Tag Archives: pediatric

A Statue For Good Health Please

A Statue For Good Health Please
 
© Dr. Rajas Deshpande
 
The 7 year old child with a swollen face and a bandage upon his skull tried to smile through his hazy awareness. He wasn’t feeling good, and his face said so amply. His father who accompanied him sat cross legged, angry and upset, and said “I don’t want him to take lifelong medicine. Suggest something else”.
 
His son was a known case of seizures / epilepsy, and was advised by each one of the three neurologists he had already seen, to continue the anti epileptic medicine. The adamant father not only did not start those medicines, but kept on searching for opinions that suited his convenience and understanding, and treating the kid with unproven herbal therapies and fanatic diets. The poor helpless child, otherwise healthy, had had over three fits in last one week, this time the boy had fallen off stairs during a fit, and sustained a head injury. The father refused to see his own faults, a very common tendency.
 
“The doctor who bandaged him also gave him some injection. Because of its side effects he is so sleepy” the father added, “He told me to admit the child but I don’t think it is necessary. I want your second opinion ”.
 
There are rare days when I let my patience be gagged by my duty, some people really do not get simple, humble and mannerful language.
 
“Sir, you are making a criminal mistake. You are not a health expert, and have no authority to withhold treatment of your dependant, especially a child. It was your mistake to stop the antiepileptic medicine. The child must be seen by a pediatric epilepsy specialist immediately. He is sleepy because of the fit and the head injury. He needs in-hospital care and urgent restarting of epilepsy medicines” I started to notice I was raising my voice. Realising that the child’s well being was more important than correcting his father’s mistake, I toned down and explained to the father that there was no choice, and more fits could risk the kid’s life.
 
“Can you give hundred percent guarantee that your medicine will cure him?” asked the cunning father.
 
“No doctor in the world can give any guarantees, and should not too. It is my duty to tell you what is necessary for the health and life of the patient”. I so much wished I had the authority to have the father arrested, and so helpless a situation it was, that there was no agency in India to report this to.
 
“It is a huge task for us to take father to hospital, you know” said a millionaire recently to me, because him and his four brothers who lived in the palatial mansion built by the same father did not find enough time to accompany him to the doctor.
 
Thousands of children suffer and even die because their adamant parents refuse to treat them in time, or even refuse to continue the advised treatment. The same fate is meted out to many dependent elderly. The romance of poverty and politics makes it easy to shift all the blame on the govt. / private practitioners who see the patient last, when it is too late.
 
The IMA, which just correctly advised doctors not to drink alcohol or go to parties, should also draft a proposal of “Criminal Child and Elderly Health Abuse” and pursue it with the PMO. All children and elderly must be taken to the doctor immediately when sick, and following the doctor’s advice must be made a legal binding upon them. Then alone this health crime will stop.
 
The same quasi-intelligent people who advise doctors to “Keep calm and communicate properly with the drunken, aggressive relatives of terminally brought patients” should also use the same halfwit to advise the community to treat their dependents in time.
 
This is my sincere, heartfelt request to our kind Prime Minister / Health minister: save our children and elderly who need proper medical care, but are denied the same in time. We need this more than any gardens and decorations, more than statues and memorials, more than any other development. May all the treatment of all the kids below the age of 15 be free all over India, may every kid and elderly be insured for health.
 
In the service of my beloved motherland.
 
Jai Hind!
 
Narendra Modi PMO (India)
 
© Dr. Rajas Deshpande
 
PS: Modified story to mask identity.
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A Policeman’s Tears

© Dr. Rajas Deshpande

“She was found unconscious and naked lying on the road. The baby was near her, moving when we found her, now she also looks unconscious” said the police constable. “Actually I had my civil dress in my jeep, I covered both with my clothes and got them here. Most likely an orphan roadside beggar”.

It was early morning, I had gone to the casualty for a call as a medicine resident, and was chatting with the CMO when this police constable had rushed in the mother and the baby, probably less than a year old. He and his colleague completed the formalities and left. The CMO was alone, so I stayed on to assist.

The lady had high grade fever and some bruises all over her body, only one on the thigh deep enough that it bled. She also had a contusion upon the head. Needless to say, unclean and unkempt, visibly quite weak and poorly fed body. There was a traditional tattoo on her forearm that said “Seeta” in distorted devnagari script. The baby was dehydrated and had fever too, with only minor contusions.

“Sending her to female ward, and the baby to paediatric” said the CMO. We completed the police information and Medicolegal form, the nurses had started the IV line for the lady. I accompanied the baby to the pediatric ward, handed her over to the resident doctor friend on duty and went to the female ward to attend the other admissions. Basic medicines for fever and head injury were started for Seeta. There was no CT scan facility in the hospital. Blood tests were sent.

