The sick wayfarer . . .

About a week back, we had a peculiar problem not commonly faced by most hospitals . . . 

There was one middle aged man with an intestinal problem which needed urgent surgical intervention . . . Read his story . . . 

SD was a helper of a truck with a National Permit. The whole of India was his backyard. He knew each city and town like his own village . . . He was from one of the major cities of the country. 

SD and his friend who was the driver was taking a consignment to Ranchi. SD started having pain as the were passing through the middle of Madhya Pradesh which continued as they entered Uttar Pradesh. In fact, they stopped to see a doctor (most probably as quack) in Robertsganj. It would have been better if they had visited our sister hospital at Robertsganj rather than the quack. The quack prescribed some medicines - antibiotics and antispasmodics. 

They continued their journey. The pain did not seem to subside. Now, he had episodes of severe vomiting and his abdomen started to bloat up. They asked people on the wayside on what to do. The next nearest city was Ranchi, their final destination. 

After they crossed Daltonganj, the pains worsened. Somebody told them about a hospital in Satbarwa. They got down in Satbarwa. Someone told them about a good doctor . . . again another quack. The quack recognised that SD was quite sick and told his friend to bring SD to us at NJH. 

Nandu saw the patient and it was obvious that he had an intestinal obstruction caused by a Sigmoid Volvulus. The problem was that he needed immediate surgery. And SD's only bystander was his driver . . . We had the unenviable task of doing an emergency surgery without any immediate relatives of the patient. 

We contacted the local police station and informed the District Medical Officer. After conveying the matter to his relatives, we got the go ahead for the surgery. It was good to have got through to our ED for advice. We had one more problem. He needed blood. That was when we realised about one patient who died in the afternoon while being prepared for surgery. Someone had donated one pint of blood for this guy. 

It was still in the fridge. It was a life-line for SD. Thankfully the blood matched.

We went ahead with the surgery. It was good that we operated on him. One part of the inflated bowel was on already looking unhealthy, but not enough to warrant a colostomy. 

SD made a remarkable recovery. 

He got discharged today morning . . . 

It was good to see him walk out happily. We thank the Lord for helping us be good Samaritans for this man. If he had become sick in a city or town, he would not had much of a problem - - - but to have become so severely sick in the middle of a journey and having had to undergo emergency surgery - - -  he was blessed . . . .

Image Challenge . . .

This young man came to us couple of days back. The history was baffling . . .

Any guesses on what had happened . . .

Scroll down to find out the history . . .

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The young man was shot point blank. His assailants thought that the bullet had gone through his head and left him for dead. Most probably, the bullet had exploded inside the pistol. The sound and the shock could have made him unconscious. The exploding bullet would have produced splinters which has left his face including his eyes burnt. . . Another explanation is that he may have turned his head away at the last moment, the bullet missed its target and the explosion within the gun sent splinters which burnt his face. . . Comments from ballistic experts are invited . . . 

As for the really lucky fellow, we referred him to a higher centre as we were not sure about how badly his eyes were affected. His hearing appears to be normal . . . But he was in sort of a daze . . . 

Photos Post . . .Snake Bites

The cobra which had bitten a lady. I insisted on seeing the snake after the relatives told me that a viper had bitten her. And I was sure it was either a krait or a cobra. I was not surprised when they brought the snake in. The 10 cc syringe was put in to show the actual size. Amazing . . . .isn't it? That people find it quite difficult to identify snakes . . . 

Well, here the relatives had identified the snake correctly. A common krait . . .

A viper bite of the hand. We had to do extensive fasciotomy of the hand.
The young girl has recovered well . . . 

Fascination for the 'phoren'

Last month, we had taken a decision to do cataract surgeries at a reduced cost for our poor patients as well as do some amount of publicity work to do cataract surgeries under RSBY. We used all our contacts to disseminate the information. 

Its been 10 days today . . . Today morning, we were reviewing how the whole thing was going as today was the last day for registration for this special scheme. The patient response has been very good. 

