NJH Annual Report 2011-12

FROM THE SENIOR ADMINISTRATIVE OFFICER

2011-12 was the Golden Jubilee year of the hospital. After a 3 year long drought we were blessed with heavy rains. And towards the fag end of the year, we were blessed to be empanelled under the Rashtriya Swasthya Bima Yojana of the Government of India, which we expect to go a long way in furthering our core value of focus on the poor and marginalized.

Although, we continue to lack a stable unit of doctors especially specialists, there has been a steady rise in the number of patients accessing our facilities.

The highlight of the year was the Golden Jubilee celebrations which extended for almost a week. We were blessed by the presence of Dr Mark Kniss, the founder of the unit as well as Rev. Paul Kniss, the pioneer missionary to this region.

The Burns Unit construction was started and is expected to be completed by October 2012.

In addition to the RSBY, the co-operation with the government continues through the Tuberculosis Unit under the Revised National Tuberculosis Program. The hospital continues to remain committed to implement the Mukhya Mantri Janani Suraksha Yojana as well to be an Integrated Counselling and Testing Centre facility under the Jharkhand Aids Control Society. The Global Fund Programme for Tuberculosis continues to do yeoman service to Tuberculosis Control in the district. Since August 2011, we are actively participating in the Institutional Maternal Death Review facilitated through UNICEF.

The networking with various mission organizations and churches including Catholic Church dispensaries, Gospel Echoing Missionary Society and the Calvary Gospel Mission.

As we look ahead, consultants, especially in the specialties of Medicine and Paediatrics is a dire need. The poverty, remoteness and lack of basic infrastructure like electricity and transport begs for external funding to sustain our smooth functioning. A fully fledged blood bank is a dire need of the region.

We continue to value and cherish the support received from the functionaries of the government especially the Civil Surgeons of Palamu and Latehar, Dr Gopal Srivastava and Dr Aaron Tigga respectively, members of the Unit Management Committee, and the Central Office of EHA

All glory, honor and praises to Jesus Christ, the King of kings and the Lord of lords.

 CLINICAL SERVICES

The reporting year has been very busy in spite of almost 2 months lost to general strikes and non-availability of a specialist team. In addition to patients from the districts of Palamu, Latehar and Garhwa, we also recieved patients from other districts of Jharkhand as well as Bihar, Madhya Pradesh, Chattisgarh and Uttar Pradesh. The followng are compilation of statistics over the last 3 months. 

Departments	Year	2009-10	2010-11	2011-12
General	New Patients	5598	5482	6188
	Repeat Patients	5757	6896	8134
Eye	New Patients	2628	2479	2617
	Repeat Patients	3054	2724	2681
ANC	New Patient	665	1068	1282
	Repeat Patient	739	822	1347
Dental	New Patients	186	286	437
	Repeat Patients	336	322	443
Others	New Patients	0	547	638
	Repeat Patients	0	547	606
Inpatients	Admissions	4812	5037	4510
General Surgeries	Gen Major	91	72	101
	Gen Minor	270	326	375
	Tubectomy	368	242	152
Eye surgeries	Ophthalmic Major	703	605	543
	Ophthalmic Minor	55	78	58
Laboratory	Clinical Pathology	40491	32357	35702
	Biochemistry	5805	4813	5818
	Micro Biology	1406	20	155
	Serology	6909	6508	4275
	Others	936	1422	1660
Radiodiagnosis	X-ray	1702	1698	2215
	Ultrasound	1517	1274	1446
	ECG	278	59	241
Obstetrics	Deliveries	1040	1294	1374
	LSCS	313	363	429

OPHTHALMOLOGICAL SERVICES

CBM SARO (N) and CBM Germany continued their generous support and encouragement which enabled us to maintain regular eye services. Major challenges in the form of bandhs (general strikes), poor communication facilities including poor road-conditions brought about a fall in the statistics of eye OPD as well surgeries. One major development which looks to be encouraging for ophthalmic services is the enrollment of the hospital under RSBY. We have been able to maintain 100% IOL surgeries and SICS for all cataract surgeries.

Dr. Pradhan`s absence on leave from the hospital  as a family for  48 days in the season for his only  daughter`s wedding affectd the eye work to a certain extent.

