February 2010

February continues to be busy as the first hint of summer reaches us. It had been unseasonaly cold over the first two weeks of the month and then all of a sudden the temperatures shot up. Now it is warm and a foretaste of summer.


The RHC monthly statistics are given below.

Total Outpatient: 1736
Below 15 years: Male - 131; Female - 105
Above 65 years: Male: 104; Female - 106
15 - 65 years: Male - 593; Female - 657

Income (per month)
INR less than 1000: 1356
1000 - 2000: 325
2000 - 3000: 40
3000 - 4000: 10
More than 4000: 05

Eye CareTotal patients: 82
Glasses: 15
Medicines: 56
Surgeries: 11

Antenatal Programme 
New registrations: 02
Delivery: 01 (Hopsital - LSCS)
Abortion: NIL

January 2010

We welcome the new year and hope it brings sunshine and happiness to all people

We added a new semi automatic analyser to the laboratory. Made by Vital Diagnostics Australia, it was funded by friends, alumni of AFMC and some well wishers. This has helped us do many more biochemical tests in our laboratory itself and saves the trouble of patient samples being sent to Madanapalle or other laboratories.





The RHC monthly statistics are given below.


Total Outpatient: 1575
Below 15 years: Male - 136; Female - 93
Above 65 years: Male: 147; Female - 147
15 - 65 years: Male - 469; Female - 583

Income (per month)
INR less than 1000: 1045
1000 - 2000: 485
2000 - 3000: 28
3000 - 4000: 25
More than 4000: 17

Eye CareTotal patients: 74
Glasses: 15
Medicines: 52
Surgeries: 07

Antenatal ProgrammeNew registrations: 01
Delivery: 01 (Hospital - 01)
Abortion: NIL

Total patients: April 2009 - January 2010: 15063

December 2009

The last month of the year and yet another year goes past.
One wonders whether this wonderful country of ours will reap the benefits of liberalisation, will the fruits of economic reforms actually trickle down to those most needing it, will governmental systems actually deliver? These are eternal questions as one continues to deal with the mass of humanity needing medical care.
The RHC monthly statistics are given below.

Total Outpatient: 1800
Below 15 years: Male - 192; Female - 173
Above 65 years: Male: 121; Female - 98
15 - 65 years: Male - 541; Female - 675

Income (per month)
INR less than 1000: 1216
1000 - 2000: 545
2000 - 3000: 20
3000 - 4000: 11
More than 4000: 06

Eye CareTotal patients: 57
Glasses: 12
Medicines: 44
Surgeries: 01

Antenatal ProgrammeNew registrations: 02
Delivery: 05 (Hospital - 04, LSCS: 03)
Abortion: NIL

November 2009

After the Vacations and the festive season, the whole staff is back, refreshed and rejuvenated.
Dr Kamakshi and Dr Kartik had gone to Mysore to attend "INDIA PACIFIC INTERNATIONAL PAEDIATRIC AIDS CONFERENCE. The conference was most instructive bringing to light the latest in thinking on this burning issue. we also learnt a lot about the need to look for HIV in pregnant women and prevent transmission for Positive Parent to Child (PPTCT).
The RHC monthly statistics are given below.


Total Outpatient: 1383
Below 15 years: Male - 138; Female - 138
Above 65 years: Male: 113; Female - 82
15 - 65 years: Male - 369; Female - 543

Income (per month)
INR less than 1000: 892
1000 - 2000: 446
2000 - 3000: 24
3000 - 4000: 16
More than 4000: 04

Eye Care
Total patients: 50
Glasses: 06
Medicines: 40
Surgeries: 04

Antenatal Programme
New registrations: 05
Delivery: 01 (Hospital - 01)
Abortion: NIL

October 2009

October is the month of festivals, with Dusshera and Deepavali. This year we kept the Health Centre running right through with the staff taking leave by rotation. This seems to have helped the local population who have benefited from this.

