Thursday, December 27, 2007
The birth weight of both the twins was 2.0 kg (4.4 lbs).
The elder twin was a girl and so the mother did not give her breast milk, leaving the baby to depend on cow's milk. Being born small, the girl had no chance and died within a month of birth.
The younger being a male had the "privilege" of mother's milk. Now, in spite of being three months of age, this one is also struggling for life. Weight at present is 2.1 kg, a scant 100 gms more than his birth weight. The baby also had cough and respiratory distress. The X Ray showed a patch in the left lung suspicious of a Bronchopneumonia. Also worrying us is the fact that the baby has not put on any weight since birth.
It may be maternal malnutrition or more likely that the mother has Tuberculosis (the mother has cough with sputum production for a month now) which has been passed onto the baby.
The baby has been admitted at St Johns Medical College, Bangalore.
Watch this space for updates
An old lady, bent at the waist, almost double, using a stick to support her feeble frame, one amongst the many you would pass by on the dusty village raods without a second glance.
She came to us saying that she was unwell and had very little energy. One look at her and Dr Kamakshi diagnosed Anaemia. Sure enough, her Haemoglobin was 3 gm% (normal 12 gm%). No wonder she was tired and fatigued.
We helped her children understand the need for proper nutrition, a roasted mixture of ragi, green gram dhal, rice and chickpeas was suggested as a gruel, with the addition of milk and jaggery. Of course B Complex and Iron tablets were added. Luckily for her, she has children to look after her.
Let us hope that her remaining years on this earth will be qualitatively better.
Thursday, December 20, 2007
KRISHNAMURTI FOUNDATION INDIA
ANNUAL REPORT 2006-07
The patient load is unremitting. Day in and out the outpatient is full of the poor seeking succour. During the year, 15,426 patients sought the services offered by the RURAL HEALTH CENTRE, up from 11532 of the previous year. We managed to streamline a few systems and also, we got used to the numbers pouring in. As ever, funding is a constraint and mobilising resources the key to the successful running of the Health Centre.
2004 – 05: 7461
2005 – 06: 11532
2006 – 07: 15426
The average daily workload of the tri weekly outpatient is about 120, with a maximum of 200, which we saw in January.
Since its inception in January 2001, the RHC has treated a total of 61,005 patients.
We are reporting an HIV +ve incidence of 2.94%. ASHA Foundation in Bangalore and the newly opened ART Centres at Cuddapah and Tirupati have helped in extending free Anti Retroviral treatment to our patients.
This programme continues to do well. Support from SILOAM Eye Centre, (a unit of LV Prasad Eye Institute) and Sathya Eye Hospital, helped us in operating on a number of poor patients.
This year, 187 Cataract surgeries and 5 Glaucoma surgeries were done at these hospitals.
Since its inception in 2001, the Eye Care Facility has examined 5798 patients and has facilitated 748 cataract surgeries in this time period.
But as with any of our programmes, lack of adequate funding remains the biggest constraint. AGAMA India, has been the prime supporter of this programme and we hope that they would continue supporting us in the future.
We are looking for funding for this programme at a cost of Rs 1550/- per cataract surgery.
This programme is funded by the SIDVIM trust. The RNTCP now accepts all cases referred to the PHC, without hesitation. The cases being treated by us are the ones, which do not fall under the purview of the RNTCP treatment protocols.
We started TB cultures in our Microbiology Centre in January of this year and this has proved to be a great boon in the diagnosis and treatment, particularly of Multi Drug Resistant TB.
HIV positives continue to be detected amongst our TB patients, with an incidence of 4 out of the 62.
221 patients have benefited from the TB programme with a cure rate of 92.76%, which compares with the best in the rest of the country.
The data for the calendar year 2006 is given below.
New Cases: 62
Sputum +ve: 19 (31%)
Extra Pulmonary TB: 8 (13%)
Number successfully completed treatment at RHC: 23 (68%)
Number carried over to 2007 by RHC: 11 (32%)
Treated by RNTCP: 28 (45%)
Number carried forward from 2005: 12
Number successfully completed treatment: 11 (92%)
Number defaulted: 01 (8%)
The antenatal programme is also doing well. There is a greater awareness amongst pregnant women on the need for regular antenatal checks. The ‘lost to follow up’ is probably because of a number of home deliveries, which do not get reported, in spite of our best efforts.
An increasing number of women with multiple pregnancy losses and Bad Obstetric History are accessing our Centre for the following reasons (i) comprehensive work up (ii) personalised guidance and counselling, (iii) close monitoring of the ongoing pregnancy (iv) liaison with Fetal Care Research Centre, Chennai and (v) support of a committed Obstetrician at Madanapalle.
