many many stories. Few days back, I was reminded once again on how bad the poverty can be. </div>
<div style="text-align: justify;">
<br /></div>
<div style="text-align: justify;">
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhSbs5cKb-puTXKRuZ39ppwBbj6rEtMNsSchPi24CsThShTE4cPYY6oWlFp_i-LuPuaMnUUTh1LCbD6n9jpALUgp9uhD7cLRmkhBQ1cl8HCHTiZCRd-Mbkidj6DFmBDTpUP2aI79GaQjFY/s1600/old+man.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" data-original-height="1023" data-original-width="555" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhSbs5cKb-puTXKRuZ39ppwBbj6rEtMNsSchPi24CsThShTE4cPYY6oWlFp_i-LuPuaMnUUTh1LCbD6n9jpALUgp9uhD7cLRmkhBQ1cl8HCHTiZCRd-Mbkidj6DFmBDTpUP2aI79GaQjFY/s320/old+man.jpg" width="173" /></a></div>
6 months back, we had an elderly man walk into our clinic with a retention of urine. He needed catherisation of the urinary bladder, which ultimately ended up with a permanent indwelling catheter. Leave alone the option of undergoing a surgery to open up his prostatic urethra, he could not afford the trip to meet the surgeon. </div>
<div style="text-align: justify;">
<br /></div>
<div style="text-align: justify;">
The maximum we could offer was a permanent indwelling catheter, which is not exactly the ideal option of treatment. He needed to get it changed once a month. </div>
<div style="text-align: justify;">
<br /></div>
<div style="text-align: justify;">
We also told him about the better options that he has. He laughed them off saying that unless someone does it on him for free, our treatment is what he preferred. In addition, he also had high blood pressure. </div>
<div style="text-align: justify;">
<br /></div>
<div style="text-align: justify;">
He came regularly till January 2017. Then we did not see him. In fact, we remembered him. Maybe he died. Or, someone gave him some money to undergo the surgery. </div>
<div style="text-align: justify;">
<br /></div>
<div style="text-align: justify;">
Today, he turned up. He was in severe pain. And his catheter had blocked. He had kept his catheter for a full 3 months.</div>
<div style="text-align: justify;">
<br /></div>
<div style="text-align: justify;">
It was a nightmare. There was skin enveloping over the catheter. It was dry and was very dirty. The attending nurse could not deflate the bulb. I could only shudder on what we will do if the catheter had become stuck. He would have to visit a urologist. The nearest one was 200 kilometers away. The maximum money he usually has with him has never crossed 200 INR, not even enough to cover the travelling cost of one person to the urologist. </div>
<div style="text-align: justify;">
<br /></div>
<div style="text-align: justify;">
We could only pray. And reattempt to deflate the bulb. It just did not budge. As we attempted again, the valve at the balloon port, broke off. To our relief, as that happened, water started to drip from the broken balloon port and with a bit of a pull, the catheter was out. The balloon end of the catheter was covered with clotted blood for about 10 cms. Thankfully, there was no bleeding from the urethra. </div>
<div style="text-align: justify;">
<br /></div>
<div style="text-align: justify;">
After everything was over, I asked the elderly man for the reason for the long delay. He told me that his son reasoned to him that it would be cheaper to wait longer before the catheter is changed. And there was no money in the family. The elderly man and his wife were non-performing assets for his son. His son was away in Kerala now. </div>
<div style="text-align: justify;">
<br /></div>
<div style="text-align: justify;">
The bill for today totaled about 400 INR. And there was a outstanding due of about 200 INR from his previous visits. I asked him how much he could pay today. He told 250 INR. We took 200 INR and wrote off the rest. </div>
<div style="text-align: justify;">
<br /></div>
<div style="text-align: justify;">
For such a patient, I cannot see how he can afford a surgical procedure even if I could offer one. Unless, we wrote off the entire amount. </div>
<div style="text-align: justify;">
<br /></div>
<div style="text-align: justify;">
There has been many a debate on how the poor can be treated. I believe there is only one way until full-fledged public healthcare becomes a reality in the country - teach them to prevent diseases, access treatment at the earliest and offer them options which they can afford. </div>
<div style="text-align: justify;">
<br /></div>
<div style="text-align: justify;">
Of course, there are always better ways of treatment. Someone could fund it out. But, the question remains about how long . . . about how sustainable are many of the healthcare options we have today . . .<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg77SMmeT9eD2qOpJl_gOV89gQoaIjgvHNp4LRibX4kS4weGpfHft3q3SqHCIfgw1nR0DOqlSUMDDAvm9V_k18nxLQFgNudbrVNnLinIYyov5TyomcGEgF7O81H9KeH-tXoiWZ4IUvaoVw/s1600/begging+hands.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="214" data-original-width="799" height="170" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg77SMmeT9eD2qOpJl_gOV89gQoaIjgvHNp4LRibX4kS4weGpfHft3q3SqHCIfgw1nR0DOqlSUMDDAvm9V_k18nxLQFgNudbrVNnLinIYyov5TyomcGEgF7O81H9KeH-tXoiWZ4IUvaoVw/s640/begging+hands.jpg" width="640" /></a></div>
<br /></div>
</div>
Jeevanhttp://www.blogger.com/profile/14805862105396943161noreply@blogger.com1tag:blogger.com,1999:blog-4522533979274351092.post-12775550774831451612017-06-23T14:30:00.002+05:302017-06-23T14:30:21.263+05:30To do list<div dir="ltr" style="text-align: left;" trbidi="on">
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjp1vnjD5nzWZ63sGtauwzPWRYMDBI0N3d5wOwLs4XzhfccvVw8ykSy5NWeIj1v9tYfIIfsZrBF2ajgGVHUhLJucME_lioooJS61Hqp2EZnydLVWfZIAuhLxPw3vs1Df4arX9Uj2nDYq10/s1600/sickbed1.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="458" data-original-width="1564" height="186" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjp1vnjD5nzWZ63sGtauwzPWRYMDBI0N3d5wOwLs4XzhfccvVw8ykSy5NWeIj1v9tYfIIfsZrBF2ajgGVHUhLJucME_lioooJS61Hqp2EZnydLVWfZIAuhLxPw3vs1Df4arX9Uj2nDYq10/s640/sickbed1.jpg" width="640" /></a></div>
<br />
Few weeks back, I had a unique experience.<br />
<br />
Early morning at around 7 am, a man was rushed into our clinic with complaints of chest pain since the last 2 days. He was taking some local treatment elsewhere when the pain became unbearable since midnight. He had a feeling that his life was coming to an end.<br />
<br />
We made him comfortable, gave some analgesics and went ahead with an ECG. It was obviously a heart attack in progress.<br />
<br />
He asked me if he was having a heart attack which he knew could be fatal. I told him that he appears to be having a heart attack. Although in severe pain, he asked one of the bystanders, who seemed to be his son to bring him a paper and a pen. We provided him with one.<br />
<br />
He was in too much distress to write. He told his son to write as he dictated. It was basically names of people along with amounts of money which they owed him. It took some time for him to remember, but he thought he had all names. The total was quite a bit of an amount .. .. ..<br />
<br />
As I witnessed this exercise, I remembered about how people like Moses, Joseph, Abraham etc. of the Old Testament in the Bible called all his children and blessed them as they lay dying.<br />
<br />
I wondered what I will have to tell my children and grandchildren as I reach my last days on earth . . .<br />
<br />
My prayer is that it would only be to tell my family about how good the Lord has been and how good is it to trust and follow the Lordship of Jesus Christ . . .<br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiUyVqKKYOM-lCGiol2YUjbU0glAQSzNau0JUwYH5KiGMFq5bQEwtpzhuF-SJv8X2N0z2pzB5mFfKt96CXjVz8BU0T6wQ_ReY4j2jWfWGFRV5kORTO6TA6qYA0dfKu2BBYpqKMGthiuujM/s1600/sickbed.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="495" data-original-width="1564" height="202" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiUyVqKKYOM-lCGiol2YUjbU0glAQSzNau0JUwYH5KiGMFq5bQEwtpzhuF-SJv8X2N0z2pzB5mFfKt96CXjVz8BU0T6wQ_ReY4j2jWfWGFRV5kORTO6TA6qYA0dfKu2BBYpqKMGthiuujM/s640/sickbed.jpg" width="640" /></a></div>
<br /></div>
Jeevanhttp://www.blogger.com/profile/14805862105396943161noreply@blogger.com2tag:blogger.com,1999:blog-4522533979274351092.post-85438938100954084792017-05-25T16:40:00.001+05:302017-05-25T16:40:51.626+05:30Misleading . . .<div dir="ltr" style="text-align: left;" trbidi="on">
<div style="text-align: justify;">
One of the major group of patients whom we serve at Barwadih are those who present with diarrhoea. Since last few months, quite a many of the patients tell us not to prescribe Oral Rehydration Solution powder as there is a ready to drink ORS preparation available in the market. </div>
<div style="text-align: justify;">
<br /></div>
<div style="text-align: justify;">
I did not care much as this drink called ORSL was quite commonly available in the market and patients especially children preferred it over the ORS powder which we prescribed. On and off, we used to get patients who said that they did not feel better and requested for the ORS powder. </div>
<div style="text-align: justify;">
<br /></div>
<div style="text-align: justify;">
However, I was in for a shock today, when a patient with diarrhoea walked in with this packaged drink. The snaps of the tetrapack are self-explanatory. </div>
<div style="text-align: justify;">
<br /></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhJxPag5VmxGCfESiVUP5VZuugQd_-RjVXTg3M7YAPkvR4D4Eb8RzLsgI9DCXq40pa7bKRnUzc-Ip4nAnfJQTBML-o2ORRnKIVvWGeGm58ws-f50uAA2dCWqgizkkcmSGx3jl0sU_-e36k/s1600/For+blog.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1033" data-original-width="1145" height="576" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhJxPag5VmxGCfESiVUP5VZuugQd_-RjVXTg3M7YAPkvR4D4Eb8RzLsgI9DCXq40pa7bKRnUzc-Ip4nAnfJQTBML-o2ORRnKIVvWGeGm58ws-f50uAA2dCWqgizkkcmSGx3jl0sU_-e36k/s640/For+blog.jpg" width="640" /></a></div>
