Fryums . . .

If you are not an Indian, you would not know much about what this post is about. Fryums is basically a cereal (flour and corn starch) based 'ready to fry' pellets. It is quite a popular snack in many a Indian homes. I remember having it in the evening after coming back from school. 

It was very much recently that I was re-exposed to this snack. And of course, our kids took a great liking to it. Today, I had gone to the market and at the usual shop where we buy this item, there was quite a large varieties to offer. 

I could only buy 5 of the umpteen varieties. Below is a snap of a plate of the snack. I'm not sure about how healthy they are. But, I tell you, it's a great relief to have this occasionally to cheer up the kids. 

Below are snaps I tried to take with my cell phone in the grocery shop. 

WARNING: I do not know the nutritious value of this snack. I am also not sure about any possible harm that can be caused by the regular intake of such snacks. I could not find any information about the above two aspects anywhere.

Pl(e)astic Surgery . . .

Since last Monday, we've been having quite a lot of surgeries going on as Dr. Nandamani is here. And with Dr. Ron Hiles also being with us, we had lot of people coming down for plastic surgeries. 

In addition to the routine contractures following burns or accidents, another group of patients were those with small areas of discolouration of skin or small scars who wanted a change for the normal. Quite interesting, since our area is quite an impoverished area with almost a majority of population with hardly any proper access for basic healthcare. 

Couple of the cases. There was a young man with a small scar in the face. He was of the opinion that he was not getting good marriage proposals because of the scar. I thought that the scar gave him quite a macho look. 

There was another young man who had a scar below his lip which he thought was spoiling his looks. He started to quote surgeries and procedures done on some Bollywood stars which helped them look better . . . and how they got a break into doing some special films . . . etc. etc.

There were 3 cases of tattoos where the patient realised that the choice of the tattoo was not a great one . . . and the patients wished that they had not done it. I found out that one of the best ways to remove a tattoo was to rub salt on it and put a dressing over it after the skin had become raw. 

Then, there were cases like that was a young boy who had a very bad keloid after a burns. The problem was that there could be a recurrence even after we took off the keloid. But the father was pleading for skin like that of a new born baby. 

As we saw these patients, we got talking into how there were such wrong notions about what plastic surgery could do . . . and how much films and the media has fostered it. Another aspect was how much people hated the way they are and wished that they look like the demigods and demigoddesses they saw on screen. 

I'm amazed how much there is an emphasis on looking perfect in the societies that we live in, rather than a preference for lives that are beneficial to mankind. And of course, there is quite a world out there who earns a living by doing exactly the same. 

On the whole, I'm however amazed at the ability of surgery to bring back quite a lot of functionality in the lives of quite a lot of our patients who had been suffering mainly because of contractures caused by accidents especially burns. The contractures are caused because of neglect of the injuries. And which is what exactly we plan to prevent by having the burns unit at NJH. 

No evidence . . . So What?

It's going to be 2 years since the WHO came out with a ban on serological diagnosis of tuberculosis. 

Yesterday, I had a lady who had no symptom of tuberculosis . . . but the previous doctor has done this test for her couple of weeks back. 

Major challenge in tackling the disease . . . 

I thought that the patient was showing signs and symptoms of depression ! ! !

The Palash Trees

I've written and put snaps earlier about the Palash trees which dot our landscape during this season. They make quite a good scenery. You must have noticed one snap in the post on the visit of Dr. Nevin where you can see them. 

Below are few snaps I managed yesterday when I had gone to Ranchi to pick up Dr. Ron Hiles. 

You can see the trees far away . . . giving a orangish glow to the forest

A memorial to freedom fighters who gave their lives for the region

World Tuberculosis Day, 2013

Yesterday was World Tuberculosis Day, 2013. I've been involved directly in clinical management of tuberculosis and public health activities related to tuberculosis since 2003. And believe me . . . each succeeding year has presented a bleak future from tuberculosis. There was quite a hype about the possible chance of seeing the end of the disease during the initial years. 

The fact remains that quite a lot of people know quite less about the disease. Many of them think that it cannot do them anything. Although the number of people dying has come down, the emergence of drug resistance is a frightening prospect. It is not any more a poor man's disease. 

