Medical suggestions for accident victim in India?

August 8, 2008 9:40 PM

Earlier this week I witnessed a pedestrian/car accident while traveling in Calcutta, India. A boy was pinned between two vehicles and his leg is badly injured. [warning] Here is a photo of his leg a few days later. His care is deficient as best and I am looking for advice and suggestions. Inside is an excerpt from my blog where you can find the full story, including known medications administered.

His leg was stitched at the government hospital, under dire conditions. He has no broken bones. He has received an IV saline drip continuously except for the 4th day when he received 2x250ml of blood (about 1 pint). He never lost consciousness and responds to questions. He has no feeling around or below the wound (right calf, extending behind knee). There is obviously nerve damage, but I have no idea how extensive. His right foot seemed cold the first night but blood flow seems to have returned. He told me he can move/extend his right leg at the knew but it is extremely painful. He is very thin and his leg is somewhat swollen. Around the wound his skin is warmer.

Advice so far:
*try squeezing a toenail, it should blanche and then return to normal
*make sure he can move his foot
*Pus, if it is a white/thick substance is obviously a sign of infection and he needs stronger antibiotics. However, if it's blood and a more-or-less clear/yellowy liquid, that's normal as part of the healing process.
*the abrasion on the left of the photo should have a different bandage than the rest of the wound, and should be kept moist

As mentioned in my blog, I know advice without face-to-face consultation is inadequate. Anything stated will be taken as suggestion only, and I will consult a doctor that can see him before suggesting or administrating any changes in his care.

posted by maya to health & fitness (9 comments total)

Can you ask him how much of his leg he can feel? He can give you a rough estimate of how much sensation he has in his leg. If his leg is somewhat swollen and it's been severely injured, it's likely he might have compartment syndrome, which is an emergency condition and needs to be operated on immediately.

My qualifications: I am a neuroscience student who has had an operation for compartment syndrome. I can provide very rudimentary advice on some of these things as they relate to a normal nervous system. PLEASE verify this with someone who has already the PhD degree that I will have in seven years and/or an MD degree before you actually use my advice.
posted by kldickson at 10:32 PM on August 8, 2008

Some posters who are worried about accountability might be interested in this selection from maya's blog, if they haven't read it themselves:

I have already briefly spoken with a doctor friend via chat, but I would like as much input as possible. You can post anonymously [on her blog] and everything you say will be taken as suggestion alone. I am not a doctor but I was able to say and suggest things at the hospitals that would not have been done otherwise. All advice and information is appreciated.

posted by Solon and Thanks at 10:42 PM on August 8, 2008

I just visited him this morning (Saturday). He has a fever and complains about pain. More blood has been prescribed. HERE is a new photo (4.5 days after accident). I want to say again that I am just looking for suggestions. Nothing you say would be used to administer medical treatment on this boy you have never seen without consultation with a doctor who can SEE and hopefully treat him.

And, I forgot to say the first time, thank you.
posted by maya at 4:01 AM on August 9, 2008

The book Where There Is No Doctor (free pdf download) is a really good place to start with these sorts of questions. The title is about "no doctor," but I've found that it is a really good resource for supplementing a doctor — giving you names of conditions and medications, alternative paths for treatment, and so on.

Secondly, I don't know what your financial situation is like, but I wonder if the best thing you could do for this boy is pay for some attention from a nurse or doctor there — perhaps as a supplemental payment to someone in the public hospital, or arranging care from someone in private practice. My experience has been that an amount that is marginal to me can mean the difference between someone laying unattended on a cot in the corridor, and them getting antibiotics, doctor's visits, and so on.

In a lot of countries medical care gets paid for ala carte — you pay cash for the MRI, you pay cash for the blood test, you pay cash for the rewrapping of bandages. If that is the case in this hospital, the cash to pay for those services is far and away the most critical need for that boy right now.
posted by Forktine at 6:11 AM on August 9, 2008

Could you clarify what leads you to believe his care is deficient? I read your blog entry as well as your question here, and you seem to be assuming his care is deficient based on the conditions of the hospital.

The fact that his leg looks worse after a few days may very well mean the healing process is working. Isn't it true that trauma often looks worse after a few days?

I guess I question the assumptions here. Yes, medicine elsewhere in the world may be different than the first-world, but it's a big leap to assume the physicians and nurses are incompetent. If I were an Indian physician, I am not sure I would embrace the input you are trying to provide. I know you have the best of intentions.
posted by jayder at 7:41 AM on August 9, 2008

Where there is pain, there is usually nervous sensation. There may be discrepancies in this, but usually, if an area hurts, the nerve supplying sensation to it is definitely not devoid of sensation - the kid's nociceptors are working, which is fantastic, although certainly, the nerve could be damaged. Let the doctors make the decision on whether there's nerve damage, in response to feedback.