<div style="text-align: justify;">
<br /></div>
<div style="text-align: justify;">
<span style="font-family: inherit;">The manufacturer has very clearly stated that IT IS NOT TO BE USED FOR DIARRHOEA and there is no mention of the WHO accepted formulation for ORS. </span></div>
<div style="text-align: justify;">
<span style="font-family: inherit;"><br /></span></div>
<div style="text-align: justify;">
<span style="font-family: inherit;">For those who don't know t<span style="background-color: white; color: #222222;">he formula for the current WHO oral rehydration solution (also known as </span><i style="background-color: white; color: #222222;">low-osmolar ORS</i><span style="background-color: white; color: #222222;"> or </span><i style="background-color: white; color: #222222;">reduced-osmolarity ORS</i><span style="background-color: white; color: #222222;">) is 2.6 grams (0.092 oz) salt (NaCl), 2.9 grams (0.10 oz) </span><a href="https://en.wikipedia.org/wiki/Trisodium_citrate" style="background: none rgb(255, 255, 255); color: #0b0080; text-decoration-line: none;" title="Trisodium citrate">trisodium citrate</a><span style="background-color: white; color: #222222;"> dihydrate </span></span><span style="background-color: white; color: #222222; font-family: inherit;">, 1.5 grams (0.053 oz) potassium chloride (</span><a class="mw-redirect" href="https://en.wikipedia.org/wiki/KCl" style="background: none rgb(255, 255, 255); color: #0b0080; font-family: inherit; text-decoration-line: none;" title="KCl">KCl</a><span style="background-color: white; color: #222222; font-family: inherit;">), 13.5 grams (0.48 oz) </span><a href="https://en.wikipedia.org/wiki/Anhydrous" style="background: none rgb(255, 255, 255); color: #0b0080; font-family: inherit; text-decoration-line: none;" title="Anhydrous">anhydrous</a><span style="background-color: white; color: #222222; font-family: inherit;"> </span><a href="https://en.wikipedia.org/wiki/Glucose" style="background: none rgb(255, 255, 255); color: #0b0080; font-family: inherit; text-decoration-line: none;" title="Glucose">glucose</a><span style="background-color: white; color: #222222; font-family: inherit;"> per litre of fluid. This fruit drink has a whopping 12 gms of sugar per 200 ml. </span></div>
<div style="text-align: justify;">
<br /></div>
<div style="text-align: justify;">
So, why the name - ORSL - which appears to stand for ORS Liquid. </div>
<div style="text-align: justify;">
<br /></div>
<div style="text-align: justify;">
I've seen patients buy this drink in cartons from local pharmacy shops. </div>
<div style="text-align: justify;">
<br /></div>
<div style="text-align: justify;">
Now, for the shocker . . . The below snap shows the price for this 200 ml drink which misleads people to think that it is a medicine. </div>
<div style="text-align: justify;">
<br /></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg4TAY9JgI0zpujhJtjnvKslw-7zfQLsHmktwndMYbAq64_OHSznYc1Pc6AvDbS8DFFw84YDk3qL2rR466TA1244hCo93wdirKtu3L6pDdo1qMRnvDqDjk-jtj9UlQPT0XTDaJYF5-CYXY/s1600/IMG_20170525_105944.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="460" data-original-width="607" height="302" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg4TAY9JgI0zpujhJtjnvKslw-7zfQLsHmktwndMYbAq64_OHSznYc1Pc6AvDbS8DFFw84YDk3qL2rR466TA1244hCo93wdirKtu3L6pDdo1qMRnvDqDjk-jtj9UlQPT0XTDaJYF5-CYXY/s400/IMG_20170525_105944.jpg" width="400" /></a></div>
<div style="text-align: justify;">
<br /></div>
<div style="text-align: justify;">
32 INR . . . when the ORS sachets are available free in public healthcare facilities and the maximum cost of a ORS sachet which makes 1 litre of the fluid is about 16 INR. So, a misled patient could end up spending 160 INR per one litre of ORSL instead of 16 INR. </div>
<div style="text-align: justify;">
<br /></div>
<div style="text-align: justify;">
Quite misleading marketing strategy to make a quick buck . . . Can't someone take this company to task for misleading people into buying this sugary drink, which is in fact harmful to health. At least they should print 'Do not use during diarrhoea' in larger print and the local vernacular language. Instead they have printed ORSL in Hindi to mislead the unsuspecting poor and the half literate Indian. </div>
<div style="text-align: justify;">
<br /></div>
<div style="text-align: justify;">
A typical example of how crony capitalism makes it's profits . . . </div>
</div>
Jeevanhttp://www.blogger.com/profile/14805862105396943161noreply@blogger.com6tag:blogger.com,1999:blog-4522533979274351092.post-43355711162129992522017-04-15T15:26:00.000+05:302017-04-15T15:26:31.026+05:30My goats are on the hill<div dir="ltr" style="text-align: left;" trbidi="on">
<div style="text-align: justify;">
It's diarrhoea season at our place now. Patients of all ages are coming in various stages of the disease. So far, the good Lord has healed everyone.</div>
<div style="text-align: justify;">
<br /></div>
<div style="text-align: justify;">
Yesterday, we got the sickest of the lot. Around late morning, an elderly lady was carried in with a history of high volume rice water diarrhoea along with severe vomitting. We could not palpate any pulse.</div>
<div style="text-align: justify;">
<br /></div>
<div style="text-align: justify;">
We were blessed enough to get a vein on her. After about 2 litres of fluid, we could measure her blood pressure.</div>
<div style="text-align: justify;">
<br /></div>
<div style="text-align: justify;">
By teatime, she was up and talking. However, she appeared so tired. During evening rounds, she wanted to go home. I told her that considering the state in which she was brought in and it being evening, it would be better for her to go the next day. I said to her that she looked tired and would benefit from a day's rest. </div>
<div style="text-align: justify;">
<br /></div>
<div style="text-align: justify;">
She told me, 'I'm not able to close my eyes to get some sleep. The moment I close my eyes, I only see my goats which I had to leave as I was brought here. They are still on the hill. I need to ensure that they are back safe'. One of her sons told her that she needn't worry about the goats as someone had already brought them back home.</div>
<div style="text-align: justify;">
<br /></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhbrFwM57UH7a2WPDgbpQa04Py9ru4sfU_u9hGMOVFv_hrtcLfnX0Zs5j0QIJrlgpAFIV7nLEM0H9Ecr98dbTQFpr0_SoGaRHigG66fbyOu4dBP1UUHWDeekSUKK_lXxIahfsh_10JFqvI/s1600/goats.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="198" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhbrFwM57UH7a2WPDgbpQa04Py9ru4sfU_u9hGMOVFv_hrtcLfnX0Zs5j0QIJrlgpAFIV7nLEM0H9Ecr98dbTQFpr0_SoGaRHigG66fbyOu4dBP1UUHWDeekSUKK_lXxIahfsh_10JFqvI/s320/goats.jpg" width="320" /></a></div>
<div style="text-align: justify;">
Amazing . . . even when she was so sick, the only thing she could think about was her goats. In rural areas, animals are the major asset for everyone. That was their bank balance. But, you had to regularly take care of them, unlike a bank account where you are assured of the money which was deposited there. Anytime they need some money one of the animals was sold. </div>
<div style="text-align: justify;">
<br /></div>
<div style="text-align: justify;">
In the changing scenario of the country, when there is a push towards vegetarianism, I can only wonder at the fate of the poor who will have to look for other avenues of income. Or maybe, there will be no more poor . . . </div>
</div>
Jeevanhttp://www.blogger.com/profile/14805862105396943161noreply@blogger.com2tag:blogger.com,1999:blog-4522533979274351092.post-86146262735881267442017-04-02T22:17:00.001+05:302017-04-02T22:17:29.220+05:30Gas . . . Gas . . . and Gas<div dir="ltr" style="text-align: left;" trbidi="on">
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiL2hvALVD85lSk8XqhZ0iAa_A5Oi8ZYodtDcqVm5KxdhFK-UwY4tksaEmpBSuTJxKIRRbSFR8xapPSjvE-HwvcgDIr9uUHnHHdD1VVnG__uaiZO81kriooSJNbw-UsV5N58yfHEvgh-iE/s1600/water+balloons.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="218" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiL2hvALVD85lSk8XqhZ0iAa_A5Oi8ZYodtDcqVm5KxdhFK-UwY4tksaEmpBSuTJxKIRRbSFR8xapPSjvE-HwvcgDIr9uUHnHHdD1VVnG__uaiZO81kriooSJNbw-UsV5N58yfHEvgh-iE/s400/water+balloons.jpg" width="400" /></a></div>
<div style="text-align: justify;">
<br /></div>
<div style="text-align: justify;">
Three days back, we had a elderly lady being brought. Carried in her son's arms, she was worn out and thin with a protruding abdomen. Clearly a case of ascites or a large abdominal tumour. </div>
<div style="text-align: justify;">
<br /></div>
<div style="text-align: justify;">
Since it was close to afternoon, I did a quick examination and sent her off for a 30 kilometer journey for an ultrasound abdomen. </div>
<div style="text-align: justify;">
<br /></div>
<div style="text-align: justify;">
She was back just before sunset with the ultrasound report. It was just ascites. No tumour. There was mention of a possibility of a chronic liver disease.</div>
<div style="text-align: justify;">
<br /></div>
<div style="text-align: justify;">
That was when I took a detailed history. She had been having this much abdominal distension since the last 1 month. She had already been treated at multiple places and had spent almost 15000 INR. It was not that they could afford that much. That was what the quacks demanded for the treatment. </div>
<div style="text-align: justify;">
<br /></div>
<div style="text-align: justify;">
The quacks had been telling the family since the first day that it was just gas that is pent up in the intestines. They even had a X-Ray abdomen to prove the point. </div>
<div style="text-align: justify;">
<br /></div>
<div style="text-align: justify;">
She had not yet been seen by a proper doctor. </div>
<div style="text-align: justify;">
<br /></div>
