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Play ball

Posted by: Philip Alex | Posted on: June 3rd, 2014 | 0 Comments

 

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PASSING THE BALL

A team game is a pleasure to watch, as different players pass a ball along, to achieve a goal. Each player puts in his or her part, and the ball passes along, till it goes through a hoop or a goal with a resounding roar from the onlookers marking its passage.

Patient care is not very different, as the patient passes along in his or her passage through a health care facility, being passed along from department to department, each person contributing in varied ways to the healing that flows from the hospital. The patient recovers and leaves, but there is no resounding roar, only a calm satisfaction in hearts as we know we have done our bit in Gods great pattern of healing.

I stand in the operating theatre as the cases progress, and wonder and thank God for the team in Manali. For every one who puts their hand to the task of taking care of patients in whatever capacity, direct or indirect.

I am so grateful for every one, and for the team here, by which we work together like a smooth machine, taking care of people who come here, hurt, hurting and in pain.

We truly are a team. I am very thankful and proud of you. Let us continue to play ball.

http://surgicalspace.blogspot.in/2014/06/play-ball.html

Young boy with tb abdomen

Posted by: Philip Alex | Posted on: May 8th, 2014 | 0 Comments

A 11 year old boy was brought to us after having being run from pillar to post for the past year. He has been consistently unwell, with abdominal pain. We thought he had tb abdomen, and confirmed this with a diagnostic laparoscopy eight days ago, when we obtained a peritoneal biopsy. He was started on anti tb medicines while we waited for the report for confirmation.

He returned to us  yesterday with abdominal pain and distension and was admitted with intestinal obstruction. While in hospital he perforated. He was taken up for a laparotomy yesterday when four entero enteral fistulae were found (communications between the bowel which had happened a while ago). One of these had perforated. He underwent a resection and ileostomies. (The diseased part of the bowel was removed).

He is now on the ventilator, on inotropes (to support his blood pressure), and is fighting for his life. Please do pray. He still has a long way to go.

We are very grateful to God for Dr. Kaaren, visiting anesthetist who just happened to be here and helped get him off the operating table alive. Also for the many donors who have given us the equipment to handle emergencies of this critical nature… blood gas machine, ventilator, syringe pumps, etc.

We ask now for your prayers for him.

Shp (secondary hospital program)

Posted by: Philip Alex | Posted on: May 7th, 2014 | 0 Comments

The students from CMC Vellore are here on their secondary hospital program, accompanied by faculty Dr. Jacob John, consultant in community medicine. The batch is an all male team this time, and they have been accompanying doctors on rounds, in the ot, and to the peripheries to conduct clinics and check ups.

We thank CMC Vellore for sending them every year to Manali.

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Subdural hematoma evacuation

Posted by: Philip Alex | Posted on: December 18th, 2013 | 0 Comments

Mrs J is a sixty five year old lady who was brought to us with the history of altered sensorium and behavior for a day prior. She had already obtained a ct scan from outside which showed a large subdural hematoma (blood clot) in her brain compressing her brain to the other side. She needed a surgery. She was referred to IGMC Simla, but the family did not have the economic means to take her there. Manali was their last hope.

Having explained all the risks of performing this surgery in a relatively unsupported environment, we did a craniotomy and evacuation of the hematoma here. The lady made a dramatic recovery and is being discharged well. We thank God for the amazing recovery she made and for saving her life.

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Farewell again

Posted by: Philip Alex | Posted on: November 13th, 2013 | 0 Comments

We bid a fond farewell to Drs Anu Yarky, Dr. Shefali and to our Staff nurse Nisha Kumari with samosa and gulab jamuns  in front of the mess. All are going for further studies, and we wish them well. We had a bit of an emotional farewell. Emotions are always at the fringes of these functions, but this time, it overflowed!