Total Outpatient: 1478
Below 15 years: Male - 122; Female - 96
Above 65 years: Male: 128; Female - 87
15 - 65 years: Male - 461; Female - 584

Income (per month)
INR less than 1000: 974
1000 - 2000: 478
2000 - 3000: 18
3000 - 4000: 04
More than 4000: 03

Eye Care
Total patients: 61
Glasses: 13
Medicines: 42
Surgeries: 06

Antenatal Programme
New registrations: 03
Delivery: 01 (Hospital - 01)
Abortion: NIL

September 2009

The rains continued through most of September and we were thankful since the water table has definitely benefited. A number of tube wells which were dry have come to life again. We now await the North East Monsoon in End October.

Total Outpatient: 1680
Below 15 years: Male - 156; Female - 147
Above 65 years: Male: 144; Female - 93
15 - 65 years: Male - 470; Female - 670

Income (per month)
INR less than 1000: 1070
1000 - 2000: 542
2000 - 3000: 64
3000 - 4000: 17
More than 4000: NIL

Eye Care
Total patients: 49
Glasses: 10
Medicines: 32
Surgeries: 7

Antenatal Programme
New registrations: 02
Delivery: 03 (Hospital - 03, LSCS - 01)
Abortion: NIL

August continues to be busy, however most importantly, the rains came. We got about 20 cm of rain, which has definitely helped the water table as well as the standing crops. The farmers are all smiles and in some farms there is hectic planting activity of short term crops like Jowar, Bajra etc.

Total Outpatient: 1738
Below 15 years: Male - 120; Female - 135
Above 65 years: Male: 133; Female - 101
15 - 65 years: Male - 551; Female - 698

Income (per month)
INR less than 1000: 1084
1000 - 2000: 588
2000 - 3000: 51
3000 - 4000: 12
More than 4000: NIL

Eye Care
Total patients: 93
Glasses: 15
Medicines: 68
Surgeries: 10

Antenatal Programme
New registrations: 05
Delivery: 02 (Hospital - 02)
Abortion: NIL

Some Patients



Rasool Bee, 85 years old, came to the RHC with an ulcerative swelling in the Left sub mandibular region. The swelling starts from the mouth as the picture on the right shows. This was most probably a Squamous Cell Carcinoma, brought about by years of betel nut chewing. She refused to go anywhere else and is being given palliative care here.

What you see in this photograph is a classical case of DERMATITIS due to Endosulfan use. The RHC has taken on a project to document diseases associated with pesticide use.

JULY 2009

The month of July saw us battling with drought like situation. The rains have failed us and we wonder whether we will last till November when the NE Monsoon makes its appearance.
The patient load remained the same:

Total Outpatient: 1862
Below 15 years: Male - 167; Female - 175
Above 65 years: Male: 107; Female - 71
15 - 65 years: Male - 513; Female - 829

Income (per month)
INR less than 1000: 954
1000 - 2000: 733
2000 - 3000: 141
3000 - 4000: 32
More than 4000: 02

Eye Care
Total patients: 121
Glasses: 15
Medicines: 95
Surgeries: 11

Antenatal Programme
New registrations: 03
Delivery: 02 (Hospital - 02)
Abortion: 01

Some Patients
Venkataramana has a Corneal dystrophy of the Right Eye. You can see the



haziness in the cornea. This was primarily due to Malnutrition. A course of Vitamin A resolved the Corneal Dystrophy.

Anjeppa, 47 year old male had been treated earlier for Pulmonary TB at a Primary Health Centre.In all probabilities he had not completed his full course of treatment. A recurrence was detected at the RHC., we suspect MDRTB, for which a TB Culture has been done. There is also a strong suspicion of Leprosy.



Leonine features, loss of eyebrow hair, hyperpigmentation and hypoaesthesia. A slit skin biopsy is awaited.

Reddy Kumar was brought to the RHC by his distraught parents. Clinically we suspected ? Downs Syndrome. His Thyroid levels were suggestive of Hypothyroidism (TSH > 150 micrograms, T3 06.57, T4 0.7). He was started on Eltroxin 50 microgram, and increased to 100 microgram a weeklater. However two weeks into the treatment, he developed a severe lower respiratory infection, wheeze etc. This proved fatal and he passed away at the Government Hospital.

