Tuesday, April 25, 2017

The little boy with a bag of stones

A three year old was sitting beside the doctor’s table, outside the labor room. He was surprisingly calm and quiet. He seemed to enjoy the tea we had given him while his mother delivered her fourth child. He had no father or any known relative to take care of them. His mother was a psychiatric patient on regular follow up and treatment.

He didn’t trouble us at all and never asked where his mom was. This little one was wearing the same old clothes that he wore when he came here few months back (We had seen him with the mother on her previous two admissions) and this mom, didn’t have any clothes for her new born either. The little fellow had a brown paper bag, which had stones, bottle caps and other junk, probably he picked up while coming to the hospital. These were his toys.

These people collected the single use, plastic water bottles from us because it was the nearest thing to a toy they knew. They filled them with stones and pebbles to create rattles for babies.

The nurse returned from the labor room with a troubled look.

“Doctor,” she said. “She has no clothes for the new born, and not even for herself. We gave her a bed sheet.”

“Don’t we have extras from the donations?” I asked.

“No,” she said. “Nothing’s left as we gave away everything from time to time.”

It was a very common scenario at this general hospital of the other end, as the population here had been battling with poverty, war and hunger for decades. Since the war ended, they had no more fears of untimely death or losing their loved ones, but the constant struggle with poverty continued.

This mother, who was now delivering her fourth baby, was seen by us at the ante-natal clinics as she was referred to us by the mental health unit. We couldn’t gather much information on her as no one came to visit her. She was a psychiatric patient and was apprehensive and reluctant to talk to us.

One of the midwives came to us with tea and biscuits for this little three year old, awaiting for his mother.

“He’s wearing the same old clothes, miss,” I told her.

“Doctor, if you could provide some clothes I will wash him up and tidy him,” she said to me, knowing that I would go to any length to achieve this. I was so thankful that we were blessed with such kind-hearted midwives and nurses. They never said no to our requests and helped us in everything as our hands were always full in operating theaters and labor room.

We called up the pediatric ward, but they had no extra clothes. I made a quick decision and walked over to the shop on the other side of the A9 Road. I bought some clothes for him and also for the new-born baby. For the mom, I got a new bed jacket and a lungi (a wrap-around cloth). We were bound to help them, as there were no other means.

A few days ago, a mother who was admitted for childbirth told us that she was willing to give the newborn away, as she was a single parent of a teen daughter. The man had left her while she was pregnant and she was ashamed to go back to the village. No one knew her situation and her plan was to deliver this child, give it away to the probation authority and return to her village to take care of her daughter.

She was willing to undergo Caesarean section as she had undergone surgery during the previous childbirth. We always used to visit the patients who underwent surgery, as soon as we returned from the operating theater. When I came back to our ward after six hours, I couldn’t see the mother who was operated on that morning. When we finally found her, she was washing clothes in the bathroom with the urine catheter pinned up into her waist. I was shocked to see her up and walking like that as we always had a struggle to make them walk after a surgery. Post-surgical patients prefer to stay in bed due to pain caused by surgical wounds.

“What on earth do you think you are doing?” all were scolding her for getting up without assistance.

“I had only those two nappies and a baby shirt you gave me the other day doctor, so I had to wash this for the baby,” she said with tears rolling down her cheeks.

I kept sets of baby clothes in my table drawer, to be given to those in need. When she told me all her social problems and situations I gave her the last few pieces I had left. Back at the store, remembering her, I bought a few extra sets of baby clothes. I knew it was not my duty to provide them everything. I have been told by many seniors to work up to my limits, but the humane side of me never let me rest. I feel so much pain seeing them suffer like this.

I shared these incidents few years ago, in my Sinhala blog ‘Anithkona’. It was an attempt to share what they were going through after the war. After a few days, I got a feedback from a kind-hearted Sri Lankan lady residing in Australia that she was willing to help these people. I refused their help as the sole purpose of my writing was to show the misery and struggle of the North End and had no intention to trouble anyone else.

Regardless of my objections, they sent clothes and other goods and it was collected by two temples in Australia. When I told about this to the Military, they were willing to help with the transportation and distribution.

I heard that they received the goods and had distributed them among the poor and the orphans.

My cousin residing in the USA had sent baby clothes, and we distributed them among the needy mothers in our wards.

When I went to post-natal wards to check on the mother, sinna thambi (little brother) was sitting on the corner of the bed with a sad face.

“I wanted a baby brother, but mom got me a sister instead. I don’t want a sister,” he sighed.

We arranged counseling and follow up for the mother for her psychological issues. With the help of mental health unit, she was donated goods for her baby.

