Tetanus . . .The Saga Continues . . .

I never had any inkling that I would end up managing quite a lot of tetanus patients. After MS, who was the first tetanus patient who got into this blog - we've had quite a few of them. In fact, at any given point of time, we had one patient in the ward with tetanus. And we praise God - all of them have gone home well.

LO is our latest tetanus patient who has been discharged well. We had a tough time with LO. LO was a bit of a adamant boy throwing up all sorts of tantrums - And then, you cannot blame him. One of the problems we face with tetanus patients is the difficulty in putting a nasogastric tube during the initial phase. LO was adamant that he would not allow anybody of us to put a nasogastric tube even after we felt that it could be put.

Maybe, he must be the only tetanus patient in the world who would have survived without a nasogastric tube. His mother was so loving - and somehow she improvised a way to feed him without allowing him to choke on the food. Everyday, we used to fear that he would choke himself to death.

Well, couple of days before we discharged LO, we had a replacement for LO. SK, a 8 year old girl has landed with a quite a bad tetanus. She is presently responding well to treatment. We pray that SK would also go home cheerful.

The rush continues... Rupture uteruses and maternal deaths

Although we are quite busy with the Golden Jubilee celebrations, we continue to see patients who are quite sick. I'm glad that I've got Drs. Nandamani, Shishir and Johnson working fulltime and Dr. Angeline, my better half. This has been an unusual period of increased patient load which we have been having over the last couple of weeks.

Over the last 5 days, we had 2 rupture uteruses, one of whom died and another maternal death who had come with eclampsia. So, I did fill up the facility based maternal death forms and submit to the district nodal officer. Hope they were not shocked to see 2 reports come in after the meeting we had last week.

Last 2 days, we had more sad cases. There are 2 mothers with eclampsia for whom we did cesarian section and were blessed with live healthy babies. Unfortunately, we had a mother with pre-eclampsia on whom we did cesarian section and delivered a sick baby. The baby died soon after.

Today, there was one more near miss. The lady had been in labour since 2 days, before the family decided to take her to the district hospital. They kept her in the district hospital for about half a day before they decided to refer her.

On arrival in NJH, we found out that it was indeed a hand prolapse and a dead baby. We were not very sure how long she was in labour. We decided against doing an internal version as there was a bit of a doubt on the integrity of the uterus.

Ultimately, we did the Cesarian section to deliver a dead baby.

Almost all the patients  mentioned above who survived could have died if we had not done anything on them when they came to us.

The last sick patient in the ward is a little boy with a very bad fever. His counts have been rising after admission and I suspect him to be in a very bad septicemia. The father badly wants to take the boy to a higher centre, but has no money.

If he stays on - I shall do an LP on him tomorrow.

However, over the next 5 days, I pray that we would not have many sick patients as I'm afraid we would not be able to do full justice to them in the middle of a very busy week of celebrations of 50 years of the existance of NJH closely followed by the Eastern Regional Administrative Committee meeting.


And to top it all, there is a young man with tetanus who has uncharacteristically turned up quite early and has been doing well.

Pray for us . . .

Tetanus - help from a Good Samaritan

CD who was with us for almost a month got discharged couple of days back. He was quite in a bad shape when he had come in.

It was a matter of concern for us on how he will make his way back home. He came from almost 100 kms away and it was not on the main highway. With great difficulty he arranged for food. We were quite sure that the family did not have any money.

I’m yet to see the total bill. It should be something around at least 20,000 Indian rupees excluding the medicines which also we helped him to buy. Tetanus is not a great disease to have. He took almost a month to recover, of which he was heavily sedated for about 20 days.

I come to the story on how the good Lord arranged for people to arrange for his travel back home.

I was in my office when a middle aged gentleman walked in. He did not look that rich though he could have been even poor. He told me that he was the father of a lady who had come for delivering.

I was very dismissive of him thinking that he has come to ask for some charity. Meanwhile I asked him to sit. He asked me how CD was doing. I told him he is fine but would need some more physiotherapy before he could be fully back to his normal routine.

