Friday, September 30, 2016

Just when I thought I had seen it all!

Just when I think I have seen it all and done most things in Lakhnadon,Alok Singh is wheeled into the OPD.He has a history of injury to the heel which was treated in Seoni .Since two days he has severe spasm in the neck and is unable to swallow anything.
I last saw a case of tetanus ten years back in Jharkhand .Here was Alok who went into a severe bulbar spasm as soon as I put my spatula into his mouth.
I had to go through the tedious experience of explaining the natural history to the  bystanders who were already very difficult to communicate to.
Just how do you treat diseases like tetanus in the current scenario?We have long stopped stocking Tetanus anti-globulins.Brought to mind Dr keith Sander whom I had the privellage to meet for lunch during my time in England.he had done some work on tetanus during his stint in Ruxual ,and I am talking about the founders of the organisation !
I remembered our escapades in Oddanchattram where day after day Dr KV during his rounds used to show us different ways of examining the well-being and progress of such patients with such patience.
The incident that stands out is of a patient from one of the Panchalur hills who was brought to Oddanchattram with the full-blown disease.The patient had to be sedated ,kept in a quiet room and had to be bagged with an ambu.We did not have a ventilator then.The tubes started clogging on the third day so a  tracheostomy had to be done.
Every day Dr KV would go through the vitals to look for features of dysautonomia,palpate the abdomen to make sure he was sedated adequately,scan the diet sheet  and go through the routines very calmly while we tiptoed around so as not to wake the patient .
One fine day the relatives decided that they had had enough and they wanted to take the patient home.
When persuasion did not work we sent the patient home with a spare ambu-bag .
A month later  my senior Alex came chuckling into the out-patient.
Much to our amusement and joy the patient had walked into the OPD all the way from Pachalur bagging himself with the ambu.
He must have recovered some time back but had been too afraid to disconnect or do anything about it.
That was good news.
However,managing Tetanus is hard and I often find that the support staffs are not trained or adequately equipped to manage such cases.Add to it I travel out of lakhnadon tomorrow and will be away for more than a fortnight.
I feel tired even as I explain the logistics to the patient and the bystanders.
He is with us tonight.Tomorrow they might have to make a more feasible arrangement.
Just how do we treat diseases like tetanus in this day and age?Sigh!!

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