In absence of relatives, it’s the interns, resident doctors and nurses who attend to the necessities of such patients. Administration mocks everyone sympathetic and compassionate to such patients, be it a government, private or corporate set up. My professor advised some more blood tests. Some tests were not available in the govt. hospital, we had to send them outside. As we had just received the stipend, money was not a big problem.

Next evening I went to the pediatric ward to find out what was happening with the baby.
“She has had convulsions”, the resident colleague told me. We have loaded her with anticonvulsants, but she still has fever. Dr. Jain madam (new lecturer in paediatrics) has advised lumbar puncture, but there’s the consent problem”.
I went to talk to the lecturer, she was all insulting. “Don’t teach me what to do. We will send a request to the dean, and if he allows, then the resident will do the lumbar puncture” she said, “By the way, what’s your interest in this baby? Why don’t you mind your own business? I have heard about you.. you are in the student’s union na? Don’t throw your weight around me.” She said.

The dean consented to our request, and a lumbar puncture was done. The baby had probable tuberculous meningoencephalitis (infection of the brain and its coverings). Antituberculous medicines were started.

The comments of the pediatric lecturer made me extremely angry. Most of her resident doctors hated her attitude too. Those remarks soon spread and various sick, exaggerated and vulgar jokes about me caring for that orphan baby made rounds among my colleagues. But one good thing about wanting to do good is the shameless pride and courage that comes ingrained with it.

My colleague Dr. Madhu stood by me. She often reminded me: “There are five percent good people in the world, and 95 percent bad, Einstein has said, but it is the five percent good who take the world forward, they represent human race”. That has always pumped me up against all the mockery that I ever faced for being “too sensitive and compassionate to be sane”.

The best support for the poor and helpless always comes from the poor and helpless. The pompous, actionless “blah blah” of advising others to be more kind and compassionate is usually the trademark of those who themselves rarely help anyone. The mamas and mausis (wardboys and helpers) of the ward came together to attend Seeta during their duty.

The pediatric resident told us on the third day that the baby’s health had gone bad, and she was unlikely to survive. Dr. Madhu stopped smiling. “At least can we shift the baby near her mom?” we discussed. It was of course not possible.

Dr. Oak (real name), one of our ophthalmology genius professors, learnt about this. He came over and told us in his royal tones, to tap him anytime for any help. He also left some money with us.

On the fourth day, the lady started having convulsions too. We ran around, trying to arrange whatever the professor suggested. She was gradually sinking. Tuberculosis neglected and untreated is one of the most cruel diseases. It takes over ten days for the action of Tb medicines to kick in.

On the fifth day, the baby passed away in the morning, and the lady shortly after. That coincidence was less tragic than their trolleys being rolled into the mortuary together.

“What happens now?” we asked the mortuary in charge.
“They will be cremated as orphan, unclaimed bodies after the post mortem” he told.

In a world of billions, ruled by religious, powerful and rich, a young mother and a baby girl would be cremated as orphans! We told the mortuary assistant to please keep us posted, and came out. Of course we could not sleep.

Next day we took special permission and went to attend their cremation.
On the way, we bought some flowers, a tiny dress for the girl and a saree for her mom, probably the first new clothes ever for either of them. Dr. Madhu had already brought a few bangles, a necklace and two bindis with her.

Dr. Madhu was sobbing as we returned. The rowdy looking policeman with us also wiped his eyes. He dropped us back to the medical college in his jeep.

He said in a heavy voice as we parted:
“Doctor, we see all the worst things in the society. We meet criminals day and night. But when such young girls and babies die, I feel like shooting everyone who didn’t come out to help them. People just talk, nobody helps. God bless you. You have what it takes to be a doctor. Don’t ever change.”

© Dr. Rajas Deshpande

P.S.
Years later, I read about a divine human being from Chennai, one Mr. S Sreedhar, who collects unclaimed dead bodies from various hospitals, and performs decent and respectful last rites for them. Planning to meet and touch his feet one day.
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Pune Mirror : Pak Patient Improves, Shows Cognitive signs

PAK PATIENT IMPROVES, SHOWS COGNITIVE SIGNS

Pak patient improves, shows cognitive signs
Sajal with her parents and her doctor, Rajas Deshpande, from Ruby Hall Clinic (PIC:MAHENDRA KOLHE)

DOCS SEE SUCCESS IN CEREBRAL PALSY TREATMENT

Rare case of 7-yr-old had several complications and drug resistance that had to be overcome

A seven-year-old Pakistani girl born with cerebral palsy has been successfully treated by city doctors — despite severe infection and an umpteen number of complications —in nothing short of a medical miracle. Not only was she cured, she also started showing signs of cognitive abilities.

