Saturday, January 5, 2013

Looking ahead . . . Anxious



The start of 2013 was quite a lot different from the previous years. Many a time, I've wondered why we need to celebrate a day as the start of a New Year. One of my seniors wonders whether there is any meaning in the celebration of the start of New Year. I also agree that it is not much different than any other day of the Year. 

Why was this year different? I've been quite anxious than the previous years.

The major reason is the planned departure of our surgeon, for a 2 year break from NJH. Being a hospital which deals with quite a lot of emergency surgical and obstetric load, a surgeon is a very much needed person in the scheme of things here. We've been searching high and low and praying a lot . . . but, there does not seem to be any breakthrough in getting a new one.

So, that is  the first reason of my anxiety.

The next anxiety that I’ve been having is the increased clinical load of the place and the lack of appropriately trained and dedicated staff. As has been described in previous posts, it is not routine clinical care which has been the most tough . . . the intensive care of patients has been a major area of concern.

In addition to the clinical load, it is the major involvement in Community Health and Development by NJH which gives me quite anxious movements. The same reasons . . . we are yet to find the complete team for giving leadership to the projects.

There is major opportunities for both clinical care as well as community health and development. And there is hardly any quality work that is happening in anything.

Few of us were discussing the other day on the possibilities here. A small hospital in a 25 acre campus catering to the secondary and probably tertiary care requirements of a radius of almost 100 kilometers is big opportunity. Pediatrics . . . Internal Medicine . . . Orthopedics . . . it’s only people who we need.

If there was one dream for me in the beginning of 2013, it would be that of more qualified and dedicated staff joining our team. It would be a great pleasure to have more people to share our 'foolishness' of trying to live out  life in this place. The only assurance I can give is that of a life which would bring blessings into the countless number of people around us. Nothing more . . . nothing less.

As I sat penning this mail, I received a call from a friend of mine. Recently, his sister was being evaluated for a very benign looking swelling of her neck. The final diagnosis was out . . . she had leukemia. All my anxieties looked minuscule in comparison to the crisis that this family was in.

She is getting treatment at one of the best centres for cancer treatment. I request prayers for this young lady . . . Her name is Rinsu Susan George.

As we in the medical profession rush for higher degrees and recognition, please remember that the world of our patients are in another realm of things. In places such as ours, there are patients who die because of the absence of very basic medical care. Or they die because they are too poor to access appropriate care.

On the other side, there are people like my friend whose lives come to a standstill because of a serious illness in the family. Many a time, we do not have an answer on why such good people go through such a tough time.

To make matters worse in this world of ours, there are events like the Delhi rape case which sends shudders through each of us.

In a time of such anxieties, my only prayer for the New Year would be that all of us would remain true to St.Peter’s exhortation to cast all our anxieties on Him (The Holy Bible, 1st Peter: 5:7) who gives everlasting life (The Holy Bible, John: 4:1-42) and to believe that God is good and his gracious love is eternal (The Holy Bible, Psalm: 106:1, 107:1, 118:1, 136:1). 

Friday, January 4, 2013

Winter Morning Sun . . .

I clicked this snap as I got out of home for work today . .  It was a sight for which I was not prepared for . . .

Nowhere a better place to call home . . . Isn't it ? 

Mismanaged Diarrhoea . . . How quacks do it . . .


Today, in outpatient, I had a 18 month old child who was being managed by a quack . . .  And below is the snap of the medicines, he has been on. 


And this is his prescription . . . 


For those who could not understand the writing - 

1. Ondansetron Syrup
2. Dexamethasone Injection
3. Ofloxacin plus Ornidazole Suspension
4. Ceftriaxone Injection
5. Aristozyme digestive enzymes. 

The parents claimed that the baby was also prescribed Oral Rehydration Solution . . . But, there was no sachet to be seen . . . They claim that the baby was initially better, but later started to have diarrhoea and vomiting since last night. 

And the most interesting aspect . . . Similar to yesterday's patient, this young boy weighed 6 kilograms . . . instead of at least 10 kilograms which a healthy child of this age should have. 

Thursday, January 3, 2013

Mismanaged Diarrhoea . . .



