Author: mygynaec

This is a true story. While I was waiting  at the signal for it to turn green I noticed a fire engine overtaking me. It barged through the red signal to attend to the fire call. The hose pipe at the back of the vehicle was leaking water and oil. The fire vehicle spelt out some water and oil while it went ahead briskly. On my right side was a middle aged man on his bike waiting to take a right turn. As the signal turned green, the biker started moving and his bike skid on the freshly spilt water. The other bike behind him could not control itself and ran over the man’s hand. The man sustained severe  injuries.

He was a law abiding middle aged man wearing a helmet. Not even speeding, he was just waiting for the signal to turn green. For no mistake of his own, he sustained multiple  fractures. Many good Samaritans helped the injured man.

Following questions came to my mind:

• Is it a sheer accident? Does the story end where  the victim  curses his bad luck and get himself treated at his own cost?
• Is it an error of the fire personnel? Should he not have waited for green signal and follow the traffic rules. Probably It is justifiable that he hurriedly wanted to rush to  the site of fire and douse it. It  is a human error. Is it  “justifiable to be erroneous”?
• If the fire engine fellows would have taken “due care” of closing the valve properly the problem could have been easily averted. And the precaution expected was a simple one. So is it the negligence of the personnel manning the fire engine? Should he be made accountable for this act improperly executed?
• Is the action of the fire personnel “rash and negligent” that led to “grievous hurt” to the victim? Should he be arrested and put behind bars?

The victim suffered a fracture, needed hospital admission and surgery, and had to spend a lot of money from his pocket. He was off the job for two months. He had to go through a lot of suffering. Is it human right violation?

Friends, I find a lot of similarity between the above mentioned story and medical accidents. A health care provider who wants to actually help the patient actually lands up messing it up unintentionally and unknowingly.

Till now patients accepted these as accidents and cursed their own fate. Some  took the doctors to courts for compensation. Then we witnessed increasing trend of  filling criminal cases. I consider this to be the most  dangerous trend in the doctor patient relationship.

Now is it right that we start calling these Human rights violations? Is it fair on the part of  National human rights commission to hear these petitions ?

Waiting for your comments…

A patient and her father came up with an interesting request putting me in tight spot. She is a decently educated girl but the father is a not so educated businessman from village in Gujrat. The plea was that  father wanted to take away the afterbirth (placenta and the cord) for some ritual and burial. He very strongly believed that not doing so will severely harm the new born.
Now according to the Biomedical waste disposal Act and rules one is supposed to hand over biomedical waste  to the authorised agency for transport and disposal. The “generator of waste” that is the hospital owner is responsible and liable for ensuring this. And not handing over to authorised person is a criminal offence. The father of the patient was hell bent on taking it away. He was willing to sign and give a letter of request too. Not allowing him to take away the afterbirth as desired  by him was an unnecessary, callous and rude behavior. Further it was like “doctor not being bothered about the emotions and well being of the new born”. And he believed into it to the core!

This incidence raised few questions and opened up Pandora’s box of possibilities.
Ethically does the patient have right to decide about the tissues removed from the body? If there is a conflict which authority should the doctor/ hospital approach?
We see the  “stem cell banking” agencies collecting the blood and placental tissues? Are they authorised to collect and transport  it by law? Do they use a prescribed vehicle? No they don’t.
What does the pollution control board do about huge biomedical waste generated by the  community? The sanitary pads, insulin syringes used by people at home are still disposed off in general garbage. So what are doing about that?
In conclusion the law on biomedical waste disposal seems to be too short sighted. Do we produce the law to make a change  or we just make it to show off as if some thing is being done?
Thanks to the man, the father of my patient. It was he who got me put on the thinking hat!!

Vaccines & pregnancy

 

Vaccines are helpful in preventing infections. Vaccines boost your immunity against an infection… thus keep you and your growing family safe. All vaccines are not safe during pregnancy. As a general rule vaccines made up from live viruses should not be taken in pregnancy. Vaccines made from dead viruses or toxoids are safe in pregnancy.

Vaccination history:

It is ideal to have an up to date history about vaccinations you have received till date… right from your childhood. You may be able to find out details from your parents. Even if previous history is not available, you can definitely start keeping a log of vaccinations from now!

