Standard format:
A 25-year-old man working as a hotel waiter, was admitted to the specialist hospital, Bharatpur, Nepal with the chief complaints of abdominal distension since the last 3 years.
On examination he was cachectic, had a prominent scalp infection and also had mild icterus. There were prominent veins over his abdomen with a loud umbilical venous hum. He had a haemoglobin of 5g/dL,a total leucocyte count of 1800 and markedly reduced platelets on smear suggestive of hypersplenism. His serum bilirubin was 3.6mg/dL with an unconjugated fraction of 2.4mg/dL,serum albumin was 2.1g/dL and globulins were raised at 4.5g/dL.His HBSAg (Virutex/latex),Anti-HCV(dot blot Assay) and HIV(ELISA) were all negative. Ultrasound abdomen showed an irregular liver surface with portal vein measuring 14mm apart from free fluid.
Morphologic diagnosis: Cirrhosis of liver
Etiologic diagnosis: Long term Alcohol injury to liver

Exploring personal and social background:

He was a regular drinker by the age of twelve. His mother abandoned him and ran away with another man when he was 6 years old From the age of 12 he was forced to work as a daily wage earner by his father. He was employed in a factory manufacturing country liquor where he had easy access to drink. Since then he started drinking 250 ml of spirits daily and would occasionally consume 2 bottles of 750ml each. At the age of 21, he had an episode of massive hematemesis and malaena for which he received 6 units of blood transfusion. Soon after hospital discharge he continued drinking for another year until he was readmitted to the same Hospital with ascites. He has undergone repeated paracentesis ever since. He also had an umbilical hernia due to ascites that burst spontaneously and was subsequently managed with regular Betadine dressings. He has been living in the Hospital (officially as an out patient) since 3 years depending on the Hospital for his food, shelter and intermittent paracentesis.
Discussion: This patient highlights the social problems posing substantial challenges to health care in the third World. Child labour was forced upon our index patient at an early age and he also took up alcohol early because of easy access to liquor. Inspite of legislative enactments prohibiting employment of children below the age of 14 years(section14;Civil rights act,2012,Nepal),the 1981 census,Nepal, showed that 4.5million or 60%of the child population in 10 to14 age group of Nepal is economically active.(ref 3:UNICEF1992).
Our present focus for analysis would be on social supports prior to and after development of chronic disease. In this example social support perhaps had a major role to play in development of disease (which we aren’t really expecting in most of the chronic diseases we plan to study here but may discover interesting linkages). After the patient developed cirrhosis and chronic liver cell failure (at a very young age) he managed to survive perhaps due to the social support extended by hospital authorities as he was completely cut off from his biological relatives.