Entertainment at the Post Office

Yesterday I had a hilarious time at the Latehar Post Office. We had decided to send Nav Jivan calendars for the year 2012 to few of our friends abroad.

It turned out that the clerk at the post office did not have much of an idea on sending material abroad. In this part of the country, there are not many people who send stuff abroad save few who have relatives working in the Gulf.

The young chap knew of only two countries in the world - Gulf and America. And I had parcels for the US, UK, Australia and Singapore.

Most of the parcels were for UK. The funny thing was our guy could not spot UK in this drop down list of countries. So, I asked him to look for United Kingdom. There was no United Kingdom too in the drop down list. The next option was Britain. That option was also not available. After that we tried England. That also turned out to be a negative lead.

By now, we had got a small audience comprising of other staff and few customers. The clerk was quite new to the place and he could not afford to know less. The smart aleck suggested that maybe it comes under US - the America he was familiar with. I told him that the British may not agree for that. I promised him to call up few of my friends and find out an alternate name for United Kingdom.

So, he started off with parcels to the rest of the countries. The United States was the first to go in. He was totally silent. Next was one to Australia - he told me that he thought that was part of America. And to top it - he thought it was the cricket playing part of America. After that was a parcel for my brother at Singapore. The cost of booking the parcel to Singapore was naturally less that the US - he was shocked.

He told me how the government was quite partial to businessmen selling electronic items. I told him that I did not understand his logic. He told me that Singapore is the place from which cheap electronic items come. His logic was that because of the cheap electronic items - the postal charges was also cheap. And the best part was that he thought that Singapore was the electonics bazaar of America. He did not have a clue that Singapore was just a 4 hour flight from Kolkota whereas the US was almost half a day's travel by air.

Meanwhile all this while, I was scratching my grey cells for the alternate name for UK/United Kingdom/England/Britain. I could not come up with one. Then, I asked the clerk to get me a print out of the country drop down box. He called me inside his booth and asked me to go through the online list of countries. And there it was - GREAT BRITAIN. That was how it should be called.

So, all my friends from the UK. You are supposed to be known as friends from Great Britain while you are in India. Otherwise, people may think that you are from 'you know where'.

However, we had an entertaining time at the post office and did not realise how fast time flew. Of course, it was at the expense of the clerk's poor knowledge of geography.

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.

Worst of all poisonings . . .

Well, kindly take a look at the photograph below. Does it not look like a bucket of floorcleaning solution freshly prepared for cleaning.

Sorry, you are mistaken. That is contents washed out from the stomach of a 65 year old lady who had come to emergency yesterday. She was totally unconscious and had a poor cardiac activity - heart beating at around 10 per minute or was it a total cardiac arrest? I was not very sure. The pulse oximeter was not picking up any signal.

We started off the CPCR. Unfortunately, both our ventilators were already occupied. There was no other choice other than to bag her manually. By God's grace, we had enough hands to do that.

The history was that CD had taken some unknown poison sometime in the afternoon when her relatives found her unconscious. They had called a local doctor who administered some medicines after which she had become unconscious.

On arrival at NJH, CD smelt of organophosphorus poison. But, it was funny that she did not have the characteristics of organophosphorus poisoning. She had already been to a quack. The relatives got the quack over the phone - he had given her a shot of Betamethasone, Gentamycin and Multivitamin. However, her pupils were normal but she was frothing in her mouth.

After CPCR, I somehow got her heart going and she was put on an Atropine drip. Another line went in with Dopamine. Simultaneously, we were doing the stomach wash and then I suspected that she had mixed Phenol too into the cocktail. ECG showed features of hyperkalemia. In went a dextrose-insulin drip.

For our hospital, she looked out of place. With the mechanical ventilation and 3 intravenous lines running, it was a real sight. The relatives bagged her through the night.

By morning, she was trying to breathe on her on and move her limbs. We are in the process of gradually weaning her out of the dopamine drip. I suspect that the old lady had taken a cocktail of organophosphorus poison and phenol perhaps laced with a third poison like Aluminium Phosphide or maybe Endosulphan.

