After condoms for stomach pain, another Jharkhand doctor prescribes pregnancy test for male patients

Source: timesnownews.com

Ranchi: It seems the government doctors in Jharkhand are leaving no stone unturned to bemuse their patients. In a bizarre development, a doctor in Chatra district of Jharkhand prescribed pregnancy-tests for two men when they complained of stomach-ache.

However, the doctor in question has denied having prescribed such a test and claimed he was being framed in the case. Earlier, a doctor had advised a woman patient to use condoms when she complained of regular stomach-ache.

According to a report, the Civil Surgeon has ordered an inquiry into the matter. The matter came to light after two patients-26-year-old Kameshwar Ganjhu and 22-year-old Gopal Ganjhu-were told by a pathology lab that they have been prescribed pregnancy tests by the doctor identified as Mukesh Kumar. 

However, after the disclosure by the lab, the two patients did not get any tests done and returned to their village. At their village, they informed people about what happened to them at the hospital. 

The report suggests that the doctor Mukesh Kumar prescribed ANC test to the two men. The test is basically prescribed for women to check pregnancy. 

As the matter became public and was highlighted in the media, the district civil surgeon ordered a probe to get into the details of the matter. 

“I have ordered a probe after the matter was brought to my notice on Saturday. And I have ordered the doctor in-charge to probe the incident. This whole incident could be a conspiracy by quacks against the doctors at this hospital,” the report quoted Civil Surgeon Arun Kumar Paswan as saying. 

Meanwhile, the concerned doctor has alleged foul play claiming the hospital register maintains the names of the wives of the two men. The doctor said it is an attempt to malign his image.

“The two women instead of entering their names in the prescription paper wrote the names of their husbands. The tests were carefully prescribed to women and this is registered in the hospital register,” the doctor said.  The doctor also claimed all the confusion was caused due to the wrong entry of the names in the prescription paper.

In August this year, a government doctor in Jharkhand allegedly prescribed a woman condom when she told him about her stomach pain.

The incident was reported from Ghatshila sub-division hospital in East Singhbhum district of the state. The accused doctor has been identified as Asraf Badar, who is working on a contractual basis with the hospital.

Mucky road test for Ranchi patients

Source: telegraphindia.com

The absence of a proper approach road to the 500-bed super-specialty wing of Ranchi Sadar Hospital is causing a lot of inconvenience to patients and their attendants.

The road that leads to the extended hospital wing, which was inaugurated with much fanfare by chief minister Raghubar Das two years back, has turned slushy after rain making the hospital inaccessible to visitors.

On an average, around 2,000 patients and doctors visits the hospital every day .

“People have been facing this problem for the last one month. You can neither walk nor negotiate the stretch on a two-wheeler without risking a fall. Patients and their attendants are the worst-hit. The state health department should at least put a layer of stone dust or morrum on the slush,” said Ravi Prakash, the relative of a patient.

One of two newly constructed buildings functions as a maternity wing where 100 pregnant women and children come for treatment daily.

“The problem recurs every monsoon. The road turns mucky and the hospital premises becomes dirty even after a mild drizzle. It’s incredible that two super-specialty units of the sadar hospital don’t have a proper road,” one of the hospital employees said on the condition of anonymity.

District civil surgeon Vijay Bihari Prasad said the department would make some stop-gap arrangement to resolve the issue.

“We are trying to get in touch with the officials of Jharkhand State Building Construction Corporation Limited (JSBCCL) so that they can direct the builder to fix the road by putting a layer of

stone dust or morrum. I don’t know whether the construction of the approach road and paver blocks are part of the project, but the problem can’t be left unattended,” Prasad said.

Prasad said the construction of the second building of the super-specialty wing would be completed by the end of December this year.

“We are also facing a problem regarding a designated parking space. We are going to ask the contractor to earmark a parking space,” he said.

The super-specialty wing, built at a cost of Rs 131 crore, has a curious past.

In 2011, JSBCCL undertook its construction and Bijeta Construction Company was awarded the contract.

In 2016, a PIL was filed in Jharkhand High Court over how the wing couldn’t be made functional even five years after the beginning of its construction. The health department had informed the high court that it would complete the construction of the first phase of the super-specialty wing by March 2017.

Digital dispensaries treating patients in Jharkhand’s ‘doctor-less’ villages

Source: hindustantimes.com

Digital dispensaries (telemedicine centres) where doctors diagnose and treat diseases through video-conferencing are turning out to be a boon for people living in remote villages of Jharkhand.

Launched by the Jharkhand government on February 20 this year, the digital dispensaries have provided medical services to around 79,000 rural people in 100 centres set up so far, officials at state unit of national rural health mission (NRHM) said.