As part of the global fund efforts to combat the disease, we've been doing our small part in Palamu district. Starting from the efforts by stalwarts like Mr. Andy Eicher, Dr. Arpit Mathew, Dr. Chering and Dr. Augustine we've come a long way. We are a Tuberculosis Unit, in fact, one of the first in the public private sector. In addition, we've been mobilising the community to disseminate information and get a earlier diagnosis in the whole of Palamu district. Mrs. Julitha Tithio spearheads the efforts. 

Few snaps from the World TB Day celebrations in Palamu district. Considering into fact that this year, it fell on a Sunday and that too Palm Sunday, we focussed quite a lot in disseminating information through the churches. 

Awareness at the Cathedral, Daltonganj

Program at the CGM Prarthana Bhavan, Abadganj

The district level celebrations

Program at Chainpur

Why do we do what we do . . .

Over the last week, we've been having some serious discussions about the reasons why many of us are serving in remote and trying locations such as NJH with supposedly hardships and challenges. Of course, this is a question which we in most of the EHA hospitals ends up replying to many inquisitive friends and even family members almost every alternate week. 

Many of us attribute our presence in such locations to a response to a personal relationship to the Lordship of Christ Jesus. Yes . . . it is quite difficult for many of our own friends and family members to understand this 'professional suicide'. 

There are quite a lot of our acquaintances who attribute our escapades to the travel bug, inability to manage a high stress job, preference for a laid back lifestyle, poor family relations etc. etc. But, on the whole, most of my colleagues and myself are quite sure about the reason why we are here.  

However, one of the major challenges in our situations is to serve alongside communities and colleagues who are just there for a reason which does not match yours, but mainly for the job and the money. Considering the crunch in resources and technical expertise, it is quite a challenge to expect the intensity and commitment from colleagues who are just there to earn a living. 

I feel sad for such people especially in a low resource setting such as ours, where what we earn is less than what we could have earned elsewhere. 

Couple of years ago, one of my friends narrated a conversation he had in a train journey with a group of staff of a mission hospital who were on their way to a conference. He started to enquire about the role and significance of mission hospitals in healthcare scenario of the country. 

My friend was shocked to find out that except one guy, none of the others had any clue on why they were the part of such an organisation. The group cut such a sorry figure . . . and of course was not at all a good advertisement of the prospects for joining such a sort of institution.

And to make matters worse, the guy who was explaining all the reasons for the existence of mission hospitals . . . he was new to his job whereas all the others were veterans in their jobs. 

I'm glad such conversations gives me the opportunity to re-look and question myself and my colleagues about the reason on why we are in this sort of a job. 

My final note on this . . . if you think that people like us are a very rare breed . . . sorry . . . you're mistaken. You may be surprised to know that there are quite a lot of such people, much qualified and dedicated than us, serving in more remote areas in very trying situations. 

We are so privileged to be associated with quite a lot of such people who are in such trying situations. Most of them belong to various congregations of the Catholic Church involved in education, healthcare and development. 

I say that even if you are in a job for no reason, you should be absolutely sure that you are there for no reason . . . rather than beat around the bush trying to find a reason. If you are there for the money and the status, be sure that you are there for the same.  

By the way, quite a lot of my colleagues think that qualified staff in the organisation get a secret packet of salary directly to their account without it coming into the account books. Otherwise, they just cannot imagine these highly qualified guys being in such difficult jobs. 

My take on the whole matter. When people do things (especially a job) about which they are not sure of the reasons or try to think of a better or 'honourable' reason, I feel that is a very sorry state. 

I could only mumble a prayer for mercy for the management of the hospital whose staff my friend met on the train. 

. . . Do take some time off and think . . . 'Why do I do what I do?' It's quite a good exercise. 

Our upcoming 'family band'

A brief preview of our slowly developing 'Family Band'.

Prayer Bulletin . . . 15-31 March, 2013

The second half of March 2013, has been quite a hectic one for all of us here at NJH. Starting off with a whirlwind visit to Vellore to attend the Snake Bite workshop to the last week when we expect Dr. Hiles from the UK as well as our friends, Nandamani and Ango to be with us, it has been quite busy here. 

