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Emergency – 24 hours

Posted by: Philip Alex | Posted on: January 21st, 2013 | 0 Comments

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Providing an adequate response to any medical emergency round the clock is a formidable task. It involves having a well trained team, being able to mobilise it, and respond quickly and appropriately every time.


We are in a mountainous area, prone to accidents, landslides and varied presentations of trauma. Vehicles tumbling down steep ravines, floods washing bridges away and buses overturning are annual affairs. Though assaults and gunshot injuries are rare, there are enough people getting involved in fights to provide patient material to our emergency room. Besides trauma, there has been a rising incidence of heart attacks, and strokes among the local populace. Organophosphorus poisoning is commonplace, with comatose people arriving having consumed it with a suicidal intent.


In many mission hospitals, there used to be a system of a call book. There was a book in the emergency room. This book used to be filled by the nurse on call, and handed over to the security guard, who would proceed to tramp through snow in winter or saunter to the doctors house in good weather. Usually the doctors quarters would be located within the campus, at a variable distance from the emergency room.  Such a call system is totally inadequate in its response time to relevantly provide timely help in the narrow window period that is available to save a life. Sometimes the security guard may even decide to refresh himself with a smoke under a tree prior to delivering the call.


Telephones replaced that system, with landlines interconnecting the campus. Today mobile phones have come into vogue and even replaced the earlier system of black pagers hooked to the belt which made doctors feel very important. However, even this system is awkward and expends precious minutes waiting for the doctor to arrive, which can mean lives lost.


When we first arrived in Manali, resuscitation was more of a last rite than a genuine attempt at saving life.  Precious minutes were lost in waiting for the doctor to arrive prior to the initiation of resuscitation. We initiated a hands on course in resuscitation for all the nurses in cpr, which did make a difference. A further obstacle was being able to have the resuscitation equipment handy. Older wards often have narrow stairs which are formidable obstacles to the emergent transport of life saving equipment. We filled a plastic toolbox, the kind that is available in any department store with emergency drugs and equipment and provided them at every station. These can be grabbed on the go and made the initial response of the nursing staff much more effective.


At code sites, having enough hands available is an essential component to resuscitation. Tertiary institutions have a “code blue” protocol, where a code pager buzzes madly summoning a multitalented team to the bedside of the patient in minutes. Other institutions have had a system of overhead announcements or lights flashing indicating the emergency.  We provided a siren in different wards, with different tones indicating the location. The siren can be heard all over the campus, and proved very effective in summoning those within earshot to the location of the emergency.


Over time, with each of these developments, we have been able to revive patients who present to the emergency room pulseless or not breathing adequately for whatever reason.  In fact, when when a pulseless patient was revived, one of the nurses eyes suddenly lit us as she realized that “This actually works!”


Mobilising the operating theatre within minutes is also a formidable task. Having the scrub team and the anesthesia person within a few minutes of beckoning means stationing them within the campus. Because Manali is a small place, we have been able to move massive trauma to the operating table within ten minutes, which is an adequate response by any standard. This too has resulted in precious minutes and lives saved.


Though BLS and ACLS and ATLS today are buzzwords with a large amount of documented data on implementation and protocolisation, this does mean different things to different people at varied locations. Each area will have to modify and tweak the practical outworking of the resuscitative attempts. The bottom line being, it has to be efficient, immediate and effective, all the time, every time.



Raffle..get a used maruti van for Rs 500

Posted by: Philip Alex | Posted on: January 8th, 2013 | 0 Comments

We are putting up the hospital maruti van for a raffle sale, tickets being priced at Rs 500. The van is in reasonable condition. The draw will be held on 26th February. All proceeds will go towards the poor patients fund. This fund allows us to take care of patients who cannot pay for their treatment. We fund about thiry lac worth of treatment for poor patients every year. Despite our costs being low, patients still can find it difficult to pay. Research has shown that 80% of treatment in India comes from out of pocket expenditure from the patient. (BMJ August 1999).  Recent reports from the Lancet also corroborate our experience (Lancet 2011; 377: 668–79). We tread the fine line between providing our service at reasonable cost, and being self sufficient, and at the same time being careful never to deny any patient treatment on account of cost. This is where the poor patient fund comes in. Even employees pay a contribution from their salary towards this fund monthly.

“Affordable, relevant and appropriate care, in the spirit of Christ”.


Repair and reconstruction

Posted by: Philip Alex | Posted on: January 5th, 2013 | 0 Comments

Three boys from Punjab were brought with the history of being assaulted with a sword. One of them was in shock, with both arteries, all the nerves and all the tendons in his forearm divided. His hand was lifeless and pale, devoid of blood supply. He was taken for surgery where the arteries were joined then the nerves joined, then the tendons joined back. We thank God that the hand pinked up and became viable again. The others were also fixed up, who had similar but injuries of lesser extent. They were all discharged safely home in two days. These procedures took all night to do.

Its not twins – dad’s derelict humour

Posted by: Philip Alex | Posted on: January 3rd, 2013 | 0 Comments

A snippet from outside the operation theatre recently.