The gentleman told me that CD was his neighbor. And also that during normal days, CD’s family had struggled for food. CD getting tetanus had made things worse. He requested me if he could allow CD to come back with him when his daughter was discharged. Thus, CD could have a comfortable ride back home.

CD (seated) with the good Samaritan (on the extreme right)

I was thrilled. It was so good to see a caring neighbor. I wish we have more people in our villages, who would care for each other especially when it came to issues of healthcare and food security. I wondered how long it has been since I’ve seen somebody offer help without being enticed for the same.

Hunger and Tetanus - Yet Again

CD, who has been with us for the last 4 weeks ultimately showed signs of recovery couple of days back. The story of the penury that his family faced and which got to be ultimately addressed made quite a lot of my followers writing back to me.

Meanwhile, there was one more tetanus patient, a 7 year old boy, BS who has been having symptoms since the last 8 days and has been on treatment at many places. Dr Shishir who was on duty 3 days back when BS came in diagnosed tetanus and we started off treatment.

Today morning, BS's parents told the nurses that they wanted to take the boy home. The reason, they do not have any money. We had been giving them hospital supply. On arrival, I wrote them a prescription for Injection Tetanus Immunoglobulin which we did not have in the hospital pharmacy. They were asked to buy it from outside.

It was only when they reached one of the pharmacies in Daltonganj, someone told them that the treatment of tetanus could be very expensive. In addition, without our knowledge, the family had not been having food since admission. The father had told one of the nurses initially that they have lot of people whom they knew and they could easily find food.

I confronted the parents. The father started to sob. He told that they have spend quite a lot of money on treatment before they reached NJH. They did not have any money that they did not have any food. Few of the local eateries had given him food for the first couple of days. But, not anymore.

They have somehow got something to eat for the boy. But, the parents had been surviving on water for the last 2 days.

I was stunned. It was about 2:30 in the afternoon. I knew that there should be food left in the mess. I summoned Dinesh. There was quite a bit of rice and dal, enough to feed 2 adults.

I just went to meet the family. The mother and the boy was eating to their heart's fill. It was such a pleasant sight to see. From the way they were eating it was obvious that both the mouths had not tasted food for quite some time.

The father had gone home. I had made a deal with the father that if he gets some vessels to cook food, we shall provide him with the rice and pulses for cooking.

Hunger . . . The issue continues to mock us . . . We may be the Cricket World Champions, we have one of the largest armies, our information technology industry is one of the leaders in the field, our healthcare industry is booming, we are one of the leaders in space and nuclear sciences . . . but the bottom line remains that we have quite a lot of our people who still goes to bed without food on account of overspending on healthcare.

TETANUS AGAIN . . . with HUNGER

CD, aged about 50 years is a farmer in the nearby district of Chattra which was quite far away. CD suffered a small injury of his left foot about 10 days back which he managed by putting some local medications.

Over the last 7 days, CD noted that he could not swallow, which slowly progressed to a stiffening of his back. As usual, he was taken to many a place before he ended up couple of days back at NJH. It impressed me that someone had actually diagnosed tetanus elsewhere and had referred him to us.

After MS, this was the third patient whom we had. We use the WHO protocol for management which we put him in. We had problems putting in a nasogastric tube as his oesophagus had gone into a terrible spasm. Till date, I’ve not been able to do anything about it even after he was put in all the available muscle relaxants.

Well, the reason I wrote about this patient was because of something I missed about this patient. Dr Nandamani noticed that the bystanders had got almost all of their medicines as hospital supply and it crossed his mind that if the family did not have money – did they have something to eat? Well, his hunch was true. The family had not eaten for almost a day after they reached NJH.

He got them something to eat from Raju’s shop. It was sad to see the family sitting in the waiting shed and whopping down the food.

It is unfortunate that even in the midst of the plenty that we claim to have in this country, people remain hungry and would not even open their mouth to tell others that they have not eaten anything for quite a long time.