Urgent . . . for those from afar

One of the peculiar aspects of NJH is the huge number of patients who come from quite far. We’ve people coming all the way from Sonbhadra in Uttarpradesh, Renukhut in Madhya Pradesh, Ambikapur in Chattisgarh, Buxar and Gaya in Bihar and even Burdhamman in West Bengal.

Because of our remote location and lack of any staying facilities in the nearby villages, many of our patients find it quite difficult to regularly come to our place.

In the earlier days, there was a well run inn for such patients.

At present, we can see the ruins of this inn.

There are 3 major groups of patients who need this facility –

1.       Many of our outpatients come one day before and stay overnight before the register in the outpatient department.

2.       There are patients who need to only have long periods of dressings especially for chronic wounds without any admission as inpatients.

3.       As we are quite well known to be a good centre for obstetric care, quite a lot of families are keen to bring expectant mothers towards the date of expected delivery for a safe confinement.

An inpatient admission the latter 2 groups is a costly affair.

We plan for the following –

1.       A open space with good roofing which patients and their relatives can use to stay overnight.

2.       A space for 2 dormitories

3.       Bathrooms and toilets to cater to above 2 groups of people.

4.       Space for cooking

Below is the only present waiting space for the above 3 groups of patients.

The estimated budget for a 2000 square feet space would be about 1.5 million INR.

We earnestly look for people who could share our burden in prayers and resources.  

Waiting . .. ...

(This post was written on Monday, the 29th July, 2013)

As we wait for rains . . . I’ve been waiting for something else since today early morning.

When I arrived for work today early morning, Titus had news for me about a rupture uterus which has been refusing to go to a higher centre after she arrived her at around 5 am today morning.

This is the second rupture uterus over the last 24 hours.

Dr. Shishir did the first one on Sunday evening.

MD had come sometime early morning on Sunday (28th July). MD had been in labour since 4 am on Saturday (27th July). This was her 3^rd pregnancy. By around 10 am on Saturday, the family realised that there was some problem. She was shifted to the nearby PHC.

The doctor at the PHC was smart enough to realise that there was some complication and she was shifted to the nearby district hospital. At the district hospital, it took some time before the family was told that she appears to have a rupture uterus.

It was late evening. The family was told that the best place for them would be a private hospital in the adjacent district. However, no vehicle was ready to take them to the adjacent district.

They were told that it would be dangerous to be in the district hospital. Therefore, they took refuge in a private hospital for the night.

Very early in the morning, they set out to the Daltonganj. The private hospital they were referred to refused to have anything to do with the patient. It was much beyond their skills. They promptly referred the lady to NJH.

They reached NJH by around 8 am on Sunday. The problem was that she had very high counts and her haemoglobin was just above 7 gm%. It was unthinkable to do anything without blood. We sent the relatives to the nearest blood bank in Daltonganj for 3 pints of blood.

The relatives returned by around 3 pm. Dr. Shishir operated. It was quite tough. She was in severe sepsis and appeared to be going to severe Acute Respiratory Distress Syndrome. She has pulled through the night. 

As I write this (Monday night), MD continues to be on oxygen.

The next maternal near miss, the one I mentioned at the beginning of this post, arrived today morning. RD, had a Cesarian section for her previous delivery. Similar to many of our previous rupture uterus following a Cesarian section, the family was ignorant of the fact that she needed an institutional delivery.

She was better off than MD. Her haemoglobin was 9 gm%. Still considering the time she was in labour and the long period of dehydration, we were definite that there was hemoconcentration.

RD had arrived at 5 am today. It was 5 pm by the time the relatives could arrange blood from Daltonganj. The surgery was uneventful. However, her uterus was quite damaged to conceive another baby.

To top the 2 rupture uterus, we had a severe eclampsia sometime around mid-morning. We kept her for normal delivery as she appears to progress well. However, we realised towards the beginning of her second stage of labour that there was a malrotation and she may not deliver normal.