We thank the Lord for the recovery so far. However, she has a long way to go - the relatives have told me that she is regular anti-depressant medication. Please pray for her.

Violence . . .Living with it . . .

Our region has been in the grips of regular violence for quite a long time. Finding dead bodies on the road, news about gun firing and bombs going off are quite regular stuff.

As I had mentioned in one of my previous posts, we had been having quite a number of bandhs since the last 10 days. In fact, bandh has been called today and tomorrow too.

However, today morning, I woke up to the rude shock of a mine blast quite near our hospital which was aimed at a Member of Parliament from the adjacent district. From the latest reports, 12 people, almost all of them policemen have lost their lives.

As I sat reading the news in the newspaper, I got a call from Manika Police Station. They were bringing in someone with a bullet injury. The inspector did not have much idea about where the injury was.

The victim was in his early 20s. The bullet had entered his right flank more towards the back and exited on the left flank. Clinically, it looked like it may have gone through his vertebral column. However, his neurological examination appeared normal. But, he was in severe pain.

We did X-Rays and a ultrasound. It was almost certain that it did not enter the peritoneal cavity. Amazingly, there was no obvious involvement of the vertebrae. On very careful examination of the lateral spine X-Ray, we could make out an area suggestive of cavitation of the soft tissue with some involvement of the spinous processes of the vertebrae.

We gave the family the option of taking him to a higher centre which they obliged. The story was that the victim unwittingly got in between crossfire between two naxalite groups.

Many of our friends and relatives question our logic of serving in such a place where there is always danger lurking around. After the gruesome murder of Sr. Valsa John, it is quite obvious that anybody working for the welfare of the poor can fall victim to the violence that can be unleashed in communities like ours.

The patient with the bullet wound was an ominous reminder about the very dangerous society we are part of. We request your prayers. . .

X-Rays with findings - all on a single day

After the quite dramatic X-Ray that we had of NR quite fresh in our minds, I had the shock of my life when I reached the outpatient department today sometime midmorning.

The below are the X-Rays which were put on the line to dry -

1. A 60 year old man with partially treated tuberculosis who has come with severe cough. We await his sputum AFB.

2. A very sad story. 30 year old man with cough of 6 months duration. When I asked him on what treatment he was on - he showed me the medicines shown in the snap after his X-Ray snap.

The blister packet on the left is the Category 1 Intensive Phase under the Revised National Tuberculosis Control Programme of the Government. And Levofloxacin is one of the drugs used to treat MDRTB. It seems that a local practitioner has prescribed it. A good recipe for XDRTB.

The young man was quite breathless. He had a saturation of only 70%. The relatives has begged me for admission. His total counts is 25,000 with 90% polymorphs. He needs a miracle to make it.

3. 70 year old man - again partially treated tuberculosis. In addition to this he had bilateral basal crepitations on examination. Shishir did a cursory look at his heart and has concluded that cardiac activity is quite sluggish - hypokinetic.

More concerning was the lesion he had. He is awaiting sputum AFB and an ECG.

4. Well, the winner is the this one. 45 year old lady, weighing 27 kilograms with cough and loss of appettite since 6 months.

After seeing the X-Ray, I initially thought of a malignancy. Then Nandamani thought about doing an ultrasound and seeing if there was any collection. Shishir reported cystic lesions within the chest and then this is what he saw in the liver.

Hydatid cysts. . . We did not know much on what to do. I thought about referral. On discussing with the husband - he told me that 3000 rupees is the maximum he could afford. I prescribed her Albendazole tablets and Prednisolone in a tapering dose for a month.

I had two more interesting X-Rays but could not take the snaps because of the lack of time. However, sometimes when I see the tuberculosis patients, I continue to wonder whether we are really winning the war against tuberculosis.

Would appreciate if you could pause a minute and pray for such patients who do not have much of a hope as well as for the need for healthcare personnal in enough numbers who will be able to cater to such a population quite early during the course of a disease.