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