It looks like his zeal to speak up for his voters can sometimes get the better of Pathanapuram MLA and film actor K B Ganesh Kumar.
What he thought was unpardonable behaviour on the part of doctors - operating on a woman and leaving the wound open - could have been perhaps the best treatment available given the conditions.
On March 13, while participating in a discussion on Public Health and Family Welfare in the Assembly, Ganesh Kumar placed before the House the shocking plight of a 48-year-old poor widow who was operated upon in Thiruvananthapuram Medical College.
"Her stomach has been cut open like a jackfruit, like a cupboard thrown open," Ganesh said, using vivid similes to paint the woman's painful condition. "Till now, it has not been stitched up. What science is this," he said, holding aloft his mobile that had the video of the wound.
Ganesh said the woman was referred to Thiruvananthapuram for expert care from Parippally Medical College December last.
Ganesh was outraged because the doctors in the Medical College did nothing to close her festering wound. "Why are they keeping it open? Can they not stitch it," he asked. Neither have they admitted her. "Now this poor woman is forced to travel in KSRTC buses with this open wound," he said.
In defence of violence
The MLA brought this to the attention of health minister Veena Vijayan who then called up the Medical College superintendent. Though the superintendent asked that the woman be admitted, Ganesh said the head of the General Surgery Department refused to admit her and purposefully went on leave. He even revealed the name of the doctor in the House.
"It cannot be blamed if such people are physically handled," he said. When Ganesh said this, there was a disturbing rise in incidents of violence against doctors and the Indian Medical Association (IMA) had called for a state-wide strike on March 17.
Kindest cut of all
Now, government surgeons have come out in defence of their colleagues in Thiruvananthapuram Medical College. According to them, the patient's history will reveal that the Medical College has virtually no role in her medical condition.
"The patient first came to the Medical College six months after she had done hysterectomy in a private hospital in Kollam in February 2022. In between she had undergone at least ten surgeries to remove the infection in her wound in various hospitals and none of these could cure her of her infection," said Dr Nirmal Bhaskar, the president of Kerala Government Medical College Teachers' Association (KGMCTA).
On March 13, inside the Assembly, Ganesh Kumar made it seem as if the second operation on the patient was done at the Thiruvananthapuram Medical College. Truth is, when she was operated on in the Medical College for the first time, it was the 11th operation on the wound.
Open wound treatment
Her wound was in a severe pus-filled condition when she first visited the Medical College. To understand the cause of this persistent infection, ultrasound scan, MRI and biopsy were carried out.
"When the puss in her wound was examined, the dangerous multidrug resistant Klebsiella pneumoniae was detected," Dr Bhaskar said. "In such a situation, the treatment options are very limited," he said.
Initially, the treatment plan was to remove the puss and to suture the wound. The infection resurfaced. The wound was then left temporarily open and stitched up a week later. Not only did this fail but the patient returned one-and-a-half months later in December with severe infection.
It was then that a surgery was done on her, the eleventh on the wound and the first to be done in the Medical College.
"After this it was decided to leave the wound open and adopt methods that would gradually let the wound heal. The plan was to clean the wound daily, apply medicines, bandage it and then, when the wound has healed satisfactorily, suture it up," Dr Rosenera Begum Beegum T, associate professor in the Department of Nuclear Medicine, Medical College Thiruvananthapuram.
Benefits of jackfruit cut
Dr Dayananda Babu, one of the leading general surgeons in Kerala and whose book on surgery is part of medical education, said the open wound treatment was an internationally accepted practice.
"She came to the Medical College after her sutures (of the uterus removal surgery) had come off. It was found that the patient had some trouble with healing. It could have been a lack of immunity or an inadequacy of proteins. We were unable to pinpoint the real problem. So this was an accepted treatment method. The wound will be stitched up when it becomes clean," Dr Babu said. "It is a scientifically sound method to not suture a contaminated wound," he said.
Dr Babu was both amused by and resentful of Ganesh's jackfruit simile. "It might have given the image of a wound from which intestines spilled out. It was not at all the case. The cut went down only up to the muscle level," Dr Babu said.
Home remedy
The patient was admitted to the Thiruvananthapuram Medical College for 12 days and then she was asked to go home. She was asked to clean the wound at a hospital near her home and to visit the Medical College every two weeks.
Doctors say she was sent home for three reasons. One, chances of hospital infection will be less. Two, higher chances of the patient getting better care and nourishment. Three, studies have shown that in comfortable conditions like in homes the chances of healing are high.
In fact, the wound had healed nearly satisfactorily when she visited the Medical College on March 4. She should have been admitted.
Admission conundrum
Ganesh Kumar said that the head of the General Surgery wing, Dr R C Sreekumar, refused to admit her despite the superintendent's order and went on leave.
Dr Sreekumar told Onmanorama that he was indeed on leave the day the woman came to the OP. "But this was a leave sanctioned at least a week ago. I was in Kozhikode for a meeting," he said.
"And why would I run away from a patient," he asked. "Daily 200-odd patients come to the OP and what makes me fear one of them. If at all I did not want to admit her, I could have easily asked the post graduate doctors in charge to ask her to come a week later," he said.
Since the woman posed a baffling medical conundrum, and was therefore a priority patient, the PG in charge called Dr Sreekumar when she arrived at the OP. "I was told she was fit for admission as her wound had healed nicely. I told the PG to admit her," he said.
Dr Sreekumar said the patient refused to get admitted as she was not given the ward of her choice. "We had always kept her in the eighth ward, an AC ward, to insulate her from infections. But usually, no patient is admitted directly to this ward. So on that day, the PG told her that she will have to first get admitted in a common ward without an AC as there was no vacant bed in ward 8. She was not willing. This perhaps might have caused some confusion," Dr Sreekumar said.
Private vs Government
The patient is now in Aster Medcity, one of the top multispeciality hospitals in Kerala, taken there by Ganesh Kumar.
Dr Binoy S of Thiruvananthapuram Medical College said this would send the wrong signal. "It can create the false impression among the public that complicated treatments are available only in rich private hospitals and not government hospitals," he said, and added: "The Medical College has given the patient the best medical care available. Even in Aster Medcity, they will have to wait till the wound is healed."
Nonetheless, Ganesh Kumar continues to be bitter. "What kind of science allows a festering wound to be kept open. I don't understand them," he told Onmanorama. "These government doctors have parallel practices in private hospitals. They attempt to pull these poor patients to these private hospitals. I will expose all of them," he said.
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