Family traditions

A new phenomena that I'm experiencing in a mission hospital is family medicine. While being in a tertiary setup, its very rare to see the same patients twice, here, everyone is connected. We are still treating the same patients we were treating 50 years back plus their children, grandchildren, aunts, uncles, nieces, nephews so on and so forth. The loyalty that this incurs is beautiful as well as dangerous. The danger arising when the problem is too big for us to handle.
Even before we explain the prognosis and risks associated with treatment in a small setup, we know their answer. Villagers and townsfolk.... Educated and uneducated...
Like the man with a huge abcess in his right hand who we wanted to send for surgery elsewhere owing the lack of an orthopedician here but who refused to go. So we operated on him with an open orthopedic textbook before us.
Or the woman from a well to do family with a breech baby who insisted on having her delivery here. The baby was so stuck that we had to push from below so we could deliver by Caesar.
Or the lady with twins that walked 200 kms from her village only to reach here at the dead of night when we had just closed the theater for fumigation. On examining her, fetal distress needing emergency surgery. So we sat up monitoring her all night till theater opened the next morning.
Then the ones with not so happy endings...
The young man with cardiac disease who insisted on staying here and died that very night.
The child with encephalitis who died because we didn't have a ventilator.

And yet they come... and keep coming... Sometimes we treat... sometimes all we can do is pray.... 

Baarish and babies....

Come June and there are two new phenomenas in my 'happening' life here.....

The monsoons...

While bringing much much MUCH needed respite from the blazing summer sun, it also means a whole new spectrum of water borne diseases and increase in general morbidity balanced out by the number of people who can't get here or get here late because of the rain. As a girl, it aggravates an already existing problem... CREEPY CRAWLIES!!!  Honestly i really don't mind the increase in snakes and scorpions, all it means is that i carry a torch wherever i go and look down at all times. But what takes the life out of me are the other creatures... insects... esp the flying ones and there's just no escaping them! Especially if you're like me and have a morbid fear that they'll fly right into you or fall on you while sleeping or even worse crawl into one or all of your orifices. Thankfully I have the first floor so i am relatively safer from all those inhabitants of the surface.

The babies....

A much more pleasanter event is the sudden rise of deliveries this season prompting the new coined hospital phrase of 'bacchhon ki barsaat' (monsson of children). This is because marriages are considered auspicious if conducted before or after diwali which happens in october thus all the fruits of their labo(u)r being seen at around this time. However, in this age of technology we still remain untouched. All monitoring here is done manually as opposed to fetal monitors elsewhere. Usually obstetrics, in small mission hospital like ours, are nurse led and the doctor only turns up for extracting the baby. Woe be to you if the staff are either not competent enough or there just aren't enough, like here, on both counts. As a result, the doctor, read me, sits by the side of the mother all though labour monitoring her parameters and her baby's by herself which on an average is 8 hours for a primi and 4 for a multi. Even worse if we plan to intervene and hasten the process, that is like my boss puts it, 'sitting on a bomb'. For here there is no waiting. The concept being, 'If some fetal heart rate abnormality is picked up in our intermittent monitoring, we have most likely missed much more'. The solution being, 'When in doubt, OPERATE'!! 

And so i wait..... 

PS - If you're reading this, please comment. So i know you're getting it!!! Thanks!!! :*

My boss

For those of you thinkin this is going to be one of those bitch-about-the-boss sessions, sorry you're going to be sorely disappointed.
For I am one of those privileged few who has a boss you can't help but adore.
Last night at 11 pm a woman in labour came in who had to be taken in for an emergency C section. My fingers were itching to do it but who will let a rookie operate in the middle of the night when all you want to do is sleep after a long tiring day. He quietly went to the assistant's place and handed me the scalpel. Half asleep but overjoyed I started. In the middle of the night, under infinite patience, I unlearnt all my wrong techniques and relearnt all the right ones. With a characteristic soft mumble he coaxed fumbling fingers to higher skill and opened a struggling mind to a superior art. And yet when my sleep deprived, struggling to concentrate mind and un-cooperative fingers made the same mistakes again and again, instead of condescension there was only friendly jest and an occasional sarcastic chuckle. Then suddenly...out of the blue... A HEAD BUTT!!!! I froze midway ready to be thrown out of theater just to be reminded that my undone mask was about to fall on the open abdomen. If the needle refused to pierce the stubborn tissue, instead of doing it himself, he supported my hands in pushing it through. After bearing (with) me patiently till the end, he helped me finishing up and sent me home before him.
And he sends his angels before me......

Something about 30

I don't what is it about the current age that diseases just seem to be getting younger and younger. A phenomena that I thought was affecting only the west. But no... Whether its the man who came with sudden inability to speak and CT revealed cancer occupying one half of his brain. Or the guy with acidity who turned out to be having a heart attack.
Definitely the last days....

Bigger problems....

Sunday, June the 11th, 3:30 am...
I was called when a patient with angina arrested in the ward. Standing over his lifeless body I realized I had bigger mountains to climb.
This brings me to my next dilemna. How do I ensure orders are carried out? Without having to permanently reside in the ward ? Or to antagonize the staff under me but above me in age and experience ?
Missing a dose of magsulf for the patient with ecclamptic seizures and forgetting to administer aspirin for a patient having a heart attack.
Fortunately the woman lived, the man died....

