July to September 2017

Wow Bountiful rains through September, the tanks have started filling up and the valley is green and lush. What hope in the air for all the farmers, daily wage workers, shepherds all those who make up our clientele
Busy as usual
 A Total of 7053 patients over the 3 month period
Children 248 M and 259 F
Elderly: 823 M and 850 F
Adults: 2012 M and 2861 F

Dr Kartik had been invited to give a guest lecture at his Alma Mater Institute of Aerospace Medicine, Bengaluru. It was a fun event giving back to the Institution.

April - June 2017

The hot months of summer brings a certain lassitude! We had quite a few patients with heat exhaustion, mainly the older people. A few young ones also. The waiting area though shaded is in the open, so heat load is high. Fans, earthen water pots (matkas) alleviate the heat to some extent.

As usual a large number of patients
4192 patients, 244 children and 750 elderly contributed to the load.

Everyone is waiting for the rains, fields lying fallow, the heat baking
The RHC closes for a summer break in May so all patients are covered till we get back.

Just a look at the NCD data over 01 years: Mind boggling

Hypertension: 6857

Diabetes: 9029

Hypothyroids: 469

Jan to March 2017

Wow its hot, March has been sizzling. Temperatures upwards of 38 Celsius and working in the heat in the mid afternoons - phew!!! Patients sit uncomplainingly

Lots of patients: 6968 of them, with the majority earning less than 48000 pa.
475 children below the ages of 15 and 981 elderly patients.

The drought has also affected the earning capacity. The effects of demonetisation are slowly fading though.

April promises to be hot as well

The year past saw us cover 22742 patients, an increase of 5% from the last year. Quality affordable outpatient medical care is so much needed. Almost 95% of illnesses could be treated at an outpatient level. The need is to have dedicated doctors and staff in rural areas. I frankly do not see it happening given the way our medical education is structured.

 This young girl had an extra orbital pseudo tumour which caused ptosis of the left eye. She was operated at Hyderabad and is slowly recovering.

 This old lady, with Hypertension, Stroke and Diabetes makes a trek of almost 40 km to reach the RHC. She has to change 3 buses to reach. We were able to help her with some transportation charges so is now able to hire an auto. She comes once in 4 months for a review.

 Young man with Congenital Hypothyroidism. Mis diagnosed and Mistreated - literally abandoned by his parents. Slowly brought under control. I suspect that he has other endocrine deficiencies too.
















Diabetic feet are so common - lack of foot care, injuries due to bare foot walking, poor nutrition all add up to this debilitating condition. Loss of earning capacity adds to the woes of the patients.

Throngs of patients. This was at 1700 having seen an OP of 180 patients

This young girl with type 1 Diabetes - is an aspiring state Basketball player. She made it up to the semifinals in the recently conducted nationals at Rajnandgaon. However she could not make the cut. Wondering whether her illness precluded her selection. 

She is well controlled on Insulin and has excellent parental support.

That's all for now folks. Looking forward to a break in May

Oct - Dec 2016

The final quarter of the year.
The first two week sof November saw the RHCtake a short break.
As usual the NE monsoon played out as a damp squib!. Cyclone Vardah deposied some 4 cm of rain and that's it
The month of December saw soms poor patient attendance primarily due to the cash crunch post demonetisation. However by the end o December things were looking up once again.

Total of 5366 patients
Children below 15: Males - 244 and Females - 174
Elderly (Above 65): Males - 338 and Females - 341
Adults: 1820 Males and 2449 females

Income Levels: 5101 earned less than INR 48000 pa and 265 were over 48000 pa

July - Sep 2016

The meteorological forecasts were optimistic - plenty of rains - unfortunately not a drop - the groundnuts have all withered, the jowar has gone - few straggly spike here and there. Makes one heart bleed
On the other side there was a sudden spurt in tomato prices - wow some families wiped out 10 years debt in one trip to the Tomato Market - suddenly there were new phones, new bikes visible on the country roads!!!!
Two sides of the same story
By end September all were wearing a glum look - withered crops, rapidly depleting ground water and soon the familiar sounds of a tractor pulling a trailer with water
Any way the RHC continued to be busy

