Summer vacation . . . Part 1

Well, ultimately, we got to take a vacation . . . although a short one. We've promised to take a longer version during Autumn this year.


I've not been an enthusiastic photographer during the trip . . .however, below are few good ones . . .


Below are couple of snaps which I took of the Burns Unit construction which I took before I started off.

The brick making machine had come out really well . . . It looks like a good investment . . . 

The upcoming burns unit . . . 

Couple of snaps from the train journey to Alappuzha . . . We travelled by the Dhanbad-Alappuzha express - the only option we really have . . .

We had packed enough food . . . But, Shalom had to have  Potato Bondas from the pantry as soon as he got into the train . . . A scene 5 minutes into the journey . . . Of course, Charis is also turning out into one great train fan . . .

10 cups of tea . . . 5 cups, the ones further away - the milk had split. . .
The pantry guys were gracious to replace is as soon as the problem was diagnosed . . . 

Charis keeping Chesed in good spirits . . . 

Shalom also joining in the act . . . 

Came Andhra and we had mangoes coming in . . . and Charis was right into it . . . 

Chesed sleeping off in Ammachi's arms . . . 

Charis taking a walk in the Chengannur railway station . . . 

Waiting at Trivandrum Pettah railway station . . .and having hot vadas . . . 

Well, this blog has turned out into a long one . . . Rest of the snaps in a later post . . . especially those from Trivandrum . . . 

Enjoying Summer . . .

It has been about 10 days since I left for a short vacation. Something waited for after all the busy times we had been having at my place of work. It is almost one year since I seriously started to blog . . .  and the rewards have been multiple. There are enough happening at my workplace that I've unusual things to write about almost every weekend. 

In the process of trying to find a wider audience for my writing . . . I ended up writing a bit more than an average blogger. My dear wife has already started to call me an 'internet addict'. However, when I got a announcement for a contest from The Lakme group through Indiblogger, I just could not resist the urge to put in one more post. 

And more the reason to put it as I had observed one of my very high risk patients who somehow pulled through a difficult childbirth put makeup on her face in the ward and my colleague made a passing comment on how better things would have been if she, rather her family had taken the same care during her antenatal period with regard to her health. I've not much a clue about all the different cosmetics available to get ones face made up. But, oh my, that pretty lass had a little cute box full of all those . . .

I had been wondering on how to combat maternal mortality and near maternal misses . . . I deal with them so many a time. 

I had a very much relaxed time over the last 10 days. . . Well, I would like to take Kyra back with me to the place and ask her to give me ideas on how to improve maternal health in the region. 

Statistics say that India accounts for 20% of the world's total maternal mortality. Do remember mothers die young . . .and many a time leaving children orphans.Well, one aspect which maternal mortality does not represent is the untold suffering, which we call 'morbidity', which many a woman undergoes during the physiological process of giving birth. 

Couple of major causes of maternal mortality in NJH is Eclampsia and Obstructed Labour, both of which can be prevented and easily managed. I have had many experiences of husbands and fathers showing me the snaps of their dead wife or daughter after the tragedy of a maternal death. Most of them took a late decision to bring the patient to the hospital even after realizing that there is some problem with the delivery.

Pretty, painted, dainty faces . . . lost in a ethereal bliss . . .stare back at me. It is difficult to imagine that those are the faces of the same young lady, whose life I had been trying to save couple of hours back.Faces twisted and contorted . . . swollen feet . . .and stiff abdomens . . . dark circles around the eyes . . . exhausted beyond imagination . . . having lost the desire to live . . .

In fact, I started to blog determined to bring the untold stories of these women out into the open. The first 3 women about whom I posted epitomized the challenges maternal care faces in this country. 

However, with relation to the cosmetics - I wondered if there is a paradox in the whole affair. 

As I looked at the family snaps of many of our patients who died - I used to wonder at the pain that each of them might have taken to make themselves look pretty rather presentable to the outside world and be the pride of their parents and husband. But, when it came to antenatal care - they seemed hardly bothered . . . 

I had patients who never had even a single antenatal check up . . . another lady who in fact of being a care-provider in her village, failed to recognize danger signs of her own pregnancy and paid it with her life. . . . Sometimes, things are beyond our control . . . Sometimes, I've wondered if the brightly painted lips camouflage the anemia which also accounts for maternal deaths . . .  I can go on and on . . . 

What I would like Kyra to do is to come along with me to the place where I work . . . She has been quite successful in promoting beauty enhancing products all around the world. . . Maybe she can explore on how to use her skills to bringing down maternal mortality and morbidity in places such as ours . . .I heard from my colleagues that while I was away on vacation, there were 2 maternal deaths . . .

