Friday, May 16, 2014

Where have we lost the plot!

I have been in Madhya pradesh for barely a little less than a month.Looking at the spectra of patients who enter my out-patient I must say I am impressed. Seoni district is supposed to be the poorest district in the state.The first thing that I had to face as soon as I started working was predictably in the field of tuberculosis. Anti-tuberculous drugs were just not available over the counter.This was a dream we had been dreaming of all those days when I was working with the tuberculosis programme earlier in Jharkhand and later in HCH and had thought would never happen in India.There have been forums which have waxed eloquent in this but practically I thought it would never happen in India,but this state has done it.Even though grudgingly,I had to give kudos to the government here. However the flipside was when a patient of miliary tb presented to us and would not give a sputum and so apart from the CXR we really did not have anything to fall back on.The bystander had to make the rounds of the government hospital thrice in the next three days before a decision could be made about whether anti-TB drugs could be procurred for her.At the end I had to refer the patient to Jabalpur medical college. Quietly ,ethically people are trying to do their best and that is the India I have secretly admired and often shared about with some of my colleagues. We,the community we belong to and the community we profess to support ,leave a lot to be desired as far as practical aspect of things are concerned. We need to do a good soul searching,whenever we become irrelevant in any way. It means we are not where we are supposed to be. Like a senior often used to tell us and has left that indelible lesson with me,'the poor and the needy will come if you are pure hearted'. Isn't the whole humanity poor and needy? Didn't they come to Christ in droves? Do we need an integrity check? Where did we lose the plot?

Thursday, May 15, 2014

You turned my wailing into dancing…Psalm 30:11.

Sumitra was thirty five ,gave a history of being four month’s pregnant, came wailing into the casualty with a back pain.She was pointing to her spine ,was more than hundred kilograms in weight. Her husband ,a handicapped person was emphathetic enough while the rest of the family watched the drama from a distance.She had a whole lot of complaints ,a lot of which could be attributed to depression. I was asking her the history and the staff was taking the FHS which could be heard clear and loud through a Doppler.I was talking to the husband and when we asked her for a history of discharge PV she said she had had it for the past two days. We decided to do a PV examination.Much to our chagrin ,she was fully dilated and the membrane was bulging.She had no USG with her but she and her husband were absolutely confident about the dates although her uterus looked almost term. We shared all the possibilities with them. We decided to induce labour with all the necessary warnings that should the baby be premature ,the baby would not survive.There was mourning in the facial expression of the husband whereas the wife seemed to be fatalistic by then. The lady was hypertensive,had swelling in the feet which could hardly be distinguished with the amount of fat she had on her. While we tried to encourage her on the labour table she was almost collapsing and would just not push. She refused to put in any effort at all. Considering the risks involved,we gave them the option of a caeserian section.They complied after a time of haggling and discussion. We operated on her and by the grace of God a healthy baby girl was born to Sumitra. Sumitra,who had been ostrasized by her siblings who had all married rich.Had no one on the maternal side to support her because she had lost a mother,father and a brother. She had been chucked out from her husband’s family’s house ,considered barren.After fifteen years into marriage and a hundred kgs later she had conceived only to have labour pains so early in pregnancy as per their calculation .There was pain,struggle and mourning all over and within that half an hour “the Lord made us partakers in her rejoicing”. Even as we thanked the Lord for his grace upon all of us in equal measures we were weeping with joy. Continue to pray fpr Suneeta,her husband ,the little baby girl who is yet to be named.

Friday, May 2, 2014

Treating Malti

Malti is eighteen .She was reffered in by one of our community nurses as having headache and fever of one month duration.Her feisty uncle and her docile father had brought her in. When she was brought to the casualty,she gave me a blank look ,hardly spoke.She seemed terrified of being examined.She read abuse all over her. When I asked her for the history of fever as written in her referral sheet she shook her head definitely to indicate she had none. It was difficult to get history from her since she looked badly. I diagnosed her as having early schizophrenia but never the less screened her for organic problems. I put in a word to Dr.Rajah our clinical psychologist in Herbertpur.Rajah as helpful as ever was effusive in his response and gave me a detailed guideline as to how I could manage her. I remembered many a day when Dr.Rajah had futilely tried to hammer in psychiatry into our medicinified brains.I had sat through his talks taking in the lighter aspects and thought, had not taken the heavier portions too seriously but now I discovered I had not done too badly or rather Rajah’s effort had paid off.I was actually considering treating her myself instead of shunting her to the nearest psychiatrist in town. The nurse on duty tried to put in an intravenous cannula and much to the chagrin of everyone concerned she started wailing loudly like a little child. The first night she was a little restless.We had to send her relatives to another town to buy her medicines. After the second night she slept well and started behaving better. On the third day I decided to send her home on medication to follow her up after two weeks. Since she looked a lot better I thought I would talk to her and try and get a little history. She denied having episodes of hallucination,thought insertion,etc. I gave her a few bible tracts to read.As I do with most patients I made her read aloud the text to make sure that she could make sense of it. At the end of the tenure she smiled and asked me for my phone number which I duly gave her. That was the first initiative she had taken on her own to connect. A dark shadow covers her even now . It is a step forward…. Do accompany us in this journey of walking with Lord Jesus into these foreign territories. Do pray for Malti and do pray for us.

Thursday, May 1, 2014

Getting to know Meenabai.

Meena Bai was nineteen years ,seven months in the family way.She worked as a daily labourer in the road and earned all of one rupee and twenty five paise. She became unwell so came to the mission hospital for treatment. The mission people had an unusual way of treating patients .They not only gave medicines and examined ,they also spent a long time talking to patients. Sister Barbara was one such lady who counselled her for a long time.She specifically remembers being told not to keep too many things in mind or worry too much. Life was difficult.Her husband had an erratic work.When there was work there was enough to eat. The hospital ,when she was about getting discharged ,conducted a camp for surgical patients.The doctor asked her to help out in the camp.She still remembers she was employed for fifteen days at a stretch . They gave her all of sixty-five rupees at the end of it. She had never seen so much of money in her life. That is how she started working in the mission. That was forty odd years ago. She still continues to work in the hospital. She remembers the dedication of the doctor sahab then. Every patient who used to come to the hospital gasping used to get mouth to mouth resuscitation. One such patient was rabid. According to her the doctor contracted the disease and became mad himself and so was taken away to Scotland for treatment. She tells me once he recovered he came back to serve again. I express my doubt about it having been rabies in the first place, and she tells me,'ask Ramabai she also remembers.' Off hand she adds, she has a son and a daughter-in-law,she is going to retire in 2015 so she plans to take a premature retirement so that her daughter-in-law can replace her because she needs to feed her kids. I am touched by her naivette and her simple calculation.I just smile.