JUNE 2009

The RHC was closed for three weeks in May, a much needed break for all of us. It was also a month for introspection and to see where we could improve. One of the suggestions was that the RHC will work through the year, with the staff taking breaks. We also designated Tuesdays and Thursdays for people coming in from more than 35 km. This will hopefully mean that the patient load is better distributed.

Total Outpatient: 1510
Below 15 years: Male - 119; Female - 116
Above 65 years: Male: 139; Female - 137
15 - 65 years: Male - 415; Female - 584

Income (per month)
INR less than 1000: 770
1000 - 1500: 440
1500 - 3000: 234
More than 3000: 63

Eye Care
Total patients: 69
Glasses: 23
Medicines: 38
Surgeries: 08

Antenatal Programme
New registrations: 04
Delivery: 05 (Hospital - 02; LSCS - 01)

Some Patients

Sharad delivered a healthyfemale baby after succesful Tubal Recanalisation. She had lost two young children to road accidents a year apart and the parents were understandably shattered. Luckily the recanalisation worked and both the baby and she are doing well.
Sarojamma, has a Squamous Cell Carcinoma of the lip, brought about by years of betel nut chewing. How does one break this ubiquitous habit? Especially when it is used to stave off hunger pangs?

April 2009

April is the start of the new financial year, so in the middle of all accounts work, the RHC has to contend with an increase in patient load.

Total Outpatient: 2037
Below 15 years: Male - 134; Female - 109
Above 65 years: Male: 190; Female - 190
15 - 65 years: Male - 633; Female - 781

Income (per month)
INR less than 1000: 1060
1000 - 1500: 651
More than 1500: 326

Eye Care
Total patients: 79
Glasses: 24
Medicines: 50
Surgeries: 05

Antenatal Programme
New registrations: 07
Delivery: 05 (03 in Hospital, 01 LSCS and 01 at home)

A Patient: Thejaswini was brought to the RHC with loss of weight, lassitude as well as recurrent fevers. A routine check revealed that she was Type I Diabetes Mellitus. She was put on Injection Insulin and has stabilised well with 22 units in the morning and 18 units at night. She is doing well.
Her management is supported by Heart and Hand for the Handicapped, USA

MARCH 2009

March is the last month of the financial year and that normally means more work in terms of stock taking, accounts etc.
However this does not make any difference to the patients. Disease and infirmity do not make a distinction between the months of the year.

Total Outpatient: 1460
Below 15 years: Male - 91; Female - 87
Above 65 years: Male: 142; Female - 112
15 - 65 years: Male - 576; Female - 453

Income (per month)
INR less than 1000: 787
1000 - 1500: 439
More than 1500: 234

Eye Care
Total patients: 68
Glasses: 11
Medicines: 50
Surgeries: 07

Antenatal Programme
New registrations: 05
Delivery: 03 (02 Hospital and 01 at home)

Some Patients: Sreenath 02 months, was brought to us by concerned parents because of the wheeze and stridor. He had LARYNGOMALACIA, for which there is no treatment. The baby grows out of it by the time he is a couple of years old. The video however is quite scary. A photo is also attached.



Mohith Naik, 2 year old male had repeated fevers and was diagnosed here as recurrent Urinary Tract Infections, most likely due to a Posterior Urethral Valve. He was operated at CMC Vellore and is doing well. You can see the bladder opening in the abdomen, which will be closed subsequently.

February 2009

Come February and the heat builds up both in terms of illnesses as well as the onset of summer.

Total Outpatient: 1504
Below 15 years: Male - 105; Female - 90
Above 65 years: Male - 100; Female - 113
Adults: Male - 496; Female - 600

Income (per month)
INR less than 1000: 784
1000 - 1500: 477
More than 1500: 241

Eye Care
Total patients: 66
Glasses: 18
Medicines: 42
Surgeries: 06

Antenatal Programme
New registrations: 04
Delivery: 01 (Hospital)

Charan Teja, 18 months was brought to the health centre with complaints of failure to thrive. Looking at him Dr Ramesh felt that it was MARASMUS (Protein Energy Malnutrition). However, since there was a history of Urinary Dribbling, we thought of Chronic Urinary Tract Infection, due to Postr Urethral Valves and Septicemia. Parentaeral antibiotics were given and he was referred to St Johns Medical College, where the latter diagnosis was confirmed. He is at present admitted at SJMCH and surgery has been planned once his Urinary Infection comes under control.
His treatment is being funded by SISHUKUNJ INTERNATIONAL

This young 19 year old girl came to us because of delayed as well as irregular cycles. Dr Kamakshi made the diagnosis of TURNERS SYNDROME since she is short statured as well as has neck webbing.