Maternal healthcare is only the tip of the iceberg of problems we deal with. One more facet of life in NJH which we would expect from Kyra is for expert suggestions on how to tackle the issue of preference of boys over girls so much to an extent that my clients end up killing girl babies expecting to get boy babies . . .

Of course, Kyra can take her cosmetic kit containing the range of Lakme products along as it would help her bond fast with the young women and their caregivers.

Photo Post . . . 21st May . . .

1. The first two snaps of this photo post are hilarious. As you can see, this is a Barium meal follow-through film taken of a patient with an episode of acute abdominal pain. And the radiologist has diagnosed appendicitis from the investigation. Well, if somebody could tell me if this is part of the investigation for an acute abdomen . . . I just can't believe that this guy has diagnosed a 'tender appendix' by ultrasound. . .

2. Few snaps of a common scene when you travel between Kuru and Ranchi especially in the morning. The region around Kuru is quite favorable for vegetable cultivation. 

It is only quite recently I found out that the local farmers cultivate seperately for local consumption and commerce. For local marketting and consumption, they use the traditional seeds without much of pesticides and fertilizers. For those being grown commercially, they go all out with all the latest technology - high yielding varieties, pesticides, fertilizers, growth hormones . . . One farmer even told me about injections being given to cauliflowers and cabbages to increase their size and give a fresh look . . .

I asked few of the locals on why they did not prefer the newer varieties - all of them had the same answer - 'They don't taste that good'. Well, those of you in cities getting fresh looking and large sized vegetales . . . be careful . . . I'm sure you won't be able to wash off injected chemicals with all the soaking and scrubbing . . .

3. This is the per-operative picture of Mrs. AD's uterus after we had put a B-Lynch suture to make the uterus contract. Well, it is sort of a modified B-Lynch suture . . . as the uterus was of a funny shape and the traditional one did not hold well. 

AD had been through regular antenatal care in one of the private hospitals in the district headquarters. 

She had gone into labor and had been admitted since morning in the same hospital where she did her antenatal care. Over the day, her blood pressures rose and she was referred. Dr Titus was on duty and I was called. She was in severe pre-eclampsia and the baby was in an occipitoposterior position and there was hardly any pelvic space - obstructed labour.

The problem was that the family was quite well off. . . Severe pre-eclampsia with obstructed labour . . . Recipe for real trouble . . . I explained to the relatives my predicament . . . To complicate matters, came her hemoglobin report - 7.9 gms%. Since she had come from outside, I had done the counts too - Total count was 28,000 with 90% neutrophils . . .

With all the required consents, I opened . . . The uterus was in a terrible state. From the outside itself, it appeared quite unhealthy. On opening, it was obvious - chorioamnionitis at its' worst.

The uterus just refused to contract. There were 2 pints of blood readily available at hand. It gave me time to start off with the B-Lynch and ask help from Nandamani too.So far, she has done fine . . . till I left on vacation. . .I was glad that she made it - otherwise we would have had the second maternal death of the month . . .

4. A scene from one of the Primary Health Centres we visited on our Tuberculosis Unit supervisory visit. The snap shows bundles of 'Bal Swasthya Card' (Student Health Card). Distributed from the government, the staff were not sure on how to go about with these documents. A well thought out program on paper, it's a waste when it comes to implementation at the grass root level.

These cards are supposed to be filled up for each student to be used as a tool to monitor their health over the entire year.

As I discussed about this with a friend of mine . . . he told me that these cards should have arrived sometime in June-July . . .they arrived sometime in January and then no-body has much clue on what to do with them. And it is already April . . .

5. Railway line construction going on between Lohardaga and Tori which is expected to make it easier for us to connect to Ranchi by rail. 

RSBY Medical Camp . . .

Couple of weeks back, I was informed about the program of holding a medical camp in Satbarwa by RSBY. I had been quite vary of medical camps since I had been part of quite a lot of them. They are quite good for bringing in publicity. From a public health point of view, I'm not sure of how useful they are except for a chance for screening populations for chronic diseases like hypertension or diabetes. 

On asking the concerned staff on what the objectives are - I was informed that it is basically to screen patients for elective surgeries. I was not much impressed. However, did not want to discourage the RSBY staff. And it was first one I was doing in the name of RSBY and also after I came back after my post-grad. And I thought of giving it a good try - with all inputs from the hospital put in. The Community Health Department made quite an effort.

Following are the snaps from the camp. We got quite a lot of patients - totalled about 150. We had 3 doctors at the place including Dr Isac Jebaraj, an orthopedic consultant from the Christian Medical College, Vellore who was visiting us along with a batch of 2nd year Medical Students.

Getting the place ready

The ophthalmology team

Registration

Everybody . . .

