Thursday, August 4, 2011
The Surgical Team and the Operation
During the course of the operation, there was a technician who was giving a running commentary top the surgeons about the positioning of the various procedures. He was using x-ray technology to guide them in their work and was an integral part of the team.
The automatic blood pressure monitoring system in that operating theater failed during my operation, so the doctors had to use the old fashioned manual ones, until another automatic one was brought from an adjoining operating theater and settled that problem. It was a little panic stations at first, as it is not easy to check the blood pressure every few minutes manually while under surgery.
The two main surgeons who performed the surgery, Dr Pubudu and Dr Dhammika were the ones who had performed the surgery last time on me. It was interesting that one of them suddenly came up with questions about my life, that he knew and said he had been reading my blogs!! Dr Banagala, was the overall consulting Orthopedic Surgeon, who was handling the case and was reviewing the work done by his HOs or House Officers.
The surgery took a while due to some adjustments that has to be made to the original plate implants as some nuts had to be removed and tightened etc. and then the tissue in the area of the joint had to be removed for the bone graft to be inserted. So it was not easy to reach all the areas to remove the tissue that had formed in the past six months instead of the bone tissue which would have formed if it fused. The cut nearer my waist to take bone near the hip for the graft had to be stitched up soon after the bone fragments were removed, as otherwise the anesthetic would have worn off. as it starts wearing off from the waist down.
A cousin who is an Anesthesiologist was also in the operating theater, and she knew the consultant anesthetist at the operation. I was not taken into the operating theater immediately so I was waiting for another surgery to finish. When mine started late, and went on for a long time, the number of staff in the theater also seemed to diminish, much like them going to lunch while the operation was going on, like hang on I am still cut up, where are you guys off to? Anyway I guess the surgeons were so confident of their tasks, even the consultant sneaked off giving final instructions on exactly what procedures to do, knowing he could rely on his team!
After the operation, I was waiting a while to be taken back to the room, and then the next team for the afternoon surgeries were getting ready with their roster. It is amazing how busy these operating theaters must be in the National Hospital. Once I got to the room, there was no one to greet me and as I did not have my mobile phone was unable to tell my family that I was OK and back in the room, in case they were wondering why it took so long.
Later another member of the surgical team dropped into meet me and have a chat about Polonnaruwa, which he may have heard from the other doctors. He said he single-handedly got funds for a rural hospital in Pulasthigama and had it all done up during the time he was in charge including the land around with fruit crops. He had been in Polonnaruwa for about 8 years, and is now specializing in Orthopedics and not had time to go back to see how things are at the hospital.
It would be nice to go with him one day soon to see his handiwork which he is very proud of. I asked his name at the time and now completely forgotten!! Another doc in the team, Dr Duminda came to have a chat about his interest in the outdoors as he has a place near Sinharaja and would like to have more time to go birdwatching. He likes the colorful ones there, and I told him I see more of the raptors in my area, the big Owls, Hawks and Eagles. He must also have gotten word about my background and wanted to share some of his experiences. It is so nice to find some common ground with people who lead such different lives.
I am due to be released in a few minutes, when one of the surgical team came earlier, we chatted about the fact that some of the instrumentation is overused and needs replacement. Apparently some are used 5 times as much as the recommended usage, due to the shortage of the stuff, presumably due to the costs for the health service. I can imagine that some of these tools of the surgeons cost over Rs1m each. So I asked the doc to give me the full details when I come to the clinic in two weeks so I can ask my contacts if they could help out with funding one that was used in my operation, which would have helped me if it had not been so worn out!
Thanks guys for all the effort and assistance in my case, and would love one day to host you all in my little forest hideout in Ratmale, when I finally am able to finish it and spend some quality time there. So please contact me. (www.ratmale.blogspot.com)
Wednesday, August 3, 2011
My experience at the National Hospital
Once the admission formalities were completed on Monday, July 25th I was admitted after 1pm, and was told due to the preparation times etc, that I would not get any food till after 1pm the next day. It is part of the bureaucracy on their part!
The room in on the 5th floor of the Bandaranayake building, and overlooks the new Central Hospital and various Colombo landmarks. There is a very wide balcony, the widest I have seen anywhere in Sri Lanka, wide enough to put a bed lengthwise. The attached bathroom is also very big, clean and basic, but fully tiled.
