The True Knot

As I had mentioned in one of my earlier posts, it has been quite busy although on another side we were quite busy celebrating the Golden Jubilee.

We had a very sad story of PD - who came with one of the most terriblest obstructed labours with an alive baby. We have seen many an obstructed labour where the baby is dead and it is easy to take a decision to do a craniotomy and deliver the fetus.

PD's case was quite different. It was quite apparent that she had recieved intramuscular oxytocin injections. The fetal head was quite firmly wedged into the pelvic outlet. In addition, she was subjected to multiple per vaginal examinations as well as attempts to somehow deliver the baby normally, because of which there was enormous edema of the vulva and the vaginal wall.

Initially, we could not hear the Fetal Heart. Later, after ultrasound, we could localise the fetal heart quite well and it was going quite strong. And we made a decision to operate to deliver the baby. I decided to take it out as breech since the head was quite deep stuck into the pelvis.

The surgery turned out to be a nightmare. The head was really wedged into the pelvis. And to top it all, there was a true knot in the umblical cord which was almost tight. I wonder how the baby had stayed alive all this time.

The baby came out quite sick and I was wondering if I had made a right decision to do a Cesarian section on the mother. I was quite tired after the preparations for the Golden Jubilee. Dr Nandamani had done a good job resuscitating the baby.

Unfortunately, he was becoming sick after he reached the nursery and I was definite that it would be quite a big ask on us to manage him. We tried our best to refer to Ranchi, but to no avail. The family was quite poor.

I wonder what the problem was  - but my weary grey cells have not been able to think much. The baby is still alive - but he has got hypoxic ischemic encephalopathy. In addition, he has got a positive sun-set sign in his eyes. Most probably, he had a intracranial hemarrhage following trauma of having got his head wedged and later disimpacted during the process of delivery.

The question is on the rationale of doing Cesarian section when there has been quite a lot of trauma on the fetus. But, here, PD was in labour for only 6 hours before she reached NJH. What could have been avoided are the intramuscular pitocin injections which she recieved from the traditional midwife in her village.

However, she is lucky to have an intact uterus. Few of my patients have not been very lucky. At least I appreciate that her relatives realised there was some problem within 6 hours of the process of labour.

Golden Jubilee CME

One of the new ventures we attempted as part of the Golden Jubilee was a Continuing Medical Education programme for doctors in Daltonganj. All the credit for suggesting the same goes to Dr Philip Finny, Consultant Endocrinologist from our sister hospital in Raxaul, Bihar State. 

We were quite encouraged by the enthusiastic response from the Indian Medical Association officebearers at Daltonganj. A total of about 40 doctors attended the CME which was on Diabetes Mellitus.

We look forward to more sessions of CMEs along with the doctors at Daltonganj.

GJ Celebrations - The Non Contact Tonometer

The second part of the Golden Jubilee celebrations on the 28th October comprised of the inauguration of the Non-Contact Tonometer in the Ophthalmology Department by Dr Mark Kniss.

The purchase of the machine was facilitated by the kind donation from the families of Mrs Betty Goodwin and Mrs Ivy Kerr of the Cambray Baptist Church, Cheltenham, United Kingdom. We acknowledge the role played by Dr Colin Binks, our former surgeon, in chanelising the funds to NJH.

We are very much appreciative of this donation and pray that it would be a blessing to the patients who visit our ophthalmology department.

Golden Jubilee - Day 1

Apologies for posting this late. We've had a very busy and exciting week.

The celebrations went off quite well. We thank the Lord for all the blessings we enjoyed during the week.

The programme on the first day was for the local community. We had invited the newly elected Panchayat Raj leaders, Sahiyas (ASHA), DOTS Providers and other community leaders.

The chief guests were the Civil Surgeons of Palamu and Latehar. We had also invited the other healthcare officials. Unfortunately, due to unnavoidable reasons, none of the officials were able to make it to the function.

The best part of the programme was the torch relay started by Dr Pradhan and passed on to the present unit leadership who ultimately gave it to Dr Mark Kniss who lit up a fire cauldron symbolising the start of the function.

Following the ceremony of the torch lighting, I welcomed the audience as well as gave a brief report on the activities of the hospital.

The next part involved Dr Mark Kniss thanking all those in the local community who helped him with the efforts in starting Nav Jivan Hospital. One of the community leaders, Mr. Bhola Prasad represented the community in thanking Dr Mark Kniss for the efforts he took in establishing the hospital.

The meeting was well attended. We were quite glad that quite a number of the Panchayati Raj elected members, Sahiyaas and DOTS Providers attended the meeting.

The meeting closed with prayers and was immediately followed by a sumptous lunch. A section of the audience along with the staff later proceeded to the ophthalmology department for the inauguration of the Non Touch Tonometer. More on that in the next post.

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 . . .