Ophthalmic services – Overview 2009-2012

	2009-10	2010-11	2011-12
Eye OPD patients	5682	5203	5298
Total refraction done	927	952	971
Cataract patients seen	2905	1861	1892
Glaucoma	114	173	176
Vitamin A deficiency	126	106	109
Others	2443	2111	2150
Ophthalmic Surgery
Major surgery (All IOLs)	720	605	543
Minor surgery	52	78	58
Total surgery	772	683	601

THE FUTURE – 

1.  800 cataract surgeries and 6000 outpatients in the next reporting year. 

2.  Open a spectacle shop within the hospital. 

3.  Network with the government to enable Sahiyas to screen causes of visual disability and refer for appropriate treatment/surgery.

4.  Further training for Dr Srijit Pradhan in Phacoemulsification. 

5.  Multipurpose training of all the staff. 

6.  Ophthalmic technician training course in the unit.

I would like to place on record the Officers from CBM SARO (N) for their kind help and understanding. We are also very grateful to the families of Mrs. Betty Goodwin and Mrs. Ivy Kerr, Cambray Baptist Church, Cheltenham, UK for facilitating the purchase of the Non-Contact Tonometer. We are also grateful to Dr. Santosh Mathew, Executive Director, EHA . Certainly I would also like to thank Dr. Sydney Thyle (Ophthalmic coordinator EHA) for his patience, tolerance and guidance.  

GENERAL SURGERY AND BURNS UNIT

- Emergency surgeries including complicated obstetrics comprise the major chunk of work.

- Initiation of the construction of the Burns Unit has been a major development the last year.

- Need to bring in laparoscopic surgery into the unit at some point of time.

- We expect the surgical services to become busier after the full fledged functioning of the Burns Unit. In addition to 2 nurse anesthetists, we’ve sent a third nurse for the Nurse Anesthetist course. We seriously explore the possibility of having one more Surgeon.

MATERNAL AND CHILD HEALTH

The maternal and health care of the unit continues to progress well in spite of the absence of consultants in obstetrics and pediatrics. The highlight of the year has been the operationalisation of the Newborn Intensive Care Unit under the leadership of Sr. Wendy Cowles along with Dr Johnson. 6 nurses were specially identified and trained. 2 of the nurses completed RCH training at Herbertpur.

The empanellment of the hospital under the RSBY program will bring more patients. We explore the possibility of expanding our labour room facilities to accomodate at least 5 delivery cots. Unfortunately, the de-empanellment of the hospital from the Mukhya Mantri Janani Suraksha Yojana has been a discouragement. 

Obstetric Data	2010-11	2011-12
Total deliveries	1293	1374
Normal Vaginal Deliveries	810	789
LSCS	363	429
Breech	36	41
Vacuum	28	32
Forceps	9	30
Craniotomy	15	6
Rupture Uterus	17	19
Twins	15	24

LABORATORY SERVICES 

The major development of the year are as follows –

-          Introduction of HbA1C and CRP

-          Analysis of CSF

-          Mr. Immanuel Rathod attended workshop for technicians at Raxual

Future plans would be

-          Facilities for Coomb’s test, in view of the increase in Ante-Natal Care statistics

-          Blood bank facilities are a crying need for this region.

 

RADIODIAGNOSIS SERVICES

The Ultrasound diagnosis services are being ably handled by Dr Shishir Jojo and we sent him for a certificate course. We plan to send one more doctor for the certificate course next year. Mr John Jeyachandran continues as X-Ray technician. Digital imaging of X-Rays is something we are exploring as we develop.  

TUBERCULOSIS UNIT

The Tuberculosis Unit which is one of the first of its kind under the Public Private Partnership of the Revised National Tuberculosis Control Programme continues to provide credible services to the region. We acknowledge the inputs provided by the District Tuberculosis Officer, Dr Anand Kumar and his staff.

NJH has played a pivotal role in the control and treatment of tuberculosis in the region of Palamu district since the year 2000. Initially the hospital provided DOTS facilities with external financial support (T.B ALERT U.K) and later was recognized as a Designated microscopy center(DMC) under Revised National Tuberculosis Control Programme (RNTCP) in 2003. Later the DMC was upgraded into a Tuberculosis Unit (T.U) under RNTCP in 2006 catering to a population of five lakhs and supervises the functioning of microscopic centers (DMC) in Panki, Patan, Lesliganj , Manatu and Satbarwa blocks. The present target population of the TU is almost 650,000.

