Friday, February 5, 2010

a typical clinic

dr sitaram, this one is for you.
on wednesday, 3rd february, i was one of eight doctors in the outpatient clinic of JSS at ganiyari. cases are screened and sent to concerned specialists, so i did not get most of the ob/gyn or paediatric, or surgical cases. the following patients are who i saw as a "general" physician:
a. a 35 year old woman with hive-like lesions on her face and legs for three months, with no itching but with jhunjhuni or tingling. a slit skin smear showed 3+ AFB: a case of lepromatous leprosy.
b. the second patient was a young 28 year old woman with swelling of the body for three days, a blood pressure of 210/130, heart rate of 120, a pansystolic murmur at the apex; urine albumin 4+, and a serum creatinine of 6.8. she is on a nitroglycerine drip to bring down her blood pressure, and we need to rule out a connective tissue disorder. USG showed normal sized kidneys.
c. a diabetic hypertensive alcoholic who had discontinued all medication on his own and came with bilateral cataracts. he came because his eyesight was too poor now for him to continue tailoring.
d. a 65 year old woman with blood and mucus per rectum for three months: she had carcinoma of the lower part of the rectum, which would need resection and a colostomy. she refused even a biopsy to confirm the diagnosis, and went home.
e. a 45 year old woman with ankylosing spondylitis.
f. a 40 year old man with a three month history of upper abdominal discomfort and severe weight loss. suspected carcinoma of the stomach, referred for endoscopy and biopsy
g. a 23 year old woman with an intra-uterine death and spontaneous abortion at 7 months, with retained POC, bleeding, and post-partum depression. Hb 5.3 gm%, and refused a curettage to stop the bleeding.
h.a baiga tribal woman who i had brought back from the field clinic inside the sanctuary the previous day with a history of a fall from the "machaan" (raised wooden structure built in teh field to safeguard the crops against wild animals at night). she had a fractured acetabulum with internal dislocation of the head of the femur. she is on traction now at ganiyari
g. five patients newly diagnosed as hypertensive
h. one 25 year old boy with a liver abscess.
i. about 10 non-serious patients.

all this in one clinic in a rural area in Chhattisgarh, seen by one physician. my other colleagues saw an equal number of seriously ill patients through the day, including several emergencies. there were about 240 consultations that day. this goes on three days a week, through the year. we get patients from all over bilaspur district, and from other districts too; also from neighbouring madhya pradesh.
these are poor patients, over half of them have BMIs less than 18.5. most are backward castes, or scheduled tribes and scheduled caste patients.
the clinic is a virtual gold-mine for those who want to learn medicine, and a sure indicator of the sorry state of our public health system - we have a medical college, and the district hospital within 25 km from our clinic. and two block PHCs within a radius of 20 km from ganiyari.
it speaks volumes too, about the burden of disease in the community.
would anyone like to come and help out for any length of time? we would really appreciate it. two weeks at least would be preferable, but even one week would help if you cant spare more time. you could plan it anytime during this year, so please do give it a thought.
(the picture shows patients waiting outside the laboratory for their reports. they will then be seen by the doctor for further management, no matter how late in the day)
for more information, please contact, or myself at


  1. Ramani, WOW! I understand even better why you followed your heart and medical oath. Your team is a blessing and you are doing an awe-inspiring work. I have sent your blog on to a young physician friend of ours who grew up in Nepal & India. I hope that he is inspired to come and share your "goldmine of experience" at least for a short while; on his way to Australia for a change of scenery. As always, receive a (((HUG))) with affection from Cynthia

  2. Here in Mumbai, you can be a few feet away from a hospital and the care will be out of reach :(

    Incredible India