We request your presence with us as we praise God for all his mercies as well as request your continuing prayers for us. 

1. There was a meeting of Administrators and Managers of EHA at Tezpur. 4 staff from NJH attended. We thank the Lord that the meeting was quite useful for all the staff and all the arrangements including travel went smoothly.

2. Kindly pray for 3 new staff who have joined the Community Health Department – Ms Archana, Mr. Satyaprakash and Mr. Phuldev.

3. From tomorrow, we’ve quite a lot of visitors in the hospital. Kindly pray for all the travel and stay at NJH. There are friends from Global Fund, Gideons International, Central Office-Community Health coming to visit us.

4. Drs. Nandamani and Ango would be with us for 10 days starting 24^th March. Please pray for their time here. There’s quite a lot of registration for surgeries.

5. Dr. Ron Hiles and Ms. RuthAnn who have been the major driving force behind the Burns Unit would also be here during the next week. Kindly pray for patients who need specialised surgery as well as all the deliberations about the final constructions of the Burns Unit.

6. We’ve informed that we have been alloted funding for the construction of overhead water tank for the campus. We thank the Lord. Kindly pray for the process of finding the right people for doing the construction as well as all the paper work involved.

7. Tomorrow is World Tuberculosis Day. Kindly pray for our work in tuberculosis. We were also blessed by the visit of the IUATLD Regional Director, Dr. Nelvin Wilson couple of days back. 

8. We have been privileged to be part of a group of researchers led by the Christian Medical College, Vellore and the South Asian Cochrane Network Centre to look at snake bite syndromes and treatment in the country. Please pray for the effort being taken as well as for local leadership being given by NJH. 

9. We request prayers for our Community Health team. As summer approaches, it is going to be a major challenge for field workers. We are working in the areas of Disability and Climate Change.

10. We're in the process of facilitating a bigger role in Maternal and Child Health in the region along with other partners. Kindly pray for the processes involved. 

11. As mentioned in one of my previous mails, we urgently require good accommodation facilities in the campus. Please pray for the initiatives being taken. The budget is about 8,000,000 INR.

12. Please continue to remember the need of a full time Surgeon and a Paediatrician. With the slow but steady increase in our patient load, an orthopaedic surgeon and an anaesthetist will be a dream come true. 

Visitors from IUATLD . . .

Starting this week, we have a constant stream of visitors to NJH. Last couple of days, we were blessed to have the Regional Director, South East Asia of the 'International Union Against Tuberculosis and Lung Diseases' (Commonly known as 'The Union), Dr. Nevin Wilson and their Technical Officer, Dr. B M Prasad . 

They came to know more about the work we are doing in the Global Fund Tuberculosis Project. 

Few snaps from the visit . . . 

It was quite humbling to see Dr. Nevin walk through the very difficult and dangerous terrain of some of the most interior regions of Palamu district. They would have realised how beautiful the region looks now with the Palash trees (butea monosperma) in full bloom. 

We thank the Lord that everything went fine and the team returned to Ranchi yesterday evening. 

Community Based Adaptation

This is a guest post written by my colleague, Mr. Avinash Biswal who serves as a Project Assistant in the Community Based Rehabilitation Project. This is in response to queries from readers about Community Based Adaptation towards Climate Change. Mr. Avinash is a graduate in Psychology who has done Masters in Social Work from Manipal University. This is his first assignment after his Masters. 

Community Based Adaptation (CBA) in simple terms is an approach which facilitates the communities to adapt to the Climate Change. Climate Change enhances hazards like Floods, Cyclones, Droughts, erratic rain fall etc. Even though it is a global issue, its impact is falling excessively on poor communities as they are highly vulnerable. In order to adapt to the Climate Change, many new and effective technologies have been developed and new developmental strategies have been adopted but all this is immensely failing to reach the most marginalized and vulnerable communities in today’s world. Therefore, CBA projects are especially focusing on the most vulnerable communities and work to empower them in increasing their resilience towards the impact of the Climate Change.

