Who are we to decide our fate?

Last three weeks have been a constant reminder of how lucky I have been. The pediatric ward has its own aroma; it took me a while to grasp. I see children, babies, and neonates with their parents who are hoping for a better life for their children. Hope is what they show to us, they are kind, they give us their time, they share matters with us.

Life is not easy. Everyone either has a congenital deformity which they will have to battle for ages, others show transient illness, acquired.

“It’s not the first time I have been here” exclaims the mother. She already knows the answers to our questions in a systemic fashion. She is very co-operative. She is repeatedly asked the same questions over and over again and yet she is not bored to inform us. She has a son who has Thalassemia, 10 years old. He comes for repeated blood transfusion every month. Life has been distressing for both the parents and the child. He misses school for the blood transfusion and also he fails to thrive like most children of his age group. He suffers from repeated infection.

“The doctors lost hope, but I am optimistic about her” says a mother, who had given birth to an incredibly low birth weight baby. The baby is tinny and her heart produces a distinctive mur mur (abnormal heart sound). There are many cases worth sharing, mostly acquired. Fever is a major presenting complaint. Patients stay in the hospital for 2-3 weeks for a spiking fever, either due to Enteric Fever or Dengue. Hospital stay is bothersome for parents, yet they decline to show any glitch when asked.

I always try to put myself in others shoes, especially when it comes to patients. What if I was congenitally abnormal? What If I had a spiking fever without any diagnosis? When I asked this question to my sub-conscious brain, I did not think about how much pain I would go through, I just imagined my parents and family who would have done so much for me.

Who are we to decide our fate? We are nobody, everything that happens lies in a single gene, chromosome. What do we do? We accept the fate and struggle. Three weeks of Pediatric ward taught me that life is worth fighting for no matter what sickness you have.

Babies Fate in One Rubella Shot!

She is just 7 months old and she lies in the hospital bed with her mother, unaware of her future. Her mother did not know about her baby’s condition prior to the babies regular check up, that her newly born child suffered from Congenital Rubella Syndrome.

Rubella falls in the TORCH group, T and O stand for Toxoplasma Gondii, R for Rubella, C for Cytomegalovirus and H for Hepatitis, Herpes, and HIV. This group of organisms can readily be transferred from the mother to the fetus at any time during pregnancy. Hence forth the baby is compromised in many ways. If the baby was born, there are more chances of congenital deformities.

In this case, the baby had cataract, she underwent a cataract surgery three days back and was at the hospital for recovery. If eyes were her only problem, she suffers from multiple VSD (Ventricular Septal Defect ) more commonly said multiple holes in the heart, which hampers her ability to grow as a baby, she fails to thrive as compared to other babies of the same age, she is susceptible to upper respiratory tract infection and she fails to respond to any noise, she shows signs of deafness  as well.

Rubella is preventable, that was all in my mind. How did this happen, why did this baby deserve blindness and deafness? I asked the mother if she took her Rubella shot, she politely said that she did not even know about a shot like that ,as she hails from a remote part of Bangladesh.

There are many people like her who don’t realize  Rubella symptoms when they were pregnant. It’s a disease that spreads through the air-borne route, its cause a slight low-grade fever (<101 degree Celsius), rash which spreads from the face and lymph node enlargement. They treat this as a minor cough and cold.

No matter how much I praise preventive medicine, it seems that patients like her will keep on coming and more babies will eventually lead a very short life span. It’s just one shot girls, if you are a women of the reproductive age group ranging from 20-30, do take a Rubella shot, it’s that simple!

Those cute little hands, responds to my finger, her reflexes are good. All that I could say to the mother was that “It’s in God’s Hands now”. Also, I requested her to take a Rubella shot before she decided to conceive again. They are waiting for her heart surgery, later this month in Delhi. I wished her good wishes and bid good-bye. 

The “D” Of Diarrhea

It’s not a mysterious disease. It has happened to you, me and most others who are trying to make their living in the developing world. It’s the leading cause of death among neonates and children in Bangladesh and even in Nepal. Diarrhea, the name starts with a D, may signify three words, Dehydration, Deterioration and Death.

Diarrhea can be defined as the loss of stool volume greater than 200 gram in a single day or having frequent stools for more than three times in a day. Nobody weighs their shit but they have kept that indicator so that we (the med people) can actually understand the term with accuracy. The later indicator is what people actually come up with.

There are several factors why diarrhea is the leading cause of death in the pediatric group. The first most important reason would be the literacy factor among the general population. Educated mothers / parents open their ORS sachets with or without dehydration and if the condition is more serve, they reach for help immediately.  The uneducated mother/parents, well by the time he/she reaches the hospital, the kid already suffers from severe dehydration.

There are many institutions in Nepal which aim to prevent diarrhea, constantly teach how ORS (Oral Rehydration Solution) is made. In order to make the solution you must make it in a 1 Liter container. Other factors like washing hands regularly to avoid any fecal oral transmission and keeping the optimum hygiene in the house are good factors that prevent the menace.

Educating the mother in antenatal examinations or postnatal visits about the signs of dehydration can help to avoid this situation to a certain extent, why not? Signs are something that med people only understand. What people come up with are called symptoms. So educating them about the signs like, check your Childs appearance, has he stopped crying? Check his eyes, is it sunken? Check his tongue, is it dry or moist? Try pinching your child’s skin in the abdomen near the umbilicus, is the skin coming back rapidly or taking longer to settle at its previous state? The latter indicates dehydration. Is there something wrong with the child’s thirst? Is he thirsty? Is the child able to drink the water?

I am very much an optimist when it comes to preventive medicine. But how much  can there be done, if parents don’t have much time to monitor their child regularly due to increased work load or due to mothers malnutrition due to poverty that she cant secrete enough breast milk to exclusively feed her young one.

Deal with diarrhea first, that’s the killer in our country suggested a friend when we talked about what projects are appropriate for Nepal via Health Nepal Foundation. What can be done?  Let’s start with, what the government can do; a) awareness campaigns every year especially in the pre-monsoon and post –monsoon season, teach the mothers about the signs of dehydration, make them the doctor for their child’s diarrhea( well to a certain extent). b) Send enough ORS solutions to the appropriate districts before the crisis occurs. c) Include the diarrhea awareness program with the antenatal check up.

I can only think of some factors right now, maybe after my graduation, when I am actually practicing in the field, I might bring some more innovative ideas for the prevention of diarrhea in our country. I am looking forward to that day!