<div style="text-align: justify;">
I got into a mini-conference with two of her male relatives and told of the possibilities. They wanted me to give her some medicines to dry out the fluid collection. They did not want an ascitic tap to take out the fluid and do some tests. The only test we could do was a microscopic examination. Under no circumstances, they were ready to take her ahead for treatment. </div>
<div style="text-align: justify;">
<br /></div>
<div style="text-align: justify;">
She did not respond to the diuretics that I tried. Ultimately, they agreed for a tap with the fiat that whatever tests I had to do with it has to be done here. They just did not want to take her nor the fluid ahead for any tests. </div>
<div style="text-align: justify;">
<br /></div>
<div style="text-align: justify;">
I did the tap today. It was a hemorrhagic tap. Microscopy showed almost 99% lymphocytes along with the red blood cells. It was more in favour of a cancer. Well, it could be tuberculosis too. Liver function tests were all normal. </div>
<div style="text-align: justify;">
<br /></div>
<div style="text-align: justify;">
The best I could do for her was to start her off on anti-tuberculous medication and send her home. </div>
<div style="text-align: justify;">
<br /></div>
<div style="text-align: justify;">
But, it would have been better if she came straight to us before they blew up 15000 INR for the quacks to remove the gas . . . </div>
<div style="text-align: justify;">
<br /></div>
<div style="text-align: justify;">
The big question is how I can enable families like these to see us as their first choice for access to healthcare . . . rather than these quacks . . . </div>
<div style="text-align: justify;">
<br /></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgaBTam6WRIQfwrSt84Aoyp1eGY4ptmKW7FETx4McamAGYBfJmkHDLmTOL0cv2bm7RpzzlFz825gi0Vwwa8XZ8sRi9bBKcBEiMfWeDLP144nFOzYvkRT2YSjUH4XnTAYy4qjVn0WTKsTY4/s1600/30511960-flying-indian-rupee.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="100" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgaBTam6WRIQfwrSt84Aoyp1eGY4ptmKW7FETx4McamAGYBfJmkHDLmTOL0cv2bm7RpzzlFz825gi0Vwwa8XZ8sRi9bBKcBEiMfWeDLP144nFOzYvkRT2YSjUH4XnTAYy4qjVn0WTKsTY4/s640/30511960-flying-indian-rupee.jpg" width="640" /></a></div>
<div style="text-align: justify;">
<br /></div>
</div>
Jeevanhttp://www.blogger.com/profile/14805862105396943161noreply@blogger.com0tag:blogger.com,1999:blog-4522533979274351092.post-45245202166577659722017-03-26T17:02:00.002+05:302017-04-02T19:27:30.291+05:30Oh . . . Ragi . . . <div dir="ltr" style="text-align: left;" trbidi="on">
After quite a long time since we had been <a href="http://jeevankuruvilla.blogspot.in/2014/01/finger-millet-recipes-book.html?m=1">trying to reintroduce Ragi</a> into the local diet (since 2011), we still don't have any data to prove that we've made any impact.<br />
<br />
However, I keep hearing stories on how many more farmers grow millets in the Palamu region now.<br />
<br />
And, on and off we get to eat ragi dishes when I visit mission stations, like the 'Ragi puttu' we were served last week at Chandwa.<br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiJvpqv-7kiAdvB-CkdUohuinqJy3AVkMNTslEQ-VKXRu7jN_byO6iMGLL_wqUr7iBUhyn4xpcSdg1xMYqkhyphenhyphentRjMo8KVewKETm_juPq_Au2pP7YpCFRHXTTzpX6mag_neXGPtrb5QCmEg/s1600/IMG_20170323_085005.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="300" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiJvpqv-7kiAdvB-CkdUohuinqJy3AVkMNTslEQ-VKXRu7jN_byO6iMGLL_wqUr7iBUhyn4xpcSdg1xMYqkhyphenhyphentRjMo8KVewKETm_juPq_Au2pP7YpCFRHXTTzpX6mag_neXGPtrb5QCmEg/s400/IMG_20170323_085005.jpg" width="400" /></a></div>
<br />
I was told that this dish is relished by quite a many of the residents there.<br />
<br />
May the tribe of ragi lovers increase . . . </div>
Jeevanhttp://www.blogger.com/profile/14805862105396943161noreply@blogger.com2tag:blogger.com,1999:blog-4522533979274351092.post-46036512553848568872017-03-16T12:08:00.001+05:302017-03-16T12:08:33.484+05:30Nowhere to go . . . <div dir="ltr" style="text-align: left;" trbidi="on">
<div style="text-align: justify;">
It was the festival of colors early this week. The whole country was in celebration. With our Prime Minister getting a major boost to his 'make India great again', the celebratory mood was well felt in every nook and corner of our communities. There were major things coming for the poor . . . the rich will be taken to task . . . there will be no more corruption . . . no-one will ever go hungry . . . there will be no more deprivation . . . there will be no more need for charity . . . </div>
<div style="text-align: justify;">
<br /></div>
<div style="text-align: justify;">
I'm encouraged . . . I see a glimmer of hope for the marginalized and the poor in our communities. </div>
<div style="text-align: justify;">
<br /></div>
<div style="text-align: justify;">
On the day of the Holi festivalI had just the sort of patient, who I feel should not exist in 2022, when the country celebrates it's 75th Independence Day. </div>
<div style="text-align: justify;">
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj_ZihrNba9Hq1JTQdEcd8m3M0-qfYIittzTN-tIYV4hHMlVqS_v4Q1Ha-sSXSq7Rywp8It6EtunI_dxMKvDD2NCEbOqR0AXpXBmF4cVDUSD62Czz7VLtF3HRHrMTFlJNdqHxNiIptcApw/s1600/elder+hands.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj_ZihrNba9Hq1JTQdEcd8m3M0-qfYIittzTN-tIYV4hHMlVqS_v4Q1Ha-sSXSq7Rywp8It6EtunI_dxMKvDD2NCEbOqR0AXpXBmF4cVDUSD62Czz7VLtF3HRHrMTFlJNdqHxNiIptcApw/s320/elder+hands.jpg" width="228" /></a></div>
Mrs. A was not an unknown face. In fact, quite a many members of her family comes to us when there is a serious medical issue. In fact, it was just few weeks back that her nephew was brought to us with clinical meningitis and he made a miraculous recovery. I've known Mrs. A since the day we reached here. She was a known hypertensive and had been on irregular treatment. But, the last time we saw her was in October, when we diagnosed her to also have quite severe Ischaemic Heart Disease with some amount of cardiac failure and a bad pneumonia. </div>
<div style="text-align: justify;">
<br /></div>
<div style="text-align: justify;">
As with the majority of our patients, she did not want to be taken to a higher centre. The maximum we could do to evaluate her was a Peripheral Smear and an ECG. Yes, not even an X-Ray. She made a miraculous recovery. </div>
<div style="text-align: justify;">
<br /></div>
<div style="text-align: justify;">
But, she never returned for treatment. Alas, we also did not notice that she had not turned up for her regular medications. </div>
<div style="text-align: justify;">
<br /></div>
<div style="text-align: justify;">
Her husband brought her in a miserable state sometime late morning last Monday (Holi). She was coughing with quite a lot of phlegm. Clinically, she got a bad pneumonia again which was causing quite a lot of stress on her badly damaged heart. I told the family that she needs evaluation. They told me that the maximum they could spare today was 500 INR. As usual they were not willing to take her ahead.<br />
<br />
Over two days with some medicines to treat her lower respiratory infection and support her flailing heart, she made a miraculous recovery.<br />
<br />
Reasons for her not coming for regular treatment for her high blood pressure and cardiac failure - they are very poor. There is one son who goes to work in the nearby town. He cannot go far as he has to look after his aged parents. There are couple of other sons who are earning a living in faraway places. They hardly come.<br />
<br />
Now, it would be a great thing if such patients are taken care of. There are two ways to do it. The first is to ensure that the public health care system is robust.<br />
<br />
And the other is to imagine that they don't exist. If the latter is the solution, people like me remain busy. </div>
</div>
Jeevanhttp://www.blogger.com/profile/14805862105396943161noreply@blogger.com0tag:blogger.com,1999:blog-4522533979274351092.post-73026232986362043132017-03-09T09:24:00.000+05:302017-03-09T09:24:37.262+05:30Misinformed<div dir="ltr" style="text-align: left;" trbidi="on">
It's been a long time since I blogged in this one. It's almost an year since we got back to Palamu region, in a smaller place than before, where I'm much more accessible to those who could benefit from my skills.<br />
<br />
I thought an incident which happened few days back in one of the peripheral dispensaries that I serve deserves a documentation.<br />
<br />
At around noon, a group of villagers reached this place with an middle aged lady who apparently had a snakebite early in the morning. It was already 6 hours past. She showed no symptoms nor signs of any envenomation.<br />
<br />
To make things easier, they had brought the snake along.<br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgsSqFXlBXwWSt7tBFmbSHnvEVdIyQmwGpuOvVh1q-OAUC2ymLfK46_3mr3bcReXM9VQbjsZM8HURapfDQwV7sACHyVlR6dqf1ohRfCO7ZZ14AnWlUgAqG92gbaNsbGjJj7JTbGTcvWNEQ/s1600/IMG_20170307_200516.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgsSqFXlBXwWSt7tBFmbSHnvEVdIyQmwGpuOvVh1q-OAUC2ymLfK46_3mr3bcReXM9VQbjsZM8HURapfDQwV7sACHyVlR6dqf1ohRfCO7ZZ14AnWlUgAqG92gbaNsbGjJj7JTbGTcvWNEQ/s320/IMG_20170307_200516.jpg" width="320" /></a></div>
<br />
It was an easy identification. A Common Kukhri.<br />
<br />
After the bite the patient had tingling sensation at the bite site, by which the villagers concluded that it was a venomous snake bite. A 'snake expert' in the village confirmed the same explaining that snakes with bands are poisonous and all the more colorful the snake, all the more venomous.<br />
<br />
A '<a href="http://jeevankuruvilla.blogspot.in/2011/10/occult.html?m=1">jhad phuk</a>' was called. He agreed to flush out the poison for a princely sum of 5000 INR, which the family readily agreed on.<br />
<br />
