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?