The room has the high hospital bed with two pillows, but the head or foot cannot be independently raised as some of the beds of the regular wards are. A desk and chair, and two more chairs along with a clothes cupboard, a dressing table,a bed side table and a clothes horse. There is plenty of fluorescent lighting and the two plug points hold square plugs. There is a speed controlled fan that gives enough power. Due to the elevation, there are no mosquitoes, and it is very breezy as the sea breeze comes all the way here, and I sleep with all the windows and doors open.
The regular service schedule is as follows. A nurse usually comes at 4.30 am to check the temperature. They are just impeccably turned out in their kits, with not a hair out of place throughout their shift. The morning coffee is brought at 5 am and at 6 am morning breakfast is served along with tea, in a large tray, (wooden) and a plastic cover to prevent flies. This morning there was green gram for breakfast.
At 7 am someone comes offering hot water either for the flask or for washing one's face, then at 8 a person comes to sweep the room and on alternate days to also mop the room. The bath room is cleaned daily by another person at around 9am. The nurses come around 8 about 5 of them to discuss each patient's particular treatment and drug schedules. The doctors assigned to the patients come later with a nurse who takes down any instructions. Then the instructions like cleaning my wound is done very professionally by two nurses with disposable face masks and gloves just for that activity.
Another team of two come every other day to change all the sheets and pillow cases! even I do not change them this frequently. There are male hospital orderlies whose task is to take patients to x ray surgery or similar function, clean them up if necessary and prepare them for surgery, like in my case the whole area where the operation was performed had to be shaved and cleaned with antiseptics.
At around 10, coffee is served and then a tray of lunch is at noon. We have already had a few days of yellow rice, and fish or chicken curry along with other vegetables, and dessert is either a yoghurt, or fruit salad or a slice of papaya. Then afternoon tea is served around 3pm, with either biscuits, or a cheese and crackers and today it was a savory sandwich.
Dinner is served around 6pm, and it was a soup, followed by boiled vegetables of cabbage, beans, carrots and potato with a piece of chicken in a gravy, along with two thick slices of white bread. the cold jelly comes about an hour later so one can eat it as is then!
The nurses come during the day with the various medicines relevant to each patient, and after dinner a final review of last medicines to sleep and after meals, and in my case the antibiotics, and pain killers to take before bed time. There is no TV and I go to sleep around 8.30pm.
The general visiting hours are 6am to 7, noon to 1pm and 5 to 6. Surprise surprise I have no visitors during visiting hours and they all seem to come at the other times!!
I have a 24 hour attendant who is a retired hospital employee who is in the room all the time except when he goes to get his food, and I have the luxury of sending him at 6 am to get me all the newspapers to read for the day! If one does not have a family member with the patient, then one is recommended.
The attendant is paid Rs1,200 for the day and room charges including food is Rs1,750. The strong Augmentin 1.2m injections at operation and thereafter we have to buy, and the follow up Augmentin 625g antibiotic course is also bought by us, but all other medications including the Walteren for the swelling and pain is supplied.
The surgery and related doctors' visits and x rays as well as the daily physiotherapy is NO CHARGE
When a visitor told me about appalling service at a 5 star hotel, where the servers were quite clueless in how to serve, I told them, that in comparison, I received 7 star service in the largest State Hospital complex in the world!
Please note that the non paying wards usually offer three rice and curry meals a day with red rice, whilst we are offered one white rice lunch as well as the less healthy white bread in the morning and evenings.
I read somewhere that the Colombo Hospitals are overstaffed, and the rural ones are understaffed with doctors as well as all the ancillary workers. Surprise surprise!
I am about to leave the National Hospital
I found out that in about 10% of cases like mine the bones don't fuse, necessitating this second operation. I am told it went as well as it could and that it should work out, though the time frame is a little vague owing to my personal circumstances, age and ability to absorb and fuse. Until the bones fuse I will not be permitted to put any weight on my right leg, and so I am in for a long period of physiotherapy and rehabilitation.