So, here was a family who had already spent 5K INR and wanted me to treat her for envenomation.<br />
<br />
I told the family that there was no symptoms and signs of envenomation, which I don't expect from a non-venomous snake. The family was absolutely sure that the snake they brought was the culprit.<br />
<br />
I told them to throw off the dead snake into the heavily forested area nearby and go back home.<br />
<br />
Couple of them appeared not much convinced. There was talk on taking her to another 'jhad phuk'. They carefully packed the snake into a bottle and was off for a second opinion. </div>
Jeevanhttp://www.blogger.com/profile/14805862105396943161noreply@blogger.com0tag:blogger.com,1999:blog-4522533979274351092.post-90411196869543491222016-01-06T08:49:00.000+05:302016-01-06T08:49:52.943+05:30Sabbatical . . . <div dir="ltr" style="text-align: left;" trbidi="on">
<div style="text-align: justify;">
The last 100 days, I thought of taking a break from my blog . . . I hope the break is over. Part of the reason for the break was laziness.</div>
<div style="text-align: justify;">
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhIzKjF_Y1jtGm7Jbya4b2vx2fH9I0MqmGfZHkfAcNjfegUNKcMgrX3VYi84rGndUpsvvQ8yXIh3kGAfQlQZJe5LJGEKwTLkDj4HttgwyotNC99rMo4TdF3AXM7Pzmw3LVmw7ODB2U7DGs/s1600/lazy.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="322" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhIzKjF_Y1jtGm7Jbya4b2vx2fH9I0MqmGfZHkfAcNjfegUNKcMgrX3VYi84rGndUpsvvQ8yXIh3kGAfQlQZJe5LJGEKwTLkDj4HttgwyotNC99rMo4TdF3AXM7Pzmw3LVmw7ODB2U7DGs/s400/lazy.jpg" width="400" /></a></div>
<br /></div>
<div style="text-align: justify;">
Now, as I mull over what caused my laziness, part of the answer was that I did not seem to get a break from the routine work. Considering into fact that blogging was taking quite a lot of my time after the change in my work environment, I came to the conclusion that the first thing that I should forego was blogging.</div>
<div style="text-align: justify;">
<br /></div>
<div style="text-align: justify;">
While at NJH, my friends used to ask me when I got the time to blog. And the answer was in between the surgeries. There would not be time to go home and take a break, but there would be time to write a blog. Outpatient was not as busy with a better doctor patient ratio.</div>
<div style="text-align: justify;">
<br /></div>
<div style="text-align: justify;">
However, Kachhwa has been different. We see the same number of patients, but has a poor doctor patient ratio - which makes things different. </div>
<div style="text-align: justify;">
<br /></div>
<div style="text-align: justify;">
So, major issues we had to grapple with over the last year at Kachhwa - </div>
<div style="text-align: justify;">
<br /></div>
<div style="text-align: justify;">
1. Tuberculosis</div>
<div style="text-align: justify;">
2. Malaria</div>
<div style="text-align: justify;">
3. Systemic Hypertension and Diabetes</div>
<div style="text-align: justify;">
4. Care of the Elderly</div>
<div style="text-align: justify;">
5. Snakes bites which is of course coming down since winter is on . . . </div>
<div style="text-align: justify;">
<br /></div>
<div style="text-align: justify;">
Shall write in detail about each of them . . . </div>
<div style="text-align: justify;">
<br /></div>
<div style="text-align: justify;">
Well, the ultimate reason on why I took back to blogging. One of my friends retorted that the reason for my silence seems to be the perceptible change in environment within the country on putting across opinions and facts . . . </div>
<div style="text-align: justify;">
<br /></div>
<div style="text-align: justify;">
As doctors, we are scientists and to voice out facts and our opinions on issues pertaining to healthcare is our mandate. Well, one could stifle them, but that would be at a heavy price . . . </div>
<div style="text-align: justify;">
<br /></div>
<div style="text-align: justify;">
I hope I get the time to write . . .<br />
<br />
Before I sign off, a small prayer sent to me by one of my seniors, with a small addition from my father in law -<br />
<b><i><br /></i></b>
<b><i>May God bless us with discomfort at easy answers, half-truths and superficial relationships, so that we may live deep within our hearts.</i></b><br />
<b><i><br /></i></b>
<b><i>May God bless us with anger at injustice, oppression and exploitation of people, so that we may work for justice, freedom and peace.</i></b><br />
<b><i><br /></i></b>
<b><i>May God bless us with tears to shed for those who suffer from pain, rejection, hunger and war, so that we may reach out our hands to comfort them and turn their pain into joy. </i></b><br />
<b><i><br /></i></b>
<b><i>And may God bless us with enough foolishness to believe that we can make a difference in this world, so that we can do what others claim cannot be done, to bring justice and kindness to all our children and the poor. </i></b><br />
<b><i><br /></i></b>
<b><i>And we pray for the gift of endurance to withstand all the above, such that inner transformation will happen to us all. </i></b><br />
<br />
Wishing you all a blessed 2016 - - - </div>
<div style="text-align: justify;">
<br /></div>
</div>
Jeevanhttp://www.blogger.com/profile/14805862105396943161noreply@blogger.com87tag:blogger.com,1999:blog-4522533979274351092.post-49251830036695379752015-08-31T08:19:00.000+05:302015-08-31T08:19:02.783+05:30Referred by a Jhad Phuk<div dir="ltr" style="text-align: left;" trbidi="on">
<div class="western" style="line-height: 100%; margin-bottom: 0in; text-align: justify;">
Couple
of weeks back, we had a young boy wheeled in. It was late evening,
just after we finished our outpatient work.
</div>
<div class="western" style="line-height: 100%; margin-bottom: 0in; text-align: justify;">
<br />
</div>
<div class="western" style="line-height: 100%; margin-bottom: 0in; text-align: justify;">
The
history was that of a bite at dawn while he was sleeping on the
floor. The boy had seen the snake slightering off into the dark but
could not identify it.
</div>
<div class="western" style="line-height: 100%; margin-bottom: 0in; text-align: justify;">
<br />
</div>
<div class="western" style="line-height: 100%; margin-bottom: 0in; text-align: justify;">
As
is common practice, he was taken to the <a href="http://jeevankuruvilla.blogspot.in/2012/06/snake-bites-and-occult.html">jhad phuk </a>who did his
chanting and gave some medicine. He proclaimed that the boy
was free of any poison and therefore sent him home. The family did
not make much about the snake bite and took him home.
</div>
<div class="western" style="line-height: 100%; margin-bottom: 0in; text-align: justify;">
<br />
</div>
<div class="western" style="line-height: 100%; margin-bottom: 0in; text-align: justify;">
At
home, our dear friend started to feel quite funny. He noticed that he
was having difficult keeping his eyes open as well as there was a
funny feeling on his throat. He thought that it must be something
which he ate that got stuck in his throat. By the time, school was
over late afternoon, he realised that something was grossly wrong
with him.
</div>
<div class="western" style="line-height: 100%; margin-bottom: 0in; text-align: justify;">
<br />
</div>
<div class="western" style="line-height: 100%; margin-bottom: 0in; text-align: justify;">
The
parents linked the symptoms to the snake bite which he had early
morning and took him again to the witch doctor. The <a href="http://jeevankuruvilla.blogspot.com/2013/09/heights-of-ignorance.html">witch doctor</a> did
his mumbo-jumbo and then proclaimed that it does not look like a
snake bite, rather it looks like a <a href="http://jeevankuruvilla.blogspot.com/2011/10/culprit-identified-sk.html">Bengal Monitor</a> bite. He washed his
hands off the patient and asked them to take him to a proper
hospital.
</div>
<div class="western" style="line-height: 100%; margin-bottom: 0in; text-align: justify;">
<br />
</div>
<div class="western" style="line-height: 100%; margin-bottom: 0in; text-align: justify;">
After
a visit to one more jhad phuk, they arrived at KCH - a full 13 hours after the bite.
</div>
<div class="western" style="line-height: 100%; margin-bottom: 0in; text-align: justify;">
<br />
</div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiaq9pkGL2ZPgKJjW9YVm7f57TGmoAWVcCuFrFP-emoQiV-sUjvWgVqLOEzpmHsTZ9OrT31jQY5sHc9ltZAEPapatp7Vg5fa2YlogwWC9vEzrkKIiTJ1mBR9dH6bBcI6tnCkmalAt5Dn0w/s1600/IMG_20150807_191108_1.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="245" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiaq9pkGL2ZPgKJjW9YVm7f57TGmoAWVcCuFrFP-emoQiV-sUjvWgVqLOEzpmHsTZ9OrT31jQY5sHc9ltZAEPapatp7Vg5fa2YlogwWC9vEzrkKIiTJ1mBR9dH6bBcI6tnCkmalAt5Dn0w/s320/IMG_20150807_191108_1.jpg" width="320" /></a></div>
<div class="western" style="line-height: 100%; margin-bottom: 0in; text-align: justify;">
<br /></div>
<div class="western" style="line-height: 100%; margin-bottom: 0in; text-align: justify;">
It
was a very obvious neurotoxic bite. I conveyed the diagnosis to the
relatives and gave the option of treating or taking to a higher
centre. Well, you may be surprised that I gave them the option to
take to a higher centre. The reason was that there was a very portly
and goon looking gentleman among the bunch of relatives who argued
with me that it was not a case of snake bite.
</div>
<div class="western" style="line-height: 100%; margin-bottom: 0in; text-align: justify;">
<br />
</div>
<div class="western" style="line-height: 100%; margin-bottom: 0in; text-align: justify;">
He
told me that the jhad phuk whom he went was a very famous witch
doctor and his success was 60-70% - which meant that 30-40% died!
That gave me enough ammunition to discredit the jhad phuk – I told
him that the jhad phuk will have a better success rate if he left the
patient alone, because of 100 bites, only 15 bites would be those
with envenomation and of that too only 4 will die without treatment.
