Manali Missives 54/2014-11-28
Meanwhile, Back at the Hospital…
There is a lot of sweeping going on in the grounds of Lady Willingdon Hospital. The Robinia trees are shedding their golden leaves forming, a rustling carpet on the ground. In the distance I can see the snow capped peaks heralding the arrival of winter. On our balcony we have some flowerpots; in one of them are some tulip bulbs that came from the Dandenongs. The tulips are growing; I wonder whether they will bloom before the snow comes. Winter will follow autumn and then spring will come. So the year goes by, seasons follow seasons, death follows life. So life in the hospital mirrors nature here in the Himalayas.
Since we arrived back from Sydney in August the Obstetrician/Gynaecologist, Dr Saroj, has left. This has meant that my life has become much busier as I now look after pregnant women as well as babies and children. This area of medicine is rewarding and happy; occasionally, though, it can bring a lot of sadness and grief.
Maya, a Nepali lady came to us from Lahaul, a valley north of Manali. It was her first pregnancy and she was expecting twins. Maya's blood pressure had been high but she had not been given any antihypertensive medication and she had developed eclampsia. She arrived at Manali after having had 3 seizures and with 2 dead babies in her womb. Maya continued to have other complications - she was blind for a day or two. Her blood pressure continued to be high even though she was getting 4-5 different anti hypertensives, she ended up having surgery and the wound broke down. Maya has now been discharged and has gone home to Lahaul with her husband. Her blood pressure is now normal even without any medication and she is well.
Monika was also pregnant with twins and came to our hospital in June with ruptured membranes at 28 weeks of pregnancy. We do not have facilities to look after such premature babies and I encouraged her and her husband to go to Chandigarh where there are big hospitals. In September Monika presented with her twins at our emergency room. The twins were very small weighing 1.5 and 1.8 kgs each. The parents had left the hospital against medical advice and now the smaller one was very sick with sepsis. He died in our ICU. His brother also became unwell and was treated in our ICU and last week the parents took this baby to another place closer to the maternal grandmother. There are no news from this family and I hope that this little baby has pulled through.
One little baby was delivered by Caesarean section as labour was not progressing well and she was getting distressed. The little girl was kept in the nursery and after some time became cyanosed even when receiving oxygen. She was healthy and well when she was delivered but the older she became and the more she cried the bluer she became. I suspected a congenital cardiac abnormality, which was confirmed by a visiting paediatrician. The baby was given some prostaglandins and referred to Chandigarh Hospital. The mother came back for check up and then told me the rest of the story, that the baby had died. The parents had been told that even if the baby had the needed surgery there was still only a 10 % chance of it being successful and so nothing was done.
Some days ago another pregnant lady arrived after having had no fetal movements for a day, she delivered a dead baby with 2 true knots in the cord.
2 weeks ago a little newborn girl was found in a rubbish bin, abandoned by her young unmarried mother. She was brought to the hospital suffering from hypothermia and anaemia. The police and child health department were involved and she is now in an orphanage in Shimla awaiting adoption.
Last week a 4 year old Nepali boy was admitted with severe stridor, he had been struggling to breathe for 4 days before his parents brought him here and on arrival was almost comatose. The history that the parents gave was of 10 months breathing difficulties. A God incidence - a visiting ear, nose and throat specialist was able to examine the boy and diagnose the underlying problem. The child has had surgery and now has a tracheostomy (a hole in his windpipe), through which he can breathe easily.
A week ago I was called to a delivery in the night. The baby showed no signs of life, but after resuscitation for 15 minutes we had a heart beat. On the second day of life the little boy started having seizures -? caused by hypoxia. After receiving drugs to settle his seizures he became very still, did not cry at all. He was referred to Chandigarh for further investigations all of which are normal so far, he now has good movements in his limbs and is crying.
In the midst of all this sadness and grief and the longing to be able to do more to help, there is joy of seeing new life and incredible joy at the birth of sons and daughters of India. There is joy in calming fearful mothers, incredible joy at seeing the little babies and children developing and growing. And most of the women and children I see are healthy and do very well! Most couples have no more than 2 children. The contraceptive methods that are available here are not as many as in Australia. Women can have tubal ligation done, they can have an IUCD inserted (copper T) or go on the OCP. We have a number of women present with bleeding due to an incomplete abortion after an unwanted pregnancy as the "abortion pill" is available at any pharmacy as an over the counter medication.
I want to thank those in Australia who have provided clothes, beanies and little bears. The little "dresses" are so useful for the newborns with drip as they can be unbuttoned both over the shoulder and the front. The beanies are disappearing quickly now with the cold weather having arrived and the little bears are very much appreciated by the poor children who have very few toys.
With winter rapidly approaching we now see more colds, coughs and fevers. Some children are admitted with pneumonia and there is quite a lot of asthma around.
Last week there was a rabid dog in a village close to Manali, it managed to bite more than 15 people before it disappeared; I’m not sure whether it died or was killed. We stock the rabies vaccine; all those who are bitten need 7 injections each over a period of 2 months.
A 17 year old male came with a severely infected leg after stepping on a nail. The trauma happened some time ago and when he presented the infection had spread to the bone. The only way to save his life was by amputating his leg above the knee.
We always have a number of residents and registrars working here and there is such joy in seeing young Indian men and women training to become doctors, at seeing them grow in some of the difficult situations. One of the young doctors has been posted in Madgram, Lahaul, for some weeks before the Rohtang pass closes. He is doing a wonderful job in this remote area. We also have another young doctor posted in Jibhi, one of our clinic on the other side of Kullu.
Of course there are times when I don't agree with what colleagues have been taught; every country has its own guidelines. To give deworming medication and antibiotics to all children with abdominal pain and diarrhoea without doing a stool test is not acceptable medical practice, I think.
There are a number of overseas medical students who come to Manali every year for their electives. Most of them have been Australians, but we have also had some Americans and also recently a student from Malaysia. I enjoy teaching them and it also encourages me to keep studying.
The staff at The Lady Willingdon Hospital and the Daystar school have been competing against each other in cricket. There have been 3 matches, all of them won by the hospital. There have been badminton matches played as well and a lot of cheering has been going on. Now the staff are preparing for the annual day where there will be skits, dancing and singing.
Last Sunday the Sunday school celebrated their Christmas party and all the parents were invited to see their children perform. The youngest ones enacted the Christmas story, and the whole audience really loved it. I will never forget the 4 year old girl, who was playing Mary, saying "But I am not married" in response to the angel’s promise of a son. It was so absurd, and everybody erupted in laughter.
The women of Manali, or maybe it is the whole of Himachal, are very industrious and do a lot of craft, especially knitting and crocheting. The women are knitting cardigans and socks when they get some free time. I have never been to a place before where the women keep on knitting while they walk! The socks and gloves are beautiful with colourful patters.
David is in New Delhi studying Hindi with the HindiGuru school. According to Facebook posts he is also visiting a number of shopping malls. That is where both coffee and internet are available. I have heard from a reliable source that he is now speaking more Hindi and that his language skills are improving. Hopefully this will mean that he will soon be back in Manali.
Only one month to Christmas now and soon Manali will be covered in a blanket of snow. There is nothing quite like a white Christmas!
Lena Reichardt
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