Some evenings this little boy was seen at our nurses’ station where he learned to write. Our wonderful nurses and midwives were teaching the kid to write and speak because he was so shy and timid as his mom almost never spoke with him.

Remember the mom who got down from her bed after surgery? After a week, she withdrew her request to give away the child.

“I breast fed her for one week doctor… I can’t give her up….I love her,” she said. I met her when she was ready to be discharged. “My eldest has attained puberty while I was here. I have to go to my village to arrange her ceremony. I will take care of my kids somehow, doctor,” she said with a hopeful smile.

We arranged social support for them by informing the Psychiatric Social Worker (PSW) of that area.

Every hospital admission is traumatic, but seeing them go home recovered and healed is a blessing indeed.

Indu and the face book !

Indu (pseudonym) was one of the permanent patients of our unit. She had nowhere else to go other than the orphanage which sheltered her. We took over her care, whenever she troubled her care takers. Keeping her in one place was hard as she had a habit of running away from every home that sheltered her. She became one of our unit’s heaviest burdens.

When she was hospitalized, we had to keep an eye on her, as she was fond of wondering in corridors, outside hospital premises and suddenly went missing during visiting hours. She was in her twenties when she was diagnosed with her mental illness. She was good in her studies but couldn’t continue as her mental status worsened. On top of this she had no family support. Her mother who was treated for the same illness showed no interest in building a healthy relationship with her daughter. The efforts we took to create a good family support, failed as it was impossible to make the mother and daughter understand each other’s situation. They had no insight to it.

This time she was hospitalized after she ran away from the orphanage for the third time and was found hiding inside a canal by the side of the road. She had cuts and bruises all over her arms and legs and we feared of her being sexually assaulted or abused when she ran away. Bringing her back to our ward was a struggle. Her medications were on higher doses but still showed no improvement. She was hasty and showed no interest in occupational therapy. As she had no family support, her recovery was not in the right path.

She fights with anyone around her, whenever she’s irritated, mostly for no reason. Hallucinations, delusions, sleep deprivations, over eating or loss of appetite, she piles them all in front of us and complains about each and every feeling she gets. She accuses us or other patients for everything that happens to her in ward.

During these temper tantrums she is often locked away in the isolation room until she calms down as she becomes a threat to her own life sometimes. Our efforts to calm her down never work when she’s afflicted, she beats whoever comes near her. Yes I have been hit with a pile of BHT files, and with her fist too. When she’s locked in, she cries and weeps for her mother, pleading her to come and rescue her.

“Why have you left me all alone here amma, am I not your child…. Why couldn’t you kill me if you didn’t want me” she weeps. I feel awful hearing her, crying and yelling for her lost childhood and mother’s love.

Every one of us needs love, care and compassion to ease our way through life. When one becomes mentally ill they need a multi disciplinary healing system. Any mental illness carries a stigma, emotional instability and a feeling of fear with lack of insight to their disease that often results in social isolation.

The poor psycho–social support system in our country has hindered the recovery and healing. Helping Indu to heal was a challenge when there is no family care or support. Her own brother who lived in a village nearby couldn’t take care of her, and mother wasn’t aware of anything as she had no sound mind.

We were the only family she had and we cared about her wellbeing. We brought clothes for her whenever she tore her clothes into pieces during the temper tantrums. Gave her comfort in every way we could.

We spent most of our time in ward as we all were away from home and our loved ones. My laptop battery was dying and needed charging time to time, and only workable place was at nurse’s station. I was there with my laptop which was near the grilled window of the female ward.

It was one of those evenings when we were free of ward work. When we were checking a photo page of a staff member’s wedding, I heard a voice behind my head, “What’s that doctor” Indu, peeping through the grilled window asks me pointing at the laptop screen.

It was the Face Book which connected me to my community when I’m here.“That’s face book, Indu…” I explained as I was happy that she came out of her lackadaisical behavior. That was the first time she showed some interest in what was happening around her. She wanted to know what I was doing there typing. “Why do we need this” she asks with a surprised look in her face.

“Well, you see, when we are so busy in our own little worlds, it’s hard to keep in touch with friends. We need a media to connect. I’m miles away from home, working here with you guys and it’s hard to meet people or be with them in their life events. Some are even living abroad. Social networks like face book, gives me a chance to reconnect with friends; Talk to them, check their photos and share what’s happening in our day to day life.”

I tell her while flipping through photos, of birthdays, weddings and parties. She doesn’t show any concern on my explanations and wonders off humming.

After few minutes she appears again” it’s such a stupid thing to have a wedding these days. It’s a waste of money doctor” she adds.