</div>
<div class="western" style="line-height: 100%; margin-bottom: 0in; text-align: justify;">
<br />
</div>
<div class="western" style="line-height: 100%; margin-bottom: 0in; text-align: justify;">
The
printed material on snake bite which we had prepared recently was a
great help. I was glad that there were couple of our previous
patients who had come for dressing of their cobra bite wounds who
supported my view.
</div>
<div class="western" style="line-height: 100%; margin-bottom: 0in; text-align: justify;">
<br />
</div>
<div class="western" style="line-height: 100%; margin-bottom: 0in; text-align: justify;">
Ultimately
the family decided to stay at KCH and allow ASV to be given.
Thankfully, he recovered well overnight. However, the surprising
thing was that the next day night, his mother and elder sister also
sustained snake bite and come to us straightaway. Thankfully, there
were no signs of envenomation in both of them.
</div>
<div class="western" style="line-height: 100%; margin-bottom: 0in; text-align: justify;">
<br /></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh5xPE63dFabr97fJJTBqzLkzf_u5UYI6mCzztTQBCNxHfkgsutu3HyrWhqktqrSOz-9ZoaNzk1TCNLbnH5mXuciBE2YTJ5FttVIkuDaYVIBzwKR7uENFw6WfZDOk6X_07TLUp6XvktR0Q/s1600/IMG_20150808_090903.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="298" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh5xPE63dFabr97fJJTBqzLkzf_u5UYI6mCzztTQBCNxHfkgsutu3HyrWhqktqrSOz-9ZoaNzk1TCNLbnH5mXuciBE2YTJ5FttVIkuDaYVIBzwKR7uENFw6WfZDOk6X_07TLUp6XvktR0Q/s400/IMG_20150808_090903.jpg" width="400" /></a></div>
<div class="western" style="line-height: 100%; margin-bottom: 0in; text-align: justify;">
<br /></div>
<div class="western" style="line-height: 100%; margin-bottom: 0in; text-align: justify;">
Recently, we've had been having discussions about how to manage snake bite. There are quite a few people who believe that it should be according to identification of the culprit snake. However, I believe that the approach should be based more on the clinical presentation. The <a href="http://jeevankuruvilla.blogspot.com/2015/08/girgit.html">case of the chameleon bite </a>and this case is ample evidence in support of a syndromic approach. </div>
<div class="western" style="line-height: 100%; margin-bottom: 0in; text-align: justify;">
<br />
</div>
<div class="western" style="line-height: 100%; margin-bottom: 0in; text-align: justify;">
After 48 hours in the hospital, the young boy was ready for discharge. Although it was a krait bite, he ended up with a bandage as the quack had made quite a few deep incisions around the bite site. </div>
<div class="western" style="line-height: 100%; margin-bottom: 0in; text-align: justify;">
<br /></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjBU8NsxPKVZmjyYdr_4voUkT1Td43AO9mZYflO0ljmttU8wvn8TDBfRfmdruHLqWmLT0v9N0QziehcWyfDeD5EnQEO0bwnnxwgEAsYYloTozmFQcdXvW3RpUQGlz6SgXn3AWANrXoZh54/s1600/IMG_20150810_143121.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjBU8NsxPKVZmjyYdr_4voUkT1Td43AO9mZYflO0ljmttU8wvn8TDBfRfmdruHLqWmLT0v9N0QziehcWyfDeD5EnQEO0bwnnxwgEAsYYloTozmFQcdXvW3RpUQGlz6SgXn3AWANrXoZh54/s400/IMG_20150810_143121.jpg" width="296" /></a></div>
<div class="western" style="line-height: 100%; margin-bottom: 0in; text-align: justify;">
<br /></div>
<div class="western" style="line-height: 100%; margin-bottom: 0in; text-align: justify;">
It
was quite heartening to see the relatives thank us for opening their
eyes on how the<a href="http://jeevankuruvilla.blogspot.in/2011/10/occult.html"> witch doctors </a>exploit poor village folk.</div>
</div>
Jeevanhttp://www.blogger.com/profile/14805862105396943161noreply@blogger.com5tag:blogger.com,1999:blog-4522533979274351092.post-77432993073826326282015-08-10T09:30:00.000+05:302015-08-10T09:30:02.446+05:30Unusual bite - 1<div dir="ltr" style="text-align: left;" trbidi="on">
<div style="text-align: justify;">
One advice we give to village folk to prevent snake bite is to avoid sleeping on the floor and rather using a cot. I've even seen advice <a href="http://www.hindustantimes.com/chunk-ht-ui-punjabsectionpage-chandigarh/using-a-mosquito-net-can-help-prevent-snakebite-say-pgi-experts/article1-1238630.aspx">to use a mosquito net</a> to prevent snakes from getting inside the cot.</div>
<div style="text-align: justify;">
<br /></div>
<div style="text-align: justify;">
However, Mrs. Guddi did all of it. But still ended up with a bite. The culprit snake got onto her cot which was covered with a mosquito net and bit her. </div>
<div style="text-align: justify;">
<br /></div>
<div style="text-align: justify;">
She came to us about 10 hours after the bite.</div>
<div style="text-align: justify;">
<br /></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj7hyphenhyphenXhSJPO7r_Gjgdxq77pIF75Q93aaA7ncnsonalkL5tYZpofApbE0EC1lAQNsbUEdxH9zadmtn_8ehlAE9objyYVlgVRJxc0GTMMvmSPeJbppv1NWhdLL85pWm7gdZWttH6Wb-DX3_Q/s1600/IMG_20150723_135129_1.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="298" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj7hyphenhyphenXhSJPO7r_Gjgdxq77pIF75Q93aaA7ncnsonalkL5tYZpofApbE0EC1lAQNsbUEdxH9zadmtn_8ehlAE9objyYVlgVRJxc0GTMMvmSPeJbppv1NWhdLL85pWm7gdZWttH6Wb-DX3_Q/s400/IMG_20150723_135129_1.jpg" width="400" /></a></div>
<div style="text-align: justify;">
<br /></div>
<div style="text-align: justify;">
The family had killed the culprit snake and brought it along with them. </div>
<div style="text-align: justify;">
<br /></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi9WCupdNdTplNj59zTmeoF3hteX1cbUaqEj5rAiD6MdKb_R1Z1oHr9XXEvemFjC5zTfl7Vn-UHsCZ2wFOXicVR1NizNY1FHcyVTqgNEyrXWVUawAnoXCYXVWmRUohjhuvxECFtWAHc9Dg/s1600/IMG_20150723_134232_1.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi9WCupdNdTplNj59zTmeoF3hteX1cbUaqEj5rAiD6MdKb_R1Z1oHr9XXEvemFjC5zTfl7Vn-UHsCZ2wFOXicVR1NizNY1FHcyVTqgNEyrXWVUawAnoXCYXVWmRUohjhuvxECFtWAHc9Dg/s200/IMG_20150723_134232_1.jpg" width="149" /></a></div>
<div style="text-align: justify;">
It was not their mistake that they came late. They had gone elsewhere where ASV was available. </div>
<div style="text-align: justify;">
<br /></div>
<div style="text-align: justify;">
Since I've started my service at Kachhwa, it is very obvious that hardly anybody in the nearby healthcentres have any idea about ASV usage in snake bite. Mrs. Guddi received 3 vials from elsewhere and when she reached us she was on the verge of going into respiratory depression.</div>
<div style="text-align: justify;">
<br /></div>
<div style="text-align: justify;">
Thankfully, Guddi managed without mechanical ventilation.</div>
<div style="text-align: justify;">
<br /></div>
<div style="text-align: justify;">
It was a joy to see the young family playing with their little child the day before discharge.</div>
<div style="text-align: justify;">
<br /></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhF4zpWxDj0heK-ew50G1_oZeeOs2kuyNyeScW3ycQXeh6Laf9eobTOaiVOoUAM88qeheSBURH6t4GmnvxbUycS4c12Eu7oHBrFSH_eNw7Ma8QAqx0TDuz4b07ZE9Ov8UrleNEGzH886s8/s1600/IMG_20150725_213003.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="480" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhF4zpWxDj0heK-ew50G1_oZeeOs2kuyNyeScW3ycQXeh6Laf9eobTOaiVOoUAM88qeheSBURH6t4GmnvxbUycS4c12Eu7oHBrFSH_eNw7Ma8QAqx0TDuz4b07ZE9Ov8UrleNEGzH886s8/s640/IMG_20150725_213003.jpg" width="640" /></a></div>
<div style="text-align: justify;">
<br /></div>
<div style="text-align: justify;">
However, please note that there is evidence which supports the <a href="http://test.snakebiteinitiative.org/wp-content/uploads/2012/07/Preventing-snakebite-with-bednets.pdf">use of bednets to decrease incidence of snake bites.</a> </div>
</div>
Jeevanhttp://www.blogger.com/profile/14805862105396943161noreply@blogger.com5tag:blogger.com,1999:blog-4522533979274351092.post-20944851754870153662015-08-10T00:30:00.002+05:302015-08-10T00:30:29.078+05:30Girgit<div dir="ltr" style="text-align: left;" trbidi="on">
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg5Si9u4zc1_F97s5T3CV0f7Wvahsttlu4hdpoFGkljY-AjoAqbsbU2UkPprWF7DAYr0EFUTzInEJawbLfGOhnFCzzgyzgCqOve_b-uxFg9c97VDKvTRchpUKjFUCnmp0f4mVuT1DB0DUE/s1600/IMG_20150731_102145.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg5Si9u4zc1_F97s5T3CV0f7Wvahsttlu4hdpoFGkljY-AjoAqbsbU2UkPprWF7DAYr0EFUTzInEJawbLfGOhnFCzzgyzgCqOve_b-uxFg9c97VDKvTRchpUKjFUCnmp0f4mVuT1DB0DUE/s320/IMG_20150731_102145.jpg" width="236" /></a></div>
<div class="western" style="line-height: 100%; margin-bottom: 0in; text-align: justify;">
<span style="line-height: 100%;">Muskan,
this little 8 year old girl in the snap appears all set to break into
a dance if some music is put on. As one of my colleagues put it,
smiles like this one can really take the stress off a very very busy
day.</span></div>
<div class="western" style="line-height: 100%; margin-bottom: 0in; text-align: justify;">
<br />
</div>
<div class="western" style="line-height: 100%; margin-bottom: 0in; text-align: justify;">
There
is more reason for Muskan to put so much of a smile. Muskan came to
us more than a fortnight back after having been bitten by a chameleon
in her aunt's house where she had gone for a visit. The problem was
that after the chameleon bite, she started to feel very weird.
