Santhosh's ramblings

We live and work in the midst of a very “low trust society”. The dominant culture of lack of trust is bound to influence all of us some time or other, if we are not careful. As I observe, I see signs of this low trust both among the community who access our caring systems and those of us who are part of the caring community. There is the issue of trust in the health care professional. People come to us with various Medical complaints, and we can identify these people with low trust easily. They would come in asking for particular doctor or person. They will have a file full of previous treatments done. They will keep talking about this doctor or that doctor. They will say, we heard your name and we came with great faith, but the fact is, there is not much faith, this is only yet another stop in their nonstop health care shopping. Many a times, the patient is not included in the decision. It is the “Neta” of the home who is the controller of these shopping’s, and one if carefully obse

Have a dream and nurture that dream - though no one may understand your dreams Never forget your roots Try on your own to change the world, and if you fail run away, but be available when the bush fires up! Stay near a bush always Take a break in the desert, once in a while! Desert breaks are preparation for future desert journeys, you may not know it now. You are ready when you are least ready You are prepared to lead when you are at your lowest ebb Hold on to your dreams till it is rekindled by a greater power than you! It might take 40 years to be rekindled! Give excuses, and try giving up, but not too often; He will not give up on you! If you think you cannot do it alone, tell Him, he has support ready If you think you do not how to speak, do not worry, He has prepared people who can speak, in your team Your ability is not what is required, but your availability Do not make it difficult for God too, listen when he speaks When He sends you, it is because He has see

I have been on the road traveling a bit, and been observing people living and running their day today lives in the context of a developed world, a change from the rural location where I live. I met a very senior person during this journey. Well, senior at my age means above 70! This person has lived and spent all his life bringing up his family, children and giving them the best options for life and even now is available to some of them, as they go through challenges in their mid-life, with advice and money and presence. In my conversations he told me – tell your children to be practical about life! He was an accomplished professional who made plans for his family, resources, and brought up his children well and planned their lives and supported them. Practical in every way. What is practical? What I observed and gathered from the many lives I saw - Think using the faculties you have. The faculties of reason and logic. Look at the context around you, think and plan and align your

Last few days, I have been away traveling, meeting with some friends who are engaged in health care networks in various parts of the globe. As I listened to stories from each of their own contexts, the challenges which they are grappling with, a common thread emerged. Whether it is in the context of rural north India where we work (the various stories which I had shared earlier) or the story of the 75 year old absolutely healthy nurse in UK who decided to go to Switzerland to have a physician help her to end her life, the “Gay marriage debates” all over the world, or the climate change and protection of the universe, all is about, “identity” and “rights”. When I was born, I was born with an identity, of being part of the family, the nation, the tribe and the universe I am part of. But the next few years of living in this world, I was told, that though I do have an identity, that is where you start, but I have to earn the rest of it and protect my rights which come along with this

In one of my recent blogs I had talked about a person who wanted treatment for TB in our center and Diabetes elsewhere and how I had asked him who takes care of him, if the different diseases are being taken care of at different centers. Over last few weeks, the number of patients who are on treatment for their various ailments from different practioners or institutions have been many. A typical example is this 50 year old man who was brought to us by his wife and daughter. He did not seem too keen to see us. He had a bipolar disease for the last 20 years on treatment form Patna, has a chronic alcohol dependent stage, for which he has been to many doctors, and he has a psoriasis, for which he is on treatment from a homeo-physician. We evaluated him and found that he is in moderate liver failure, due to the chronic alcoholism. We asked, what is that you expect from us? They wanted treatment for Psoriasis only. After going through the initial discussions we told him, unless he stops alc

Quite a number of the patients who come to us are the in the geriatric age group. The lady about whom I wrote earlier, her issue on further reflection and questioning was, one of comfort than cure. The family was quite keen to explore options for cure, but what she was asking was for comfort and care. The health care systems they have been to, including ours is not built for comfort or care, but for cure. Comfort for an elderly is, the family around, people to care for her and basic amenities taken care of. She was not sure, once she goes home if she will get the comfort she was experiencing to some extend, in the palliative care ward where she was. But even what was being provided was not enough. Institutions do not allow family to be around to provide care and comfort in a hospital context. We want less disturbance to do the curing. We want all the relatives (other than may be one) out during rounds and nursing care. This is best provided at home, but will Medical care be possible i

This 75 year old lady was brought into our hospital a month back with distension of abdomen. Distension usually being of surgical cause, she ended up in the surgical ward. The next day, our senior surgeon recognized that she had a Renal problem and asked some of us to review. We saw that the lady had a chronic kidney failure with a creatinine of 2.9 – indicating that she has lost almost 60 to 75% of her renal function. An US examination confirmed our doubt. Being of elderly age, and not having options for renal replacement therapy – (Dialysis or Transplant) we did the best we could. We gave her drugs to control her blood pressure, electrolyte abnormalities and prepared the family for a palliative care at home. But the family was very insistent. Somehow she has to be made well, and they wanted to take her to a higher center. Being insistent, and having little trust in our “Diagnosis” and advice, the best we could do was to give them a referral letter. We did not hear from them for