Hospital Normal: 04
Caesarean Section: 02
Lost to follow up: 07
COMMUNITY DIAGNOSTIC CENTRE
A total of 9305 tests were done at the Community Diagnostic Centre. As in any clinical setting, haematology and biochemistry predominated.
The Microbiology Centre, which is the only one of its kind in a 120 km radius, has proved to be highly beneficial in early diagnosis of various infections. The Centre did 150 cultures this year and we hope that more clinicians will avail of this facility.
Urine Analysis: 1802
Clinical Pathology: 87
X Ray: 227
HIV: We tested 170 patients using a rapid agglutination test (TRIDOT). Of these 5 were declared positive, giving us a rate of 2.94%, which is comparable to what is reported in the literature.
Endocrinology: This was of a greater surprise to us. 25 out of 110 patients tested (22.73%) showed evidence of Hypothyroidism. This raises the question as to why there is so much of hypothyroidism in these areas.
To all of you who have supported the health centre, emotionally, financially and in every way possible. The list is big and there is not enough space to thank one and all.
Every bit small bit helps in our endeavours and we welcome any contribution. Please look at www.rvrhc.blogspot.com for our funding requirements.
Wednesday, December 19, 2007
Skeleton staff manned the health centre, by turns, providing basic first aid and emergent medications. The health centre resumed its functioning from 26th Novmeber and right from the first day we were up and running starting with a hundred patients, going up to 150 patients by the end of the week.
Total Patients: 653
Total Patients: 08
Cataract Surgeries: NIL
Total Patients: 321
Total Patients: NIL
Cataract Surgeries: 03
When we look back, we wonder where the vacation went!!!! Just kidding.
Here are some statistics:
Number of Children: 103
Total Patients: 1942
Total Patients: 112
Cataract Surgeries: 15
Ante Natal Programme
Number of Children: 73
Total patients: 1858
Total Patients: 70
Cataract Surgeries: 10
Ante Natal Programme:
All in all not a bad couple of months work.
Wednesday, August 22, 2007
Thursday, August 02, 2007
Eye patients: 76
Cataracts Operated: 3
Eye patients: 103
Cataracts Operated: 11
By the 2nd week of July we were upto speed seeing 130 - 150 patients on teh outpatient days.
There were the usual mix of cases with Pulmonary infections and Viral fevers predominating in the cold damp weather - yes we have had some rain and it is wonderful to see the fields full of groundnuts growing well. We hope that the rains continue, the tanks fill up and that the crops are good this kahrif season.
We had great hopes that Ramalinga Reddy would make a good recovery - after all he was in the best of hands - being admitted to St Johns Medical College on 21 Jun 2007.
Unfortunately that was not to be.
A week after extraperitoneal drainage of the Psoas Abscess he started passing fecal material from the wound. A laparotomy was done and an Ileo-Caecal Perforation was found. Following resection and closure he started recovering. However on the 3rd post op day he threw a convulsion and was admitted to the ICU. His condition continued to deteriorate and he was intubated, put on aventilator and finally a tracheostomy done on 08July 2007. In spite of the best possible care he did not make it. His relatives decided to tke him home and he was discharged against medical advice on 11 July 2007. He died at home on 12 July 2007.
Cause of death - we can only surmise - poor wound management at home when he put leaves and lime etc in the wound, general malnutrition leaving the body in no condition to fight the overwhelming infection, and of course the dreaded word - POVERTY.
I have no idea what the finl bill would be. Since we supported him we are bound to get a whopping bill. Will anyone in the wide world help?
Friday, June 29, 2007
Now the other one. Venkataramana came to the health centre on 11 June with a classical history of cough, sputum, fever and weight loss. He had already spent upwarsd of Rs 10000, going from one RMP to the other, but never once accessing the Primary Health Centre or a Physician. Many injections and IV fluids later, his weight was down to 32 kg (from I guess a healthy 55 kg) and he could barely walk to the outpatient. Clinically his lungs were full of crepitations and Sputum was 3 + for TB Bacilli, HIV was negative. OK so now we were sure and promptly started him on aggressive Anti Tubercular Treatment. His house was close to the PrimaryHealth Centre (5 minutes walk) and he enrolled with them for continuation of treatment.
Today his wife came and met me. Venkataramana had passed away, 10 days ago. Within a week of starting ATT, he developed high fever and progressive breathlessness. By the time they decided to take him to a hospital it was too late - he was gone leaving behind three children ages 15 years to 9 years. The village has rallied around, but what will become of the children, with their father having gone leaving behind a mountain of debt.
