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Showing posts from December, 2010


The Gene X-pert was apparently developed by the department of defense after the events of September 11th when biological threats became a national priority in America.It was used to analyse the DNA in potential toxins in pieces of mails.In 2008,funding from Bill and Mellinda Gates Foundation ,FIND and NIH began to assess the machine's effectiveness in diagnosing tuberculosis. Gene X-pert as per a study published in the 'Journal' identified 98 percent of active infections because the tests look for the bacterium itself,latent infections are ruled out. Detection of latent infections would have no significance in the indian scenario because tuberculosis is so rampant in india. Treating latent infections could be potentially dangerous and could promote drug resistance because only twenty percent of the population harbouring the infection could manifest the disease. Inroduction of GeneXpert technology in the national health programme would pose two-fold challenges in india.

Let me heal in His hands.....I have not had the time!!

Someone asked me how was last christmas?...For the last four years I have been away from my family during christmas.I remember last christmas like the back of my hand.Infact for the past three years or so I have spent the christmas nights resuscitating patients back to life by the grace of God.It has invariably happened that the patient and myself ,we walk out of the ACU in the morning.They blessing me and I ,thanking the Lord for the Gift of life given for Christmas.However,last christmas was unusual indeed and will not I guess, go away from my memory too soon in the future. My cousin was struggling for life in Jaipur,the family had all but given up on him..Mr Ram Narayan Sahu(name changed),from Satbarwa,who had just had a bypass surgery ,who also had diabetes mellitus with stage four nephropathy came in with acute on chronic renal failure with gross fluid retention ,huffing ,puffing and frothing out blood and could not go for dialysis till the day-break.That was enough to keep me by

There it is !!

Sadoli block has been bothering me for the past two days.Today ,I shot a letter to the CMO,ACMO and the medical officer incharge of the block.Mukesh is planning a mela for Hep B awareness,immunisation and testing in the area.He called up a panchayat head in the village and was told that another person near his house had just died of jaundice a few days back. Got talking with one of the patient's bystanders from the area and he was sharing how the previous day when he went to a visiting RMO?Quack ?from Dehradun to administer a pain injection for his old man, he observed that the so called Dr was using the old man's used syringe and needle for a little baby and another patient who came in after that. When he reprimended him ,I believe he said,-'they cannot afford a fresh one ,so never mind!'. Waiting to see how the government goes about investigating the issue and taking some measures.


Five of a family from Sadoli block presented with severe jaundice with cholestatic features,ages ranging all the way from five to fifty five.They turned out to be hepatites B positive and negative for Hep C and HIV.I had just about started getting perplexed and getting the point person from the Sadoli block mobilised, another young fellow from the same block but different village altogether came in with the same picture and turned out to be Hep B positive again. Sadoli is a block in Saharanpur district in Uttar Pradesh.Our man is making a fleeting visit through the block to actively look out for more cases.These are the cases which have landed at our hospital.Are we looking at some epidemic of some sort, I wonder.Will try to intimate the CMO tomorrow after we get more details,I sincerely hope the government takes note and swoops down to the root of it all.

Being Thoughtful!

Ango was with me for less than a month preparing for her DNB exams.She has always been for me a little sister ,brought my way ,I believe,by the Holy spirit.I have stopped wearing a watch for the past five years and have all but given up on my phone for the last one year.I carry the latter around more for incase,but never felt the urgency to charge it.People have a way of reaching out to you in this highly sophisticated world of advanced communication. Coming back to Ango,she would be up and alert at five or so in the morning.I would hear her rustling around her room,having her quiet time,studying,etc and invariably I would be calling out to her in the other room asking her for the time. It went on everyday for the rest of the days she was with me. Time plays an important role in the mornings for me.It's a precious part of the day and I normally push in the best part of my day's schedule for then.It is perhaps the most important time of the day. Ango presented me with a love

Human rights issues in TB control.

