How are you Ashok Kumar Reddy?
Dr. Araveeti Ramayogaiah
Chittoor is a quiet medium-sized in Andhra Pradesh. I was medical officer in the government hospital in the nineties and made in-charge of the children’s unit though I was not a pediatrician.
My out patient attendance was heavy –usually around 120 plus. One day in1996, while I was busy on outpatient work, I noticed a middle aged man bringing a male child on his shoulders. As the child needed immediate attention as he was in coma and had a feeding tube in the nostril, I examined him. He was about six years old and preliminary diagnosis showed that it may be a case of suspected encephalitis. I began the treatment after taking the child, whose name was Ashok Kumar Reddy, to the inpatient area.
About three days earlier, he was treated at Christian Medical College Hospital (CMCH) at Vellore in Tamil Nadu. The diagnosis at CMCH also was suspected encephalitis. After a weeks’ treatment in the stage of coma with instructions to provide home care, the hospital discharged him. The parents, agricultural labourers, brought him to their village in Chittoor.
I presumed he was discharged at the parents’ request due to poverty and language problems. CMCH is a famous tertiary hospital equipped with high-end investigations and super specialist services whereas my hospital had hardly any biochemical, pathological and microbiological support. All patients were treated on clinical judgment with some basic investigations.
As per the parents’ version, home care in the village was a difficult experience as villagers either showered unwanted sympathy and advice. “How can you keep a child in this state at home? What will you do if he needs emergency medical care?, were the usual comments. That made parents to bring the boy to me.
A government hospital doesn’t have a choice and has to treat every patient, regardless of his condition. Saving Ashok was a challenge for me and my team.
Encephalitis is a vector borne viral disease with children showing symptoms of high fever, headache, vomiting, altered sensorium and fits. Available literature shows that one-third of the patients, die, another third recover with some motor and sensory disabilities called post-encephalitis sequalae and one-third recover completely. The treatment, probably in any set up is empirical, symptomatic and supportive.
We worked on Ashok with all the skills at our command. Fortunately I had a very committed nursing team at that time. After a week, Ashok started becoming conscious and showed positive signs of progress. Soon, he became completely conscious and out of danger. We were overjoyed as he had survived his battle with the disease though with post encephalitis sequalae.
He had speech problems, motor deficiencies in using his legs and hands but we took the sequalae as another challenge. He required a variety of stimuli to improve various functions. We talked to him, played with him, sang and danced with him and also give him a transistor radio. We allowed his father to take him to matinee show daily to make him a functional child.
After three months, we discharged him on request with great reluctance with mixed feelings. After presenting him with dresses and toys, we instructed the parents to give him hygienic food, protect him from mosquitoes, allow him to mingle with other children and send him to school. I followed up periodically for about a year.
Ashok was my favourite patient. He may be around 26 now but I don’t know his whereabouts or the name of his parents and his village. I long to see him and ask him “how are you Ashok Kumar Reddy”.
Dr. ARRAVEETI RAMAYOGAIAH
MBBS; DCH (Kurnool Medical College, Kurnool, A.P. Government Medical College)
FOUNDER : Organization for Promotion of Social Dimensions of Health (OPSDH)