Total of 6997 patients
Children below 15: Males 281 and Females 220
Elderly (above 65) Males 401 and females 385
Adults: 2657 Males and 3053 Females -
As is always the females tend to seek health more than males

Income levels less than 48000 pa 6683 and more than 48000 (APL) 314

Despair of Poverty - Cowering, hiding from the world and the wind

                                                                                                                                     This young boy swallowed a Re 1 coin - Bananas did the trick, The X Ray shows the coin in situ                                                                

Severe Osteo Arhritis - Helped with a knee brace

April - June 2016

Its been a hot summer, we had temperatures of more than 42 C for a month or so. In spite of exhortations, patients reported with heat exhaustion as well as heat hyperpyrexia. The elderly and the young were affected more than the able bodied
We also saw a few young males with Renal Stones - following the hot spell. Possibly dehydration due to farm work?
Patients continued in spite of the hot weather.
May provided a respite for all of us as it was a vacation time
Total Patients: 3522
<15 115="" 88="" p="">Children M: 115, F: 88
<15 115="" 88="" p="">Elderly M: 456,  F: 473
Adults M: 1172, F: 1218
<15 115="" 88="" p="">Income levels
<15 115="" 88="" p="">Below 48000: 3392
<15 115="" 88="" p="">Above 48000: 130

This little boy developed seizures, delayed milestones and also had an abnormally shaped head. He was diagnosed with Cranial Synostosis. Plastic surgery was done at St Johns Medical College. he is now recovering well and slowly improving

One of the most common afflictions of Diabetics - a diabetic foot. Poor hygiene, walking barefoot, poor diabetes control, smoking are all factors in causing this. Once affected the treatment is long affecting wage earning with its attendant problems of increasing poverty, depression etc. Apart from physical care most of these patients need psychological care to help them cope with this trauma.

Jan to March 2016

The financial year draws to a close. In spite of the heavy rains in October/November the heat has picked up. Working in the afternoons is quite difficult. Matakas of cool water are consumed to slake the thirst

Total Patients: 6323 

Below 15 years - Male: 280; Female: 258
Above 65 years - Male: 390; Female: 380
Adult: Male: 2546; Female: 2469

Income (₹) Distribution

Below 48000: 6167
Above 48001: 156

So we close the year with 21644 patients - first time that we have crossed 20000 patients in a fiscal,

April dawns!!!!

October - December 2015

Wow what a change - for the better - Splendid rains - rained continuously and we got a years rainfall in 2 weeks Approx 100 cm - gods be praised
Everyone has a big smile on their face and why not - the percolation tanks are full and overflowing, the streams running, borewells recharged - there is now drinking water in the bores as well as enough and more for agriculture. At least for the next year we should be comfortable
The big challenge is to get farmers to continue to conserve water and not waste it with indiscriminate flooding of the fields.

The Health centre also had a 2 week break over Deepavali. As usual it was terrific to put ones feet up and come back recharged

The number of patients took a dip because of the rains and increase in Agricultural activity

Total Patients: 4945 

Below 15 years - Male: 286; Female: 265
Above 65 years - Male: 213; Female: 208
Adult: Male: 2022; Female: 1951

Income (₹) Distribution

Below 12000: 3056
 12001 - 24000: 1422
 24001 - 36000: 249
36001 - 48000: 133
Above 48001: 85

July - September 2015

Decided to write up 3 monthly rather than monthly
The rains have played truant El Nino effect. Lots of dry weather bringing with it viral fevers, the flavour of the season being Dengue !!!
The Vascular Disease Project goes on and the data collection is in full swing. The response from the participants has been incredible.