I remember trying to convince Phoolmati Devi(name changed) to continue with her DOTS.She was an alcoholic lady in her forties with a family of twelve or more ,clustered in a two bed-room house,unwilling,uncaring and careless.After a series of visit from our boys and the doctors in turns she continued to be a potential source of infection in the middle of the village in Satbarwa.I was totally frustrated.I asked a series of experts on tuberculosis whether some way one could legally presurise her to take the medicines....everyone quoted human right issues..sounded a little confusing ...the knife could cut either ways.I got my answer in the meeting yesterday.

Why is the doctor so irrational??

The New yorker apparently carried a story about tuberculosis on the streets of Darbangha in Bihar recently. If there was a strong message to be carried from the sympossium,it was the message to ban the use of serological tests for diagnosis of tuberculosis.WHO is ,for the first time in it's history ,putting forward a negative recommendation. We stopped using serology for TB diagnosis five years ago,but never mind-it's better late than never. The article I believe,goes on to highlight how the doctors in Darbangha continue to order this expensive test for diagnosis of tuberculosis.The cost of the test runs up to 25 dollars.The patient is a labourer who earns around 2 dollars per day and the profit made from the twenty five dollars received ,is shared between the doctor who prescribes it,the person who imports it and the french company which produces it. So our poor rickshawpullers on the street ,who contract tuberculosis, are making these dubious companies in Europe rich!One

The important ..and the very important!!

I remembered Nirmal Bhuiya yesterday while attending the international sympossium for TB in Delhi.Nirmaljee was our DOTS provider.He volunteered to become one after his daughter who had tuberculosis was cured under the programme in Satbarwa.As I rave about it often,the DOTS providers in Satbarwa were one of the wonders of the world.Their dedication and perseverence and commitment to the cause of DOTS was phenomenal.That was before the government renumeration made it a paid service.These simple villagers pursued the cause of DOTS at considerable costs to their livelihood...paying at times out of their pocket for the transport and things and the government renumeration was not even forthcoming. Nirmalji contracted tuberculosis one day.He had quietly come into the clinic,had enrolled in and was about to go home when one of the TB workers up-dated me about things.I sat and talked to Nirmaljee for a while,some words of encouragement and promised to visit him at his house. We made a trip t

Tuberculosis-GenXpert /MDR/Rif.............right to life!!

Was on and off for the sympossium conducted by the Bill and Melinda Gates foundation and FIND on tuberculosis in ICGEB in Delhi.It was on diagnostics and with the current onslaught of GenXpertMDR/RIF being endorsed by WHO the mood in the TB world is upbeat no doubt.However,in one of the presentations on ethics some points were highlighted which were rather disturbing.I,being a clinician working in a relatively rural set-up where MDR is rampant would naturally have a single question in my mind and that would be-how is it going to effect my patients with MDR?I came back totally discouraged by a few points put forward by a speaker who was discussing the ethical aspects of the tests in hand. He was putting forward the options that lay before the government of India.I thought the cost of the infrastructure would be a case in point but what was on discussion was the dramatic increase in case load,without a back-up of proportionate treatment facility which could have moral and legal implicat

Meanderings of the mind!!

Sometimes it so happens that you just want to let your mind wander and keep hasn't happened to me for sometime but I can see all the traits of a workoholic developing in me.I do my share of duty and more normally ,I do it because there is a need .I enjoy the work that I do but I don't necessarily drag myself around my work twenty four hours a day.I stuff in a lot of other things within that schedule but the last but one week I am beginning to observe myself staying longer hours at work....I leave the workplace by seven or later which is not normal for me....I need a lot of time to myself and I am quite possesive about it. The other day my sister was having a spell of dizziness and the doctors were at it trying to get to the bottom of it and now she has a MRI in her hand which reads a 'small six into six millimetre patch in the left parietal lobe ,may be demyelination!'. She is a non- medico and was on the phone asking me about it's implication.I kept

What Mathew shared today…..!