Vaccines before getting pregnant:

Technically one should be immunised against all possible infections before planning pregnancy. It is reasonable to take vaccines at least against the common infections which can cause harm to the unborn baby. One such vaccine that is highly recommended is Rubella vaccine.

Rubella (German measles):

Rubella infection in pregnancy can cause a lot of harm to unborn babies. It may cause serious birth defects with devastating, life-long consequences, or even death before birth. It is a good idea that you have a pre-pregnancy blood test to see if you are immune to the disease. In India, children usually receive the combination vaccine for measles, mumps, rubella vaccine (MMR). Usually this leads to adequate immunity. If you are not immune to rubella you should take a vaccine. Remember …it is a live virus vaccine. If you get vaccinated for rubella, you should avoid becoming pregnant until three months after receiving the vaccine.

Vaccines which are safe during pregnancy:

Flu vaccine:

H1N1 or swine flu is increasingly becoming common in India. Pregnant women, especially in the later half of pregnancy are more likely to get severely sick if they catch up the infection. This can be avoided by taking injectable vaccine is made up from dead virus and hence safe in pregnancy.

Toxoid vaccine:

In India, it is recommended that a pregnant women should receive two doses of  tetanus toxoid. (Of course there are some exceptions!).

A combination vaccine called TDaP which protects against tetanus, diphtheria and pertussis is now freely available. As recommended by CDC (The Centre of disease control, US), it is should be taken after 27 weeks of pregnancy. It protects the mother as well as the new born against tetanus, pertussis and whooping cough.

Vaccines that you may consider before or during pregnancy:

These vaccines are safe in pregnancy. However the incidence of the infection is not so high that they need to be recommended to every one…especially when pregnant. Your job or lifestyle can make you more susceptible to specific illnesses, as can certain chronic health conditions, such as diabetes. You may discuss these with your doctor.

Hepatitis B vaccine:

Hepatitis B is a viral infection that causes liver inflammation, nausea, fatigue, and jaundice (yellowing of the skin and eyes). In some cases, it can cause chronic liver disease, liver cancer, and death. A pregnant woman with hepatitis B can pass the infection to her baby during delivery, and without prompt treatment, the baby has a high risk of contracting serious liver diseases as an adult.

The CDC recommends that all pregnant women be screened for hepatitis B because it’s possible to have it without knowing.

It’s safe to get this shot when you’re pregnant, especially if you’re a healthcare worker or you live with someone who has the disease.

Hepatitis A vaccine:

This vaccine protects against a liver disease that spreads through contaminated food or water. Symptoms include fever, fatigue, and nausea. It isn’t usually as serious as the B version of the disease, and the illness won’t affect an unborn baby most of the time. In rare cases, hepatitis A may contribute to premature labour and infection in the new born.

The safety of this vaccine has yet to be determined, but because it’s produced from dead viruses, the risks are likely low. Especially if you’re traveling to a place where the quality of water you drink may be poor, you may consider this.

Pneumococcal vaccine :

If you have a specific chronic condition, such as diabetes or kidney disease, your doctor may recommend the pneumococcal vaccine, which protects against some forms of pneumonia. Although potential harm to an unborn baby is unknown, researchers believe that the risk is low.

What after you deliver?

Did you miss any of the vaccines before or during the pregnancy? Now is the time to catch up! Breast feeding mothers can get vaccinated according to a normal adult vaccination schedule.

In addition you may consider taking HPV (human papillomavirus) vaccine that helps protect against cervical cancer. The shot isn’t recommended during pregnancy because studies haven’t yet determined its safety for a developing baby.

Vaccines & side effects:

Serious reactions to vaccines are rare. However, your doctor may tell you to skip certain shots if you have an allergy to a substance they contain. Those who are allergic, for example, to baker’s yeast (used in making bread) shouldn’t get the hepatitis B vaccine; those with a severe egg allergy should avoid the flu shot; and people with a severe allergy to gelatin or to the antibiotic neomycin shouldn’t get the measles, mumps, and rubella or varicella vaccine. If you’re skipping any shots, you should discuss alternate ways to prevent illness with your doctor.