The Defaulter

The Defaulter

Dharamnath (Name has been changed), came to visit us on the first day of our sangwari clinic at Biniya in Lakhanpur block of Surguja district, Chhattisgarh. He had heard that few new doctors have come to his nearby village and so he thought to consult for his non reliving symptoms since last 4 years. He hadvisited several clinics and hospitals till now and on the basis of X-ray, he was told repeatedly that he have Tuberculosis infection in his both lungs, popularly known as TB. He sincerely completed his first anti-TB treatment (ATT) for extended 1 year, which used to be 6 months in usual cases. But when he was again prescribed same ATT for the same symptoms that were not reliving he stopped them on his own in frustration, and received the label as Defaulter in his every case records.

When Dharamnath was asked what was troubling him, he remained silenced for few seconds and then said that he is coughing out blood in his sputum and also has some breathlessness. The person accompanying him quickly interrupted and said “sir, he has TB and he is a Defaulter”. After quick history and examination his both lungs revealed bubbling sounds which can be heard in an active TB patient. My colleague was saddened by his conditions and questioned him repeatedly why he left the medicines. He didn’t say a word. That day he was referred to a nearby facility for examining his sputum and chest X-ray.

Though Dharamnath realised that he was following the same course of orders and again likely to be prescribed same medicines, something propelled him to do the same investigations. His sputum revealed nothing and he had to pay 3 visits to that facility to have X-ray done.  Someone again labelled him as Sputum Negative butX ray positive TB. Dharamnath didn’t come to next clinic; probably he knew the further formalities.

My colleague, search for his phone number, which found again in defaulter patients list; called him and requested to come to visits next clinic once. He had also called the lab technician in that hospital and came to know that his sputum was negative for TB; multiple question marks could be seen on everyone’s face. On the next clinic he was waiting and asking others did anybody call him to remind. Fortunately Dharamnath has come with the long waited and troubled x-ray.

My colleague saw his x-ray against the light and was stunned. He gave frequent looks towards x-ray in disbelief, moving the x-ray against different backgrounds. Now he had realised something terrible.There was no any tress of TB on his X-ray. He ran towards the patient,made him lie and auscultate his chest several times at several positions. Checked his Pulse again and again and finally dropped his head in disgust. “We were about to do a crime”, he said.

Dharamnath actually had Rheumatic heart disease, a disease in which the Valves, like doors of the heart chambers, were damaged. They were not only stenosis but also leaking blood into another chamber of the heart. Because his condition was not diagnosed earlier, his heart has swollen and deformed. All these assaults on the heart have disturbed the regular ‘lub-dub’ rhythm to irregular chaotic rhythm. This is a serious condition in which he is prone to develop paralysis and death anytime even at that moment. He is unknowingly carrying this threat for death since last 4 years! Without any damn medication!!

Dharamnath was suffering from palpitations day and night. He had episodes of waking up in the middle of night due to breathlessness.He has given up his job as he could not even walk few steps on his own leave away working in a farm. When he was asked why he did not tell his true complaints earlier, he said, “After seeing my records everyone just told me,that I have TB only and these symptoms are not so important”. How can we label a person just from his records forever? We realised our mistake and remembered the old lesson again-‘always believe on what patient says’. The moment we breathed a sigh of relief that we saved him taking again useless medicines, we found ourselves in a bigger mess. How and where do we going to send him for heart sonography to confirm the diagnosis? Will he be able to pay for such a costly investigation? If the diagnosis is correct, we need to put him on anticoagulation- a medicine that keep your blood thin but simultaneously increases the risk of bleeding. What if he starts bleeding here in a deep jungle and difficult roads? Will the ambulance reach in time? Where will he have a regular blood check-up? It cannot be too far from him. Where will we send him for operation to change his valves? Will there be long waiting time? Will his smart card work over there? Will someone do his surgery for free, as he can’t only pay for such an expensive surgery?Will his replaced valves be Metallic or Bio prosthetic? If metallic, he will be on anticoagulants for his whole life. Will he then be able to do his work? Will he be able to at least live few more years without suffering? All these questions have baffled us. Dharamnath is seeing us with hope that someone has caught his illness and now he will be cured. How we are going to explain him prognosis? And tell him his poverty is worsening illness.