Once upon a time... Part 2

In case you haven't realized yet, the lady mentioned above was a case of post partum ecclampsia following a home delivery. We treated her with Magsulf and she goes home tomorrow. But the story doesn't end there.
The 'tel gaadi' aka govt oil truck went back to the village with the news that sheela bai has been cured. So they decided to send another dying patient to our doors.
Uday Lal presented later that day with a one month history of jaundice and black stools. Honestly when they brought him in, I thought it was a corpse. 'White as a sheet' was literally what he looked like. All my medical sense told me to refer him. The relatives told me, "You are God. Only you can heal him. If you can't then we will take him back home".
Investigations revealed a hemoglobin of two. 2?!!! At first I thought the lab guy was pulling my leg. After checking and rechecking, my fears were confirmed. He had a hemoglobin of 2 and he was still alive and I had the job of keeping him that way.
With all of the advancements of India shining, there is a downside. It becomes more and more difficult for mission hospitals to function. To standardize treatment, there is a law passed that allows a blood bank only with the presence of an MD pathologist or a radiodiagnosis department only with an MD radiologist.
Thus the poor relatives go to the government hospital and wait an entire day to get two pints of blood even after donating and paying. Meanwhile I start treatment for Iron deficiency anemia which is the most common in the region. The blood finally comes and we transfuse him. His hemoglobin comes up to 4 and he finally sits up. They don't have money for any more blood. So I give him some more parenteral iron and refer him to a bigger place for further evaluation, knowing full well that they will go back home and the referral letter I give will come back to me in a few months. But all I can do now is pray.
However tonight there is rejoicing in Bagrekash...

Once upon a time...

Once upon a time... In a faraway land... Some call it the 'boondocks' of India... There lived the Gonds. About 100 -200 kms from CFH, Raj nandgaon, nestled in the Maikal hills this ancient tribe lived their lives roaming naked under the sun, farming and gathering, hunting with bow and arrow just as their ancestors before them. Sunup, Sundown, Autumn, winter, summer, monsoon, sickness, health, life and death... The only contact with the outside world is the government trucks that bring them oil and the children that visit the nearby town and talk of the light that glows inside huts, the river that flows out of metal, talking through a box and the like....
Medically, they believe in the healing powers of the sun, fire, the elements and the more sinister arts of the local magician. Even the barber's wife is a advancement for them.
Then on rare occasions, people who look like them but dont believe in karma and speak about a strange god who forgives sins. They are sent from a very big village with a special house where more magicians practice, even a woman!! [;)] They speak about clothes, food, clean water, mosquitos and disease... Now why does a woman need help making babies?!!! She can do it all by herself!!! If she lives, praise God, otherwise it was written in her fate....
Now Sheela Bai jus gave birth two days ago. Tonight the spirits possessed her and wouldnt let go. The priest will not touch the evil woman so the 'white babu' was called. He told her husband to take her to his village for the woman magician to see. Thankfully today the tel gaadi will come so she can go on that. They reached a white big hut where the woman magician saw her and pricked her with many needles and gave her magic fluid. The gods came down and the spirits left. She will live and so will the child....

LNMs and beyond....

Another very interesting fact about this place - the lack/ absence of trained personnel both clinical and paraclinical. Take for example our theatre assistant... NS... A cobbler by profession who used to sit at the gates of the hospital taken in by my senior and trained as the jack of all trades. Driver, chowkidhar, lab technician, nurse, pharmacist, compounder, doctor.... wait a minute.... DOCTOR?!!!! Yup. He became so empowered by his new found abilities that he decided to get a local practitioner/quack degree (secretly of course) and now has a flourishing practice (not so much of a secret). But they say a little knowledge is a dangerous thing... which brings us to my dilemna...

Wednesday, June 8, 1:00pm... Unbooked third time pregnant woman in labour with two previous home deliveries... On examination - Breech with fetal bradycardia.... Treatment plan - Emergency ceasarean.... Operating surgeon - Me!!! At which point I have to seat myself to take few deep breaths while weighing the pros and cons... Pros - The only chance for the baby to live, the cheapest and closest, the other option being the govt hospital where she's as good as dead... Cons - Me never having delivered a breech via caesar, limited facilities for neonatal resuscitation, absence of a more experienced surgeon around (my senior consultant is currently on leave), and did i mention... ME!!!
With the scales tipping heavily in the favour of the baby's last hope for survival I decided to operate.
Thats when NS announced, "I'm not doing this operation. I can't take this risk, I'm not going to be responsible." And so he proceeds to dissuade me and the relatives for treatment here. But as luck would have it the relatives want to take a chance on me!! :) So I proceed to prepare the theatre... As soon as I'm out of earshot.... "She is just a girl. She doesn't know anything. I'm telling you take your bai to the govt hospital...."
I return to find the patient and relatives gone.... 

ASV Rs. 400 per vial

Tuesday, June 7, 10:30 pm
"Madam ji... A child... Snake bite.... Jaldi ao...." And so i picked up my stethoscope and ran to find a 10 yr old girl still covered in the mud she was playing in and a crude tourniquet applied to her right leg where the local baba tried to stem the flow of the poison... No pulse... Pupils fixed and dilated... Extremities in rigor mortis... Time of death hours before her mother found her in the fields...  Before the villagers ran to arrange for a tempo to bring the girl to the nearest hospital.... Minutes after the deadly cobra stung her foot and left and she in all her innocent ignorance thought it to be an insect on the ground... And yet the father held her lifeless body and travelled 4 hours to bring her to madam ji.... Thats me btw... Who even if had seen her alive would have been helpless to save her owing to the non availabilty of anti snake venom in private hospitals, thanks to exorbitant costs and short shelf life...
Then begins the journey home... To return a daughter's body to the hands of a mother who has already accepted the fate of her child as the will of Naag ...

New beginnings...

Hello world!!
Six months after my last blog and so much has happened...
I finished my sojourn at CMC...finally!!!
I joined Christian Fellowship Hospital, Rajnandgaon and for the next two years my life is going to be all about my adventures as a primary health care provider to the forgotten with a behind-the-scenes look at being a young unmarried girl in rural north India....
So... Happy reading!!!

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