Ancient communities have extensive knowledge on climatic conditions and since many generations, they have been using their own strategies to adapt to the changes in climate. But due to reasons like Unsustainable Development and Irresponsible Planning, complications in climate have been increased drastically. Thus it has gone beyond their capacity to adapt to the present Climate Change. Hence, CBA in its strategy never encourages communities to adopt outside strategies, instead it facilitates communities to develop local strategies and enhance their capacity in the adaptation to the Climate Change.

Nav Jivan Hospital has recently undertaken the CBA project in the local community. The target is 30 villages with an approximate total population of about 40,000. The community is severely affected by droughts whereas most of the members of the community depend on the agriculture for their food as well as income. The organisation is working with the community to cope with drought by helping them to adopt drought resistant crops and alternative livelihood. 

Community Based Rehabilitation

This is a guest post written by my colleagues, Ms. Rachel Belda Raj who serves as a Project Officer in the Community Based Rehabilitation Project. This is in response to mails from readers about what Community Based Rehabilitation exactly is. Ms. Rachel is a Masters in Social Work from the Madras Christian Collge and has served at the Physical Medicine and Rehabilitation Department, Christian Medical College, Vellore before joining NJH

Disability has been an age old problem in our societies and would continue to be present. People with Disabilities(PWDs) have always been excluded from the mainstream society. As human rights developed, PWDs started raising their voices for their rights but it has been limited to the educated society who are aware of their rights but the majority continue to live in ignorance of their rights and under discrimination. But approaches to disability have evolved and view of disability have changed from giving charities to a medical perspective and finally to an empowerment model. Hence the development of the Community Based Rehabilitation.

The Community Based Rehabilitation Project, as the name suggests involves in working in the community using the community resources as opposed to an institutional based rehabilitation where more focus is on the medical condition. Hence, CBR involves Persons With Disabilities (PWDs), along with their families, community they live in and the respective government including policy makers and implementers. The dream of the CBR project would be to facilitate a just society where PWDs are given equal opportunities in all spheres of life. The first step towards this goal would be for PWDs to know and access their rights and move forward into the mainstream society.

This project facilitated by Nav Jivan Hospital is the first of its kind in the area and covers a area of 10 blocks with a population of approximately 1.5 million. The initial feel from the field reveals that ideas about disability are still very raw. Therefore a community based project would be a good start in dealing with disability in the area. 

Plastic Surgery . . .

The term 'plastic surgery' conjures up images of perfect smiles, chin lifts, ironed out crease lines of the forehead, smoothened wrinkles for most of us . . .

We've been privileged to have Dr. Ron Hiles from England coming almost every year to teach and facilitate our surgeons to do 'plastic surgery'. Most of the time, it involves straightening out contracted limbs following accidents . . . especially burns . . . most of them neglected when they should have been well taken care of. 

Accompanying Dr. Hiles is Ms. RuthAnn Fanstone, an accomplished Physiotherapist, also from England who specialises in burns management. 

Since Dr. Nandamani is away on a long leave, we've requested him also to be around when these special surgeries take place. This year, it's going to be another milestone for us as a new physiotherapy graduate, Ms. Sheron Mathew from the Christian Medical College, Vellore would join us.

And for the first time, we tried some advertising on the radio. For most of us, it's a forgotten means of communication media. But, it still holds fort in remote areas such as ours. 

We've already got about 15 patients lined up only for the 'plastic surgery'. Cases as severe as the burn contracture in this one year old child . . .

. . . to the love-stuck young man who realised the folly of permanently tattooing his first love's name on his forearm. 

There would be quite a lot of patients who would not be able to pay for their surgeries. If you would like to make a contribution to help us subsidize the cost, please get in touch. 

The big killer . . .

Come spring, and we have quite a spurt in the number of patients with respiratory diseases. And quite a good number of them would be tuberculosis patients . . . A selection of cases .. .. ..

The first one, a young lady who has been on and off treatment. The first 3 X-Rays here are her's taken over one year. It's very obvious that the second film is a bit better than the first one . . . but that was when she had stopped treatment after she was feeling better after about a month of treatment. Then, she was quite sick after the winter. And the third X-Ray was taken after that.