January 2009

January is traditionally a leaner month, because of the harvest season and the important festival of Sankranti. The statistics for this month are given below:

Outpatient Total: 1419
Below 15 years: Male 124, Female: 82
Above 65 years: Male: 70, Female: 55
Adults: Male 435, Females: 653

Income:
INR less than 1000: 683
1000 - 1500: 480
More than 1500: 252

Eye Programme
Total Patients: 96
Glasses: 29
Medicines: 61
Cataract Surgeries: 05

Antenatal Programme
New: 07
Delivery: 1 (Hospital)

Venkatalakshmi, is about 60 years. All but crippled because of her Osteoarthritis, she is dependent on two sticks to help her walk. She finds it impossible to go about her daily functions. NSAIDS (Painkillers) and Calcium tablets alleviate the pain to some extent. Her treatment is being funded by the Village Development Council, London.
Bavaji: July 2008 and January 2009. A patient of Severe Thyrotoxicosis, who with treatment has shown dramatic improvement. The two photos say it all.
Pavan Kalyan, 18 months, had a broncho pneumonia. Use of Nebuliser and additional oxygen, as an outpatient procedure ensured that he survived. Ideally he should have been have been hospitalised, but lack of money, meant that we had to treat him at the RHC. Thanks to Dr Ramesh for seeing him through.
His treatment was funded by Heart and Hand for the Handicapped, USA.

December 2008

As the year comes to an end the health centre continues to move on in providing health care for the rural poor.

Outpatient: Total 1865
Below 15 years
Male: 150; Female: 114
>65 years
Male: 101; Female 81
Adults
Male: 537; Female: 882

Income levels (INR per month)
Below 1000: 1006
1000 - 1500: 619
Above 1500: 240

Eye Programme: 108
Glasses: 26
Medicines: 28
Surgery: 07

Antenatal Programme:
New: 07
Deliveries: Home - 01, Hospital: 03 (02 LSCS)
Abortions: Nil

Subhadra, delivered a baby after 07 years of marriage. The look on her face says it all.

You could not have asked for a more proud set of parents.

Apuramu is 24 years and suffers from Epilepsy. The plaster cast on her left arm bears testimony to an injury sustained during an epileptic attack.

She is 04 months pregnant and is under our care. We are hoping that her epilepsy will be controlled so that she can have a normal conception and delivery.

Both Apuramu and Subhadra have been supported by funding from the Village Development Council, London, England

October 2008

Outpatient Total: 1566

Children < 15 years
Male: 127 ; Female: 108
Old Age > 65
Males: 80; Females: 80
Adults
Male: 449; Females: 772

Income Levels of Patients (INR per month)

< 1000 pm: 802
1000 - 1500 pm: 555
1500 - 3000 pm: 209

Eye Programme:
Number Examined: 99
Glasses Prescribed: 26
Medications: 58
Surgeries: 15

Ante Natal Programme:
New registrations: 02
Deliveries: Nil
Abortion: 01

September 2008

Outpatient Total: 1721
Children < 15 years
Male: 171; Female: 126
Old Age > 65 years
Male: 117; Female: 97
Adults
Male: 487; Female 723

Income Levels of Patients (INR per month)

< 1000 pm: 771
1000 - 1500: 431
1500 - 3000: 505

Eye Programme
Number Examined: 95
Glasses Prescribed: 22
Medications: 63
Surgery: 10

Ante Natal Programme
New Registrations: 2
Deliveries: 02 (Hospital 02, LSCS 01)
Abortions: 01

August 2008

Outpatient Total: 1550
Children <>Male: 142; Female: 77
Old Age (> 65 years)
Male: 99 ; Female 174
Adults
Male: 465 ; Female 593

Eye Programme
Number examined: 74
Glasses prescribed: 26
Medications: 34
Surgery: 09

Ante Natal Programme
New registration: 3
Deliveries: 02 (LSCS 01)
Abortions: Nil

Reddi Babu had a severe Viral Keratitis. Malnutrition and local practices like putting milk in the yes aggravated the infection. Fortunately we were able to save the eye with minimal corneal damage.