I am still in a little pain, reduced by pain killers, but my leg is extremely stiff and painful to move, but move I must to get as much movement as possible with the help of the physio, to speed up the recovery.
I was told I will be discharged tomorrow. Where to may I ask?
Sunday, July 24, 2011
"My Reality" this year is one of extreme hardship
After this there will be usual recovery and rehab which will effectively put me out of action for the rest of this year. I wont have access to a computer from tomorrow, so I will be out of touch with the world for a while.
Since the accident, most of my agricultural activities had to be curtailed. Much of the produce being sold on site for a fraction of what I could get if I was able to market it myself, and further due to the lack of responsible people to oversee the operations, I have incurred significant losses and so decided to let someone else farm the paddy lands for a share.
Just to illustrate the point, my mangoes are falling off the trees in their thousands, or being eaten my the monkeys, as it is hardly worth selling it on site. I had a person bring me 350 mangoes by bus the other day, and I distributed them to friends and family within an hour of their arrival. However the cost to me for their transport was not even covered as I gave away everything. In the days I was delivering and selling I would have received at least Rs30 per Mango. So that is the reality. I have a waiting list for the bees honey, but I have to go and pick it up, as I don't trust anyone with the purchase or transport. These are all the issues.
My vehicle was a write off in the accident, and I am currently living on the proceeds of the insurance for the vehicle, how I am going to get back on my feet is something I will confront when I can walk. I am told that now I should sue the Ministry of Defense as the police vehicle that crashed into me and was uninsured belonged to the Ministry of Defense. They are building a Rs20B headquarters for the Army but would fight tooth and nail to give me a dime for their negligence. If only you knew how the driver of the vehicle was treated you would not want to confront them. He lost his job, and was asked to pay Rs400,000 to repair the Police vehicle that crashed into me. The driver tells me the brakes failed and that is why he could not control the vehicle that ploughed into me.
Of course it is 7 weeks since the Minister, whose convoy was the cause of the accident came to see me, but despite many reminders he seems to be ignoring the issue hoping it would go away.
I have kept myself very busy these days and try not to worry too much of the current disability, but after I return to normal will have to re asses my options to be more practical in what I do, as I will no longer be able to carry king coconut bunches(around 25 nuts per bunch) up three flights of stairs single-handedly which I could before the incident!
Bear with me, and trust me there will be even more interesting stories to tell in the future. In the meantime try and obtain some level of consolation from my writings in the other blogs, some of which are quite controversial, but then why have an opinion if one cannot express it?
Thanks guys and gals for your patience and understanding. We have to face life's challenges in whatever form they are thrown at us and make the most of the circumstances.
Tuesday, June 21, 2011
Is it ever too late to apologize?
What could I tell him? I just had to give him a brief history of myself, and explain that what I had achieved by sheer hard work over a long period of time just disappeared in a moment, with no glimmer of hope on when I could resume some element of it. I said that he as the Minister of Justice should ponder on the justice of this, as I was not begging for anything from him, but some sense of self respect.
I also informed him of the latest bad news where the surgeon not happy with my slow progress suggested I have a bone graft to speed up my recovery, which would entail a further recovery period of not less than 5 months. All this means nothing to him who was more concerned has lost his backup vehicle. Well does he need a back up vehicle anyway? to backup what I may ask.
I am sorry but my regard for people in power lost a few more notches, as I realized this pathetic figure would be hard-pressed to find a job as a security guard in a foreign country, and he was instrumental in meeting out justice in this country. A sad state of affairs!If he was walking down Gregory's Rd on his own I don't think anyone would even notice him, and hence need for security just to get noticed. It is interesting that even the gate keeper on being told by the security that they were police and the minister wanted to meet me was non plussed, wanting more information on his credentials. I hope the police got a sense of their self importance thinking that providing security to them does not mean much to even lesser mortals.
I told him, a political turncoat, I had never accepted a bribe in my life, and would never want to for the rest of my life, having worked hard for everything I have. (for those who don't understand why I refer to him as a turncoat, is because he got elected from a group which he then abandoned, and it appears took money to change sides and join the government with a promise of a cabinet post.)
