Praise and Prayers - 26 Nov, 2011

1. Today was Chain Prayer and Revival Meeting day for the hospital. Quite a lot of staff and students actively participated.

2. We've had quite a number of very sick patients over the weekend. We thank the Lord for KB, who had septicemia and a dead baby in her womb - she underwent a normal delivery. PD and SD had quite complicated pregnancies, - although they lost their babies, they made remarkable recoveries and were discharged.

3. The very preterm baby born to the eclamptic mother who died is doing quite good. Kindly continue to pray that he will put on weight and we would be able to discharge him soon.

4. FD who turned up quite late passed away couple of days back. It was sad that she did not know about the facilities we provide for burns patients. Kindly pray that the local communities would know more about the work we do and would come fast if there is a burn accident.

5. The construction of the burns unit is progressing well. Kindly pray for all the efforts going on to mobilise more funds.

6. Over the last year we have realised that there is a major gap in cancer care in the region. I wish the Lord would raise up people who would have a burden for involvement in this area of healthcare.

7. Since the last 2 months we have been witnessing a major epidemic of malaria and quite a few young lives being lost. We know that we can respond - but we need people with expertise. 

8. Yesterday, one case which was foisted against the hospital has come up again. There is no iota of truth in the case which has been filed. Kindly pray for the Lord's mercies on the people who have filed the case and the police officers who have raised it up again. We need wisdom and good guidance as we deal with it. 

9. SR, who came to us with a very severe case of pyopneumothorax has responded well to our intervention. Kindly pray that he would be fully healed. 

10. Over the last one week, we have not been having electricity. We end up spending almost 200 litres of diesel everyday to run the unit. Kindly pray that we would get regular electricity from the Electricity Board. 

11. The roads from NJH to Daltonganj continue to be in a very bad state. However, we've got news that the Chief Minister is visiting Daltonganj by road and therefore road repairs is being hurriedly carried out. Kindly pray that we would have good roads soon. 

12. Over the last 10 days, there were 3 days of bandhs/strikes which has affected the flow of patients to the hospital. A bandh has been called tomorrow also in response to the killing of a leader of the naxalite movement. 

Pyopneumothorax. . .and Massive

SR, worked as a daily wage labourer in umpteen number of brick kilns near the town of Balumath. Rather than a town, it is more of an overgrown village. Balumath is famous for the umpteen number of proposals for coal fields by umpteen number of multinationals. However, it is also one of the most impoverished regions of the state.

One may remember about the tetanus patient whom we had who was in terrible state of poverty when he came down to NJH. It was a miracle that he survived.

When SR came down to NJH, he was in a terrible state. Having been diagnosed to have tuberculosis about 5 months back and also having been on treatment on a daily regime, he was not getting better. Rather he was worsening.

And this was his X-Ray when he came.

 We knew that we had to put in a tube and there it was – I had never seen this much pus together in a person’s body so far. After he had drained about 4 litres, we clamped the drain as we feared that he will go into pulmonary edema because of the quick release of so much of material from within the chest cavity. Over the next 2 days we had drained almost a total of 6 litres of pus.

SR also needed blood. When we told his father that he would do good with a pint of blood, he expressed all helplessness. But SR was lucky. He had my same blood group. And the pint of blood I donated for NS was still in the fridge. 


SR is making a quick recovery. We praise God. Kindly continue to pray for SR as he has quite a long way to go.

NS – story of ignorance and apathy

NS, a 4 year old boy came the next day after the 2 sisters were admitted. NS was quite sick. The history was more suggestive of acute intestinal obstruction with severe anemia. And interestingly his mother was also quite sick. The only difference being that NS looked very sick and was almost unconscious.

NS’s blood tests were terrible. Hemoglobin of 4 gm%, 40% of the RBCs filled with the falciparum parasite and a platelet count of 20,000/cu mm. We needed blood fast. A peripheral smear showed all signs of hemolysis. NS reminded of Shalom, my son. He was almost of the same age.

NS was from Phulwaria – a village along with banks of the river nearby. Phulwaria is a common name for villages in this part of the country. The basic characteristic of all Phulwarias I know of is that they are usually the name given to the outer neglected part of the country side. And it is the same with the Phulwaria that NS’s family came from.

Families living in utter poverty and neglect. The only attraction for them to live there is the river that flows nearby. Most of the families live on some odd labourer jobs and most of them are at the mercy of the local landlords. The women live collect wood from the forest part of  which is sold and the rest used to cook whatever they can afford to buy. The perennial river ensures that there are collections of pools of water at many places away from the area of water which flows constantly. And this supposedly is the place for breeding of mosquitoes spreading all diseases which the mosquito spreads.

I told the relatives that if we need to save him, we needed blood. Off the 3 male relatives went off to get blood. It was then I realized that I was fit for my next donation and our blood groups matched. And I did not have to give much for a 10 kg child. Off went the donation and the blood was being transfused in no time.

I was with the child for about half an hour as the blood was being transfused. I was looking at the possibility of intubating NS and ventilating him. The other option was to put him on CPAP. But his saturation was maintaining well.

I thought of rushing home and getting freshened up. I had just reached home when I got a call from Acute Care that NS had arrested. Nandamani was in the next room doing a cut down on FD. He had NS intubated but he was not responding to any resuscitation.

By the time I reached ACU, there was nothing we could do. It was not surprising that NS collapsed so fast considering his hematological parameters.