The next one is that of a middle aged lady who also has been on irregular treatment. 

The one below is that of a young man, who had been sick for about 5 months now. He had stopped tuberculosis treatment after 2 months as he was feeling better. Now, he has about one third of his total lung left. 

And the final one- A 10 year old who has been sick for almost 1 year. He has been sick on and off. The main finding . . . he weighs a measly 15 kilograms. 

The common links between all the 4 patients . . .

All of them are poor and there is a major issue with food security in all the four families. 

I've written quite a lot of poor nutrition last year. As the number of poor patients who access our facility increase, the strong association between poor nutrition and disease is very much evident. 

We've focussed quite a lot on Human Immunodeficiency Syndrome which is a cause of an immuno-compromised state (all 4 patients are HIV Negative). I wonder how long will it take for healthcare providers and policy makers to understand that the most common cause of an immuno-compromised state is M A L N U T R I T I O N . 

Focus . . . Snakes and snake bites . . .

Last week, NJH was part of a group of hospitals who were invited by the Christian Medical College, Vellore to look into snake bites and their management . . .

I leart quite a lot of things. It was a privilege to rub shoulders with who’s who in herpetology. Romulus Whitaker, Gerry Martin, Dr. Oommen V Oommen, Dr Bawaskar, Dr Punde . . .quite a lot of big names in the field.

Yesterday, I was talking to my staff in Community Health and Development about how fast we draw conclusions without looking into evidence.

Over the last month, I had put up the post on the clientele we serve at NJH. And later something about neurocysticercosis and their cause. Regarding the former topic, quite a good number of our staff thought that we serve a higher number of poor. I got quite a number of feedback about the ‘new information’ they received in the post on neurocysticercosis.

The common aspect about snakes and snake bites are the myths that surround them.

Couple of the myths that I harbored for long were given the boot after the meeting.

The first one . . . I was under the impression that a venomous snake bite late in the night or early daybreak would be less venomous compared to a bite in the evening. The reason . . . the snake would have already spent it’s venom on a prey and therefore a lesser amount only would be available to inject into the next victim. The same logic applying to snake bites on two consecutive victims by the same snake. The second victim would have lesser venom injected thereby causing lesser envenomation in the second victim.

The venom is the saliva of the snakes. Even after a biriyani, you’ll continue to secrete saliva if there is ice-cream after that. Similarly, the snake would continue to secrete the venom irrespective of the fact whether it had a prey before biting a victim.

The second one . . . a non-poisonous snake in your backyard means no poisonous snake in the same area. Absolutely wrong. Any snake seen means more snakes in the area. It was reported that it is not uncommon for a venomous and non-venomous snake to share the same hole!!! I remember someone tell me that it is not good to kill a non-venomous snake as it’s place in the habitat may be taken by a venomous one.

There is nothing like a territory for a snake. . . the way they have for tigers etc.

The third one . . . which is quite frightening. I used to believe that use of chemicals such as phenol would help keep out snakes. And after we had couple of snakes inside the house during our first year at NJH, we’ve not seen them inside after we started to regularly use phenol to wipe the floor. In fact, there is no evidence to support the fact that snakes dislike phenol. However, snakes don’t like clean places. They love dirt and areas with things like papers, leaves etc. piled up. The fact that snakes are not entering the house is because of cleanliness that accompanies a daily wipe with phenol and not the smell of the chemical.

However, the best ones . . .

Kindly see the snap below. The blue bordered regions are places where a proper taxonomy of existing snake species has not been done. Quite an exciting thing for mission hospitals in North India such as ours as we can be base for quite a lot of work on getting to know more about these creatures.

The final straw . . . The snap below. Kindly note the thing written in red. This is the number of vials of antivenom that will neutralise the maximum possible venom that is injected during a bite of the concerned snake.

The question is now going to be about how WHO has come up with a protocol of 20 vials to be used for any sort of snake bite. . .For units such as NJH, this has major implications . . . as a low dose protocol should theoretically be enough to salvage viper and krait bites . . .

We’re quite excited of the future . . . we could be part of path-breaking research on snake bite syndromes and their management.

Pray for us . . .