Jharkhand has tied up with the Apollo Hospitals Enterprises Ltd for the telemedicine services. A panel of 30 doctors and specialists related to gynaecology, paediatrics, general medicine and dermatology, has been providing medical services from 10 am to 4 pm daily, excluding Sundays and national holidays, sitting in Hyderabad or Chennai.

The state government has converted 100 primary health centres, where doctors’ availability is negligible, into digital dispensaries.

Interestingly, rural women have shown more interest to the services. According to the dashboard of telemedicine centre, 78,550 patients have visited the digital dispensaries till 12.30 pm on Monday since February 20, of which 48,793 were females, while number of male patients was 29,735 in the state. The officials engaged in monitoring the patients footfalls at the centre said a total of 879 patients visited digital dispensaries till 4pm on Monday.

The NRHM’s IT (information technology) Cell head, Abanindra Kumar, said: “We had set target to treat at least 10 patient at each centre and 1000 across 100 centres daily, which was almost achieved. Now, we are targeting to raise the number patients to 20 at each centre daily and 2,000 across the centres in state.”

He, however, said there was lack of awareness about such facilities in some of the centres. “We are working to make it popular in such areas so that maximum people could get affordable and standard health facilities,” he said.

Dumka has the highest 11 such centres where more than 8922 patients have visited so far, while East Singhbhum, which has nine centres, has witnessed second highest 8762 patients till 12.30pm on Monday since February 20. Over 7241 patients have availed the facility from six centres in Ranchi district.

Maya Devi, 35, an anaemia patient from East Singhbhum district, said she visited telemedicine centre and found it very easy. “My disease was diagnosed by a doctor through video-conferencing and he advised me for haemoglobin test. Getting treatment in telemedicine centre is very easy as well as beneficial,” she said.

An auxiliary nurse midwife (ANM) and a lab technician are deputed in each digital dispensary. After registration of the patient, the ANM and lab technician would conduct vital tests for height, weight, blood pressure, sugar level, body temperature of the patient.

Patients can also avail medicines from the digital dispensaries, where 60 types of common generic medicines are stored. Besides, patients can also get to avail tests for malaria, typhoid, dengue, haemoglobin, urine analysis and pregnancy in the telemedicine centres.

Ground Zero | Bihar AES deaths: A hundred deaths, and no answers

Source:- thehindu.com

Cases of acute encephalitis syndrome have seen a spike in Muzaffarpur this year, already claiming more than a hundred lives. Jacob Koshy reports on the appalling state of health care in Bihar, even as the debate on what is causing the deaths rages on

For three days, Bihari Mahato and Shyam Babu Saha’s families have shared a hospital bed. The two daily-wage labourers, who have had to give up work for three days, haven’t exchanged a word, though they have much in common. Both have a boy and a girl each. And their children are battling for life.

Sundar, Mahato’s three-and-a-half-year-old son, is naked, emaciated, delirious and has a distended stomach. Himanshi, six months old and in a striped shirt and shorts, looks bigger and healthier than Sundar. She sleeps longer — fitfully, her mother Vimla says. Both families are from different districts of Bihar. Mahato is from Muzaffarpur and Saha is from Sitamarhi district. Their children were suddenly taken ill. When the children were convulsing and feverish, they were rushed to the Sri Krishna Medical College and Hospital (SKMCH) in Muzaffarpur. The doctors noted that their blood sugar had dropped precipitously.

Both children are being given dextrose saline (a sugar solution often administered intravenously), but their parents are nervous. “The fever has subsided but it keeps returning,” says Saha. “The doctors aren’t paying us much attention.” But that’s a quibble given that many other ailing children are sprawled out on mattresses on the floor. Amidst peeling plaster, strewn banana peels, stomping doctors, nurses, journalists and television crew, the children’s ward at SKMCH is symptomatic of the confusion and panic that has gripped Muzaffarpur since early June.

The floor above the general ward is home to the Intensive Care Units (ICUs). Each of the five ICUs has eight beds. Not one of the beds has fewer than three children hooked to bleeping monitors and intravenous lines. Unusually for an ICU, there’s little restriction on non-hospital staff shuttling in and out, but unlike the squalid paediatric wards below, there are no patients sprawled on the floor. The floor is clean, the air-conditioners work, the nurses are extra vigilant, and yet here’s where death lurks around the corner.