The statistics over the last three years are given below – 

	2009	2010	2011
No. of patient suspected to have T.B.	2734	2785	3062
Total Sputum Positive Patients	489	428	472
Registered patients	822	771	813
Success rate of new smear positive patient	95.2%	94.5%	91%

All the staff of the TU was trained for implementation of DOTS Plus during the year. We look forward for the empanelment of the hospital for Integrated Counseling and Testing Centre under the Jharkhand State Aids Control Society. The GF TB R 9 project continues to provide synergistic support for the Tuberculosis Unit.

  

DENTAL SERVICES

The dental services which were started by Dr Mimi were restarted after Dr Aji Mathew was posted to NJH. With a vision to provide services in the neglected area of mouth care to the poorest of the poor in the region – we have been able to provide wide range of service and quality care in affordable prices. The following ranges of services are available –

1. Preventive and Conservative Services

1. GIC, MIRM, Light Cure Restorations
2. Root Canal Treatment for Anteriors and Posteriors
3. Apicoectomy, episectomy
4. Scaling

2. Cosmetic and Prosthetic Services
1.  Veneering of anterior teeth, crowns and bridges
2. Complete denture and removable partial denture
3. Denture rebasing and relining
3. Oral Surgical Procedures
1. Tooth extraction
2. Surgical extraction
3. Flap surgeries for periodontal instrumentation

ADMINISTRATION

The following staff joined the institution during the reporting period (April 2011-March 2012). We sincerely hope that their period of service through NJH would bring glory to the Lord. 

First Name	Designation
Mrs. Pramila Devi	General Worker
Mr. Suresh Rajak	General Worker
Mrs. J Chandrakala	Staff Nurse
Mrs. Sushma Lakra	General Worker
Mr. Malaya Kumar Deep	RSBY Coordinator
Mrs. Deepti Jose	Staff Nurse
Ms. Shazia Parween	Project Officer
Dr. Angeline M  Zachariah	Medical Officer
Ms. Birsi Orain	ANM
Ms. Kusumlata Ekka	ANM
Dr. Titus Raju	Jr Medical Officer
Mr. Selvin N	Staff Nurse
Mr. Mohendra	General Worker
Ms. Poonam Tigga	ANM
Ms. Anjlina Minz	ANM
Ms. Vibha Rani Lakra	ANM
Mr. Pratap Ekka	Jr. Manager

We are thankful to the staff who have moved on from NJH as part of their job description as well as to places where the Lord has called them.  

 

Name	Designation
Mr. Paresh Gaikwad	Clerk
Mrs. Shabnam Barjo	ANM
Dr. Nelen Ranjana Aind	Medical Officer
Mr. Susovit Sagar	Project Officer
Mr. Satyaprakash Mishra	Community coordinator
Ms. Jissa Sara Jose	Staff Nurse
Mrs. Nean Ekka	ANM
Mrs. Martha Tigga	ANM
Dr. Mitali Soren	Jr Medical Officer
Mr. Anup Prakash Minz	Multipurpose Worker
Mr. Samuel Dhiraj	Community coordinator
Mr. Sunil Minz	Multipurpose Worker
Ms. Vanlalmuani	Administrator
Ms. Kresencia Ekka	ANM
Ms. Anita Tirkey	ANM
Mrs. Rumul Kerketta	GNM

 Special mention of gratitude to Sr. Martha Tigga and Sr. Nean Ekka who retired last year. 

Sr. Martha Tigga

Sr. Nean Ekka

 

The following staff underwent various courses aimed at skill and spiritual development - 

Name	Details of T/D
Mr. Anil Nand	Mission Update Conference, Dehradun
Sr. Kresencia
Sr. Namyani
Dr. Chongtham Nandamani	Secondary Hospital Training, Vellore
	National Burns Conference (NABICON 2012
Dr. Titus Raju	Medicine CME Training, Herbertpur
Dr. Shishir K O Jojo	Ultrasound Training, Delhi
Dr. Jeevan Kuruvilla	Burns Training, Bangladesh
Dr. Immanuel Rathod	Laboratory Update Training, Raxaul
Dr. Rita Pradhan	Nursing workshop,Tezpur
Sr. Bharati Mohapatra
Sr. Vanlalmuani	Costing workshop, Chhatarpur
Sr. Mejhras Minz
Sr. Abha Kujur	Reproductive Child Health Training, Herbertpur
Sr. Pratima Tirkey (Jr)
MsVanlalmuani	Finance workshop, Herbertpur
Mr. Mejhras Minz	Finance workshop, Herbertpur
Dr. Johnson C Bage	Counselling Training(Shalom), Delhi MO-TC Training, Ranchi
Sr. S. Nand	Effective Teaching and Student Learning, Indore
Sr. Alice Kaschap
Mr. Arvind Tirkey	Sustainable Agriculture, Allahabad
Mr. Prabodh Kujur	Community Health themes -          Disaster Risk Reduction -          Advocacy
Rev. Ramji Mehta
Anurag Bhengra
Arvind Tirkey
Shazia Parween
Dr. Titus Raju	CME in Internal Medicine
Sr. Silwanti	Emergency Obstetric Care, Herbertpur
Sr. Pratima Tirkey