As usual the data
Total Patients: 6769 

Below 15 years - Male: 365; Female: 382
Above 65 years - Male: 345; Female: 333
Adult: Male: 2610; Female: 2734

Income (₹) Distribution

Below 12000: 4096
 12001 - 24000: 2037
 24001 - 36000: 350
36001 - 48000: 171
Above 48001: 115

June 2015

Back after a months break, which was rather busy in itself. Early rains and the valley is looking green. However groundwater is fast depleting. Conflicting reports of the monsoon, skymet saying it  would be normal, while IMD predicting a deficiency. No planting has occurred while some farmers have ploughed their fields.
This slight increase in farming activity means that the number of patients also drops off. Also a large population has migrated out of the villages to cities looking for work.

Total Patients: 1515 

Below 15 years - Male: 94; Female: 97
Above 65 years - Male: 90; Female: 81
Adult: Male: 553; Female: 600

Income (₹) Distribution

Below 12000: 1059
 12001 - 24000: 316
 24001 - 36000: 74
36001 - 48000: 37
Above 48001: 29

April 2015

Its becoming increasingly hot. One has to drink water by the litre to keep hydrated and have some semblance of alertness while dealing with patients.
A couple of showers have helped cool the heat, albeit temporarily. Some relief!!!

Total Patients: 2092 

Below 15 years - Male: 87; Female: 82
Above 65 years - Male: 82; Female: 132
Adult: Male: 740; Female: 926

Income (₹) Distribution

Below 12000: 1231
 12001 - 24000: 618
 24001 - 36000: 127
36001 - 48000: 68
Above 48001: 48

Vignettes of Patients 2014 - 15

Severe Osteoarthritis of  both the knees making him unfit to do any kind of work.
Such patients are disadvantaged both economically as physically

Basal Cell Carcinoma of the cheek
No treatment available in Madanapalle and he is too old to travel

A 10 year old girl. Diagnosed as Hypothyroidism
Now on Eltroxin also investigating for other endocrine anomalies

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Mental Retardation and Hemiplegia
Consanguinous parents

Microcephaly with early fusion of sutures
He also has hypospadias
Another victim of consanguinous marriages

A Diabetic with a large ulcer after debridement
With good control of sugars his foot is healing well

March 2015

Clear skies, warm nights and increasingly hot days. Summer is here and rather quickly. The trees are withered and all the leaves fallen off. Looks like a hot summer ahead. There is already talk of El Nino doing the rounds. Wonder what it augurs for our monsoon? 
The media has stopped reporting H1N1. Maybe the real issues will surface, but one doubts it as malnutrition, Diabetes, Hypertension are not headline grabbing stuff. 
The heat does not seem to affect the inflow of patients however. The crowds seem to have increased. Wonder where they get their money from with crop failures and no work?  

Total Patients: 2293 (Annual Total 2014 - 15: 19650, Annual Total 2013 - 14: 19477)

Below 15 years - Male: 125; Female: 120
Above 65 years - Male: 99; Female: 88
Adult: Male: 877; Female: 984

Income (₹) Distribution

Below 12000: 1364
 12001 - 24000: 737
 24001 - 36000: 108
36001 - 48000: 51
Above 48001: 33

February 2015

Clear skies, cool nights and mornings, a little bit of dew in the early hours, spring is here and a few new leaves. As yet nature has not indicated how the monsoon might be. 
A quite month, but for the H1N1 scare which seems quite misplaced, if one looks at the absolute numbers. More people die of TB, Malaria and other so called common illnesses and yet the media continues to write about this "new" disease!!!! Wonder how long the media interest will last. The response of the Min of Health has been graded and well thought out, No knee jerk reactions.

Total Patients: 1700

Below 15 years - Male: 97; Female: 89
Above 65 years - Male: 74; Female: 76
Adult: Male: 647; Female: 717

Income (₹) Distribution

Below 12000: 1032
 12001 - 24000: 538
 24001 - 36000: 63
36001 - 48000: 36
Above 48001: 31

January 2015

The new year has dawned clear and bright. It was warm over the new year but cooled dramatically after that for a few days. Not a hint of a cloud. 

