Hetauda picnic

Hi there folks. If anyone reads this that is. Well it has been a long while since I blogged last. I realize that though a lot had been happening all this while, I just couldn't put it all online for you.

So here it is. I am starting from the picnic the whole hospital had over 2 days in Hetauda, Nepal, about 4 hours from here. It was a great outing and we all had a lot of fun. We needed it.

We went in about four vehicles, which included 2 hired buses.
All the junior doctors went together in a small van.
The picnic was on the banks of a small river.
The water was very cold.

There was this bridge which led to the other side of the river. And on the other side were hills covered by forest.
And there's where I saw these two kids rocket right up a hill. It was all dry; the forest was further up.

And then I saw them zoom down the hill at top speed.

And when they realized that I had a camera and was awestruck at what they were doing they gave me an opportunity to take some great action snaps.

Now by action snaps I mean real lively action like doing a somersault jumping off a small rock, and jumping down a cliff into the not so deep water.

We came back by seven in the evening, dead tired.
Most of us crashed right away not to wake up till the next morning.

All in all it was a good day. ;-)

The five legged cow, the deathly dwarf and other stories

I have seen my share of the weirdest things on earth during the past few weeks, and thought I would enlighten the readers with some of them. On doing so, I would also like to add some of the stuff I had seen earlier and was hesitant to post hitherto. So brace yourselves for the blog of the month.











I would like to start with a cow I saw a couple of weeks back as I was returning from a weekend trip to Birgunj. Now, cows are commonplace in India. And everyone knows there are more cows than there are vehicles on the streets of Bihar. But this particular cow had all my attention for the few minutes I could have it in my field of vision while speeding past on a cycle rickshaw. This monster cow had five legs! I'm not kidding, and this image is not photoshopped. The thing on the back of the cow is an extra leg. So much for the first occurence of the month.



Allow me to tell you this one. The other day they called me to resuscitate a baby in the labor ward. The lady had not had any antenatal checks and had arrived in the second stage of labor. The head of the baby was out, and the shoulder was stuck. By the time I arrived at the scene however, the baby, or rather the babies were already out, though it still baffles me how it happened. Take a look for yourself. This is not what you call a 'normal' baby. Had there been a heart beating, I would have been at a loss as to which one to resuscitate first. But they were born dead.















Three hands, two legs, two heads, one umbilical cord and a male genitalia... That explains the Siamese twins.



Now the next one may not be that dramatic, but it highlights an important point I had made in one of my previous blogs about the village doctors. This kid was brought to the outpatient department with a history of multiple episodes of loose stools and vomiting. This had been going on for about five days and the child was treated with all kinds of antibiotics by the village doctors. I should mention that the child was just a couple of months old.



















Today I received a call from the labor ward again and was told that a baby had just been born and had not cried after birth. I rushed in to find this tiny baby with tinier limbs and the nurse hovering over it trying to resuscitate. The baby had a steady heart rate and though we promptly intubated her and bagged her for some time, we couldn't save her.



















The next picture is of a baby brought to the out patient department about four days after birth. This condition, I learned is known as exstrophy of the bladder. We had to refer the child to a higher center.



















One night in the emergency room, a patient arrived, all alone. He was apparently crossing the international border in the evening and had fallen on a metal object, hurting his head in the process. This had happened about five hours prior to his arrival, and he had struggled on to the hospital despite being injured. I wasn't actually prepared for what I would be seeing under the turban on his head.



















A child with mouth full of candidiasis. This baby couldn't feed from the breast. On treatment it improved drastically.













The next couple of pictures are old ones which I hadn't put online. The first one is of an anencephalic baby, which was born way before term.



















This next one was taken when I was still in Obs and Gyne. Was called upon to do a dilatation and currettage for a lady with severe bleeding one day and this tiny little baby was born.

This baby was brought to the out patients department with history of some rash on the face. Probably hadn't been given a bath since the day he was born.

And last of all, well since I am running the doctor's mess here now, a weird potato..

Work

Working in Peds is fun, much as I thought, and I am enjoying every bit of it. Got peed on twice. But trust me, that is nothing compared to getting your underwear soaked in blood during a c-section. Plus I would do anything to see those toothless smiles. Have been doing nursery rounds by myself of late with a lot of help from Rimi. We had some really sick meconium stained babies who were resuscitated properly and did well in the nursery. Most of our pre-terms in the nursery are also doing well and I am so thankful there have been no deaths in the nursery this month so far. That is rather unusual here. Last month we had problems with the 'meconium' babies. Some of them had aspirated so bad that no amount of resuscitation and care with the facilities we have here could keep them alive. The labor ward was overflowing and babies were booming.

Casualty duty
What scares me is the emergency room responsibility. I am required to attend to any case other than an obstetric case that comes to the hospital at night. On call duty starts at 6:00 pm and goes on all the way till 7 in the morning the next day. Most patients who make it to the hospital are awfully ill. And it takes a lot of effort for me to come to the right diagnosis, and I have goofed up; thankfully, not in a major way. We have about fifteen admissions on an ordinary night... that is when the doctors at the district hospital across the border are not having a party and the hospital is functioning. Apparently they did that a couple of days back and we had a huge inflow of partially treated patients. All very ill. And also we have all these medico legal cases coming in on most nights. My last night on duty, I attended to a gunshot wound; entry wound on the left side of chest, exit wound on the right. The bullet had then penetrated the inner part of the right arm and was palpable just under the skin on the lateral surface of the arm. There was no lung injury and the patient was stable. So after providing basic resuscitation we referred the patient to a higher center.