July 2008

As expected the pace of work picked up in July.

Outpatient Total: 1686
Children < 15
Male: 167, Female: 107
Old Age (> 65 years)
Male: 120; Female: 104
Adults
Male: 405; Female: 782

Eye Programme
Number examined: 103
Glasses Prescribed: 34
Medications: 56
Surgeries: 13

Antenatal Programme
New Registered: 05

Bavaji is a 17 year old boy, who came to us with massive loss of weight. As is apparent from the photograph, he is emaciated and the swelling on the neck is apparent.
He has THROTOXOCOSIS.
Clinically he also had Aortic and Mitral Regurgitation
His laboratory Investigations done here proved this diagnosis and an Echo done at St John's Medical College proved the presence of valvular heart disease.
He is now under treatment at the Health Centre.
His Investigations and hospitalisation was supported by SISHUKUNJ INTERNATIONAL
His medications are being supported by HEART and HAND FOR THE HANDICAPPED.


Kadirappa, is a 65 year old man who came to the Health Centre with a chronic pain in the neck and difficulty in walking.
Clinically his gait was spastic, with brisk lower limb reflexes. Bowel and bladder control were maintained. This suggested a cord compression in the cervical (neck) region.
An X Ray done at the Health Centre, proved this diagnosis.
He has been put on a Cervical Collar and NSAIDs for the pain.
He will require graded physiotherapy and cervical muscle strengthening excercises.
The cost of his collar and investigation were supported by the Village Development Council.

The health centre restarted work on 02 June, a Monday, and sure enough the word of mouth express ensured that the patients were there in full. We have decided to showcase our statistics in a different way which we hope will be clearer.

Outpatient: Total 1382
Children (<15)
Male: 132 Female: 132
Old Age (> 65 years)
Male: 120 Female: 102
Adults
Male: 389 Female: 559
Eye Programme
Total Patients: 66
Glasses: 16
Medications: 37
Cataract Surgeries: 13
Antenatal Programme
New Patients: 01


Every day one encounters a slew of stories, some to do with hard luck, some just defeated by the world, but in all this the very spirit of humanity shines through....
A few of the stories are given below:

Shivaiah, who is 70 years is a Rural Artisan. What that means is that he depends upon traditional art work for his living. He has an only son who is mentally retarded. Shivaiah takes care of him with his meagre earnings and old age pension of Rs 200 pm. Shivaiah himself is a Diabetic and Hypertensive. The health centre provides free treatment to both Shivaiah and his son.
Shivaiah's treatment is possible thanks to a grant from Village Development Council, London, who have funded us for Old Age support.
His son's medicines for Fits comes from a grant from Heart and Hand for the Handicapped, New York

Deena has no parents, both of them succumbing to some illness - possibly AIDS. She is looked after by her grandmother. Deena stays in the Rural Education Centre, through the week. At the REC she gets to eat three meals a day and also gets a few clothes. Weekends she is back with her grandmother.
Subbamma, was hit by her son, because she was too old and was a drain on her family. As youcan see in the photograph, her right shoulder is swollen and distorted from the blow. This is domestic violence aimed at the old. Rising prices and runaway inflation is making life all the more difficult for the rural poor.

A Death

Shanaz Bee was only 30 years old when she died leaving behind five children, the youngest being twins aged 08 months.
Why did she have to die at this young age - its is a story of neglect, poverty and probably mismanagement.
She had not been well for over two months, going to some village doctors, who treated her with Injections etc - the usual stuff. Her mother kept insisting that she come to the Health Centre, but she would not or could not - putting off the visit with some excuse or the other - "Who will look after the kids?" "Who will cook food?" and so on and so forth.
Finally her parents convinced her to come and stay with them. By then she was apparently in a pretty bad shape. She went to a private practitioner in Madanapalle, who again treated her with some antibiotics.
She finally came to the health centre on a Friday morning, reaching early to beat the rush. When the staff came in an hour later, they found her quite breathless. They were in the process of shifting her to the Emergency Room, when she collapsed. We tried resuscitating her but to no avail.
Why did she die - no one knows - a post mortem may have helped, but then who has the money to pay the police, the civil surgeons? After all it is one more death in an overpopulated land.
But a death is a death and what of the kids?