This is also the time for Sankranti - the harvest festival. Quite subdued this year with the lack of rains. The long wait for the monsoon has begun. One hope that this year at least we get bountiful rainfall

Total Patients: 1714

Below 15 years - Male: 92; Female: 82
Above 65 years - Male: 65; Female: 64
Adult: Male: 700; Female: 711

Income (₹) Distribution

Below 12000: 1238
 12001 - 24000: 361
 24001 - 36000: 63
36001 - 48000: 35
Above 48001: 17

December 2014

Well the North East Monsoon fizzled out. A few drops here and there and that's it. This year we have had just 25 cm of rainfall. Migrations from the villages to the cities has started and of course most bore wells are dry. The South West monsoon is still 5 months away. Wait and see, hope and pray. 
Though we had a fair number of patients, we found that many of them were opting not to do testing or asking to cut down on the number of investigations or drugs prescribed. For example - a Diabetic with myalgia who would benefit from Calcium and D3, but could not afford it, was prescribed only Oral Antidiabetic drugs. Such examples are many. Also patients are postponing doctor visits, simply because of the costs involved.

Total Patients: 2161

Below 15 years - Male: 120; Female: 114
Above 65 years - Male: 89; Female: 104
Adult: Male: 838; Female: 896

Income (₹) Distribution

Below 12000: 1324
 12001 - 24000: 688
 24001 - 36000: 75
36001 - 48000: 42
Above 48001: 32

November 2014

I have been away for almost two months, tied up with various domestic issues. Spent time in Chennai.
The RHC reopened 2nd week of November and a few patients started dropping by.
The constant refrain was the lack of rains and the hardships it has caused
Hoping that the North East Monsoon will at least bring some rains. Its also become quite cold in the nights.Always wonder how the poor survive!

Total Patients: 751

Below 15 years - Male: 64; Female: 63
Above 65 years - Male: 52; Female: 47
Adult: Male: 275; Female: 250

Income (₹) Distribution

Below 12000: 522
 12001 - 24000: 162
 24001 - 36000: 30
36001 - 48000: 21
Above 48001: 16

October 2014

The vacations are due soon, the RHC will close for Deepvalli in the 3rd week of October. The number of patients has come down, possibly due to the lack of rains and also the fact that the RHC closes.
End October is also when the investigators for the Controlling Hypertension in Rural India (CHIRI) a multicentric study meet in Hyderabad to discuss progress and future plans

Total Patients: 1316

Below 15 years - Male: 77; Female: 55
Above 65 years - Male: 69; Female: 68
Adult: Male: 502; Female: 545

Income (₹) Distribution

Below 12000: 805
 12001 - 24000: 416
 24001 - 36000: 51
36001 - 48000: 25
Above 48001: 19

September 2014

A few scattered showers have helped the hardiest millets and ground nuts to grow. Other crops have dried out without water. There seems to be no hope in sight. It is eerie to see people dying in floods and here we suffer with minimal water.
We are hoping against hope for a revival of the monsoon in our area

Total Patients: 2254

Below 15 years - Male: 126; Female: 125
Above 65 years - Male: 116; Female: 107
Adult: Male: 836; Female: 944

Income (₹) Distribution

Below 12000: 1401
 12001 - 24000: 678
 24001 - 36000: 83
36001 - 48000: 60
Above 48001: 32

August 2014

The rains continue to play truant. Cloudy skies promise a shower and that's all. A few drops of rain and its all over. Migration to cities continues, and the water trade booms.
As yet, however, the lack of rains have not made any significant impact on the people accessing the RHC. 

Total Patients: 1734

Below 15 years - Male: 112; Female: 113
Above 65 years - Male: 76; Female: 89
Adult: Male: 649; Female: 695

Income (₹) Distribution

Below 12000: 1030
 12001 - 24000: 573
 24001 - 36000: 56
36001 - 48000: 41
Above 48001: 34