Thursday, January 29, 2015

The Preventable

A major scourge of healthcare in India is the presence of preventable diseases. The incidence of malaria has definitely been on the decrease. However, I’ve few friends who believe that there is not much of a decrease in incidence, rather, it is a failure of reporting that has sort of given across the message that the incidence has decreased.

At Kachhwa, we see quite a few cases of malaria every week. Most of them are Plasmodium Vivax cases. 

Yesterday, we had a very interesting patient. A young man working in a town in North Bihar, he had come with fever of quite a long duration – almost couple of months. We had seen him about a month back and had treated him as Enteric Fever. And he had responded well to treatment.

However, he came back within couple of weeks of stopping treatment. We did a malaria smear and this is what we got.


The smear was full of gametocytes. In fact, almost every field had at least one gametocyte and surprisingly we could not find any ring forms. It is not very common that we got a field with 3 gametocytes.

The scenario of having Falciparum Malaria cases in the community is frightening. It exposes the population to a chance of morbidity and mortality from severe forms of malaria. And it is a harsh reminder of the infantile public health scenario of the country. 

5 sisters

Over the last 2 weeks, we were treated to a visual delight in the flowers in Barsati's garden. However, there was a special rose plant which had 5 flowers and it was quite special. Snaps of the same . . .









Wednesday, January 28, 2015

Menace

As most of us, tuberculosis is a major problem all over the country. 

One of the major issues in tuberculosis management is over the counter medications. Almost all anti-tuberculosis medicines are available very easily. 

Yesterday, in OPD, there was a boy who came with a peculiar skin lesion. We did a biopsy of the lesion. However, the boy also had a prescription written by someone on a piece of paper. He was told that this medicine is quite strong and should clear out the disease. 


He was smart to have not taken the prescribed treatment and opted to have it checked with a doctor. 

Unless, we can rein in such prescriptions, we are inviting avenues for emergence of Drug Resistant Tuberculosis. Of course, another cause of DRT is sub-optimal prescription doses of anti-tuberculosis medicines. 

The question is about any of us being serious about this issue. 

Barsati's Garden - Dahlias

More flowers from Barsati's Garden - this time, Dahlias . . .








Monday, January 19, 2015

Barsati's Garden - Roses 2

Diagnosing the unknown

One of the major challenges in a poor resource setting is to diagnose conditions when the history given is poor. Of course, there are occasions when one cannot come to a straightforward conclusion even with the latest equipment.


Last week, we had a patient where we could not come to any conclusion about the diagnosis.

RRD, a 12 year old girl was wheeled into emergency one day evening with a history of becoming confused after having returned from the fields. She was frothing from the mouth and nostrils and had a bradycardia. She was not able to narrate anything. Her uncle who had rushed her to hospital told us that she claimed that she was bitten by something.

The first thing we thought about was a scorpion bite. However, I was not sure about bradycardia being a part of a scorpion bite syndrome. I expressed my doubt if this was a scorpion bite. The relatives told that there was very less of a scorpion bite as it is very harsh winter and the region they come from does not have scorpions.

Then, one of the relatives told us about the possibility of her having accidently ingested some poison. Maybe, she has eaten some vegetable on which pesticide was applied very recently. A phone call to home and someone confirmed that she had eaten couple of tomatoes and peas as she walked across the fields. But, she did not have constricted pupils. Rather, it was dilated, but reacting to light.

Giving a benefit of doubt, we gave her atropine. The bradycardia got taken care of. But then, we realised that she was going into pulmonary edema. Soon, we had to intubate her and she was on manual ventilation. Nevertheless, the pulmonary edema was quite bad. We had to pump her little body with over 120 mg of Frusemide over couple of hours. And even after we had got the pulmonary edema in control, she needed 10 mg Frusemide per hour.

She was not fit for transport. However, she improved miraculously overnight and we could extubate her and by morning next day, she was sitting up and talking. But, she was not all well. She was breathing fast and there was tachycardia. We suspected myocarditis.