Mathew for one always surprises me with his faultless hindi. He gave the sermon in the church and it was a powerful sermon. Few things that I remember … We are here on a Sunday because of the Cross and not because of Christmas. When Mary said ‘so shall it be with me !’ to the angel ,she was fearful in the circumstances that surrounded her where the punishment for adultery was being stoned to death and being a social out-caste. When she agreed to the virgin birth she also agreed to a lifetime of pain. God put the burden of the salvation of the World on two young shoulders ,who went through periods of uncertainity,displacement…during this very season…. Christianity is a lifetime of intense pain which brings us to the experience of exceeding joy amidst it and is not a chocolate candy solution for everything there is. He challenged the youth in the church ,amidst the activities of the christmas to read through the four gospels. He cautioned us against institutionalizing

Disadvantaged or advantaged..??

A fifty year old lady came to the out-patient accompanied by a fiesty husband with a history of having been through the DOTS-1 and DOTS-2 in the local PHC with continuing symptoms and with added features of florid peripheral neuropathy.The lady was having a tough time standing straight the first time I saw her.They were poor ,refused admission.Came back with the investigations which made my heart heavier.She had a suspicious mass in the right upper zone in the X-ray and her sugars were touching 400mg%. She needed a CT,but that would put them back straight by two grands where they were counting the pennies for the immediate treatment.It was a saturday afternoon and it was well past the out-patient time.While the out-patient staff patiently waited,I struggled through my words to convey the news.The man looked a little indecisive and wanted his wife's opinion.The wife took the matter in her hand and very calmly made some very practical decision taking the matter and the responsibilit

It happens sometimes...!

This has been a mad week end indeed! With all the students and the consultants away for the examination week ,I was supposed to be the lone doctor managing the medical out-patient which has an average of eighty to ninety patients,I actually ended up seeing my usual thirty patients (don't ask me how ? we have not solved the mystery as yet),second call for the emergencies in medicine ,as well as consultant incharge of the wards and the acute care unit with another resident doing the hands on. Yesterday evening,a patient with a broncho-pleural fistula went into an acute episode of traumatic pneumothorax following a tube block-he was a hefty man to boot who already had a chronic kidney disease,it was a frightening three hours with us almost losing him but somehow we got the better of the pneumothorax with my heart in my throat even as we flailed around with the patient.Thanks to the few colleagues around who were such a rock I thought I would collapse on the spot.Just as the calm was

Tuberculosis and HCH!

Started organising the TB work in HCH. It's a mammoth work with hordes of multi-drug resistant tuberculosis patients.Trying hard not to think too hard about the challenges that are going to come my way once I get started.It's amazing just how much of involvement each of these individual would need.Have roped in Mukesh from CH to help me out.He already has an extensive field experience in tuberculosis. Started off with preparing my colleagues and getting a register started with the patient details.Have segregated a room in the out-patients that is going to serve as the clinic on wednesdays.We will need a lot of grace from the Lord even as we get deeper into the work.Today I met a patient who was well into the third year of the drug,having lost his family to the disease,being supported by the hospital entirely. There are a lot of patients who are potential MDRs. A huge number of cases are from the adjacent Saharanpur district of UP. A month back,one of the patients walked in

'Fazal tera hum par prabhu..raham tera hum par....'

One of our seniors was visiting from abroad. While speaking in one of the devotions,he was reminding us how fortunate we were to start off a day's work with the morning prayer.He asked us if we were aware of it. Having worked in a mission hospital for most of my adult life it is a norm but for me every day,a good time of corporate worship with devotion before the work starts off continues to be precious.I remember during my post-grad days running to the chapel early in the morning to sit on the cold cement ground of the ODC chapel to listen to the nursing students singing those melodiously beautiful Malyali and Tamil songs ,not that I understood too much of it ,but it used to be ethereal.Even now in HCH,the OPD staffs lead the worship to some out of world worship songs accompanied by beautiful indian and western instruments.Songs like 'Fazal tera hum par prabhu,reham tera hum par' typically folkish and heavenly ,has the ability to export us to another world alltogeth