However, what my ophthalmologist told me was baffling. Very few people wanted to do the surgery under the reduced rate or under the Rashtriya Swasthya Bima Yojana. The reason . . . Almost all the patients wanted to put an imported lens. We had taken a decision that we would only use a intraocular lens made in India unless someone asked specifically for an imported lens, for which normal rates would be applicable . . . 

But, after all the developments that we have had in our country, folk prefer to have an imported intraocular lens . . . As far as I understand, India produces intraocular lens which are as good as imported lens . . . I hope to hear from ophthalmologists who differ . . . 

For all the swadeshi movement stalwarts . . . isn't it intriguing that our countrymen still prefer foreign goods even when we produce quite a lot of stuff which are commonly used. 

Well, I don't think the village folk here are exceptions . . . I remember how my folk back home used to flash imported saris. It was quite later that I realised that how come there are saris made abroad when the sari was an Indian dress. 

Many of us would really like to get imported chocolates, pens etc as gifts. So, I don't find anything wrong about preferring imported things . . . 

But, do remember, we in India produce stuff which are quite good to compete with those made abroad . . . And when it came to healthcare, I do not think that things like intraocular lens made abroad are any better than Indian made ones . . . Hope that we could feel proud of things that are produced in India . . . 

The First Maternal Death . . .

This is an account of the first of the three maternal deaths which came through NJH over 24 hours of last Sunday-Monday. This lady, SD was brought dead. We did not know till yesterday that she was from one of our nearby villages, Piperakala. 

Later, we had 2 more maternal deaths which have been mentioned in my previous posts. 

We found some time today afternoon to visit the family. 

It was a very depressing time. The house was in the middle of the village. Quite in the middle of filth and rubbish, the house was quite a symbol of severe poverty and despair. 

An old woman and a below 2 year old boy was sitting in a charpoy inside the house. The air smelt of rotting cow dung. Houseflies hovered all around the place. The old woman started to cry as we entered the house.

After introductions, we asked about SD. The old woman who turned out to be SD's mother told us that this was SD's fifth pregnancy. She had lost her second and third babies. The first child, a girl was about 7 years old. She came into the house weeping in the middle of our visit. The second child, another girl died at 10 months age. No one knew how she died. She had fever and then died. The third child was still born. The fourth child, a boy had just turned two. 

SD had come to us sometime back for her antenatal check up. For some reason, we had given her a referral to Ranchi. I would need to get hold of the out patient chart some time.

Her contractions had started sometime on Sunday morning. It was quite uneventful. Sometime in the evening, since nothing much was happening, the family had summoned the Auxiliary Nurse and Midwife of the area. She had given her couple of intramuscular injections, following which she had collapsed and the family rushed her to NJH. 

The interesting aspect was many people in the village did not know about SD becoming serious and ultimately dying. Many people came to know of the news when our team went visiting. 

Dr Johnson who had seen SD's lifeless body told us it looked very much like a Rupture Uterus. 

Later, we had some discussions with some of the villagers. There was much anger against the Auxiliary Nurse who came to help with the delivery. It seems that she gave quite a few intramuscular injections and demanded money. 

Well, ultimately, what mattered was that there was a maternal death in the block after almost a year. 

There are unanswered questions - - - 

1. How come many of the villagers did not know about SD's complicated labour. Was the family ostracised?

2. Was it intramuscular pitocin that SD recieved? It is quite common even for someone as qualified as an Auxiliary Nurse to give intramuscular pitocin for delivery in most of rural India. 

3. Why do patients not prefer to come to hospital for delivery but have no problems in paying up quacks as well as other persons who come and try to do the delivery at home. There is an allegation that the concerned Auxiliary Nurse demands speed money from those she helps to deliver at home. And the rates being quoted are not small . . .

There are major issues which need to be sorted out if deaths such as that of SD has to be avoided. The question remains about our political will to bring about healthcare reforms . . . 

I shall reserve more comments on this till I hear from those who read about these unnecessary deaths. . . However, what is going to haunt me is the helpless frightened look on the faces of SD's first two children. I'm not sure how secure their future, especially that of the daughter, is going to be . . .