Other major requirements are–

1. Separate office space for administration.
2. The attendance marking system is manual at the point and so many a times we observe manipulation in marking attendance which also affects the leave compensation of the employees. Therefore we also need a better system for attendance marking and leave management, like a biometric attendance marking unit.
3. Unique identification system has been put into place. However, we need a human resource management system (HRMS) to streamline the details and data.

NURSING SCHOOL

The school of nursing runs one and half years (18 months) ANM course. Prior to the new intake, a pre Nursing Course is held for 10 days. This introduces the students to an over view of nursing including a three day Spiritual retreat. MIBE has its internship for six months. 

 

During the reporting year, there was 100% pass percentage in both first year and second year.

The following were the highlights of the year –

-      1. After quite a long duration, Jharkhand State Nurses Council Inspection was done inspectors were from Ranchi RIMS and health ministry personnel .

-       2. The external and internal evaluation of the Nursing School was done.

-       3. 3 day Spiritual Retreat led Rev. Prakash George

-       4. World Aid’s Day was celebrated in the hospital on December 5, 2011

     5. Sr. Alice went as external examiner to Holy Family Hospital, Patna and Sr. Rita Pradhan went for inspection at Nuagaon and St. Thomas Hospital, Balasore, Orissa

-     6. 37^th Graduation and 39^th Capping &lamp lighting ceremony was held on 10^th Feb `12’ the chief guest was Mrs. Elisaba Dhan from Ranchi.

o    The following students were honored during this occasion.

§  MIBE Topper in NJH in first year  Ms. Madhu Kujur (2010-2011)

§  MIBE Topper in NJH in second  year  Ms. Roshan Gidh (2011-2012)

§  PTS Topper Ms. Reema Tigga (2012)

Requirements –

·         Inproved space and facilities in the students hostel.

·         School bus for the nursing school.

·         Explore the possibility of starting GNM programme.

We acknowledge the financial sponsorship given to one student each from Duncan Hospital, Raxaul; Compassion Institute from Gangopada  and Mennonite Church Chandawa.                                                                           

We are very thankful to our Executive Director, Dr Santosh Mathew; previous regional director Mrs. Margaret Kurian and present Regional director Mr. P Jayakumar, Nursing Co-ordinator – Eastern Regon, Sr. Manjula Deenam; Registrar, Jharkhand Nursing Council, Lakhiya Lakra; SAO/MS of NJH, Faculty for their hard work , Nursing Superintendent NJH, staffs , well wishers from far and near  who had supported us with your helpful hands ,prayer and guidance .

Last but not the least we thank our God Almighty who has led us throughout the last year.

Sr. Rita Pradhan, Principal

COMMUNITY HEALTH AND DEVELOPMENT

The Community Health and Development initiative was supported till September 2011 by Simavi, Netherlands and March 2012 by Tearfund UK. We acknowledge the support provided by Sampurn Development India in facilitating bore-wells and hand-pumps in the surrounding villages.

Main Goals:

A. Improve the health status of women and children in Satbarwa block of Palamau district, Jharkhand.

B. Major disease burden of the communities are reduced equitably, through their participation and at a cost that they can afford.

C. Communities prosper economically, demonstrating good stewardship of their available resources, living in a safe and healthy environment, constantly learning, demonstrating mutual trust, co-operation and caring attitudes towards other communities.

 Major Activities done:

·         Capacity building of the Community Based Organisationss, Panchayat Raj Institutions, Accredited Social Health Activist (ASHA/Sahiya), School Students, health volunteers.

·         Training for the Auxiliary Nurses and Midwives and Anganwadi workers of the Public Health care systems of the government.