One of our staff was waiting anxiously outside the operation theatre while his wife was undergoing an elective caesarean. More of our staff “supporters and well wishers” who were with him during this wait used the time to convince him that his wife was actually having twins. The gag caught on, and eventually  they managed to sow this seed of doubt successfully, reinforcing it by drawing allusion to his wife’s “huge” tummy and the necessity to perform an elective caesaran. The poor father to be was most relieved when only one bawling baby emerged!

Well wishers or wishers in the well?




Large ovarian cyst

Posted by: Philip Alex | Posted on: January 1st, 2013 | 0 Comments

A lady H had come to us with awareness of a mass in the abdomen and pain. Examination revealed a large mass arising from the pelvis. Ultrasound had showed a cystic mass filling the pelvis adjacent to the uterus. On surgery a large ovariancyst was found adherent and torted. It is amazing how much discomfort and pain the local people can tolerate prior to seeking help!

Photograph shows Dr. Sarah Funai our gynaecologist removing this cyst.

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Posted by: Philip Alex | Posted on: December 31st, 2012 | 2 Comments

Baby K is the son of a Nepali labourer family. The child started crying suddenly at four pm and then started vomiting followed by the passage of currant jelly stools. The young yet astute mother noticed a mass in the abdomen. The child was brought to us  in the night. A working diagnosis of intussusception was made, confirmed by the “Sign de dance” on the plain x ray ( empty right iliac fossa).

Hydroreduction  was attempted but was not successful, hence the infant taken up for surgery, where ileocecal intussusception was found which had approached the sigmoid colon in its extent. Thankfully, on reduction the bowel was viable. A type 1 malrotation had predisposed to this. A cecopexy was performed. ( The bowel was returned to the proper place it was supposed to be in, which was why this happened in the first place).

The baby is now doing well.

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Posted by: Philip Alex | Posted on: December 27th, 2012 | 0 Comments

Mr. R had come to us from Chamba, over two days journey away. He had sustained a fall and a straddle injury which destroyed one testes and ruptured his urethra three months ago for which he had a suprapubic cystostomy to drain his urine. He had already been to PGI Chandigarh and IGMC Simla, but for one reason or the other, was not able to get anyone to fix his problem, which would require a surgical refashioning of his ruptured urethra.

He arrived here last week and was most adamant that he stay till we were able to operate on him. He underwent a successful urethroplasty, which cuts away the damaged portion of the urethra and refashions it to create a passage for urine. He is now doing well and should be able to be discharged soon.

We thank God that we were able to do this for him.

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Ct Scanner

Posted by: Philip Alex | Posted on: December 23rd, 2012 | 0 Comments

For a number of years, we have been working towards obtaining a ct scanner in manali. The nearest CT scanner is in Kullu, one hour away by road. This journey can be a life threatening one for a patient who is seriously injured. As a result, we have often had to perform exploratory burr holes in patients who had sustained severe head injuries to establish the site of the collection of blood. Further, we have not been able to send our critically injured patients for a ct scan. On an elective basis too, we have always had to refer outpatients for a ct scan to Kullu.

We need a sum of fifty lacs (Ninety four thousand three hundred US $) to allow us to purchase a refurbished ct scan with a digital cr system. Obtaining these together is advantageous since the machines use similar imaging cameras.

We have collected a sum of thirty five lacs so far, with the help of donors and by saving money.

We hope to install this machine by April of 2013.

We invite any further help to allow us to make this dream a reality.

Please contact Dr. Philip Alexander on if you would like to help with this project.

Donations can be made to us directly or through charities in the United States or the United Kingdom which are registered in the respective countries.

Do help us to make this a reality for the people of this region. 

Vascular repair

Posted by: Philip Alex | Posted on: December 23rd, 2012 | 0 Comments

Two tourists from Punjab had come with the history of assault with a sharp edged weapon. One had all his nerves, arteries and tendons divided in his forearm, and his hand was lifeless. The other had all the tendons that cause flexion divided. All night surgery managed to restore function and blood supply to the hands of both. They are now safely discharged back to their home town.

Christmas baby

Posted by: Philip Alex | Posted on: December 21st, 2012 | 1 Comments

Baby of Amy – a Christmas message of hope


Baby of Amy (name changed) was born to a mother who had previously had a stillborn child here in Manali. The husband is a tailor here and is basically from another state. The child was born by a Caesarean section and developed severe respiratory distress after birth. An x ray revealed that both lungs had fluid, probably from the baby aspirating fluid inside the mothers womb. The gestational age of the baby was at 36 weeks,  the mother not being absolutely sure of her dates and some discrepancy with the ultrasound estimation of the dates. The family was not able to transport the baby to a higher centre. The child was first given oxygen through a special apparatus engineered here in Manali, but then developed a pneumothorax ( a small hole in the lungs) which needed a chest tube. The child went on to need intubation and ventilation. For the first time in the history of Manali a child this small was ventilated with our ventilators, with the able assistance and supervision of pediatrician Dr. Feico, who just happened to be here at the time. If he was not here, we may not have had the guts to ventilate this small baby. Night and day vigils at the baby’s bedside with our doctors and staff in constant attendance eventually bore fruit and the baby stabilized, was gradually taken off the ventilator and was handed over to the beaming parents. The child was discharged last week, a true Christmas baby and a testament to God’s faithfulness in answering our prayers.


This  family would truly rejoice as this baby lights up their world just as the world rejoices remembering Christ’s arrival to light up its darkness.