We ended up doing a Cesarian section for her. As it was a second stage Cesarian section, there was lot of problems. The uterus was in atony for quite some time after delivery of the baby. And she lost quite a lot of blood.

Again, we needed blood. We tried to send the relatives to Daltonganj for blood. But, it was too much of an ask. We have to ensure that she does not bleed more during the night.

The availability of blood is quite a crucial aspect in the smooth running of a centre like ours.

Last year, we’ve had about 1500 deliveries. And with quite a large proportion of them accounting for high risk obstetrics, if we need to develop further, we urgently need to think about setting up of a blood bank.

And not to mention the very high chance that all three of them could have ended up as maternal deaths if NJH was not around. 

However, the big question remains about committed personnel who would be willing to come all the way to a remote location such as ours . . . and continue the good work and look at possibilities of new avenues of quality care. 

Miracle . . .

Since the last couple of days, we were debating about the spot where we would try to dig the borewell for supplying water to the new water tank.

There were varied opinions. Our previous experience has not been very fruitful. At the places we thought there would be lots of water, we did not hit the water table even after 600 feet.

Mr. Prashant and Mr. Shekhar, the staff from Sampurn Development India who was facilitating the construction of the water tank suggested that we try a place which is very near to the water tank. All of us were quite skeptic.

We had our reasons. The place was the highest point in the campus. And the traditional belief was that the whole of the campus was on top of a large piece of graphite rock. And we had seen it in one of our previous experience of trying to put a borewell.

However, we decided to go ahead.

Well, to our surprise . . . we hit water at around 80 feet and there was quite a lot of it. The team decided to dig for a total of 300 feet. And we got water at 3 levels . . .

We praise and thank God for this abundance provision of water . . . 

Rains . . . Still waiting . . .

We had some amount of rains over the last week. However, it has not been enough to get our water table up. The clouds have been playing hide and seek with us for quite a long time. 

Few snaps which he got over the last few days . . .

Please pray that we would get good rains over the next 2 weeks . . .

Water Tank - Groundbreaking . . .

Snaps from the groundbreaking ceremony of the construction of the water tank . . .

The site . . .

Few of the staff and students who've assembled for the prayer and groundbreaking ceremony

Mr. Jayakumar, our Regional Director turning the first sod . . .

And then the bull-dozer took over . . .

This is the final result . . . Took only 4 hours to finish .. .. ..

Now they'll put a scaffolding of steel into this, raise up beams for the water tank and pour mortar into the beams . . .

Please pray that the work will finish soon . .. ...

Road Rash

As I had mentioned in one of my previous posts, roads in our area have been relaid since about 4 months. Which has resulted in a major spurt in accidents. Considering into fact that we do not have an orthopedician, accidents cases do not come to us as most of the time, they involve broken bones. 

Few days back, we had a major accident just about a kilometer away from the hospital. All 5 of the patients had grievous injuries. And of course, almost all had broken bones. One of the victims passed away on the way to Ranchi after we referred him for head injury. 

The accident happened when a truck driven by a drunk driver veered off the road and ploughed into a group of men and few vehicles which were parked by the side of the road. One of the vehicles was carrying oil which burst and splattered on the victims. 

Snaps from the accident site. 

One of the bikes

The Tata Magic which was on the way of the rampaging truck

The oil splattered on the road

Another mangled bike

The culprit truck

Dr. Titus was on call. However, quite a lot of the staff pitched in to tend to the injured. As most of the injured were very poor, we had to write off their bills. 

3 requirements which has come out as we went through the process of caring for these unfortunate men. 

1. The great need of an orthopedician at NJH. 

2. We are yet to have a dedicated space for severely ill patients. A full fledged space for casualty is something we need to plan. However, with no surgeon or orthopedician, I wonder how much of a utility that would turn out to be. 

3. A caucus fund to treat such patients patients. I'm sure an amount of 100,000 would be a great help. 

Couple of snaps of our team at work . . .