April 2008

Well the new year has started without a let up. Patients continue streaming in, more numbers than usual as they know that it is time for our annual vacation!! This much needed break will give us all a breather to recharge batteries, exhausted minds to ensure that we continue to give our best to our patients. The health centre closed on 26 April and will reopen on 25th May. Exactly a month's break.
The numbers for April:

Patients
Children: 46
Adults: 1851

Antenatal
Registered: 02
Spontaneous Abortion: 01. She had an abortion at 10 weeks of pregnancy

Eye Care
Patients 38
Cataract Surgeries: 07

March 2008

As the Financial Year closes, it is time to take stock of what happened the previous year and look forward to plans for the coming year, not that it makes a difference to the patients as any year, day is the same when it comes to illnesses.
March was like any other month, probably busier than others. The review of work is as follows:
Patients:
Children: 104
Adults: 1861


Antenatal
Number Registered: 05
Deliveries: Nil

Eye Care
Patients: 85
Children: 01
Cataract Surgeries: 04

Gowthami - ? Lymphoproliferative disorder

Gowthami, a 6 year old girl, from a village about 15 km from here, was brough to the RHC with a h/o poor apetite and increasing lassitude.
Clinically she was undernourished (as the photo shows), there was pallor and she was very hesitant in answering questions. Her parents had followed the usual route of going to RMPs, Doctors who all have given her injections and IV fluids. Not one of them had done a blood test or examined her.
There was Cervical lymphadenopathy and diminshed air entry on the left side of the chest
Investigations:
Hb: 12 gm%, TC 30000/cumm, P 18%, Lymphocytes 79%, E 02% and M 01%
Peripheral smear showed normocytic, normochromic RBCs with moderate Leucocytosis and atypical lymphocytes. Immunohistochemistry was suggested

The X Ray of the chest showed a fullness of the Pulmonary Bay, suggestive of a mediastinal mass, probably a lymph node.
This made us think of a LYMPHOPROLIFERATIVE DISORDER, ? Hodgkins or NHL.
We have sent her for CT Scan to find out the spread of the disease. We are awiting this report.

February 2008

As usual another busy month:
Outpatient:
Children: 165
Adults:
Total: 1888
Eye Care:
Children: 01
Adults:93
Cataracts Operated: 05
Ante Natal:
New registrations: 05
Deliveries: 02 - Birth Weight (3.2 kg and 0.750 kg)
Still Birth: 01 (0.750 gm - Mother contracted chicken pox in her 2nd trimester and had a still birth)

Our New Generator

As you can see we have a new generator, which has been installed, tested and is now fully functional. This hopefully will help us tide over the ever present problems of power cuts, which, as summer approaches is only bound to get worse.
This Generator was thanks to the kind generosity of Mr Shyamal Purushottam, a prent of Rishi Valley School. We all thank him for his generosity.

Paediatric Camp 16 Feb 2008

16th February is always a date that hangs heavily over us. Dr Ramamurthy, PhD passed away on this date. This year, thanks to his brothers, we were able to organise a Paediatric and Dental Camp for about 100 children of the Rishi Valley Rural Education Centre. These photos are from the camp. Ofcourse analysis of data will take some time.

A New Ambulance for the School

The pictures you see are that of a new ambulance. This has been made possible thanks to class of 1982 of RVS. After buying the ambulance we found a builder in Bangalore who modifies Ambulances. We got it modified to suit our needs with roll on/off stretcher, airconditioning doctors seat, electricalpoints etc, including a placement for an Oxygen Concentrator. We now need to get a Defibrillator and a Transport Ventilator to make the ambulance fully and effcetively functional.