</div>
<div class="western" style="line-height: 100%; margin-bottom: 0in; text-align: justify;">
<br />
</div>
<div class="western" style="line-height: 100%; margin-bottom: 0in; text-align: justify;">
She
had a funny feeling in her throat and she found it difficult to open
her eyes.
</div>
<div class="western" style="line-height: 100%; margin-bottom: 0in; text-align: justify;">
<br />
</div>
<div class="western" style="line-height: 100%; margin-bottom: 0in; text-align: justify;">
Her
father was a sensible man and brought her to the 'bite hospital'
which is us. My colleague received her in emergency and she told him
that she was bitten by a girgit – that's the word for a chameleon.
</div>
<div class="western" style="line-height: 100%; margin-bottom: 0in; text-align: justify;">
<br />
</div>
<div class="western" style="line-height: 100%; margin-bottom: 0in; text-align: justify;">
Dr.
Ao did not feel that things were okay. He called for a second opinion
and while I was repeatedly asking her if she was quite positive that
the culprit creature was a girgit, it was very obvious that the ptosis
was worsening.
</div>
<div class="western" style="line-height: 100%; margin-bottom: 0in; text-align: justify;">
<br />
</div>
<div class="western" style="line-height: 100%; margin-bottom: 0in; text-align: justify;">
I
told my suspicion of a cobra bite to the relatives. They wanted to know about the
costs involved and was reluctant to give Anti-Snake Venom. To buy
time, I told them that I'll start off with a small dose and see how
things progress. However, as our staff got the ASV ready, she went
into a respiratory arrest and we had to put her on mechanical
ventilation.
</div>
<div class="western" style="line-height: 100%; margin-bottom: 0in; text-align: justify;">
<br /></div>
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj54sKC6CfctMF1JG7HiepPOixBfWiYL9lUUxhX-j6yogNGFrHwEqo7YyDWeFDZdaW7fEMGNE6JIuOBuUglXr9-4DwlI43IUHFU0l2Q7FbheQ6Ko1vRcbqduSi8Qjqp3MtjoIpj8dprbbI/s1600/IMG_20150725_204846.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="480" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj54sKC6CfctMF1JG7HiepPOixBfWiYL9lUUxhX-j6yogNGFrHwEqo7YyDWeFDZdaW7fEMGNE6JIuOBuUglXr9-4DwlI43IUHFU0l2Q7FbheQ6Ko1vRcbqduSi8Qjqp3MtjoIpj8dprbbI/s640/IMG_20150725_204846.jpg" width="640" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Muskan immediately after the intubation. I got the snap to use later if there were medicolegal issues. Notice the bite mark with black surrounding skin. Incidentally, when I photographed here on one of the review days, she was wearing the same dress which she wore the day she got bitten. </td></tr>
</tbody></table>
<div class="western" style="line-height: 100%; margin-bottom: 0in; text-align: justify;">
<span style="line-height: 100%;">Things
became easy for us. Very soon, she was receiving treatment for cobra bite. </span></div>
<div class="western" style="line-height: 100%; margin-bottom: 0in; text-align: justify;">
<span style="line-height: 100%;"><br /></span></div>
<div class="western" style="line-height: 100%; margin-bottom: 0in; text-align: justify;">
<span style="line-height: 100%;">With the ASV, atropine and neostigmine, she was
conscious, breathing on her own and talking after 3-4 hours. I again asked her about the
animal that bit her – girgit was the answer.</span></div>
<div class="western" style="line-height: 100%; margin-bottom: 0in; text-align: justify;">
<br />
</div>
<div class="western" style="line-height: 100%; margin-bottom: 0in; text-align: justify;">
By
now, her bite site had swollen up quite a bit and it was obvious that
it was a cobra bite.
</div>
<div class="western" style="line-height: 100%; margin-bottom: 0in; text-align: justify;">
<br />
</div>
<div class="western" style="line-height: 100%; margin-bottom: 0in; text-align: justify;">
The next day, Muskan
narrated on how she had turned to take some rotis which was kept on a
window sill and as she turned after taking the food, she saw a
chameleon sitting beside the plate of rotis, which lunged at her and bit her on the upper part of her right arm. That narration was
difficult to believe as chameleons are quite timid creatures and they
run for their lives when they see someone.
</div>
<div class="western" style="line-height: 100%; margin-bottom: 0in; text-align: justify;">
<br />
</div>
<div class="western" style="line-height: 100%; margin-bottom: 0in; text-align: justify;">
However,
Muskan was the first of our two patients who misidentified the animal
that bit them.
</div>
<div class="western" style="line-height: 100%; margin-bottom: 0in; text-align: justify;">
<br /></div>
<br />
<div class="western" style="line-height: 100%; margin-bottom: 0in; text-align: justify;">
About
our second patient, in the next post. And I can assure you that it is
hilarious. </div>
</div>
Jeevanhttp://www.blogger.com/profile/14805862105396943161noreply@blogger.com12tag:blogger.com,1999:blog-4522533979274351092.post-63685903998096900992015-08-08T14:46:00.002+05:302015-08-08T14:46:45.179+05:30First Aid in Snake Bite<div dir="ltr" style="text-align: left;" trbidi="on">
On the opposite side of the leaflet on Preventing Snake Bites is the First Aid which is to be done in case of a snake bite.<br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh0QRyvKcImDhSJ_NngI7R4ErFW93OPywylsDeI9zRfb5S0_RnF03Adada3i2HhL4dJUtK52Q-6tVxjSUFV9zzo0newhO6ili6vQyNpZPtAHbqycsHcrpXbEFA9DZT-7YKjpMKf9OTxg7g/s1600/IMG_20150805_120403_1.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh0QRyvKcImDhSJ_NngI7R4ErFW93OPywylsDeI9zRfb5S0_RnF03Adada3i2HhL4dJUtK52Q-6tVxjSUFV9zzo0newhO6ili6vQyNpZPtAHbqycsHcrpXbEFA9DZT-7YKjpMKf9OTxg7g/s640/IMG_20150805_120403_1.jpg" width="478" /></a></div>
<br />
<div style="text-align: justify;">
The pictures here have been taken from the website - http://www.she-india.org/snakebite-first-aid/ where it is attributed to the Nisarga Vidnayan Sanstha. Unfortunately, our printers did not add the acknowledgement for the cartoons when the final printing was done although it was there in the final proof. </div>
<div style="text-align: justify;">
<br /></div>
<div style="text-align: justify;">
The English translation of the leaflet is as follows - </div>
<div style="text-align: justify;">
<i><br /></i></div>
<div class="western" style="line-height: 100%; margin-bottom: 0in;">
<i><span style="font-family: Times New Roman, serif;">1.
</span><span style="font-family: Times New Roman, serif;">Keep the patient calm and
reassure him. Please note that 70% of snake bites are caused by
non-poisonous snakes and </span><span style="font-family: Times New Roman, serif;">of
</span><span style="font-family: Times New Roman, serif;">the rest 30%, </span><span style="font-family: Times New Roman, serif;">only
half of them would have features of envenomation.</span></i></div>
<div class="western" style="line-height: 100%; margin-bottom: 0in;">
<i><br />
</i></div>
<div class="western" style="line-height: 100%; margin-bottom: 0in;">
<i>2.
Keep the patient quiet. Don't move the site of the bite. If the bite
is on the arm, put a splint. If on the leg, splint the limb and don't
allow the patient to walk. There is no advantage of putting a tight
tourniquet proximal to the site of bite, rather it would do harm.</i></div>
<div class="western" style="line-height: 100%; margin-bottom: 0in;">
<i><br />
</i></div>
<div class="western" style="line-height: 100%; margin-bottom: 0in;">
<i>3.
Go as soon as possible to a hospital which has ASV available. Use
whatever means of transport is available.</i></div>
<div class="western" style="line-height: 100%; margin-bottom: 0in;">
<i><br /></i></div>
<div class="western" style="line-height: 100%; margin-bottom: 0in;">
</div>
<div class="western" style="line-height: 100%; margin-bottom: 0in;">
<i>4.
It is harmful to put nicks or cuts on or around the bite site. It is
also not advisable to wash the wound. Both these practices ensures
that the venom spreads fast all over the body.
</i></div>
<div class="western" style="line-height: 100%; margin-bottom: 0in;">
<i><br />
</i></div>
<div class="western" style="line-height: 100%; margin-bottom: 0in;">
<i>5.
Please note that even after you reach the hospital, treatment with
Anti-snake venom is started only when signs/evidence of venom
envenomation is noted. It is dangerous to inject Anti-snake venom
without signs/evidence of envenomation.
</i></div>
<div class="western" style="line-height: 100%; margin-bottom: 0in;">
<i><br />
</i></div>
<div class="western" style="line-height: 100%; margin-bottom: 0in;">
<i>6.
It is good to be kept under medical observation for 12-24 hours after
the bite. There are some snakes like Krait where the symptoms of
envenomation may be observed only after 6-24 hours.
</i></div>
<div class="western" style="line-height: 100%; margin-bottom: 0in;">
<i><br />
</i></div>
<div class="western" style="line-height: 100%; margin-bottom: 0in;">
<i>7.
It is better to keep a snake bite victim nil per orally until the
doctor allows to eat orally.
</i></div>
<div class="western" style="line-height: 100%; margin-bottom: 0in;">
<i><br />
</i></div>
<div style="text-align: justify;">
</div>
<div class="western" style="line-height: 100%; margin-bottom: 0in;">
<i>8.
