Dr. Rajiv's Crusade of Decade 1992 - 2012

Strategies to Prevent Hypoxic Ishchemic Encephalopathy

(Delivery related oxygen lack to the brain which causes the baby to be mentally and physically handicapped)

Dr. Rajiv had identified the most important problem confronting an unborn baby was its potential risk of getting sub optimal oxygen via the placenta and getting brain damaged during labour. This was the ultimate misfortune, which could befall a family whose golden dreams of their offspring are shattered due to this potentially preventable problem. It is sad to state that up to 60% of admissions to any newborn ICU would have an element of labour related brain damage. Dr. Rajiv analyzed the complexity of this problem and launched a multi pronged attack with a five year feed back strategy on the various programmes being implemented.

Programmes and Strategies

Maternal Literacy Pertaining to Pregnancy Care:

Strategic Use of Media
Use of media (Asianet Pulse, Vanitha etc.,) to highlight to the pregnant woman the various pit falls and warning signals of a complicated labour and delivery. The use of Cardio Toco Graphic (CTG) monitoring, biophysical profile by ultra sound and Doppler flow studies of the placenta can easily predict oxygenation lack during delivery and give warning signals to have early intervention done before brain damage occurs. The media hype and the maternal awareness created encouraged even small nursing homes to use CTG monitoring in labour. Currently CTG monitoring is widely used making the future of the unborn baby's brain safe in Kerala. This simple low cost strategy of maternal literacy pertaining to newborn care has paid wide dividends to the pregnant population of Kerala.

High-risk concept for mother and baby:
Dr. Rajiv by conducting various conferences and interaction with the government was able to convince the medical fraternity on transfer of high risk mother to a good center using the caption. Mother is the best transport incubator.

The babies who evidenced problems at birth were given objective criteria for early referral to an advanced center.

Training of all personal including the nursing staff dealing with maternity on the use of AMBU BAG which can effectively give artificial respiration even at the most primary level of health care in Kerala. (FIRST BREATH CONCEPT)

Giving suggestions to Government of Kerala on upgrading district hospitals to level II capabilities and medical college to level III capabilities (Ventilatory care)

Recommendation to Government of Kerala to incorporate newborn intensive care in the MBBS curriculum and all doctors who have passed out to have 3 months posting in the primary health center. These doctors would in turn trained all paramedical staff on the first breath and high risk concept.

Dr. Rajiv has used his technological ability to carry his department to the national level but has also been a social scientist helping the grass root medical care and the government to improve the basic care given to a pregnant woman and newborn baby. The impact of these programmes has helped reduce infant mortality rate by a factor of at least one per 1000.