·         Promotion of institutional deliveries through street plays. (Nukad Natak)

·         Fixing of posters and display boards on Reproductive and Child Health

·         Installation of bore-wells and hand pumps in the surrounding villages.

·         Promotion of Rashtriya Swasthya Bima Yojna.

·         Identification of disabled in the communities.

Outcomes of the project:

Ø  43% increase in the institutional deliveries in the block.

Ø  28% pregnant women accessed quality antenatal care during the year.

Ø  Infant Mortality Rate has been reduced to 7.5%

Ø  Increased in the number of eligible couples who adopted different family planning methods

Ø  Level of knowledge of the community has been enhanced on malaria, diarrhea, HIV/AIDS & TB

Ø  People taking benefits of govt. schemes e.g. JSY, RSBY, Indra Awas etc.

Major impacts of the project on the communities:

      PRIs, CBOs and ASHAs have started to take lead roles in development initiatives.

      Awareness initiatives have helped communities to participate in the welfare schemes

      The SHGs taking up different IGPs have helped them to improve their financial concerns

      Net working with government has provided opportunities in development programmes

GFRB R-9 PROJECT (Project Axshaya) - PALAMU DISTRICT

Goal: To decrease morbidity and mortality due to drug resistant TB (DR-TB) in India and improve access to quality TB care and control services through enhanced civil society participation.

Networking

        Akhil Bhartiya Sarvodaya Mandal- Lesliganj & manatu blocks.

        Calvary Gospel Mission –Panki block.

        Gospel Echoing Missionary Society - Patan, Chhatarpur, Husainabad, Mohmmedganj blocks.

        Samaj Vikas Samithy - Working in Chainpur block.

Activities & Achievements:-

District Level (Palamu District):

·           57 RHCPs(Rural Health Care Providers) have been trained.

·           Soft skill training for - 189 Govt. health staff were trained.

·           20 members from various Community Based Organization were trained as peer educators for create awareness on TB and mobilizing the community.

·           BCC training – 27 members from different community groups were trained to use Inter Personal Communication tool on TB.

·           TB forum has been established at the district level. 

·           Quarterly follow up meeting of RHCP, CBO, ICTC & DMC staffs & TB forum with DTO.

·           Observation of World TB Day at district and block level.

Community Level:

·           307 community meeting (through Gaon kalyan Samittee, CBOs, VHCs, SHGs)  done by the NGOs where 4725 members took active participation.

·           Mid Media Activity – Total 47 awareness programme through skit/film show.

·           Sputum collection of 513 patients (1026 samples collected and transported) for testing. 84 patients of the 513 tested AFB positive and started on DOTS.

·           Retracing defaulter - Total 25 defaulters were retraced by the NGOs and they were again put in the DOTS.

MAINTENANCE

The year 2011-12 was a very busy year for the Maintenance Department. The major projects which were completed or initiated are the following.

1.       Streamlining of power suppy –

a.       Underground wiring

b.      Power distribution panels

c.       Earthing work

d.      Stabilizers and Power back up at various departments in the hospital

2.       Energy conservation initiative –

a.       Change of conventional filament bulbs to energy saving LED bulbs and tubelights

b.      Street-lights installation

c.       Change of wiring of selected buildings

3.       Construction/Maintenance of buildings –

a.       Started burn unit construction

b.      Renovation of outpatient department

c.       Purchase of Fire Fighting Equipment

d.      New toilets constructed.

e.      Purchase of brick machine

4.       Campus maintenance –

a.       Tree planting initiated

b.      Fish cultivation

c.       Pruning of trees in campus

d.      Cleaning of septic tanks

Maintenance of the extensive areas in the campus is a major challenge. Most of the residential areas are quite old and in a dilapidated state. The major requirements for the new year will be funds for

a.       Boundary wall construction

b.      New residences

 -    Water harvesting

c.       Shrub removal machines

VISITORS

We would like to thank the following organizations/individuals who helped us to facilitate services to the poor