A group of doctors from Ruby Hall Clinic treated the girl, named Sajal, last week. She had been brought to the hospital with glossitis, laryngitis, pharyngitis, pulmonary aspiration, bacterial infection, urinary infection, skin rashes and severe sepsis. Timely medical intervention helped treat all these problems even though the child was resistant to several antibiotics. “This made it even more challenging for us to control her infections and treat her thoroughly,” said Dr Rajas Deshpande, head of neurology, Ruby Hall Clinic, adding, “The child came to us with seven to eight types of issues. It was very difficult for us to treat her. But, with the right antibiotics, we managed to ease the severity of her condition. Now, she is all set to fly back home.” He was helped by Dr Ventaramani and Dr Bamkin Amin in the case.

Sajal’s mother, Shahzia, offered, “Sajal suffered from many complications and was not even able to pass urine or stool for three to four days in a row. We were not able to feed her or admit her to any hospital in Pakistan as many doctors turned us away, looking at her complications, saying there were no chances of improvement. That is why we came running to Pune and got her admitted at once. Sajal’s mouth had a lot of rashes, her lips were torn. No cream or gel given to us in Pakistan would heal her tearing lips. The infection was severe and kept spreading. Within three days of coming here, my child showed signs of improvement. Now, after six days, we are flying back to Pakistan.”

This is not her first visit to India; she has made several visits to treat her daughter’s cerebral palsy. “In the last few years, we took her to many countries, from Germany to Europe and Holland. But, no doctor was willing to take up her case. They said our child could never recover. Sajal had several fits and epileptic attacks in a day and a number of allergies and resistance to drugs. She was in a totally vegetative state. After coming to Pune, she began recognising voices, especially mine and my husband’s, reacting to light and also to her siblings. Now, there is more than 20 per cent improvement in her condition,” Shahzia added. She was told that no drugs for epilepsy or cerebral palsy were available in Pakistan.

“If the epileptic attacks of such patients are controlled well, learning or recognising people or voices can get easier. In Sajal’s case, we controlled her fits and her brain showed improvement. Strong antibiotics and antiepileptic drugs were given to her. And now, Sajal has improved by more than 20 per cent,” Deshpande stressed.

Other prominent doctors hailed the judicious treatment, with Dr Hemant Sant, president of the Neurological Society of Pune, saying, “A single infection is commonly spotted, but many infections coupled with complications is uncommon. Such cases are very challenging and a moment’s delay can prove life threatening.” Dr Sushil Patkar, a neurosurgeon from Poona Hospital and Research Centre, added, “Children born with this condition are very difficult to deal with. So, one has to be careful when they get infections. They need constant attention and care. Controlling seizures and convulsions should be the main aim to better the child’s condition.”

Dr Nirmal Surya, regional vice president of the World Federation of Neurorehabilitation and treasurer of the Indian Academy of Neurology, also brought out some ground realities. “Many a times, due to lack of hygiene or low immunity, children do get infections, but severe complication in one of them is usually not reported. With stronger antibiotics, such infections can be controlled and managed well, if the patient is brought in early. More important are rehabilitation, regular physiotherapy and proper diet, which can help boost the immunity for such special children,” he explained.

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This story was published in Pune Mirror today.

Thank you Dr. Bankim Amin, Dr. VenkatRamani, Pediatric resident doctors (Dr. Upendra, Dr. Tanvi Priya, Dr. Abhijit Kudale, Dr. Supriya Takle, Dr. Radhika Gupta,Dr. Suyog Choudhary, Dr Smita Sangade), Nursing and ward staff, Overseas care staff and so many others who made this possible.

Doctors always make one world, without any borders.
We all treat everyone alike, God / Nature decides about the outcome.
We were blessed with some smiles recently.

The miraculous recovery from infections and cognitive improvement in this girl is also due to the unending effort and sacrifice of her parents, who did not “Dump” the extremely challenged girl child as advised by relatives and society, but gave her the life of a princess, breaking umpteen impossible barriers that stood between her and the medical aid anywhere in the world.

Every parent has boundless love for their child, but these two parents have made her health their career.

May every child be blessed with such parents!

Thank you Ms Nozia Sayyed (Pune Mirror) for your dedicated awareness initiative, and Mr. Mahendra Kolhe (Pune Mirror) for the picture!