Life..Just before Death..But not Less

 Dr Sonia Singh

Hello friends,  I am Dr Sonia Singh, in charge of the multi drug resistant tuberculosis (MDR TB) ward at Indira Gandhi Institute of Medical Sciences in Patna.

I would like to share my experience about MDR TB patients who have the right to get treated and cured like other patients, but many a times they are devoid of their rights as a patient and as a human!

I write about a student of class 12. He acquired MDR TB infection most likely from the hostel. He was admitted in MDR TB ward and we started treatment after pre treatment evaluation. His general condition at the time of admission was fair so he tolerated medicines well. To our surprise, he was not accompanied by any family member or relative and he did not call them when asked. Finally he confessed that he did not want anybody to know about his disease else they might boycott him at every level; in the family, society and the school. We counselled him nothing like that would happen and that the family is meant to give all kinds of support at hours of need.

He had high blood pressures, so along with MDR TB drugs antihypertensives were planned. Then the patient said that he was afraid to see the nurse and we thought about the possibility of white coat syndrome. He was finally discharged after 7 days. We counselled him again; although he was suffering from a difficult condition , if he adhered to the drug regime he would be totally cured and would be a healthy person in the society. At the same time we advised him to use mask to avoid spreading infection to others. He left our ward happily and is coming for follow up in OPD along with his parents .The best part was that he continued to study throughout his stay in the hospital and was very much concerned about his future and career. (Picture: the patient reading a book )

I conclude my story with mixed feelings. When I was  appointed, my fellow colleagues discouraged me from joining such an infectious ward but my family supported me. They said being an FP I should not turn away from my duties towards society as MDR TB is a new threat to society.I read detailed literature about MDR TB and MDR TB wards and found that health professionals were prone to get infection. So I presented the design of MDR TB wards with adequate ventilation, Ultra Violet Germicidal Irradiation Techniques (UVGI), use of N-95 respirators and also trained nurses to work with full safety. Rest I leave to Almighty!

Some patients often complain that they are ill treated by DOTS-PLUS supervisors and counsellors. We approach them and request not to hate patients but to help them.

We also advise yoga, meditation, positive thinking, listening to music etc. to patients so that they are able to cope with tough situations of life with ease.

I know, it is not so easy but at least a full attempt should be give to Lives..just before death!

Human kindness

Amanda Howe

©AmandaHowe2016

My friend walked down the lane
Was entranced by the green wood,
And the wet lushness,
And the long horizons,

And lost himself amid this English fervour.
He asked a working man for help,
Who sent him home.

We laughed, and ate,
And were glad of our time together.

I thanked my neighbour later -
He asked about my friend
“Nigeria” I answered.
He nodded wisely -
“I didn’t think ‘e cum from round ‘ere”….

I would be glad
If more dark strangers met such kindness
In this land.

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My area of practice is in the edge of a city, with poor people and some better off, but the region (Norfolk) is very rural by English standards. Our students go to practices where the nearest hospital can be 40km away. The epidemiology is typical, mostly NCDs of lifestyle and ageing, though with farming accidents commoner because of the local employment in that area.

When I first came to Norfolk the non-white population was only 3% though it has risen in recent years., especially in the university and hospital areas in the city. As my poem suggests, foreigners can still be a novelty in some parts. I thought of this story when the UK voted to leave the EU, much of which was led by the press and rightwing politicians promoting the fear of immigration-hence the last part of my poem.

©Amanda Howe July 2016

Adjustment to the Mississpippi Twang

  Shailey Prasad Brief 

 The drawl was unmistakable. It was long, rich, and seemed to have stories untold in it. More important, I had no idea what my patient had just said. It was my first week working in rural Mississippi as a family doctor, and all the warnings that my colleagues in Detroit had given me kept ringing in my ears. I could not seem to get a decent history from him. Was I doomed as a family doctor? Was it ridicule that I heard in his voice?

Time passed. I stuck around and built a practice that was as varied and challenging as any I had imagined. Slowly, I was integrated into the workings of the small town and countryside–the football games, the crawfish boils, the school plays, and graduation. That was the backdrop of all clinic encounters, the context for the pictures being described.

The work seemed to flow from clinic to hospital, from homes to school clinics. The key context was that of the “community.” I was like an essential monument in town–“Doc.” It seemed like I had come a long way from fearing “The Drawl.” And then, in the middle of shrimp season, I heard a voice through the back door of the clinic. It was the patient with the strong drawl again–this time I understood it–dropping off a gift, several pounds of fresh shrimp, “for the Doc and the clinic.” We got to talking, and he mentioned that he was thankful that I was taking care of his kin–a cousin with depression, a grandson with asthma, his Maw-maw with arthritis, and his Pa with a “bad heart.” I looked at the clinic appointments. I had seen 6 generations of his family in the past month. I thanked him for the gift: that night, my family cooked up those delicious, fresh-caught gulf shrimp.

Fewer silos, more community, more comprehensive primary care–these are what I remember of my time as a rural doctor. As we discuss the future of health care delivery, I think about building community and planning for local needs. We need to understand the backdrop, the colors that enrich the lives of the folks we work with.a

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Description about the author: Shailey is a Professor of Family Medicine and Community Health and does research in Health Policy as it pertains to Rural Health at the University of Minnesota 

Area of practice: Currently in Minneapolis, MN. Formerly in rural Mississippi and in Tribal/Rural areas of southern India 

Epidemiology of the area described: Significant concerns of Non-communicable diseases with new emerging infectious diseases 

Suggestions for strengthening rural healthcare: Get young folks discover the fun and passion of Rural Health Care.

 Originally posted on: http://www.zocalopublicsquare.org/2012/02/26/what-you-city-docs-miss/ideas/up-for-discussion/

A spiritual indigenous story

 Priscila Goré Emílio

Video with the testimony of Priscila Goré Emílio a indigenous Kayngang psychologist from south of Brazil. This video was recorded during the "1st State Seminar of Health of Traditional Communities: indigenous and Maroon - Rio Grande - Brazil‏" ("I Seminário Estadual de Saúde das Comunidades Tradicionais - Indígenas e Quilombolas " - http://www.sinsc.furg.br/site/isesct/ ).

Note by editor (10/07/2016): Regarding some questions about "Evidenced Based Medicine", this story is about the personal spiritual experience and how this changed the person regarding understanding its people. The focus of sharing this experience is not discussing the treatment in the western medicine, it is to see this special community moment and the important role that it has. It's much more about cultural competence and understanding it.(Mayara Floss)