God saved me number of times (more than thirty times) till date. Now I am giving the real account about one very extraordinary event that occurred recently. Details are as follows: I retired from the state government service, working in the medical and health department, as medical officer. By the grace of God, I was again given posting to work as medical officer, on contract basis, in a primary health (Medicare) centre, in a remote area. (Previously this type of system was not there). Doing Tubectomy (Female sterilization) surgeries is one of my duties as per the job chart and I did a number of tubectomies. 1. August 20, 2004: I did four tubectomies on that day and all the cases were all right and were discharged in the evening of the same day and they left for their respective native places. There is one female health nurse to give follow up, post operatively for seven days, to every Tubectomy case. Now I am giving details of one case of the four Tubectomy cases. She is about 26 year old and having three children, at the time of surgery. Her native village is 20 km away from my headquarters (PHC). The patient was without any complications for the next two days, i.e.; on 21st and22nd August. 2. August 23, 2004: The patient developed spotting (slight blood discharge) at 2 pm. But the female health nurse did not visit the case for these three days (negligence on her part). There are other health personnel (supervisory category) also, who also not visited that operated case. The parents of the woman patient approached a rural practitioner (a quack) and brought 3-4 tablets to arrest the bleeding and gave them to the case. But the little discharge of bleeding was still continuing, even on August 24. 3. August 25, 2004: The patient suddenly developed heavy bleeding discharge and went into unconsciousness. The parents and the relatives of the patient were in panicky condition. As it is a remote area, there was no immediate transport facility to shift the patient. Somebody went to a nearby a big village and brought a rented vehicle and the patient was taken to Kanigiri (a medium sized town), which is more than 35km away from the patient’s native village. All the way (in the journey), she was having the bleeding discharge. 4. At Kanigiri: She as admitted in a private nursing home and her Hb (Hemoglobin or blood) blood count was done which is 35% (normal 70-80%in this area) only. The private practioner secured 2 bottles of blood (belonging to her blood group) and started transfusing the blood intravenously to the patient. The bleeding is not stopped and she is in semiconscious state and the Hb is 35% and there is no improvement in her condition. Mean while, a health worker (a relative to the patient), happened to be there and he phoned to the deputy district medical officer(stationed at a place which is more than 40 km away from Kanigiri) and on his advice, at 6.30pm, the patient was referred to Ongole town (district H.Q hospital), which is more than 85-90km away from Kanigiri. Blood transfusion and artificial oxygen (given through nose from O2 cylinder) were provided, as the patient was unable to take breathing, due to less Hb%. The patient reached Ongole at about 8pm. 5. about me and my paramedical staff members: At that time I was in my native place (to attend personal work), which is far away from Kanigiri and knowing the situation through phone only. At Kanigiri, the relatives of the patient began to pass adverse comments against me and my operation procedure. The most horrible thing is, the medical staff (stationed at PHC –H.Q, which is just 22 km away from Kanigiri) were requested by the doctor (who was treating the patient at Kanigiri), to come over to Kanigiri, to follow the case. But no body from the staff, including the ANM (happened to be the relative of the patient) also did not go there (even though vehicle is readily available for transport purpose), to see the patient, thinking that the relatives might manhandle them. They showed such negligence of duty on their part, and left me to my fate. The higher authorities informed me by phone to go to Ongole and I reached Ongole at 9pm and talked to the patient. 6. At Ongole: The gynecologist examined the patient. There is no improvement in the condition of the patient. There were only two options: 1. If the hysterectomy (removal of uterus) operation is not done, the patient would certainly die, as there is continuous bleeding from the uterus. 2. If they do operation, the survival chances of the patient are 50% only. So what to do? Doctor is in dilemma. After consultations with the parents of the … [Read more...]
Injection in rural health care
This incident was happened in 1987 in a tribal area (Rajavommangi) in Andhra Pradesh, where I worked as a medical officer. A female patient about 26 years old was brought to the hospital by her husband at about 2 PM. Complaint: Severe pain in the abdomen. The time is an odd hour as hospital was remain closed from 12-30 PM to 4-00 PM. Only one staff member was with me at that time. I gave her anti spasmodic drug in the IV (intra venous) form in anticipation for quick relief. The injection was bought by the patient relative from a near by drug store as the hospital store was closed. Immediately, the lady developed sweating and pulse became weak. I immediately gave her required treatment for the reaction in the form of Dexamethasone injection. She recovered within 10 minutes. But, I LEARNT A BIG LESSON. Lesson: Never give injection in Intravenous route when you are working in rural areas unless it is necessary or it is the only possible route for that drug. Please comment on this article. … [Read more...]