Snake bite
I get to see on an average one snake bite a day. Snakes here are usually elapid - cobra or krait. I have noticed that those with cobra bites are the ones who develop signs of envenomation most of the time. Not that krait bites are safe, but most of the time they are not very disastrous.

Assault
We get to see this in plenty here. People come with bleeding scalps and broken bones. The entry is the scariest part. Everybody is so charged up and wild, yelling at the doctor to do something. It is not unusual to have a crowd of twenty people with one patient and all may be very loud. I thankfully haven’t come across a burns patient yet, but we do see cases of burns. What is interesting is that if you are from Nepal, there is no medico legal case registered where as if you are from Bihar every case gets reported. All poisoning and attempted suicide cases from Nepal thus find their way here.

AGE in Shock
From last month we have been seeing a lot of Cholera cases. And I see about two to five people with AGE in shock on any given duty night. The other night a group of people brought a lady who had been dead for a while. She apparently had been passing loose stools only for the past one and a half hours. Another gentleman who was brought gasping with a history of passing loose stools sat up and talked after we rushed in 6 bottles of ringer lactate.

The Village-doctor
Most of the patients from the village get some medicine from the local doctors before coming here. These are guys who prescribe medicines for most illnesses in the villages, and also in towns. They are not qualified by law to prescribe medicines. But they give everybody who approaches them a shot of two medicines... probably the only ones they know: Dexona; trade-name for dexamethasone, and Monocef; trade-name for Ceftriaxone. No matter what the illness is you can rest assured your patient arrives after shots of these two medicines. So you have to scramble for a higher antibiotic at times. The way they give IV fluids is worth mentioning. They just pump in as many bottles as the patient can afford through a peripheral vein, which is accessed by a large bore metal needle. You have to see it to believe it. They come most of the time with the needle half out. Some times a doctor would accompany his patient posing as one of the family. And he would hang around you just to watch how you treat other patients. Once I had one of these guys come up to me and say, "Hum bhi medical line ke hain." Translation; I am in the medical line also. Talking with him proved to be a very good exercise for building up my patience.

Children

Well the fact is I love kids. Here are some snaps of children, from Raxaul.

Christine and Ashish on a swing…

Stagnant water behind houses makes an ideal fishing spot.



















A baby who was brought to the Out patients



















Pre-term twins in the nursery… they were in for quite some time.



















One day, while making rounds, I came across this irate patient who just wouldn’t talk.




















This one was frantically trying to pull out his NG tube.





















Spikey






Confiscated milk bottle… this step probably saved a life.



Little girl and her sibling with a swollen eye from a flood affected village






















We got new toys from Birgunj.






















Malnourished child.































Wasted bum of the same child.

Now, I wouldn't pick a fight with this one.

Adios Amigo...... for now

It's been a long time since I blogged last and I decided now was as good a time as ever to do so. I am out of Obstetrics and Gynecology for now... have been for quite some time in fact.. about a month and a half to be exact. And the feeling is.... YEAH! Much like the way James Hetfield says it. Things were interesting in the beginning, but towards the end they became...well, scary. We had some women who would just bleed like crazy on the table after a c-section, with nobody willing to donate blood. And some deaths... really sick patients.

I am working in the department of Pediatrics now. And I seem to love it. At least you have patients who look at you and smile when you give them that clown face... and you can do a lot of things you cannot dream of doing with other patients... like holding them against your chest and listening to their heart, for instance. And that's not all. You don't have to listen to the constant drone of complaints that can sometimes get annoying, like the woman who said, " I still have that tingling on my little toe that I mentioned to you during my last visit.. And not one medicine you gave me seems to work.." ...not that softly, here in Raxaul, and at the end of seeing one hundred women that day you feel like saying, " I thought you were here to make sure that your baby in there was doing okay."
Of course I am overlooking the occasional child who screams on seeing you. Or the over anxious parents, occasional again, where the above mentioned drone sounds more like a twin engine.

My current work involves doing emergency calls and receiving sick babies born in the labor ward and OR... feels better to be on the other side of the operating room. There is so much to learn and it feels good.

Here are a couple of interesting things I came across in the last few weeks of my Obs and Gyne posting.


Another of those bad obstetric history charts.


This is hilarious!

One of my patients had already taken this wonder drug. Here's what the label says... since the photograph is more a strain to the eyes than anything else...
An easy way of birth Control
One capsule is sufficient to avoid conception for one year. 52 capsules are enough to prevent whole life conception without any side effects. A harmless medicine and no bad effects on health. Followed by directions and then,
Caution: After taking this capsule, sex in indulgence should be aboided atleast for one month.
I forget what she presented with, but it was nothing major. The whole thing is kind of scary because it probably torpedoes the ovaries. Sterile for life with no side effects. Found that really funny.