Drs. Isac Jebaraj (white shirt), Nandamani (blue shirt) and Titus (yellow shirt)

Lessons learnt at the end - 

1. Medical camps are a waste of time especially for hospitals like us which have quite a regular crowd.  At least when they are arranged like this without much of a targeted approach. Lately, I realized that even hospitals such as Apollo has dropped their camp approach for valvular heart diseases.

2. Providing constant and regular service is more important in healthcare rather than mass efforts such as medical camps. 

3. We never got any surgical patients. Most the patients were those with backaches and vague complaints. Like most medical camps I've been to, most of the patients appeared to have come because there was a doctor available for free consultations and some free medicines.

Well, this post would not be complete without the mention of some small drama that happened. We had been told about the camp for almost a week. The venue was all decided and we were given the responsibility of publicity, which we did quite well. However, on the day before the camp, I received a phone call from the RSBY DPM saying that they were thinking of changing the venue. 

The venue surprised us - a newly opened private hospital about 1 km beyond Satbarwa. It was outrageous. I wondered what they were up to. I expressed our unwillingness to go and sit at a private hospital. I told them that I would not have any problem having the camp in the local government subcentre or the new primary health centre almost nearing construction. 

After being stubborn about this, they finally relented and agreed for the original venue.


Well, for a status update, since we were empaneled (March 2012), we've already treated 100 odd patients as in-patients and 570 patients in out-patients under the scheme. And do remember, we must be one of the very few hospitals in Jharkhand who does not charge registration and consultation fees for outpatient care for RSBY card-holders.


The challenge remains payments from the insurance provider - so far we've only received about 120,000 INR out of the 250,000 claimed (only claims submitted 21 days back) . . .  We hope that payments would be a bit more fast . . .We're already making extra investments for the poor - but payback is becoming tough. Do remember the 50,000 INR we lost because of free outpatient registration and consultation. And expenses for medical camps such as the one I described . . .And all these in a space of not even 3 months . . .

Prayer Bulletin . . . 20 May . . .

1. We thank the Lord that the progress of the burns building. Over the last week, we had the new Brick Making Machine arriving all the way from Coimbatore. We've already started making the bricks. 

2. Couple of weeks back, a major fire within the campus was averted. We thank the Lord that we were able to detect the fire on time and fire-extinguishers purchased quite recently were available on hand to put out the fire. In addition, we also had a major fire in the local telephone exchange following which our telephone connections had gone off for about a week. Couple of days back, our mobile connections were restored. The internet and landlines are still to be restored. 

The clump of bamboo trees that caught fire behind the mess

Smoke billowing from the burning telephone exchange . . . 

3. I hope that you read about my post about a particular incident published in paper couple of weeks back. Kindly pray for this country. The amount of occult and evil practices continue to hold a stranglehold in our society. Many of these practices which is aimed at the poorer and marginalized sections of the society continue in the name of traditions and customs. Please pray that people will see the futility of practices such as these. 

4. The need for a medicine consultant in the hospital is becoming all the more evident. In addition, we need a pediatrician and nursing personnel. We pray that the Lord will move the hearts of people to serve alongside us. 

5. The beginning of the hot and fiery summer came up with major financial liabilities for the hospital. To start with 2 of our generators crashed. By God's grace, we could repair one without much problems. Unfortunately, the second one which is actually the newer one was found to have a major fault which needs expensive repairs. To make matters worse, we realized that the newer one had some sort of technology which was not in use anymore and therefore is of no resale value. Which ultimately means that we should be planning to buy a new 100 KV generator which would cost about 700,000 INR (approx 14,000 USD/Euros or 9000 GBP). We had also been planning for a smaller 30 KV generator which would cost an additional 350,000 INR (approx 7,000 USD/Euros or 4500 GBP).

6. The urgent need for the purchase of new school bus remains, which would cost approximately 1,300,000 INR (approx 26,000 USD/Euros or 13500 GBPs). 

Our old school bus. When I had put this snap few weeks back someone suggested that the bus looks new.
Well, our engineer has kept it going on for some time now.  But the engine and interiors are quite worn out. 

7. Kindly pray as the minimum standards for the Clinical Establishment Act is formulated.


8. We thank the Lord for the students from CMC, Vellore and senior consultants, Dr Isac Jebaraj and Dr Prasanna who gave us company for about 2 weeks last month. We hope that this experience would widen their outlook to healthcare scenario in the Indian subcontinent and play a role when they determine their choice of service. 

The students at a teaching session

A visit to the nearby dam.

9. Quite a lot of of our staff would be away travelling during the next one month on holiday. Kindly pray for journey mercies as well as time of relaxation and rest during the holiday season. Please also remember those who are staying behind in the harsh summer (I heard that it is 46 degree Celsius today) to serve our patients.


10. We start the admissions for the Nursing School from next week. Kindly remember the entire process in your prayers.