Season of trouble

There is a protocol for doctors. As soon as children are wheeled in, they are monitored for fever, convulsions and signs of confusion or loss of consciousness. “What I’ve seen is that several children are brought too late. Unfortunately we lose them,” says J.P. Mandal, a resident doctor at SKMCH. Between June 1 and 17, 312 children were admitted to the hospital under the umbrella diagnosis of acute encephalitis syndrome (AES). According to the Bihar health department, 85 died. The bulk of the dead, 48, were children aged three to seven. Twenty-nine children were less than three years of age. As of June 21, 104 of the 424 children admitted since January 1 had died. Encephalitis, which refers to an inflammation in the brain due to a viral or bacterial attack, causes fever and almost never a drop in blood sugar. In the current epidemic, as well as in previous ones in Muzaffarpur, the doctors have marked cases of and deaths by hypoglycaemia (drop in blood sugar), which is unusual.

While Bihar loses hundreds of children to AES every year, there were sharp spikes in 2012 and 2014, when 395 and 372 children, respectively, lost their lives. Through the years, AES cases have been reported from several districts in Bihar: Gaya, Patna, Aurangabad, Saran, East Champaran, Sitamarhi and Vaishali. Government figures show that the peak years of 2012 and 2014 saw Muzaffarpur account for 35-40% of hospital admissions. While this year’s incidences and deaths are fewer in comparison, the season of trouble is far from over. The outbreak in 2012 took place between May and November. In 2014, it was from May to July. There’s no saying how long the current outbreak will last. A common refrain among district administration officials and some doctors is that the yearly outbreak ceases in intensity soon after the monsoon rains begin in Bihar. Why is that? Nobody ventures an explanation.

Sanjay Kumar, the State’s top civil servant in charge of health, says he cannot quite put a finger on a “single, determining factor” that is responsible for 2019 turning out to be a bad year. It could be the ongoing heatwave — several parts of Patna, Gaya and even Muzaffarpur have recorded temperatures in excess of 4-5°C over what’s normal for this time of the year. At least 80 people have succumbed to the heatwave. “The added heat and humidity could have made young children particularly susceptible to dehydration,” he reckons. “It could also be an infectious disease. It could also be because of children eating litchis.”

Kumar says all the children who are admitted belong to the lowest socio-economic rung; there are no instances of infection in cities or even semi-urban localities. He emphasises that the government had been prepared this year too, like in the past, for the outbreak. It stocked up and supplied oral rehydration solution, ensured that medicine and equipment were provided at medical colleges and district health centres, and conducted public awareness campaigns about the imminent outbreak. However, he admits that the district’s key referral hospital, SKMCH, wasn’t equipped to deal with the deluge of patients. “This year will be a turning point. The bed capacity will be increased to 1,500 and we will have a virology lab [to better investigate vitals of patients and determine disease causes].”

Debating the litchi link

Arun Shah, a paediatrician and private practitioner who has been working in the city since 1984, insists that the spike in AES cases and in fatalities is a result of malnourished children suffering brain damage after eating litchis, particularly unripe or overripe ones. In a 2014 paper, Shah and virologist T. Jacob John had argued that the children in Shah’s clinic in Muzaffarpur were found to have extremely low blood sugar levels and signs of brain damage. While viral or bacterial infections that cause encephalitis (an inflammation of brain cells due to an infection) were well known in Muzaffarpur and neighbouring districts, many of them were taking sick and dying due to encephalopathy (brain damage, in this case, due to an environmental toxin). In 2016, a detailed investigation, published in The Lancet Global Health by the National Centre for Disease Control, India, and the U.S. Centers for Disease Control and Prevention, found “confirmation” that litchis contained a chemical called methylene cyclopropyl glycine (MCPG). These are naturally occurring toxins that cause hypoglycaemia and metabolic derangement in children.

When a child is malnourished, her body, having exhausted its reserves of glucose from the digestive tract and the liver, typically turns to fatty acids in biochemical desperation to supply blood sugar to the brain. MCPG, the theory goes, thwarts this mechanism. This can send the brain into hypoglycaemic shock triggering convulsions and, if unaddressed, even death. “But please don’t blame litchis,” stresses Shah. “It is the pride of Muzaffarpur.”

At a press conference two years ago, to underline that the litchi fruit was only a triggering factor and sickened only malnourished children, Shah and John ate a bowlful of the fruit in front of television cameras to emphasise that it was malnutrition, and not the fruit, that was the dominant cause of the disease. Shah is unambiguous that the children are suffering because the government didn’t do enough. The recently concluded Lok Sabha election distracted the government from adequately preparing for the outbreak, he says. In 2016, he was part of a government-constituted committee that prescribed guidelines: Children shouldn’t be allowed to skip their evening meal, they should avoid stepping out in the heat, and local public healthcare centres must stock up on anti-convulsion drugs as well as dextrose. These were adhered to in 2017 and 2018. And that’s why there were relatively fewer reports of AES, he argues.

