Thursday, October 29, 2009

a sick clinic

tuesday this week was another busy clinic at bamhni. i was supposed to be training the birth attendants this week, but did not get much time to sit with them. several patients sick with malaria were seen. then the vehicle was requested to bring a patient from surhi 6 km away: a man breathless with pneumonia, not getting enough oxygen into his system. i started him on antibiotics and oxygen and the saturation slowly crept up but not good enough. by evening he was worse, the left side of his chest completely dull, the breath bubbling in his chest. he probably had empyema (pus in his pleural cavity - the space around the lungs) and he was in heart failure.

meanwhile, more malaria patients later came a young woman who seemed at first to be hysterical, shying away from anyone touching her. but i found she had an acute abdomen - an emergency. the junior doctor who had accompanied me to bamhni was anxious about getting back and handling these emergencies himself, so i walked to the bend in the cc (cement concrete) road in the village - the only place where one can get a mobile network signal if the wind is right, and called raman, the surgeon at ganiyari to inform him about the patients i was sending back. he assured me that he would wait, however long it took.

back to the clinic, started antibiotics for the woman with the surgical emergency, and sent her and the patient with empyema to our base clinic, which is an hour and a half away by road from bamhni. i learnt yesterday that he was taken straight to the OT and had a litre and a half of pus removed from his pleural cavity. when i saw him last evening after returning from bamhni, he was much better. the woman had an appendicular abscess and had been operated on, and was smiling - no longer in pain, no longer seemingly hysterical. my colleague had been in the hospital till after 10 pm the previous night, attending to them.

meanwhile i kept behind at bamhni a 12 year old boy weighing 27 kg who i suspected had tuberculosis, and perhaps something more serious. also at the clinic that night was a pregnant woman with malaria and a child with malaria who was severely anaemic, both under observation to see that they did not worsen.

4 am yesterday morning i was woken up: a 10 year old girl from a hostel in jakadbandha was complaining of chest pain for a few hours. turned out it was another pneumonia. we started her on antibiotics, kept her at the centre, and sent the warden back to inform her parents who live in a remote village. i huddled back into my sleeping bag after seeing her but could not get back to sleep due to the cold. i could hear her brassy cough in the hall next door where she was sleeping.

both the children - the one with TB and the child with pneumonia were sent to ganiyari the next morning and are admitted there now. the patients with malaria were better and went home.

the dai training went on too, meanwhile.

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