Medical Caes: Dog bite and Rabies
This I a real story happened in 1974 in Maharashtra, India, where I worked as medical officer in a primary care centre in Apatapa, Akola District. I was called upon to examine a female patient aged about 28 years. She was complaining of pains all over the body, running temperature, headache and also feeling uneasiness. I have necessary medicine and rated it as a emergency case. In spite of good treatment, her signs and symptoms are recurring after a brief period of relief. After 4-6 hours, I enquired the patient about the complaints, whether it is the first time or any similar past history. Then, the relative of the patient informed me that there is no such past history. But, she earlier came to the PHC for dog bite treatment. Then, I recollected previous history of the patient. It is as follows: Two months back, this young lady came to the centre with a history of dog bite. I came to know that it was a street dog and suspected that it was a case of Rabies (also known as Hydrophobia). After giving first aid and Tetanus vaccine, I advised her to go to Government general hospital, Akola for taking Anti-Rabies vaccine as they are not available with us. In stead of going to main hospital, they went to local rural unauthorized doctor. He gave some injections and tablets and sent them to their village. Afterwards, she did not come to see me. She might not have developed signs and symptoms of Rabies. For most of infectious disease, there is an incubation period i.e. the time of getting infection and developing signs of symptoms. This patient developed signs and symptoms after 2 months. She died on the next day. I explained to the relatives about the cause of the death. In Rabies case, she may not take any thing through mouth or intravenous route as throat muscles contract and could not allow any thing to swallow. Patient may die due to dehydration. The Quack’s selfishness and lack of knowledge between ordinary dog bite and mad dog bite, patient paid the penalty. I saved many tribal lives from rabies by explaining the severity of this disease, while I worked as a medical officer in Maredumilli in Andhra Pradesh, India. Please comment on this article. … [Read more...]
Medical Cases: Snake Bite – My experience
This happened when I worked as a medical officer in Maredumilli, agency area in East Godavari district, Andhra Pradesh, India. When I enquired her about the bite, they gave the history of black cobra first bit the hen and then this lady. They killed the snake. I saw the hen which was died and turned into black color. I thought that the snake spit the venom first into the hen’s body and then into this lady (may be in very little amount). So, though snake is a poisonous one, she is out of danger. I explained it to the patient and their relatives. If the snake is a non-poisonous one, fear of bite brings shock and patient may die. I repeatedly encouraged her to be confident and there is no danger to her life. Symptoms of poisonous snakebites? bloody wound discharge fang marks in the skin and swelling at the site of the bite severe localized pain fainting, dizziness and burning blurred vision and excessive sweating fever and increased thirst Rapid pulse and numbness and tingling Snake bite treatment: First Aid: Wash the bite with soap and water. Immobilize the bitten area and keep it lower than the heart. Cover the area with cloth and monitor vital signs. Doctor gives Anti snake venom. Please comment on this article. A female patient aged about 25 years old was brought to the hospital at around 2PM with a history of cobra bite. She is conscious and slightly apprehensive. I gave Anti Snake venom (ASV) injections. I advised them to go to district hospital which is more than 100 km away. But, they were reluctant to go. I advised her be bold and did not go into panic. There was gradual improvement in the condition. … [Read more...]
An unconscious alcoholic man
In the year 1973, while I was seeing a patient in health centre in Maharashtra, A patient aged about 35 years old was brought to the hospital in a cart (drawn by an Ox). He was in the unconscious state and not able to move his hands or legs. But, Breathing and heart rate are normal. I came to know through his relatives that the patient was lying in the agricultural field for the last 24 hours without taking any diet. He took country made alcohol. It indicates that he is in hypoglycemia. Immediately, I gave 25% dextrose of 200ml through big syringe into his veins. He immediately woke up and sat on the table. The first sentence he uttered in local Marati language is " Where am I?" ( English Translation). The persons around him are laughed biggerly including myself. They thanked me very much. I never forget the incident and the sentence uttered. Though the case is routine one, My inexperience, innocent rural people and dramatic recovery made the incident unforgettale even after 33 years. Please share your opinion. … [Read more...]
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