While encephalitis outbreaks in Uttar Pradesh’s Gorakhpur were due to other causes, and children from Muzaffarpur and neighbouring districts have battled viruses such as the Japanese encephalitis virus, the large-scale litchi cultivation in Muzaffarpur, which contributes about 40% of the State’s litchi production, “can’t be ignored as a triggering factor,” he points out.

At SKMCH, several parents of the ailing children are categorical that their children did not eat litchis. The authors of The Lancet study found that two-thirds of children who were sick had eaten litchis. “We work in the fields and there are litchi orchards aplenty where we live,” says Indal Paswan, whose two-and-a-half-year-old son is prostrate on a hospital bed. “But this boy isn’t capable of plucking fruit on his own. We do feed him some fruit as well as other food but we don’t starve him.”

Mandal is insistent that there is a virus or some biological agent that is responsible for the recurrent outbreaks. He scoffs at suggestions of the litchi’s complicity. Children who were brought to the hospital were “poor but not classically malnourished,” he says. If malnutrition and litchi consumption were the causes, then there ought to have been a fairly constant number of deaths every year. This has not been observed, he says. “A peak and an ebb in cases and deaths is what we see. And that’s more typical of a biological agent.”

That no virus or bacteria has been isolated yet in Muzaffarpur is because the hospital lacks adequate facilities to collect tissue and blood samples from patients and preserve them adequately for examination. “I’m confident that at some point this will be found and there will be no mystery,” Mandal says. The focus of treatment, he adds, is to ensure that convulsions are brought under control and blood sugar levels are restored.

What Shah and Mandal do agree on is that the vast majority of deaths could have been prevented if the children had made it to a hospital on time. The most important medicines were easily available, and most of the primary health care centres were well stocked and equipped to deal with AES cases.

No time to grieve

Yet, four-year-old Mohammed Jahid lost his life. Until he fell sick, Jahid had spent his days playing with his older siblings and cousins in the village of Bishnupur Chand, Musahari. His home was a single room thatched hut that did not have a toilet. His and his cousins’ houses lay at the edge of an orchard that had several rows of tall, stout litchi trees. In June, there were only a few fruits that clung to the trees. Most had been plucked and carted away for sale by the owner of the orchard who lives in Patna. “He didn’t show any signs of illness. He had a fever for two days,” recounts Jahid’s aunt, Asha Khatoon. “We took him to a private doctor nearby.” One night, Jahid became delirious, and his father Mohammed Idris rushed to get an autorickshaw to take him to a hospital. He didn’t find one immediately as the roads had been dug up. When they made it to SKMCH, Jahid was immediately taken to the ICU, but he didn’t survive beyond three hours. A day after burying Jahid, Idris was away to find work as a daily-wage labourer. There were still two boys, two girls and a wife to feed.


In Bihar, doctors treat patients on floor as hospital tries to cope with rush

Source:hindustantimes.com

So chock-a-block are the wards at Muzaffarpur’s Sri Krishna Medical College Hospital with patients suffering from Acute Encephalitis Syndrome (AES) that doctors are being forced to treat children on the floor.

At least 43 of the 50 deaths due to AES in Bihar have taken place at this hospital, with Muzaffarpur being the epicentre of the outbreak. Ten other districts have also been affected.

Sri Krishna hospital medical superintendent Sunil Kumar Shahi said, “We have an in-patient bed strength of only 610 whereas the number of patients admitted to our hospital is around 876. We do not refuse any patient, so we put mattresses to treat them on the floor.”

To cope with the rush of patients, the superintendent has converted all 20 beds of the intensive care unit (ICU) into paediatric intensive care units (PICU).

“If we come across patients, who need to be admitted to ICU, we will admit them in the coronary care unit (CCU). Against 14 existing beds at our PICU, I have converted all our 20 ICU beds into PICU, taking the number of beds in PICU up to 34,” Shahi said.

“Given the disease burden, even the central team which is here has suggested increasing the number of PICU beds to 100,” he added.

The government has ensured the availability of all drugs free of cost to AES patients. Sri Krishna hospital is also providing food to patients as well as their attendants. “Though we are not supposed to provide food to patients in PICU, on the advice of health minister Mangal Pandey and principal secretary, health, Sanjay Kumar, I am supplying milk, supplements, fruit, bread and eggs to all AES patients and their attendants on humanitarian grounds,” said Shahi.

The parents of some children being treated at the hospital are satisfied with the facilities provided. Some of them, including Md Aslam Madan Sahni, Ram Bharos Thakur and Gayatri Devi, are hoping the hospital will start supplying diapers free of cost too.