Two men of the same age - luck favoured one and deserted the other - I suppose that's the way life is. It is never easy to face the death, least of all, when it is theyoung and the poor who have suffered.
Thanks for bearing with me in my sadness and angst.
I would be failing in my duty if I did not thank all of you, who have contributed to supporting our activities. The number of the rural poor who have benefitted from your generosity, both directly as well as indirectly are enormous.
I would like to publicly thank:
Mr Murali Reddy - a Chemist and a son of the soil of Rayalseema who has encouraged us both financially and more importantly keeping my spirits up through his regular email correspondence.
Sishukunj International of the UK - for supporting child care in tertiary hospitals - may god bless all of you.
Mr Jagdish Dore - an old student, many years my senior who has helped us immensely, year after year with the Tuberculosis Programme, and in the process saved many a family from the brink of debt trap and extinction.
Mr Ashok Singhal - my classmate from school and a friend for the running of the health centre.
Mr Ramkumar Ramaswamy - another old student and a friend for helping us upgrade the laboratory
Ms Priya Kamath - an old student of Rishi Valley - for help in subsidising treatment for the elderly
Ms Chatura Padaki - an old student of Rishi Valley, who with her regular contributions keeps us going.
Mr PV Rao - A philanthrophist who lives very humbly in a village nearby and whose contributions to improving the lot of the rural poor has benefited all of us.
AGAMA India - for helping with the ophthalmic programme
and many many others who have chipped in through the year past.
Both Vidya and I hope and pray that many more will contribute and help us in our endeavour to reach out to the sick and suffering rural poor.
Saturday, April 14, 2007
Maddamma is all of 65 years. She is virtually blind thanks to poorly done cataract surgeries done in a camp many years ago - the thick spectacles being testimony of the same. She has been virtually abandoned by her sons, two of them, who have migrated to towns and cities for better jobs. The lack of rains coupled with poor landholdings has ensured that the family can not survive on agriculture. So what happens to an old woman who is "unproductive" as she is weak, infirm and can not see - GERIATRICIDE.
She was brought to us in a moribund condition - fever for three months, malnourished and we thought so thats it.
Modern antibiotics and good nursing care did the trick. She is now OK. But what about her future. Who will support her, feed her?? Was it ethical to treat and prolong life so that she will continue suffering?
I do not know - I have no answers only a whole lot of questions.
Thursday, April 12, 2007
Well the merry month of March marched along - 1697 patients, 83 eye patients seen and 09 cataracts operated. Not bad for two of us slogging it out here.
It becomes increasingly difficult as the days go by try and and achieve a modicum of control. We are constantly being overwhelmed by numbers seeking help and a friendly voice. Many a time I doubt the "friendly" voice as the day goes along I find that I become progressively more irritable and at times do snap at the patients - Not good clinical practice - you will all agree! But whenone is overwhelmed the mind and to a greater extent the physical body can only take so much. What does one do? I really do not have any answers.
All of us here at the health centre are eagerly looking forward to a break in summer when we close for a month - a much needed one to recharge ones batteries and come back with a fresh outlook to life and to try and serve the needs of the needy.
Thursday, March 22, 2007
None of this however makes any difference to our patient load - 1626 patients, 108 eye consults, 11 cataracts, 1 dacryocystectomy and 1 trabeculectomy. One feels happy that all this was possible thanks to some money which accrued over the last month.
We have also had a number of "difficult" diagnosis to make and here the power of the web is immeasurabale. Google and particulalry Google scholar have helped in at least pointing out a reasonable path to follow.
As ever money continues to be at a premium. HELP!!!!!
Wednesday, March 14, 2007
Well examined him:
Spine: Marked tenderness from D(T) 10 to L2 levels. Paraspinal spasm and worst of all there was pitting oedema in the same area and with deep palpation there was a suggestionof a boggy swelling under the lateral spinous ligament.
Peripherally: Absence of fine touch from the D10 - L1 dermatomes. Diminished Knee jerk and superficial abdominal reflexes.
There was no bladder dysfunction.
So what does one do next. Here the "cut system" of private practice works in our favour. Since we do not take "kickbacks/ cuts" from laboratories/ diagnostic centres we were able to get an MRI spine done fro Rs 2500/- Quite reasonable in today's age. That the MRI was in Tirupathi (120 km) and patient had to be transported there was another matter.
1. Shows a Destruction of D9 vertebral body and posterior bony elements with spinal cord compression.
2. Destruction with soft tissue mass lesion at D12 to L1 with mild compression of Thecal sac ? Metastatic
3. Disc bulge at L4-L5 and S1 with bilateral nerve root compression.
No we were in trouble and the only option was a neurosurgical intervention. Managed to get the local MLA to write a letter to SVIMS, a super speciality hopsitla run by the TTD, and hey have promised all help and concession.
