A happy family

Two days ago a family came to meet me. A 32- year-old husband with his wife and 3 year old son. They came to see me regarding a minor fever for the wife. They seemed to be happy, especially the kid who kept on exploring my consultation room for treasures. My thoughts went back to the time they visited me the first time.

They were referred to me by a Gynecologist when a routine HIV screening on the pregnant woman was found to be 'positive'. They were in tears, the husband and wife. They did not want the baby but it was too late to abort. They wanted to end their lives as the husband also turned out to be 'positive'. I tried to talk to them in a positive way. I assured them that with proper treatment for the mother and the newborn, the baby will be negative. I also told them that HIV/AIDS is now a well treatable condition, and they will be able to continue living with a good quality of life indefinitely. They did not want any of their family members to know. I promised that I wont tell anybody.

Next day itself I started Mother to Child infection prevention medicines. Her pregnancy period was uneventful, and she delivered a normal boy by Cesarean section. In case of a 'positive' mother, it is always better to avoid breast feeding if the parents could afford formula feeding. So the paediatrician while giving the newborn the medicines for prevention of infection asked them not to give breast milk. This advice produced a commotion among women members of the family. The guy (new father)called me frantically warning me that both Grand mothers are coming to me to ask me about breast feeding. He pleaded with me not to say anything about HIV.

Meanwhile I called the Gynecologist and pediatrician and discussed with them what to reveal and what not to reveal. We decided that we will tell a lie as per the wishes of the couple. The Grand-mothers arrived in front of me. I told them that a virus that can cause jaundice is there in the mother's blood. If she breast feed, the newborn will get infected with dire consequences. So, it is better to give formula feeding. If they have any doubt they can ask the other 2 doctors. Some how or other, I was able to convince the two women. Later I learned that they did not go to other 2 doctors.

All was seemingly well for a few days when suddenly I heard that the guy was hospitalised for attempted suicide. The young mother one day told her mother all the truth. On hearing that, the husband not able to bear the thought of stigma tried to kill himself but fortunately was unsuccessful.

After 18 months, the couple came to me with the kid. They were very happy. They just got the result showing that their boy is HIV Negative. I asked them how is it with their families. They told me that both parents know the truth and they are very supportive.

Later last year, I referred the guy to the ART centre as his CD4 count was below 200. Now he is on ART for last 9 months. His last CD4 count showed steady improvement.

All these I remembered as I watched the son happily playing with a paper weight on my table.
Then the mother said, 'He has not been given any shots'.
I was shocked. The 3-year-old child has not been given any vaccines for immunisation. How could it be like that?
She said that when they went to the nearest Govt Health Centre for immunisation, they saw the HIV positive status written on the mother's medical record. The doctor there was confused which all vaccines to be given. So he referred the child to a Higher Centre some distance away, but the couple fearing stigma never went there.

I asked them to get the child vaccinated immediately, told them to take ART regularly, also reminded them about measures to prevent further pregnancy and said goodbye.
It was a pleasantly satisfying interview for me.

Poverty and Medicine

Being a doctor you come in touch with the economically weaker sections day in and day out. When ever you write a prescription or order a test you have to keep in mind the financial status of the patient.
In India very few have health insurance. The very poor go to the Government run Hospitals and clinic. Those who can afford to spend some money from their pocket go to privately owned Hospitals and clinics. But many times the poor may have to go to private Institutions as the Govt Hospitals may not be accessible or the one near to their home may not be adequately equipped to deal with their problem.
So the treatment that is given in private Hospitals [like where I work] differ according the monitory status.Intensive care, frequent blood monitoring,expensive imaging tests like MRI etc may be offered but not insisted upon in case of poor patients.We doctors try to diagnose using all our experience and many a time rely on empirical therapy[ie presuming the diagnosis and treating].The drugs prescribed will not be the newest and expensive ones. Even among poor patients there is discrimination.Families tend to spend less for older people. Many a time they discharge and take home the old before complete recovery. Ventilators and other life saving equipments will be switched off on request.
Though it is expensive many poor people like to get treatment from private Hospitals.One of the major reason is lack of dignity and personal care in Govt Institutions.Over crowding and lack of funding is the cause for this undignified treatment for patients. Severe shortage of infrastructure,staff,equipments etc make the matters worse.
Is Health Insurance for All the solution?

Doctor's Day

Today, July 1st is celebrated in India as Doctor's day. Today is the both the birth and death anniversary of Dr.Bidhan Chandra Roy a renowned freedom fighter, administrator and a physician par excellence.

What do I like about being a doctor?

You are able relieve sufferings of some and is able to reassure many and to make so many people happy.Even minor things like speaking to a patient for few extra minutes,or giving a reassuring look or touching a patient or patting them give so much happiness and hope.It gives good exercise to your brain[though not much to your body] and it pays well too.It is even now a prestigious profession and you meet so many different kinds of people in your work. You can contribute a lot to the well being of the community in which you live.

So still I am happy being a doctor