1. Tearfund UK
2. Simavi Netherlands
3. Christoffel Blinden Mission
4. EHA, USA
5. EMMS International
6. Families of Mrs. Betty Goodwin and Mrs. Ivy Kerr, Cambray Baptist Church, Cheltenham, UK
7. Dr Colin Binks, Cheltenham, UK
8. Dr Roy Kuruvilla, Consultant Orthopedician, Saudi Arabia
9. Dr Heinrich Stolbrick, Consultant Physician, Germany
10. Dr Mark Kniss, US
11. Sr. Wendy and Mr. Jerry, Maine, US
12. Mrs. Juliet, UK
13. Dr Elizabeth George, US
14. Varghese Mathew, Pullad, Tiruvalla, Kerala
15. James Kuruvilla, Singapore
16. Mrs. Margaret Oliver, Cambray Baptist Church, Bristol
17. St. Francis Church, Westborough, Guildford, UK
18. St. Clare’s Church, Park Barn, Guildford, UK
19. Castle Square United Reformed Church, Treforest, UK
20. St. Mary’s Church, Ash Vale, UK
21. Putson Baptist Church, Hereford, UK
22. Fishponds Baptist Church, Bristol, UK
23. State Bank of India, Daltonganj
24. St. Thomas Marthoma Church, Kolkota

 CAPITAL REQUIREMENTS

S. Nos	Category of Capital Item	Total Amount
1	Building – Residences 27000 square feet	27000000 (54%)
2	Building – Renovation of residences 15000 square feet	7500000 (15%)
3	Building – New OPD Building – 6700 square feet	6700000 (13%)
4	Office Equipment – new computers and new HIS	1000000 (2%)
5	Water Supply – change of supply conduits	200000 (<1%)
6	School bus	1200000 (2%)
7	Four wheeler	700000 (1%)
8	Generators (100 KV & 30 KV)	1000000 (2%)
9	Nursing School Upgradation including Hostel	5000000 (10%)
	Total	50300000 (100%)

 VISITORS

We are quite grateful to the following visitors to NJH who encouraged us as well as gave valuable input into our work here.

1. Mr Hari Krishna, Honorable Member of Legislative Assembly, Manika Assembly Constituency
2. Dr. Gopal Shrivastava, Civil Surgeon, Palamu District
3. Dr Awadesh Singh, MCH Officer, Palamu District
4. Dr Anand Kumar, District TB Officer, Palamu District
5. Dr Barwar, MOHFW, Jharkhand State
6. Mrs Ullasi Lakra, Comptroller of Examinations, Jharkhand Nursing Council
7. Mrs Prabha Dey, College of Nursing, RIMS
8. Dr Mark Kniss
9. Rev Paul Kniss
10. Dr Vikram Tirkey, EMFI
11. Fr. Christu Das, SIGN, Ranchi
12. Fr. Regi Cyriac, Samaj Vikas Sanstha,  Chandwa
13. Sr. Augustina, Co-ordinator, Catholic Health Centres, Daltonganj Diocese
14. Dr Ronald Hiles, FRCS, OBE, Plastic Surgeon, UK
15. Wendy and Gerald Cowles, Grace Babies, USA
16. Mr. Victor Immanuel, Central Office, EHA
17. Ms Esther Ghosh, GFTB, Central Office, EHA
18. Dr Ashok Chacko, Regional Director, Central Office, EHA
19. Mrs. Margaret Kurian, Regional Director, Central Office, EHA
20. Mr. P Jayakumar, Regional Director, Central Office, EHA
21. Dr Uttam Mohapatra,  Regional Director, Central Office, EHA
22. Dr Santosh Mathew, Exective Director, EHA 
23. Dr Anil Cherian, Central Office, EHA
24. Dr Sunil Gokavi, Regional Director, Central Office, EHA
25. Me. E Vijayabhaskar, Central Office, EHA
26. Dr Sam David, Central Office, EHA – Chennai Office
27. Dr Philip Fenny, Duncan Hospital, Raxual
28. Dr Sam Thomas and Sr. Shashi Thomas, Dehra Dun
29. Dr Kenny David, Christian Medical College, Vellore
30. Mr. Vinay John, Director, Nursing Education, Chattarpur
31. Mr. Shailendra Ghosh, Principal, Nursing School, Herbertpur
32. Dr Jeff Mathias, Consultant, Climate Change and Disaster Risk Reduction, EHA
33. Mr. Thomas John, Program Manager, Climate Change and Disaster Risk Reduction, EHA
34. Ms. Doerthe Stolbrink and Ms Manuela Loux, Germany
35. Ms RuthAnn Fastone, Interburns
36. Mrs. Juliet Herd, UK
37. Dr Mathew George, Duncan Hospital, Raxaul
38. Mr. Ravee, Duncan Hospital, Raxaul
39. Dr Vijila Isac, Premjyothi Hospital, Barharwa
40. Dr Singson, Utraula