Luckily, the patient ahs some money and since both his sons earn, they have sold a cow for approximatel Rs 15000 to meet the expenses.
As i write this, the patient is on his way to Tirupati for admission.
Let us hope and pray that the selling of the cow was worth it.
I will update this in due course.
Pulse 90/min, BP 110/70 mmHg, Clubbing Gd 1, No pallor.
RS: Trachea central, diminished movements Left Inframammary and Infraxillary regions. VF and VR were also diminished, percussion being impaired. There were a few fine crepts.
He was investigated with a suspicion of Tuberculosis;
Hb 12 gm%, TC 6500/cumm, P 76, L 20, E 04, ESR 32 mm 1st hour
Sputum for AFB x 3 times was negative
X Ray Chest showed a mass lesion LMZ.
After this we did
HIV (Tridot) which was negative, Random Blood Sugar was 70 mg%, Mantoux was -ve.
We were fairly sure that we were looking at a Malignancy but decided to give him a month's trial of ATT with Rifampicin, INH, Ethambutol as well as Pyrazinamide. ATT was started on 14 Feb 2007.
He was reviewed on 13 March 2007 with repeat XRay chest.
On the Photograph, the one on the right is the recent (12 March) and on the left is the older one (12 Feb).
As you can see there is no difference between the two films.
We are now trying to convince his sons (2 of them) to raise Rs 1500 for a CT scan which in all likelihood will give us a diagnosis.
Then the struggle to find a hopsital and funds for further treatment.
This is a daily struggle at the health centre. One feels a sense of impotence to be able to detect diseases but then what? Plead helplessness!
Tuesday, February 20, 2007
He came back to us on 16 Jan 2007 with (i) Pain and swelling in the small and medium sized joints, with early morning stiffness (ii) Parasthesiae in the lower limbs (iii) Mild breathlessness.
Clinically: Vitals were within normal limits. There was marked swelling of the Interphalangeal and ankle joints.
Investigations: Hb 12.5 gm%, ESR 10 mm, Total Count: 5000/cumm, P 70, L 27, E 02, M 01, Random Blood Sugar 90 mg%, VDRL - Non Reactor, RA Factor - non reactor
The diagnosis now looked like Sero Negative Polyarthritis.
He was started on Tab Diclofenac 50 mg bid, Tab Folic Acid 5 mg od.
0n 22 Jan 2007 he was reviewed and his condition had worsened - (i) increased pain all over (ii) Unable to walk or lift hands above the head (iii) increasing tremulousness.
Clinically - All joints were swollen and movements of all limbs were sluggish. This prompted me to do a CNS exam:
Power UL - Grade IV, Lower limbs Gd III - IV, Deep Tendon Jerks Bilaterally diminished, absent ankle jerks. Plantars were flexors.
Sensory - Fine touch was absent till mid chest. There was patchy loss of pain and vibration sense over the legs and upper arms.
This got my suspicion up and I thought of an Acute Cervical Cord Lesion.
NIMHANS being the closest and most affordable we sent him there. By the time he reached NIMHANS, about 150 km over bad roads, he had developed acute retention of Urine and needed to be catheterised.
1. Extruded disc material and superior migration/ Extradural lesion at C5 C6 levels causing focal compression and thinning of cord.
2. Cervical Spondylosis with myelomalacial changes.
Just putting up this as a reminder that what is apparent may not be the actual facet of the illness. We need to keep our eyes and ears open for the most unexpected. After this I did a search using both PubMed and Google Scholar, but really found no such progression described.
Any comments from the Neurologists/Physicians/Neurosurgeons??
A G3 P3, 1st child born through LSCS.
O/E: General Exam - was normal.
Abdomen: Tortuous dilated superficial abdominal veins, with hepatic flow. (The pictures below show you the location and size of the veins)
There was a 2 cm soft hepatomegaly, no splenomegaly or free fluid.
USG: Mild to moderate hepatomegaly, abdominal varices, prominent mid hepatic vein with absence of right and left hepatic veins.
Whats the Diagnosis and how will you proceed? Please help????
Tuesday, February 13, 2007
In this not so clear photograph, you can see the yellowish cream colonies of Mycobacterium Tuberculosis, grown in our Microbiology Laboratory.
The patient is in all likelihood a case of MDR TB, due to multiple, ill advised, irregular Anti TB Therapy instituted at various times.
A 26year old male presened to the RHC with a 6 month h/o
(i) Progressive inability to lift both hands baove shoulder
- (ii) Weakness and wasting of shoulder muscles
He denied any h/o substance abuse, trauma, fevers, convulsions, or exposure.