The next day, Angel reviewed the peripheral smear of NS where she found out evidence of severe hemolysis. Most probably, NS had gone in a state of auto-immune hemolysis which is commonly seen in severe malaria.

The saddest part of the story was that the male relatives came almost 3 hours after NS had died. I told them that we had tried our best. As I was conversing with them, I realized that all 3 of them very stinking alcohol and I was talking to 3 fully intoxicated men. I realized the futility of my talking and left them to take the dead boy home.

It was sad. NS was the only child of his parents. As with almost every family in Phulwaria, NS’s family also had a hand to mouth existence. Everybody drowned their sorrows in alcohol which was available plentiful. If the local women did not make the country brew, it could be brought in the nearby Satbarwa village or they could always buy a bottle of ‘English liquor’ which was a bit more expensive. The story about alcohol use would distract you from the objective of my post.

Malaria continues to ravage in parts of Jharkhand in an almost vengeful manner. There are multiple factors which would continue to ensure that the parasite would remain in the communities we serve. Unqualified medical practitioners also compound the problem.

I could only watch helplessly as the nurses removed the almost full pint of blood. They asked me what to do with the rest of the pint. I told them to keep it in the fridge. Maybe, if I got someone else with a A positive group, I could transfuse the rest of the blood. I wish I waited to donate blood for another patient who had a better chance of surviving.

Malaria Galore. . .

It all started yesterday with 2 sisters, both below 5 years coming to Emergency with quite high grade fever associated with chills and rigors. Both of them were grandchildren of one of our watchmen, Mr. Jithen. They were being managed in the village.

However, the parents or rather the grandparent realised that both of them need serious medications.

When they came in on Sunday morning, both of them were partly conscious, one of them had falciparum plenty within her red blood cells whereas the other one did not have obvious parasitemia. Both were terribly anemic with haemoglobins of half the normal values.

As I had written in my previous blogs, there has been quite a lot of malaria in this part of the country since the last month. Even, the local newspapers have been reporting increase in the number of deaths as well as large number of villages being terribly affected by the malady.

Both of them have been started on quinine and the relatives were able to arrange blood transfusion for both the children. They have improved quite well and should be fit enough for discharge in a couple of days.

However, it is very evident that both these little girls are quite lucky compared to NS, a little boy who came with very severe anemia yesterday, about whom I shall write in my next post.

Maternal near misses continued . . .

My last duty was a bit stressful. I had to do 3 Cesarian sections back to back. And to make things quite difficult there were the 3 malaria patients in the ACU and the terribly burnt patient which Nandamani kindly agreed to manage.

The first one was SD who came in at around 10:00 pm with a hand prolapse per vagina. I somehow hoped to do an internal version. However, she being a primi – it was quite a tough ask. And when I examined her, it was obvious that I would not be able to do the internal version. The uterus was in a state of tonic contraction without any moment of relaxation.

Per operatively, I was glad that I did not try the internal version. The lower segment was on the verge of a rupture. Later I found out that she had recieved intramuscular pitocin injections from her village.

However, what I wanted to bring to your attention was the fact that SD had been diagnosed to have breech presentation on arrival in the Leslieganj PHC and she had a referral letter dated the same day at 5:00 pm. But, the relatives decided to stay on whatever the consequence is. There was a high risk consent absolving the PHC doctor of any complication if she did not go ahead to a higher centre.

The hand prolapsed occurred on the way. The baby was freshly dead. Maybe, we would have got a live baby if she had turned up early.

The second one was AD, who came in sometime late morning. It was AD’s first pregnancy and she lived adjacent to the District Hospital at Daltonganj. Interestingly, till the day of admission her family never thought about taking her to the District Hospital for an Ante-Natal Check Up.

On the day of her admission to NJH last Monday, sometime in the early hours of the morning, AD threw a fit out of the blue. There were no warning signs. No swelling up of the body or no blackouts. Taken straight to the neighbouring district hospital, she was referred to NJH. Unfortunately, on arrival at NJH, AD was quite groggy and had 5 episodes of seizures.

The problem was that according to her dates, she was just in the middle of 32 weeks of gestation. Her blood pressure was 160/100, and Urine Albumin was 2+. As always is the case, we explained the limitations we had in terms of not having an obstetrician, a paediatrician, anesthetist, medicine consultant, ventilator, blood bank…everything I could think of. Armed with a high risk consent, I told them that I shall try for a normal delivery – without any sort of guarantee for the mother/child.

Over the next two hours, her blood pressure had become controlled and I was sort of confident of somehow getting the steroids to act on the baby’s lung tissue by waiting for 24 hours before we acted. I also induced her with Misoprostol.

As evening progressed, with the malaria patients and hand prolapsed, my thoughts were on how AD is doing. In between the surgery for SD who came in with the hand prolapsed, the nurse in the Labour Room informed me that there was a rise in AD’s blood pressure and her Urine Albumin is 4+. I knew that I had to act.

I posted her for Cesarian section immediately after SD’s surgery. AD delivered a healthy boy more of a Small for Gestation Age baby rather than premature weighing about 2 kgs. The mother and baby have done well so far.

It was quite a paradox that within a week of my post about non-availability of proper medical facilities, here was a patient who totally ignored getting herself at least one ante-natal check up and ended up with a complication and another one who ignored an advice to go to a higher centre.