So what next? I know not and he left with the parting words of " lets see if I can do something. "
Thursday, May 5, 2011
An enforced TIME OUT or Recovery from atrocity coming to an end
These past few months have been life changing, difficult and frustrating and I do see some light at the end of the tunnel as the physical healing process is noticeable . The lack of transport to go places and get things done has also meant a big financial loss to me in the agricultural field as well, and something I had not expected or bargained for.
The insurance proceeds for the loss of the vehicle finally came through nearly 3 months after the accident from my insurer, but that hardly provides 50% of the funds necessary to purchase an alternative vehicle leaving me in quite a quandary as to what to do. I will not be able to drive for a further three months rendering a further question of how to get along till that time.
I use the tuk tuk mode of transport, to take the dogs to the vet, go to the bank and the basic shopping. I have been unable to go to outside physio, being on the farm, these past few weeks. When I go to Colombo in a few days, I will have to recommence that, by either home visits or rely on some transport from family to get to the hospital for such therapy.
In the meantime, it is the IPL (Indian Premier League Twenty20 Cricket) on the local channels, as I don’t have cable to keep me occupied in the evenings and sorting out other matters during the day.
There was the Royal Wedding too, on my birthday, which surprise surprise was telecast live on Rupavahini, the main state Channel. Otherwise I would not have been able to watch as the aerial I have does not allow other channels on my set. Of course I reminisced as I was in the Mall that day 30 years ago when the grooms parents were wed and saw similar outpourings of joy and laughter. I was working in London at the time and living not too far away from the proceedings of the wedding, though the service itself was near my workplace at St Pauls Cathedral.
It is noteworthy to point out that I had made some payments some years back on some EPF/ETF contributions based on an totally unfair assessment which insisted that I have a domestic on EPF when no one in Colombo does. Now having made all the payments and penalties, they are now hassling me for the same amount saying they have not received the same. We therefore have to go and dig out check stubs and obtain copies of the cheques from the banks in order to prove that the payments were made, as there must have been some form of misappropriation of funds at the department, which they are not able to get to the bottom of. If this is one incident, I dread to think how much money has been misappropriated by those responsible in safeguarding the workers contributions of the country’s citizenry.
The forthcoming Pensions Bill therefore will again be full of anomalies, where in the end the onus will be on the employee to prove their contributions, which is really a very impractical request. In this day and age of computers it should be a matter of just logging into the database to find out one’s contribution at any moment in time, with no problem.
Wednesday, May 4, 2011
When the cat is away the mice are fighting
I am both immobile as far as walking is concerned and without transport, so I have had to manage the two properties in Polonnaruwa by remote control and have had to face an untold amount of issues. I decided that as it was impossible to manage the staff to allow them to do the cultivation of paddy, that task was dropped and the land given to others to farm for a rent, usually payable in paddy.
Then I had to deal with one member of staff (in a drunken state) who had hit another in the adjoining property owned by my sister. I told the recipient of the blows to make a police report, as I was concerned there would be a repeat of the incident. The Minneriya Police refused to take the statement at first, as they are also resource constrained and each of these incidents have to be investigated. (This is an indication of the ground realities in Sri Lanka where there are so many disputes in villages of this nature and the Police are stretched in being able to investigate them, and so their initial inclination is to refuse to take on board any but the most grave incidents. My name had to be mentioned in order that they agree to take the statement. (Hand written in a large book – no computers yet in the SL Police)
When the investigating officers arrived the next day to speak to the accused, on my property he had evaded the Police, much to my annoyance as this causes further problems for me also. He was then asked to show at the Police the following morning where the accuser was also asked to be present, which he failed to attend, thereby mounting his and my problems.
This staff control and management has already been referred to on numorous occasions and I have yet to come up with suitable solutions to this perennial problem. Staff require ever increasing benefits, not reciprocated by reliable and conscientious performance. I believe the core of the dispute was also to do with one person being honest and the other deceitful, with the latter being shown up by lack of performance and the former unable to take the shame resorting to a lowdown brawl. Why not fire him you may ask, but replacements are also a rare commodity in such parts.
It is important to appreciate how difficult or impossible it is to manage an agricultural enterprise in Sri Lanka by remote control, and in order to effectively perform this productively one needs a much larger investment in Land and Manpower as well as a superior quality of the human capital.