Leopards sighted in Betla

Hello everybody. Great news for wildlife enthusiasts from the Palamu Tiger Reserve. There have been confirmed sightings of leopards through trap cameras in the Betla National Park. According to latest estimates there are about 14 of them now in the park and there are also reports of sighting of wild dogs.

 

Couple of weeks back we had been at the park. The guides were telling us that there is a good possibility of animals coming back to the park now as the rains have been quite good and the vegetation has become quite thick. There has been news of half a dozen tigers being sighted in the Tiger Reserve area of the National Park

I hope that the wildlife authorities will build up on this advantage and promote the park as well as take steps to retain wildlife even when there is a crunch situation like a drought. The possibilities for wildlife conservation are immense in this region and I hope that the government and the wildlife enthusiasts will take interest. Below is the newspaper clipping regarding the news of the leopard sightings.

So, friends, another reason to visit us during the Golden Jubilee celebrations or being part of us for a short duration of time or maybe for a lifetime.

Cancers in rural India

Over the last week we’ve had an epidemic of cancer patients visiting the hospital. When I joined work here, I would not have thought that I could end up dealing with cancer patients in a remote place like this. But the truth is that things are changing.

It all started with RD, a 56 year old Post Office employee from the nearby village of Polpol who had been suffering from invasive cancer of the mouth which extended to his cheek and the jaw. It was quite a pathetic sight to see. It was quite a long time since I had seen such a bad malignancy. Having studied in Medical College, Trivandrum where the Regional Cancer Centre is in the same campus, it was not a new thing for me.

RD had been taking treatment for a quite a long time for his cancer from Mumbai. However, over the last month, the family ultimately realized that there is nothing more which can be done. But, living in a village with such sort of a condition was very difficult. They were very happy to know that we could help them. Over the last 3 months, RD would come on and off. It would be to either adjust his nasogastric tube, or do a bit of extra cleaning of his wounds or just like that. The last time he came over, we had to admit him.

It may sound a bit bizarre. Few maggots had come up in the wound and his family had tried to clean it up. Suddenly, RD became breathless and he was rushed here. Nandamani found out that one of the maggots had slipped into RD’s trachea which was exposed by the malignancy. We thought that this was going to be curtains for RD. The family requested that he dies peacefully in one of our private rooms. We were not very keen – but the family was quite adamant with the request.

RD hung on. He was sick for the first couple of days but made a remarkable recovery and was ultimately discharged after about a week. RD did not wait to say bye to us before he left. Maybe he knows that he will be back soon.

Of course, disease profiles are changing in the rural areas too. The other cancer patients whom we had over the last week – the first one, SSD, about 35 year old male had carcinoma head of pancreas and the second one, KGD, a 40 year old mother of 3 boys had cancer of the bladder. Both the stories are quite pathetic – stories on how the health care profession almost looks like vultures waiting to pounce on the sick and bleed them of their possessions and dignity. But that would be later.

There is a glaring need for palliative care as well as early cancer detection programmes in our area. Considering that tobacco is being abused in all sorts of forms in almost all age-groups, much needs to be done regarding educating communities on cancer prevention as well as early detection of the disease. Ultimately, the truth is that while we still struggle with the good old malaria, tuberculosis, typhoid etc. the newer non-communicable diseases including malignancies makes life quite burdensome to the poor in the rural hinterlands of the Indian subcontinent.

PS: EHA has already started a Palliative Care unit at Harriet Benson Memorial Hospital, Lalitpur, Uttar Pradesh.

Photo post

It seems I've been writing too much prose in my blog. One of my friends suggested that I should put in more pictures. So, a mini photoessay today. Note: I'm on call today and the hospital is full. I should be able to share few stories if I get the time.

Snap 1: This can be scandalous. Well, this is one pint of blood which SD's husband (You can read more about it here and here) brought from Daltonganj. SD's hemoglobin on arriving to the hospital was 1 gm%. Till today morning, we have given her 3 pints of blood. After 2 pints of blood, the hemoglobin had risen to 2.6 gm%. The photograph I have here is of the 3rd pint.

It is obvious that the blood has been mixed with some other fluid. I've heard that they use Normal Saline to dilute one pint of fresh blood into 2 or 3 pints. I requested to do a hemoglobin of the blood being transfused. It was 5 gm%. I could not find the husband to tell him about it - but this is something common we find in this place.