The above snap is of medicines that this 18 month old baby had been having since the last 3 days. The list includes - - -

1.       Cefixime with Lactic Acid Bacillus Dry Syrup
2.       Ofloxacin with Ornidazole Syrup
3.       Nutrolin B Syrup
4.       Furazolidone and Metronidazole Oral Suspension
5.       Nitazoxanide and Ofloxacin Oral Suspension
6.       Ondansetron HCl Syrup
7.       Acetaminophen Oral Suspension.

The worst part was that there was no Oral Rehydration Salts prescribed. So much for all the awareness being spread about this intervention, which has been proved to have been one of the most effective life saving interventions ever invented.

And to complicate matters, the child weighs a measely 7 kilograms. And therefore, she is malnourished like the 54% of under fives of this state.

If a doctor with a graduate degree does not know how to manage a case of diarrhoea properly, you cannot blame them going to quacks . . . However, part of the blame is also with patients who believe that more the medicines prescribed, better thedoctor and faster the recovery.

However, this is much better than the last one which I had posted aboutmismanaging diarrhoea.

Wednesday, January 2, 2013

The Fourth Estate . . . Quo Vadis


It was quite surprising that Mr. Shashi Tharoor was again on centre-stage all over in almost all media circles yesterday night. The reason . . . he had posted something on Twitter regarding the Delhi rape victim. 

Yesterday night, the way the story was reported, showcased Mr. Tharoor as an uninformed ignorant person with ulterior motive. However today morning, with the family having obviously given it's consent for the same, most of the newspapers have backtracked and have been sort of commending the idea. This is a good article on how the media handled this. 

The whole incident shows how thoughtless are our media and politicians. We under-estimate the capability of a person who was an illustrious diplomat and was in the running for the UN Secretary General whereas we are ready to accept statements of people who end up apologising most of the time that they were misquoted. We would rather get along with people who would state what we want to hear rather than hear someone who talks from one's heart with conviction. 

And the media just waits to pounce on things. Everyone wants masala so that their viewers or readers would increase. The number of newspapers and news channels who publish real news are on the constant decline. 

Well, it's not in the national scenario that media does not behave with responsibility. 

In my routine clinical practice, it is quite often that I hear about patients threatening to call the 'patrakar' (the local journalist). I ask them to go ahead. During my first year here, there were few who tried to publish news against the hospital. However, when I convinced the local patrakars that they could end up in serious trouble if they published baseless news, they've left me alone. 

One of the common practices in this part of the country is 'paid-news'. If you run an NGO, it is very common for you to call the 'patrakar' and give him a 'baksheesh'. The prominence, the news about your program will command is directly proportional to how much you pay. 

I made a conscious effort to ensure that these guys are not called when we have big programs in the hospital. However, there is one problem. When we call some of the big shots in the government or administration, they usually ask where the patrakar is? I politely tell them that we usually don't invite the patrakar separately. However, they end up calling them up and they usually rush to cover the event. 

Even, with this Delhi rape case . . . although I'm quite encouraged by the protests it could muster and the awareness people got after the media coverage. I wonder .. .. .. is it that we never had molestation against women? In fact, 2 young men (Keenan Santos and Reuben Fernandes) were killed in Mumbai when they went to protest against a young lady being molested. To make matters worse, I read that there were about 25 cases of reported molestations against women since the Delhi rape all over the country. However, you were not interested in following them the same way you reported this particular incident. 

My dear friends . . . in the light of such incidents and experiences that we've had with the media, I propose that nobody of us believe much on what they say and publish. 

And my friends in the media . . . there is something called ethics which you need to follow. Please remember that you are not the rule enforcers or the judiciary. Your role is to report what happened . . . and not to report what you think should/would have happened . . . or not to report what you are paid to report. 

And please do remember . . . there is another India, news about which does not make find many takers. Hope you remember the Banwari Devi case. I wonder why much fuss was not made for that poor lady. There are many more which go unreported . . . 

Hope that you would be a voice for the voiceless rather than an amplifier which decides when to switch itself on or how loud and clear one should sound. 

Wish you'll report with sense and responsibility in 2013. Happy New Year . . .