Please remove ornaments like rings, bangles, wrist bands etc. if any
near the bite site as swelling of the bite site can cause problems
with their removal later. </i></div>
<div class="western" style="line-height: 100%; margin-bottom: 0in;">
<br /></div>
<div class="western" style="line-height: 100%; margin-bottom: 0in;">
<br /></div>
<div class="western" style="line-height: 100%; margin-bottom: 0in;">
Please feel free to use the material to print your own 'first aid for snake bite' leaflets. However, as noted above, you'll need to take permission to use the cartoons.</div>
</div>
Jeevanhttp://www.blogger.com/profile/14805862105396943161noreply@blogger.com4tag:blogger.com,1999:blog-4522533979274351092.post-24799165615516569742015-08-08T14:35:00.001+05:302015-08-08T14:35:45.474+05:30Preventing Snake Bites<div dir="ltr" style="text-align: left;" trbidi="on">
Couple of weeks, staff at KCH helped to put together a leaflet on preventing snake bites . . .<br />
<br />
The cartoons have been done by Mrs. Blodwen Shankar.<br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj-vyp7WGuOEMjk8lrCD31VhKSkH0xsOp1WyWmy4fiUlzvi9OUxzEVieBrNl_kbnZqen2rO59qLpmMH5dtxe1u597N0A2T3ttu8SOnihSxv_zOieQtFOB4llX8EgcL5KJQPo8Nzge-EUM4/s1600/IMG_20150805_120416.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj-vyp7WGuOEMjk8lrCD31VhKSkH0xsOp1WyWmy4fiUlzvi9OUxzEVieBrNl_kbnZqen2rO59qLpmMH5dtxe1u597N0A2T3ttu8SOnihSxv_zOieQtFOB4llX8EgcL5KJQPo8Nzge-EUM4/s640/IMG_20150805_120416.jpg" width="479" /></a></div>
<br />
The English translation is as follows - <br />
<br />
<div class="western" style="line-height: 100%; margin-bottom: 0in; text-align: justify;">
<i><span style="font-family: Times New Roman, serif;">1.
</span><span style="font-family: Times New Roman, serif;">When you go out of home at
night, please use a torch or some other light source. If you don't
have a light source, use a rod to tap the ground heavily as you walk</span><span style="font-family: Times New Roman, serif;"><b>.</b></span></i></div>
<div class="western" style="line-height: 100%; margin-bottom: 0in; text-align: justify;">
<i><br />
</i></div>
<div class="western" style="line-height: 100%; margin-bottom: 0in; text-align: justify;">
<i><span style="font-family: Times New Roman, serif;">2.
</span><span style="font-family: Times New Roman, serif;">When you cut grass or pick
vegetables or fruits from a bush, use a small stick to probe the
place and clear the vegetation where you'll place your hand.</span></i></div>
<div class="western" style="line-height: 100%; margin-bottom: 0in; text-align: justify;">
<i><br />
</i></div>
<div class="western" style="line-height: 100%; margin-bottom: 0in; text-align: justify;">
<i><span style="font-family: Times New Roman, serif;">3.
</span><span style="font-family: Times New Roman, serif;">When you collect dry
leaves or twigs from the floor, use a stick to probe the place from
where you'll pick the leaves/twigs.</span></i></div>
<div class="western" style="line-height: 100%; margin-bottom: 0in; text-align: justify;">
<i><br />
</i></div>
<div class="western" style="line-height: 100%; margin-bottom: 0in; text-align: justify;">
<i><span style="font-family: Times New Roman, serif;">4.
</span><span style="font-family: Times New Roman, serif;">When you remove anything
from your attic or machaan or the shelves of your home, use a torch
and stick. Be vigilant about snakes hiding there. Don't put your hand
or feet into a dark area without looking</span><span style="font-family: Times New Roman, serif;"><b>.
</b></span>
</i></div>
<div class="western" style="line-height: 100%; margin-bottom: 0in; text-align: justify;">
<i><br />
</i></div>
<div class="western" style="line-height: 100%; margin-bottom: 0in; text-align: justify;">
<i><span style="font-family: Times New Roman, serif;">5.
</span><span style="font-family: Times New Roman, serif;">Keep your surroundings
clean. Don't allow rats to thrive inside your home. Dirty and unkempt
surroundings encourage breeding of rats which in turn attracts
snakes. </span>
</i></div>
<div class="western" style="line-height: 100%; margin-bottom: 0in; text-align: justify;">
<i><br />
</i></div>
<div class="western" style="line-height: 100%; margin-bottom: 0in; text-align: justify;">
<i><span style="font-family: Times New Roman, serif;">6.
</span><span style="font-family: Times New Roman, serif;">There is a higher chance
of your being bitten by a snake if you sleep on the floor</span><span style="font-family: Times New Roman, serif;"><b>.</b></span></i></div>
<div class="western" style="line-height: 100%; margin-bottom: 0in; text-align: justify;">
<i><br />
</i></div>
<div class="western" style="line-height: 100%; margin-bottom: 0in; text-align: justify;">
<i><span style="font-family: Times New Roman, serif;">7.
</span><span style="font-family: Times New Roman, serif;">Don't grow plants near
windows and doors. If you have climbing/creeper plants climbing onto
your house, snakes can enter your home with ease</span><span style="font-family: Times New Roman, serif;"><b>.</b></span></i></div>
<div class="western" style="line-height: 100%; margin-bottom: 0in; text-align: justify;">
<i><br />
</i></div>
<div class="western" style="line-height: 100%; margin-bottom: 0in; text-align: justify;">
<i><span style="font-family: Times New Roman, serif;">8.
</span><span style="font-family: Times New Roman, serif;">When you move about in
areas with dense foilage, use a long stick to clear the vegetation as
you move. Boots, full pants and full sleeves shirt can help you avoid
fatal snake bites</span></i></div>
<br />
<div class="western" style="line-height: 100%; margin-bottom: 0in; text-align: justify;">
<br />
</div>
<div class="western" style="line-height: 100%; margin-bottom: 0in;">
<br /></div>
<div class="western" style="line-height: 100%; margin-bottom: 0in;">
Please feel free to use the above material. You can contact me at jeevan53@gmail.com for the cartoons in jpeg format. </div>
<div class="western" style="line-height: 100%; margin-bottom: 0in;">
<br /></div>
<div class="western" style="line-height: 100%; margin-bottom: 0in;">
On the backside of this leaflet was also information on first aid to be given in case of snake bite. That would be my next blog post . . . </div>
</div>
Jeevanhttp://www.blogger.com/profile/14805862105396943161noreply@blogger.com2tag:blogger.com,1999:blog-4522533979274351092.post-59361286672790047172015-07-12T22:23:00.000+05:302015-07-12T23:12:09.061+05:30Snakes galore<div dir="ltr" style="text-align: left;" trbidi="on">
<div style="text-align: justify;">
The last week was quite busy. We had about 20 patients brought in with snake bite. <a href="http://jeevankuruvilla.blogspot.in/2015/07/is-it-really-worth.html">We lost Shivam </a>couple of days back. By God's grace, only 8 of the 20 patients had evidence of envenomation. Interestingly, nine of the 20 patients brought the culprit snake, 7 of them dead snakes and two alive ! ! !. </div>
<div style="text-align: justify;">
<br /></div>
<div style="text-align: justify;">
Here are the snaps of the snakes brought . . . I'm glad that <a href="http://jeevankuruvilla.blogspot.in/2013/08/the-wrong-one.html">none of the snakes were non-venomous</a> . . .</div>
<br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhtIe8EVl1lRJG5Q7Qa1uPlem_MkKRFH0H6mVtrWC3BErkD-riCzk-JTGfrYBgsroMHYpK8OBzTXp8L1zryWuGp_Y6OVPxPGSJ8y7Dc1JJMAH5dwKK2i6mEZclTaj-XEUnNTimV3Q4jd_A/s1600/DSC05365.JPG" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="480" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhtIe8EVl1lRJG5Q7Qa1uPlem_MkKRFH0H6mVtrWC3BErkD-riCzk-JTGfrYBgsroMHYpK8OBzTXp8L1zryWuGp_Y6OVPxPGSJ8y7Dc1JJMAH5dwKK2i6mEZclTaj-XEUnNTimV3Q4jd_A/s640/DSC05365.JPG" width="640" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">This is a baby cobra which bit a 30 year old lady. Thankfully, there were no signs of envenomation. </td></tr>
</tbody></table>
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhrZPwEGPCLNlJ0A34lVtvIKjErN9f8-4Lmw-8Ls_8krcH1NfZZIlmkRcqw8cCg2_wy9RQWVeGbGPQP7RmdbbTBLkezp1c3ETjPpJ7nrdENAx6n7LrfxvkR1KwQd7MH59vRKwnDGTu9yVI/s1600/IMG_20150630_141953_1.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="480" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhrZPwEGPCLNlJ0A34lVtvIKjErN9f8-4Lmw-8Ls_8krcH1NfZZIlmkRcqw8cCg2_wy9RQWVeGbGPQP7RmdbbTBLkezp1c3ETjPpJ7nrdENAx6n7LrfxvkR1KwQd7MH59vRKwnDGTu9yVI/s640/IMG_20150630_141953_1.jpg" width="640" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">This is a krait which bit a lady who was sleeping on the floor. Again, there was no envenomation. </td></tr>
</tbody></table>
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEirKs5gamQZs9QFJ_zlIBPaTbYtukR68GXpmLUTh38tAu_Zvse5bk7fCx83P7kV3DH84qfF2QdLZEsANsEyq7-Gfzn-suvj9ynQHCh2WNDsJCwCwMSFH3CzjEHQeobkbs7BaAKcztDN8O8/s1600/IMG_20150707_191255_1.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="478" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEirKs5gamQZs9QFJ_zlIBPaTbYtukR68GXpmLUTh38tAu_Zvse5bk7fCx83P7kV3DH84qfF2QdLZEsANsEyq7-Gfzn-suvj9ynQHCh2WNDsJCwCwMSFH3CzjEHQeobkbs7BaAKcztDN8O8/s640/IMG_20150707_191255_1.jpg" width="640" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">This bit a 25 year old man on his toe. Again, no envenomation</td></tr>
</tbody></table>