“Indu, I agree… you are absolutely right!” hearing this her face brightened.

“Why do they post photos, like this, on a web page” she asks pointing at the laptop. Her mind rapidly changes subjects.

“To share all those special events with friends. We can respond with a like, or a comment or even share ideas” I explained.

“What’s the purpose of showing photos to others doctor? Why does one show off all that happens to them?” She asks as she shrugs her shoulders with a startling look.

“Well, that’s a good question Indu, I too have no answers yet, but I guess it makes them happy”

“Happy? Who’s happy?” She asks with a puzzled look on her face.

“Those who share and those who can see them… I guess…” I felt that I was succeeding more in confusing than explaining.

“Hee hee…that’s crazy right…” she tells me with a heavy tone and runs away giggling. For a moment, I was speechless. People love social networks and enjoy sharing their life events, even the plate of food they eat, or make up they put on. I guess it was hard for her to understand the common flow of the modern techno world. She calls it “crazy” to promulgate on our daily whereabouts and feel contented about it.

Indu, who’s on mind medications, finds it confusing that we maintain virtual profiles. She thinks we are “crazy” for wanting to post and proclaim every good thing happening in our lives. We grade her imperceptive, uncomprehending and psychotic, and we obstruct her thinking to put her mind to rest but she laughs at our mundane ego boosters.

Back in those days, I remember painting, cards for birthdays and penning notes for sharing.

We never print a photo or an album these days but we log in to check the photos in time lines instead. We console each other with likes and comments but no effort is taken to meet in a real life event. I guess, this posting and boasting, which she calls crazy makes people feel less lonely and more heroic.

I was lost in my own thoughts about social networks and couldn’t help being dismayed at our ways in finding soul superiority in these virtual platforms.
 Dr. Bodhini Samaratunga

Tuesday, April 18, 2017

Standing Hazards - Women workers

Health Complications Which May Result in Female Workers Who Stand for a Longer Period of Time
Dr. B.R.M. Samaratunga (M.D.)

Women Workers who stands for longer hours at work place are prone to develop health conditions such as musculoskeletal disorders, varicose veins, heart and circulatory problems and pregnancy difficulties. The most frequently and commonly complained symptoms are discomfort, fatigue and swelling in the lower limbs. Standing hazards

· Pain:

o Physical pain – musculoskeletal disorders

o Swollen and painful limbs mainly lower limbs.

o Joint pains (increased risk of knee and him arthritis)

o Neck and shoulder stiffness

· Poor posture (and its effects)

· Plantar fasciitis

· Stretched Achilles tendon. Flat feet and heal spurs

· Varicose veins

· Poor circulation

· Increased risk of carotid atherosclerosis and stroke

· Pregnancy difficulties

· Mental distress and depression which may result due to long term pain. 

Varicose veins are a common complication of standing for a longer periods of time. Standing and walking upright increases the pressure in the veins of your lower body and this in return makes enlarges the veins and bulge out. Varicose veins add a higher risk to circulatory problems.

Even though any vein could become varicose, the most affected are veins on legs. These veins could also get infected or become chronic and painful. It may even cause serious acute illnesses that may need urgent medical help. (Thrombophlebitis, deep vein thrombosis, pulmonary embolism)

Chronic heart disease and circulatory disorders are linked to prolonged standing at work. Prolonged time in an upright posture at work may cause hypertension comparable to 20 years of aging. Strong evidence linking prolonged standing at work to an increased risk of heart problems and stroke has recently come to light. Researchers have linked prolonged standing to an increased risk of carotid atherosclerosis, which in turn can cause an increased risk of heart attack and stroke.[1]

Muscular pains, soreness and numbness of lower limbs, swollen joints and arthritis of hip and knee joints will result in temporarily immobilized or locked joints. This can later result in rheumatic disease too.

Having these work place and work related issues will not only give physical pain but also may alter one’s day to day living and activities. Being in pain for a long term may also add a mental stressor to one’s life. This will create a psycho - social hazard in worker’s life that may ultimately lead to a depressive state.

Some of these medical issues will occur later in life but in return will add a physically and mentally disordered population to the society.

[1] (Krause N and others. Standing at work and progression of carotid atherosclerosis, Scandinavian Journal of Work, Environment and Health, vol.26, no.3, pages 227-36, 2000.)
2. McCulloch J. Health risks associated with prolonged standing. Work, vol.19, no.2, pages 201-5, 2002.
3. Tüchsen F, Krause N and others. Standing at work and varicose veins, Scandinavian Journal of Work, Environment and Health, vol.2 no.5, pages 414-20, 2000.