 

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Lahaul Spiti camp

Posted by: Philip Alex | Posted on: September 29th, 2013 | 0 Comments

 

The access to this district is over the formidable Rohtang pass, and traversing the road into this region comes with its share of excitement. The land is a study in contrast from east to west. Cut off and remote, the people have learnt to survive in this harsh environment with an innate fortitude and strength. Every thing here is scarce. Water, electricity, health care, newspapers. Everything has to be brought in over the pass, and the outcome of every emergent situation is decided by whether the people can carry the patient out over the pass, or whether the patient is hardy enough to survive. Understandably, the average populace is hardy, and healthy, because only the healthy survive. Yet, they brave the inclement weather and circumstances with a cheerfulness and a smile that is humbling to the visitor. Medical care is provided by a chain of government health centres, which are usually staffed by a few doctors. Specialists and specialised care is scarce. Surgical services can usually be accessed only in Kullu, Manali or Simla. Recent reports of surgical care being a public health problem where people are unable to access surgery has been highlighted by reports from Sierra leone and Africa. http://www.who.int/bulletin/volumes/89/6/11-088229/en/. The situation in Lahaul Spiti is not very different and indeed, one can understand why surgery will elbow a place for itself as a public health issue. To meet this need, we will need to plan and execute camps in the future. The provision of safe surgery in remote locations is an incredible challenge.

 

Scrub typhus

Posted by: Philip Alex | Posted on: September 2nd, 2013 | 0 Comments

From the last year, we have been seeing scrub typhus (presumably) in Manali. Patients present to us with fever, chills, respiratory difficulty, with or without jaundice. They may also have central nervous system symptoms, with confusion and headache. The characteristic eschar alerts us to the possibility of typhus. They invariably have a low platelet count and may also have leucopenia and anemia. The respiratory distress is usually progressive when diagnosed late or when they present to us late. They often need ventilation and are very sick. They may also go into renal failure. The presence of jaundice and altered liver enzymes often compounds the seriousness of the disease. Early initiation of doxycycline therapy, blood transfusion if appropriate and steroids with early ventilation saves lives. A four percent hospital mortality has been described.

Transmitted by the trombiculid mite, chigger bites transmit the Orientia tsutsugamushi. The disease can occur a week after being bitten and the eschar by this time is a characteristic central dark necrosed area often well circumscribed and circular in appearance.

Diagnosis is by the indirect fluorescent antibody test or PCR, or biopsy of the eschar. We have been informed that the Weil Felix test is available in the Kullu zonal hospital.

The clinical and laboratory picture is pretty characteristic to allow the early initiation of therapy.

Scrub typhus is becoming a problem both to diagnose and treat in time in Himachal and other areas of North India as these links to newspapers suggest.

http://articles.timesofindia.indiatimes.com/2013-09-03/india/41725012_1_test-facility-scrub-typhus-kangra

http://www.ibtimes.co.in/articles/503396/20130903/scrub-typhus-trombiculid-mites-leptotrombidium-deliense.htm

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Sugam service pack

Posted by: Philip Alex | Posted on: August 31st, 2013 | 0 Comments

Sugam service pack has been upgraded to version five, with more features, reports and integration in with our otrs ticketing system. This has made it more convenient for all, and has worked on fixing some bugs in the system. We thank our team of developers for this upgrade.

Digital CR X ray system

Posted by: Philip Alex | Posted on: August 28th, 2013 | 0 Comments

Lady Willingdon hospital now has a digital computed radiography (CR) system, which allows our x rays to be far clearer and sharper than they were with conventional film.

Here is a KUB and IVP (Intra venous pyelogram) to illustrate how clear the system is.

For us, it is now like daylight, while our earlier experience with x rays in comparison was like peering through a dark and gloomy tunnel.

Besides, these images can be viewed on consoles in the emergency department and in the outpatient clinic  and on computers in other areas in the hospital.

The images can also be manipulated to zoom and rotate, and focus on areas that we would like to magnify.

Amazing technology. We are so grateful to those who have made this possible.

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Stones anyone?

Posted by: Philip Alex | Posted on: August 28th, 2013 | 2 Comments

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A fifty year old patient had come to us with pain in the right flank. Investigations revealed a large staghorn calculus on the right side. A retrograde pyelogram showed some obstruction at the pelvi ureteric junction. He underwent a dismembered pyeloplasty here on the 28th of August. He is doing well.

The size and number of the stones is pretty impressive.

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