THANKS CLASS OF 82 FOR YOUR GENEROUS CONTRIBUTION

Tha

Congenital Heart Disease - Operated - Thanks to AROGYASRI

The Andhra Pradesh Government had recently launched the Arogyasri programme in which, the poor get access to high end medical care which otherwise would not have been accessible to them because of the costs involved.
Mallika, was diagnosed in the health centre to have a Congenital Heart Disease - most likely a Patent Ductus Arteriosus in early February this year. She was referred to SVIMS, Tirupati, under this schme. The the ECHO Cardiography confirmed the diagnosis and by the 20th of Feb she was operated and discharged by the end of the month - ALL DONE FREE OF CHARGE.
Mallika is now doing well and is quite health post operatively.
Such programmes, if they function well can do a lot of good for the poor,who are as it is hamstrung by the lackof financial resources. May the Arogyasri continue doing good work.

December 2007 and January 2008

A usual the days go by with the constant flow of patients.

December 2007

OUTPATIENT
Children: 150
Adults: 1634
Total: 1784

EYE CARE
Children: 02
Adults: 71
Cataracts: 04

ANTENATAL:
Registered: 07


January 2008

OUTPATIENTS
Children: 90
Adults: 1444
Total: 1534

EYE CARE
Children: 01
Adults: 71
Cataracts: 05

ANTENATAL
Registered: 04

We have a new Doctor

Dr Ramesh, a paediatrician, joined us from the 01st of January. His presence has made adefinite and positive impact on the quality of health care for children. His wife, Jyothi teaches English at the Rishi Valley School and we hope that he will be with us for a long period of time.

Venkataramana - A wizened baby - UPDATE

An update.
Venkataramana barely survived a week in St Johns Medical College, succumbing to his various illnesses.
Loosing a life is always a hard one to take. In this case the mother is also ill with a Congestive Heart Failure due to Rheumatic Heart Disease. We have been counselling the family to avoid further pregnancies as it could prove dangerous to the mother.

Venkataramana - A Wizened baby

A three month old baby, one of the surviving twins.
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 Age Story

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.

ANNUAL REPORT 2006 - 07

RISHI VALLEY RURAL HEALTH CENTRE
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.

OUTPATIENT

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.

EYE CARE

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.

TUBERCULOSIS PROGRAMME

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.
Cases Details

New Cases: 62
Sputum +ve: 19 (31%)
Extra Pulmonary TB: 8 (13%)

Treated at RHC: 34 (55%)
Number successfully completed treatment at RHC: 23 (68%)
Number carried over to 2007 by RHC: 11 (32%)

Treated by RNTCP: 28 (45%)

Old Cases

Number carried forward from 2005: 12
Number successfully completed treatment: 11 (92%)
Number defaulted: 01 (8%)


ANTENATAL PROGRAMME

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.

Statistics: 2006

Registered: 40
Delivered: 22
Domiciliary:16
Hospital Normal: 04
Caesarean Section: 02
Ongoing: 11
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.

Statistics:
Haematology: 3274
Biochemistry: 2441
Serology: 313
Urine Analysis: 1802
Clinical Pathology: 87
Endocrinology: 388
Microbiology: 150
Sputum: 379
FNAC:1
ECG: 243
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.


THANK YOU

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.

FUNDING
Every bit small bit helps in our endeavours and we welcome any contribution. Please look at www.rvrhc.blogspot.com for our funding requirements.

OCTOBER and NOVEMBER 2007

Dr Kartik was away from mid October to mid November, to Oak Grove School of the Krishnamurti Foundation of America, Ojai, California, USA as part of a teacher visit programme. October was also the month of Deepavalli and the health centre was closed for two weekd from the middle of October to the end of October.
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.

October 2007

Outpatient:
Children: 55
Total Patients: 653

Ophthalmic Programme
Children: NIL
Total Patients: 08
Cataract Surgeries: NIL

Antenatal Programme:
Registered: 03

November 2007

Outpatient
Children: 20
Total Patients: 321

Ophthalmic Programme
Children: NIL
Total Patients: NIL
Cataract Surgeries: 03

Antenatal Programme:
Registered: 04

When we look back, we wonder where the vacation went!!!! Just kidding.