RRD also told us that she felt a searing pain on her right ring finger as she was searching something on the ground. She did not remember about what happened after that. She faintly remembered being taken to a witch doctor.

Her family was well off. We told the family of getting a consultation elsewhere. They happily took her further. We’re yet to hear from them.

I still think that she had a scorpion bite. The only hitch was that there was no local sign of a bite.

I wonder if we could have given the Prazocin tablets without confirming that it was a scorpion bite. I also think that the Atropine did more harm than good. But, then, we did not know what we were dealing with.


I shall let you know as soon as we hear more about it from the family . . . 

Monday, January 12, 2015

Calamondins

CALAMONDINS - yes, that is the name of the little oranges in my post on the limes of Kachhwa

More snaps of the same. And the best part, they make really good marmalade with a very different flavor. The downside - one plant gives only about just enough fruit to make couple of half little bottles of marmalade. 








Snaps from the marmalade making process. The recipe is from this blog.



The bottle on the left is from Calamondin and the one on the right from Orange. 
By the way, nobody got the answer posed in the previous blog. 

A Challenge

Over the last few weeks, we have had quite a lot on how India’s ancient were quite progressive in science and technology and it was only an irresponsible government coupled with left wing ideologues who suppressed such information.


I’m sure that there were quite a few things we knew about India’s contribution to science and technology. I’m very familiar with the names of Sushruta and Aryabhatta from childhood. And of course later names such as JC Bose, CV Raman, S. Chandrashekhar, Hargobind Khorana etc. are quite familiar.

However, as of now, we all know that our country is struggling with a myriad number of issues which can be solved. The Mangalyan exploration proves that we have quite innovative and brilliant scientists who will excel if given the right environment.


Last year saw a lot of challenges. In this post, I challenge my countrymen to come up with 5 issues which need to be addressed by Indian scientists as a priority. Here is my list of 5 challenges to each one of us, especially those of us who are students of science - - -

1. Tuberculosis continues to be a major killer in our country and other developing countries. We still rely on sputum microscopy which is quite an ancient test by medical standards for routine diagnosis. To make matters worse there has not been much change in the drugs which are used to treat the disease. We need faster and cheap diagnostic techniques and newer drugs which can be taken for shorter duration and has low drug resistance.

2. We depend quite a lot on fossil fuels. We’re yet to increase our reliance on non-conventional and environmental friendly sources of energy. In fact, we seem to have joined the race of development at the expense of the livelihood and existence our many traditional people groups who live in areas of fossil fuel deposits. We need research on solar energy and other possibilities of energy sources.

3. The human race generates lots of waste. And waste pollutes. Could we have research on minimizing and recycling waste?

4. Non-communicable diseases are a major scourge. Traditional systems of medicine promise quite a lot forprevention and treatment. However, there is very poor research done on their efficacy.

5. Our eco-diversity is under threat. Even some of the foodstuff which was common is not seen of recent. Traditional foods are slowly on the way out. Whatever research was done on them have shown them in good light. More research needs to be done. Can we look at our ancient texts about spices, vegetables and cereals used in ancient times? We not only need to conserve them but also popularise them. It can only be done through proper research.

Few reasons I can think about as reasons for non-acknowledgement of our contribution to science and technology.

a. We don’t document anything. Whatever is documented is done in a language which is not understood by much of the population. Therefore, the first step can be to translate all Sanskrit documents into a commonly used language.

b. We bicker among ourselves. We are famous for pulling each other down. I hope you heard about the story of the Indian crabs.

c. Whatever we discover, we do not share with the wider population. The discovery remains with a few elite and the technology is not shared for common benefit. Documentation in an elite language ensures the knowledge being limited to a certain group of the population.


If we are so sure of our scientific capabilities, I challenge the government and our scientists to take these issues seriously. If we do, I’m sure that the next century is going to be that of India.