 

Snap 2: I'm sorry that I had to black out his eyes inspite of him giving a consent for the photograph and publishing it. KD, 30 years old has been having these lesions on his face for the last 4 months. I hope you've noticed the thickened ears. Yes - Hansens's disease.

The disease is not supposed to be happening anymore in the country. We get quite a few cases every month. I've sent KD to the District Leprosy Officer to get free medications. The last time I had sent someone - he did not get. And we could not get the medicines in the open market for quite some time, before we found a supplier in Ranchi who sold it.

Snap 3: I wonder how this small boy should have the condition - herpes infection of his eyes and face. Usually seen in the elderly, I've not seen them to occur in children. Unfortunately, he had done some doctor shopping before he came to us. And whoever had seen him has started him on steroid ointments and eye drops.

The steroids have resulted in the condition flaring up and becoming more worse. I hope he gets better.

Fatal festivities

Today evening, we SSB, a 18 year old boy in the casualty. Yesterday and today, it is a tribal festival here – called Karma. The specialty of the festival is the feasting that takes places especially the use of alcohol.

SSB has been having a good time with his friends on the occasion of the festival. Someone had told them about some new substance which will give you a kick if mixed along with alcohol. SSB was the first to try it out.

SSB is still unconsciousness. I hope he will wake up to tell us what this new substance is. SSB had come in quite late – about 6 hours since the accident occurred. His friends have told us that they have made him to vomit after which he started coughing violently and passed out.

After he came in, we have given him a stomach wash and put in activated charcoal. We could not attribute the symptoms to any specific poison – the ones we know here – organophosphorus, aluminium phosphide or zinc phosphide. The positive aspect is that his vitals are all fine.

Later in the day, I was talking about it to the other young men I know in the neighbourhood. They told me about this new thing – something sold in a bottle which is mixed along with alcohol to give a kick. I hope I’ll be able to find out what this new intoxicant is. I had noticed another patient who was brought quite sleepy couple of days back – it seems that he had also taken the same thing.

However, as I see SSB lying in the ICU – I wonder how often in the developing world we see festivals developing into tragedies for families. One of the major problems is alcohol. During Christmas and Onam in Kerala, each year record breaking amounts of alcohol are drunk. Well, that is another story.

We pray that SSB will regain consciousness and that we would able to talk him out of the habit. I hope that he did not go into an episode of hypoglycemia or hypoxia which has damaged his brain permanently. It is so sad to see young lives being lost for no reason.

Essential Drugs

Recently, there has been reports of a major study which brought out the fact that cheaper effective drugs are not being used to combat non-communicable diseases in the country.

Although I did not read about this study in 'The Lancet', I’m reminded of the umpteen number of patients that I see with very expensive medicines given for diabetes and hypertension. Couple of hours back, one of the patients’ bystander, BBM whom I discharged today came to me very discretely and wanted to know if the patient needs to continue the drugs which she is taking from elsewhere. I was a bit taken aback as during admission we had asked the patient about previous treatment being taken. The relatives had replied in the negative.

She was admitted with septicemia and urinary tract infection. The treatment has been quite expensive for the family.

Now, here was a relative of the patient whom I had not seen before standing in front of me saying that she had diabetes and hypertension and she was on quite a lot of treatment. She had 3 different medicines for her hypertension, 3 other medicines for her diabetes, one drug for lowering cholesterol, one for lowering triglycerides, couple of vitamin tablets and two drug to prevent platelet aggregation. The total cost of her medicines for one day was about 60 rupees. It was only 3 months since she has started on the treatment and the family was already feeling the pinch.

If you thought that she must have been a very obese lady looking very sick, you are mistaken. She was quite fit and when she got discharged she looked quite fine. Her blood pressure was normal throughout admission and her random blood sugar was a bit on the higher side. We were planning to do a FBS/PPBS sometime during admission which we missed out.  

Well, I did not know what to say to this man. First of all, this family had not mentioned anything about her medical problems during admission and now they want me to take a decision on whether she should continue on her present medicines, almost half which I've no idea about.

BBM was already discharged. Her blood pressures were normal. I’ve asked the family to bring her in after about a week where I would be checking her FBS/PPBS and other parameters. I hope that I would be able to start bit more simple medicines for her when she comes back next week and enable to make her treatment more affordable to the family.