<br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjVoopAlAZ0paBspK6dqf2zwJox37ItucCzmcHkiFuDCvDf8nPqaSCWXTLYwFkFiC-3vnXqxoh8RThlDzXTWAR_Zqg0He1waPnj1MI_cCShAmC7md_Sd5l73kg-UbTweMOK98Spp6rjL0I/s1600/IMG_20150709_123639.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjVoopAlAZ0paBspK6dqf2zwJox37ItucCzmcHkiFuDCvDf8nPqaSCWXTLYwFkFiC-3vnXqxoh8RThlDzXTWAR_Zqg0He1waPnj1MI_cCShAmC7md_Sd5l73kg-UbTweMOK98Spp6rjL0I/s640/IMG_20150709_123639.jpg" width="480" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">I thought this was a wolf snake. This is live. The local experts say it is a krait. The 35 year old lady who was bitten by this snake had some sore throat and dizziness for about 12 hours which settled over time. There was no ptosis. We kept the patient on observation for 36 hours and discharged her. <span style="font-size: 12.8000001907349px;">No ASV was given. </span></td></tr>
</tbody></table>
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiHKQ7-7yMrXmw-tMKeXMVL5cFvfQ1xp-4E5q702xByiwznTh1tVBtTpVRauyMmzbg9itcZUkvNKYCjXnFSEsDQcPUuIE6i0Ar8CJRKOinawl3q_1iK-v0VrLOkUYoHgk_IIiV-5fsNIqI/s1600/IMG_20150709_143313.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="480" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiHKQ7-7yMrXmw-tMKeXMVL5cFvfQ1xp-4E5q702xByiwznTh1tVBtTpVRauyMmzbg9itcZUkvNKYCjXnFSEsDQcPUuIE6i0Ar8CJRKOinawl3q_1iK-v0VrLOkUYoHgk_IIiV-5fsNIqI/s320/IMG_20150709_143313.jpg" width="640" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">A cobra who bit a prominent person of a village about 40 kilometers away. Mr. Phekku, 60 years old came in about 2 hours after the bite after the customary visit to the jhad phuk. He was on mechanical ventilation for about 2 days. He is doing fine now. We gave him the maximum possible dose of 20 vials ASV. Interestingly after we told the family that the culprit snake could be in the enclosed space where he was bitten, the family hired couple of snake charmers who caught the snake live and brought it to the hospital for identification. God only knows if this was the culprit snake or one which the snake charmers got out of their kitty and show cased it. </td></tr>
</tbody></table>
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgndkExDV34k-zHgV3bFOeFu2UQdSq4VTx4plgDGmp3Yoa9-m3LisgE37wAhsC4BbtNMAAWA6lO4PfhWvsABvjv-uNt9oUs_6YrWhu7Y5xhNO7MgWvWudIchLPjnrQqncRj8TjQ3tAXthM/s1600/IMG_20150709_175834.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="480" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgndkExDV34k-zHgV3bFOeFu2UQdSq4VTx4plgDGmp3Yoa9-m3LisgE37wAhsC4BbtNMAAWA6lO4PfhWvsABvjv-uNt9oUs_6YrWhu7Y5xhNO7MgWvWudIchLPjnrQqncRj8TjQ3tAXthM/s640/IMG_20150709_175834.jpg" width="640" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Another krait. Again, the victim did not have features of envenomation. </td></tr>
</tbody></table>
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEisQ5aUIIdyQkEOI6isaDcvfrzethtOXHJUKAc-BzLlLIqjlFTIu77zJwgtWdzIPnTEguwtDw7tOPhkWHOkul4xRfgNH1aoxzOxA2M8RPxbVv9WMdT2DFORhY0UAz_-np-rWgLBzK6xKHw/s1600/IMG_20150710_101039.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEisQ5aUIIdyQkEOI6isaDcvfrzethtOXHJUKAc-BzLlLIqjlFTIu77zJwgtWdzIPnTEguwtDw7tOPhkWHOkul4xRfgNH1aoxzOxA2M8RPxbVv9WMdT2DFORhY0UAz_-np-rWgLBzK6xKHw/s640/IMG_20150710_101039.jpg" width="480" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">This snake bit a 40 year old lady from a nearby village. She was brought in almost 12 hours after the bite. She had ptosis and respiratory distress. She maintaind saturation without need of intubation. Her ptosis resolved after 10 vials of ASV.</td></tr>
</tbody></table>
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj6mAJMhRuLe1tUPV4YMEswrBrZGLYEXnSuBVL0jpXu0bFfDAfAi6ZkJ1fBTRrmUX8ZQ1lJz83Kj8F5nXp9vb_6kYIuIUKWcybQi9Z144isCtsoWZAqeasQHBRnO5hc2aPR_49_lf8lV0o/s1600/IMG_20150710_192403_1.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="316" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj6mAJMhRuLe1tUPV4YMEswrBrZGLYEXnSuBVL0jpXu0bFfDAfAi6ZkJ1fBTRrmUX8ZQ1lJz83Kj8F5nXp9vb_6kYIuIUKWcybQi9Z144isCtsoWZAqeasQHBRnO5hc2aPR_49_lf8lV0o/s640/IMG_20150710_192403_1.jpg" width="640" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">A 3 feet long cobra which bit a 50 year old man inside his flour mill. It was wrapped around one of the machine parts which he was cleaning. He came in within 15 minutes. Initially, they did not know what snake it was. Later, when we told the relatives that considering that the bite happened in a room, the snake could still be lurking inside, the searched and found it out and killed it. Interestingly, within few minutes of the snake being brought in, the patient started developing ptosis and throat discomfort. He responded well to ASV and got discharged aftr 48 hours. He needed only 10 vials of ASV. </td></tr>
</tbody></table>
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiwHgsGHCB6w0YVfMZyTNQ_7Q3TaQ9p1nAsdp_egOThpQxFXgi6rqSuJNxyLT1o0GPxtsWYAwzzSNIJnigi9-F7lTjXfhRxdijU01sd077uRDRVZmUZymZfC-MF1J9rNA2TfnKXT8SDkkQ/s1600/IMG_20150711_084840.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="280" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiwHgsGHCB6w0YVfMZyTNQ_7Q3TaQ9p1nAsdp_egOThpQxFXgi6rqSuJNxyLT1o0GPxtsWYAwzzSNIJnigi9-F7lTjXfhRxdijU01sd077uRDRVZmUZymZfC-MF1J9rNA2TfnKXT8SDkkQ/s640/IMG_20150711_084840.jpg" width="640" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Another krait brought in by a patient who was bitten on the leg. Again, no features of envenomation. </td></tr>
</tbody></table>
<div style="text-align: justify;">
It is quite interesting that only one patient out of the six who brought in the dead krait had features of envenomation whereas two out of the three patients who brought a cobra had features of envenomation. Please note that there were 11 other patients who came with bites from unidentified snakes. 5 of them had features of envenomation and we had to give ASV. </div>
<div style="text-align: justify;">
<br /></div>
<div style="text-align: justify;">
And, we finished about 100 vials of ASV in 3-4 days, including 50 on a single day . . . </div>
<div style="text-align: justify;">
<br /></div>
<div style="text-align: justify;">
More, in the next posts . . . </div>
</div>
Jeevanhttp://www.blogger.com/profile/14805862105396943161noreply@blogger.com4tag:blogger.com,1999:blog-4522533979274351092.post-43935870478500928902015-07-06T07:27:00.002+05:302015-07-06T07:27:44.043+05:30Dear Citizens<div dir="ltr" style="text-align: left;" trbidi="on">
<div style="text-align: justify;">
Someone had forwarded this message to me in my WhatsApp. I thought that it was good enough to be posted in my blog . . . Honestly speaking, I don't know that source. I thought that it was worth exploring . . . </div>
<div style="text-align: justify;">
<br /></div>
<div style="text-align: justify;">
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj-Ra8F6OPG1X3uHZ5yyvsDgzPpEc_bCOiNMKCWWuM_dUWkIys3-tSMOUax94jhx0ds0rJiqfSmR8ibW9RjHMhemORyZ8rwIeMNjwdg6m58OzhDHU6Vq36eUntyXaQWsbGyVvK7XtM1Kag/s1600/IndianParliament.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="276" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj-Ra8F6OPG1X3uHZ5yyvsDgzPpEc_bCOiNMKCWWuM_dUWkIys3-tSMOUax94jhx0ds0rJiqfSmR8ibW9RjHMhemORyZ8rwIeMNjwdg6m58OzhDHU6Vq36eUntyXaQWsbGyVvK7XtM1Kag/s640/IndianParliament.jpg" width="640" /></a></div>
<br /></div>
<div style="text-align: justify;">
Suggested REFORM ACT OF 2014</div>
<div style="text-align: justify;">
<br /></div>
<div style="text-align: justify;">
1. No Tenure/No Pension: Parliamentarians collect a salary while in office, but should not receive any pay when they're out of office. </div>
<div style="text-align: justify;">
<br /></div>
<div style="text-align: justify;">
2. Parliamentarians should purchase their own retirement plans, just as all Indians do. </div>
<div style="text-align: justify;">
<br /></div>
<div style="text-align: justify;">
3. Parliamenarians should no longer vote themselves a pay raise. Their pay should be linked to the CPI or 3%, whichever is lower. </div>
<div style="text-align: justify;">
<br /></div>
<div style="text-align: justify;">
4. Parliamentarians should lose their current healthcare system and participate in the same healthcare system as the Indian people.</div>
<div style="text-align: justify;">
<br /></div>
<div style="text-align: justify;">
5. Parliamentarians with tainted records, criminal charges and convictions, past or present should be summarily banned from the parliament and fighting election on any pretext or the other. </div>
<div style="text-align: justify;">
<br /></div>
<div style="text-align: justify;">
6. Parliamentarians should equally abide by all laws they impose on the Indian people. </div>
<div style="text-align: justify;">
<br /></div>
<div style="text-align: justify;">
7. All contracts with past and present Parliamentarians should be void effective 1/1/2015. The Indian people did not make this contract with them. Parliamentarians made all these contracts for themselves. </div>
<div style="text-align: justify;">
<br /></div>
<div style="text-align: justify;">
8. Serving in Parliament is an honor, not a lucrative career. The founding fathers envisioned citizen legislators, so ours should serve their term, then go home and back to work. </div>
</div>
Jeevanhttp://www.blogger.com/profile/14805862105396943161noreply@blogger.com3