Here is a summary of what I can find about the medications he has:

Enzoflam is an anti-inflammatory analgesic. I'd be a little suspicious of Noveran - it's a trademark infringement by some guy on Voveran, which is an NSAID. Oframax is an antibiotic. Pantop is a proton pump inhibitor which is indicated in gastric acid-related conditions. Paracetamol is an NSAID. Revotaz is an antibiotic. Tetglob is an anti-tetanus immunoglobulin. I can't find anything on the other drugs. Investigate these drugs - it'll give you an idea of what the kid has dealt with.
posted by kldickson at 9:20 AM on August 9, 2008

In my ignorant opinion, a dirty hospital and a dirty bed do mean deficiency. Especially when infection is a worry.

*The wound was not examined before he was stitched up. (I was there from before the accident through the stitching). Nor was the wound flushed or the area around it cleaned. The flap was simply moved and closed.
*The nurse in charge of his case did not know he had lost sensation in his lower leg.
*To get blood a second time, an orderly was given the money but he never showed up with it. We had to track him down.
*I have seen assistants go from patient to patient, including a recently dead one, without hand-washing.
*Orderlies do not routinely wash hands between delivering meals, assisting with bedpans, moving patients.
*In the first hospital, dried blood and bloody cotton was everywhere.
*I was the one to alert an assistant to his fever on Friday.

Jayder, please believe me when I tell you I am being very respectful to the hospital staff. Personally, I am trained as an anthropologist, and I have done my best to work within this system of which I am an outsider. It is here online where I can be outspoken and critical. When I said that the leg looked worse, I only meant that "hey the leg looks worse to me", I have never criticized the staff nor suggested in any way that I know more than them.

Thank you everybody for the input. When I saw him this morning (Sunday) he seemed better than last night, was trying to bend his knee, and gave me big smile.
posted by maya at 11:22 PM on August 9, 2008

A few thoughts:

Compartment syndrome is a real risk; someone I knew at university lost their leg below the knee because it wasn't picked up in time after a rugby accident.

Is the kid getting decent food? Good food might make all the difference between a quick recovery and a long drawn out decline.
posted by pharm at 12:15 PM on August 10, 2008

Hi Maya, First I wanted to send you some loving support. May I offer you a cyber hug? How kind and good of you to help this young boy in such a critical circumstance. Reading your story made my heart happy. It also reminded me of my own ten years in India, from 21 to 33 years old, the moral quandaries of helping others, the difficulty of setting limits, not being able to do everything for everybody at all times. It's a learning experience, it can be a profound one.

One learns to choose the situations to offer help. Sometimes the choices made may seem quirky because there are more serious cases at hand.

Once outside Calcutta I saw a puppy outside a chai shop that had gone to sleep on a soft mound of tar and woken up covered in the stuff, now all stiff, trapped an immobile in this tar suit of armor. It was just a puppy, one of those pariah dog puppies. But I was prompted to take it home try and fix the situation, failed and took the pup to a vet, ashamed to put energy into a pariah dog, when there were millions of children who needed more help. But the vet cleaned the puppy immaculately, didn't change me a paisa. Uh Oh, as I called the dog, was adopted by a local and went on to live a happy life.

It's never enough and it's always too much. Somehow one may find a compassionate but practical way to live with the inequalities of that. India offers many mysterious lessons to Western visitors.

Poor Indians have no idea how much money Westerners have and it's sad that her son's accident brought up a yearning for this mother to have a sari and her other child helped in Bihar. That happened to me many times in India, helping out one situation and feeling taken advantage of. This was while I was living on $100 a month as a student there. I once gave my wristwatch to a young Tibetan girl and dozens of people who found out about it, then accosted me for money, things, sponsorship, including her father. I felt awful and somewhat bitter. But really, there wasn't any way for them to know my situation. The West and Westerners seem -and often are- vastly wealthy comparatively.

Offering help is a real skill and has all kinds of unexpected emotional impacts on the people giving and receiving. It's worth learning about.

I've had major, emergency abdominal surgery in a rural, funky hospital India and it's surprising how well it turned out in spite of things not being as hygienic in the West. My clothing wasn't changed. I was operated on in my street clothes. Had no nursing after the first night, depended on the kindness of strangers.

I do think the loving kindness you are offering is deeply meaningful. There may not be a perfect outcome. When is there in life? In a way one of the many gifts India offered me was to deal with the imperfect in life and to learn to handle rough situations, to set limits, to let go, while still keeping an open heart and sometimes to help when there was no end to the help needed, but do what I could at the time.

Practical things you might do:

Write Calcutta Rescue and ask for their advice
info [at] calcuttarescue [dot] org

This man may direct your message to the man, Jack Pregar, who founded Calcutta Rescue and might might have a suggestion:
basil122 [at] mail2world [dot] com

Another possibly useful contact:

CHILDREN HOSPITAL
139, Binova Bhawe Road
Kolkata - 700033.
Contact Person:
• Samiran Mullick.

INDIA OFFICE
Hope Kolkata Foundation
39, Panditya Place,
Kolkata - 700029.
Tel: [phone]
Fax: [phone]
Email: info [at] hopechild [dot] org

re their Aastha unit

A multi vitamin with minerals to build up the kid's health.

Glucose-D, a teaspoon with lime juice and water for energy.

In any case, you're not alone. Feel free to write or call me any time, nickyskye at gmail.
posted by nickyskye at 1:11 PM on August 19, 2008 [1 favorite has favorites]