Clinically: Pulse 78/min, BP 110/70 mm Hg. No lymphadenopathy, icterus or pallor.
CNS: Higher mental functions were within normal limits. There were no cranial nerve anomalies. Spine was normal - no deformity, tenderness or gibbus.
Bilateral symmetrical wasting of shoulder muscles (see photo) with clearly defined bony prominences.
Power at shoulder joint: Shoulder shrug V/V, Abduction O/V, Adduction III/V, Extension III/V, Flexion III/V, Ext Rotation III/V. Unable to lift hand over the head but when he moves his upper limb at a rapid pace he is able to lift his hands over the head.
All other muscle groups power was V/V. Deep tendon jerks unaffected.
There was no sensory deficit.
Investigations: Hb 10 gm%, Total and Differential Counts: WNL, ESR 20 mm 1 st hour, Urine analysis : WNL, HIV (Tridot) - ve.
We could not do CPK due to lack of facilities.
SO WHAT's THE DIAGNOSIS? I put it as FASCIO SCAPULO HUMORAL DYSTROPHY or some other Muscular Dystrophy.
The biggest problem is that this young man is the sole earning member of his family, ekeing out a living on daily wages, and as he can not work, or rather no one is willing to give him work because of his disability, he has been reduced to abject poverty. I am trying to raise funds to send him to Bangalore to at least get a diagnosis. Even with a diagnosis, there is really nothing one can do for him, I suppose and that is the saddest part of it all.
Thursday, February 08, 2007
January is also the month of festivals, with Pongal/ Sankranti being celeberated with great enthusiasm here in the south by one and all, irrespective of caste, creed or religion. This is the harvest festival and it is a very important one. Traditionally a pot of rice, milk and jaggery are cooked together and the pot has to boil over signifying a year full of cheer and bounty ahead. The cattle are all bedecked as they are the ones who actuually provide the work force around here. Tractors still being too expensive and the fact that tractors can not provide milk(!).
So also ID was also celeberated with great fervour. We had to refuse any number of invitations to partake in the feasts as both of us are vegetarian.
Just to see the spirit of the people celeberating these festivals is, as always, an eye opener to me about how people live together in peace and harmony.
January also ushered in the new year and the republic day. We decided to close for these days and fortunately/unfortunately these days happened to fall onour OPD days. Not that any one was cribbing.
Well, started on 03Januray our first working day with a 184 patients. Whew ! at the end of the day Vidya and I were staggering. The relentless pressure kept on and in spite of only 9 OPD days we ended up seeing 1571 patients. January ended with 188 patients and we are desperately hoping for a respite or someone to help us.
We finally also started work on an extension to the building, a waiting room for patients and a water point. I will be publishing these photos soon along with what we plan to do with the extra spaces we have created.
Watch out for Diagnostic Conundrums being published soon.
So here goes:
October 2006: 1036 patients, 63 eye patients, 23 cataracts done at Madanaplle. We worked only three weeks this month before pushing off for a break.
November 2006: Repoened the Health Centre on the 10th of November and in the first week, we did refresher traing for all our staff on basics of health care and management of emergencies. It really paid off because soon after reopening we had a lady who had a convulsion at our door step and the staff were able to handle it without resorting to "nails" etc.
We saw 518 patients, 54 eye patients of which 7 of them were operated for cataracts.
December 2006: Boy, this has been a tough month. 1776 patients blew us away, 82 eye patients and 16 operated. We could have operated more but for a shortage of funds. We raelly are struggling to make both ends meet and are hoping that some of who read this would contribute to our Health Centre.
Thursday, January 11, 2007
Into the new year and may it bring cheer to all the people of the world especially the old and the poor.
The December monsonns have failed us and so we look "forward" to a hot and dusty summer. As it is the experts are proclaiming the year 2007 as the hottest one in history. One hopes that this hot summer along with the El Nino phenomenon does not play havoc with our monsoons. There is barely any water left in our open wells and tanks and soon it will only be a marsh land only to dry out to a hard baked clayey surface.
We had gone on a two week vacation in November and had closed the health centre. After our reopening, the centre continues to be as busy as before. Patients keep pouring in in droves stretching our resources to the limit. It seems almost impossible to keep up ones concentration at the end of the day. Mistakes do happen. At times we are forced to undertreat and call the patient back the next day just for want of time and the fatigue of seeing more than 120 patients of all sorts.
Funds continue to be a problem, though some alumni of the school have promised some money. One hopes that we get some soon.
We are looking for donors as well as any doctor who might be interested in working in a rural setting.
Bye one and all