AUGUST and SEPTEMBER 2007

It has been a while since I updated this so here goes. August and Spetember were busy months as usual. In fact it seems that we have got inured to the deluge of patients.
Here are some statistics:
August 2007

Outpatient
Number of Children: 103
Total Patients: 1942

Ophthalmic Programme
Children: 01
Total Patients: 112
Cataract Surgeries: 15

Ante Natal Programme
Registered: 02

September 2007

Outpatient
Number of Children: 73
Total patients: 1858

Ophthalmic Programme
Children: 05
Total Patients: 70
Cataract Surgeries: 10

Ante Natal Programme:
Registered: 04

All in all not a bad couple of months work.

Vanaja - Traumatic cataract

Hi all - Sorry that the images are not very clear. Vanaja had a traumatic catarct following a stick injury. The image below represents that.

Here she is post op - dark glasses and all. The parents being emotional and greatful to what has been achieved - all for the princely sum of Rs 1500.00 only.

June and July 2007

We reopened the Health centre on 01 June, after a 4 week break. In the interim we had got some renovations done, added a couple of rooms, a day care centre and worked at streamlining the patient flow. Luckily for us, the patient number started small initially - around a 100 per dya, giving us time to shakedown and sort out the teething troubles.

Statistics:

June 2007:
Patients: 1133
Eye patients: 76
Cataracts Operated: 3

July 2007:
Patients: 1799
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.

Ramalinga Reddy - An Update

Reference to my earlier blog on "TB - two sides of a coin"
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?

TWO SIDES TO TUBERCULOSIS

In this blog, I would like to discuss, two patients with Tuberculosis, both males, aged 45 years, but the outcomes were vastly different in them.

The first - Ramalinga Reddy, had presented with a lump in the Right Groin (Inguinal region) in May of 2007. Fortunately for him he went to Tirupati, where in the Government Hospital (SVRR) he was diagnosed as having a TUBERCULAR PSOAS ABSCESS, based on Ultrasound and FNAC of the lump. He was the started on Anti Tubercular Treatment and was transferred back to RNTCP, Madanapalle. He had completed about 8 weeks of treatment, when the abscess busrt to the outside. Then what - the local quacks and well intentioned neighbours took over. The poor man was starved, some leaves, lime and other sundry items stuffed into the wound and it was left to fester.Fortunately, a relative of his approached us and he was brought in a three wheeled cargo carrier to the health centre. He was in a

bad shape - Temp 99 F, HR 120/min, BP 90/60 mm Hg, Respiration 22/min. Looking cachectic and dull.

Well, it looked like septicemia and incipient peripheral circulatory failure. Hb 5 gm%, TC: 7600/cumm, P 78% with toxic granulations, ESR 122 mm, RBS 69mg% all pointed to the above. What could we do here. Started an IV, pumped him with Ciprofloxacin and Flagyl and told the relatives to take him to Bangalore - St Johns Medical College. A taxi driver friend of theirs helped and he reached Bangalore 4 hours later. Two pints of blood and then he was operated the same night. It is now a week, post operatively and he is doing well. Dr Santosh of SJMCH has been of immense support and help.

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.

THANKS - DONORS: 2006-07

TO OUR DONORS - MAY YOUR TRIBE INCREASE

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.

A NEW LOOK HEALTH CENTRE

Its been a while since I have blogged - heh! heh! vacation and all that. After getting back, there was the usual flurry of work, in getting the HealthCentre ready for another year. There have been changes both in terms of infrastructure as well as staffing - No I or my wife have not runa away!

First of all - in the adjoining photograph you can see the extended roof. We cannibalised old GI and Asbestos Sheets to cover our frontage.

Now patients waiting have a shade over their heads and the roof came in just at the right time. We completed the work in the first week of June and promptly thereafter it rained - Boy did the patients bless us for providing them with shelter.

Secondly we got two additional rooms - a Registration room and a room for us to consult in with a modicum of privacy. Oops - sorry no photograph of our consulting room. There are separate sections for the pharmacy, accounts and we have even managed to add a single bed as a DAY CARE/EMERGENCY ROOM.

All this has made the patient flow much easier and there seems to be no rush or hordes of patients peering over ones shoulders to see when their turn comes.

Promise you more photographs as time goes by.