What gives

Manikram came to us with a rotting leg.There were ulcers down the front of the shank to the dorsum of the foot.Maggots were having a field day feeding off his flesh. My junior did a good debridement along with the senior nurse. I saw Manik Ram in the ward accompanied by his wife they were simple village folks.They had come from a faraway place and there was no way they could have managed to come for dressings so they decided to stay back in the hospital. Anticipating a big bill, we decided to discharge the patient in our software but never the less keep him back in the hospital free of charge while we did his dressing. At the end of the second week his perky daughter-in law appeared out of nowhere. Maniklal seemed to have made up his mind to go home. I thought he might have been home-sick so I agreed to let him go and offered to teach the bystanders how to do the dressing at home They could come back to us for further management. Meena bai,our nurse assistant , matter of factly enlight...

In my three months of tenure in Lakhnadon I have but lost one patient truly .There were two young kids with aluminium phosphide poisoning and one lady who was brought in decerebrtating ,a case of hanging which I would not count because they were expected to die anyways,we do get extremely sick patients reffered to higher units by our colleagues from the government hospital and local nursing homes. I have been severely restricted in my patient management due to lack of equipments. In my earlier tenures I have seen aweful iatrogenic faux-pas in well-equiped places which have given me restless nights. Having talked to a physician colleague who works in a critical care unit in a research institute and her observation that patients actually do better in a peripheral set up because we are less invasive ,I wonder if she is right.She was talking about how elective intubations expose patients to nosocomial infections and the pneumonia resulting greatly increases the cost for the patient beca...

Today,I stand in a strange place. I do my rounds of the hospital ward and I wonder where I am . I have two ladies who have undergone total abdominal hysterectomies,one gentleman who has undergone resection anastomosis who has just started liquid diet,one gentleman who had his obstructed herniae released and underwent a herniorhaphy with a mesh insertion,two ladies who delivered by caeserian section,one lady with a breast abscess who underwent incision and drainage,one patient post-snake-bite who underwent skin grafting,one patient who has come for exploration of the sole of his feet for probable foreign body.One gentleman who has presented with a bad wound infection post-electrocution for wound debridement. I also happen to have a lady with unstable angina,a young kid on ambu ventilation for snake-bite ,a few patients with fevers and acute gastr-enterites. By the grace of God they all are doing well. These past few weeks I have seen a lady with a haemoglobin of 1....

Malti was brought in with snakebite. A tribal from a village in Seoni ,was not talking,drowsy and had labored breathing. We pumped in ten vials of anti-snake venom ,gave her neostigmine and atropine, intubated her and taught the relatives to ventilate her with an ambu-bag. She needed ten vials more but financial constraints on the part of the hospital and the relatives did not make it possible. At ten in the morning the nurse anaesthetic after consulting me decided to extubate her.However, on extubation, her breathing stopped.I was busy attending to another patient ,so the nurse anaesthetist intubated her and she was back on ambu bag.The whole village it seems were keeping a vigil in the vicinity of the hospital so there were no dearth of hands to bag her. We had given them some tips about watching the saturation et,al. At around ten–thirty at night I received a phone call from the nurse asking me to attend to the patient immediately as she was bloating everywhere.I rus...

Today I got talking to Suresh our chowkidar.His only child had had fever so he had brought him for evaluation. I saw that the little kid had pierced one of the ears and had put a ring in it.I asked Suresh, ‘Is it a girl or a boy?’ He answered, ‘it is a boy’. Why have you pierced his ears? Sahab,if I don’t then they will take my child. I asked ,who and where? To use as a sacrifice for building dams,etc. Open mouthed by now I asked ,so if he pierces his ears they will not take him? Yes sahib ,it means that the ear is already cut so he will not serve as a sacrifice. This is India,in the 21st century. I guess nobody has told them that the sacrifice has already been made.

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 round...

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 ...