Drs. Shishir and Titus at work

Dr. Roshine, our Internal Medicine consultant
also helped

Praise and Prayer Bulletin, 15-31 July, 2013

Apologies for the late Praise and Prayer Bulletin. Do remember us in prayers . . . 

1. Over the last few weeks, we had been quite busy with preparations and participation in the Regional Governing Body meetings of the Emmanuel Hospital Association. It was quite a busy time. We thank the Lord that we could see through this very busy phase of work.

2. We thank the Lord for positive information about starting work of the water tank in the campus. We thank the Lord as well as the facilitating agency, Sampurn Development India, Varanasi. Today, the digging of the pits for the foundation has been started.  

3. We thank the Lord for the transformer we received from Duncan Hospital, Raxaul. Kindly pray for the processes we are taking to install it in the campus.

4. We thank the Lord for the major rise in patients which continues over the last 3 years. The trend continues. Please pray that we get more fellow labourers for quality clinical care.

5. We’ve finished one year of our Community Health Projects in the themes of Community Based Rehabilitation of the Disabled and Community Based Adaptation towards Climate Change. We are also thankful for extension of the CBR Project in our block.

6. We’ve had a major increase in staff compensations starting from April 2013. Kindly pray that we would be able to generate enough revenue to meet the increased expenses.

7. Malaria appears to have made a major comeback this year. We’ve already had couple of deaths. We also thank for patients who made it after having cerebral malaria. Please pray for protection of patients.

8. We’ve had couple of families who lost their loved ones during the last fortnight. Mrs. Suroshini Nand, Tutor in the Nursing School lost her younger brother and Mr. Joram Ekka, Support Staff lost his nephew in a road traffic accident. Kindly pray as their families go through this time of bereavement.

9. Tomorrow (25th July, 2013), we would be having our Nursing School selections. Please pray that we would get a very good batch of students. We just got information that tomorrow is a bandh. 

10. The arrival of Dr. Roshine M Koshy, Medicine Consultant has seen a major increase in our critical care patient load. Kindly pray as we plan to expand our services. This includes purchase of equipment for which our budget is about 2,000,000 INR. Kindly pray and pass on this need to those who could help us.

11. We’ve had a small hitch in one of our Income Tax dealings. Kindly pray as well settle this issue. 

12. Kindly pray for more consultants for the hospital. We pray for a orthopedic consultant and a pediatrician. Of course, a surgeon is the number one priority. 

New Rajdhani Rakes

Couple of weeks, I got to travel for the first time in a new Rajdhani rakes. 

It was just couple of days since it was introduced for the Ranchi Rajdhani. 

My first take on them. 

The look really great to travel on . . . The windows and the build is all so cool. 

The downside is the space to sit and sleep . . . The snaps say it all . . .

Usually I'm able to keep my head straight in the upper berth

And a good one feet of my legs dangling outside . . .

J u g a a d

A very common word in the North Indian milieu of things - JUGAAD. Means an innovative or simple cheap solution. 

Yesterday, I found this good example of a Jugaad . . .

Uttarakhand Disaster Response

The Emmanuel Hospital Association, of which NJH is a unit, responded to the disaster at Uttarakhand through the Community Health Department of the Landour Community Hospital, Mussoorie and Community Health Global Network, Uttarakhand. Today, there was news about almost 6000 people who are going to declared presumably dead after remaining missing after a month of the tragedy. 

Below are the pages of a very initial report about the efforts of the EHA team and the area we are involved in. 

The area and the lives we are going to be involved in is quite small if you compare the magnitude of the disaster. We look at funding to help the 40 villages who have lost almost everything except their lives in this tragedy. 

Please contact robert@eha-health.org or thomasjohn@eha-health.org if you would like to get involved. 

Alarm Bells

Today, there was a news item in the local daily about a decrease in the monsoon rains in the state over the last 2 weeks. It seems that there's enough alarm bells ringing about a chance of a poor monsoon. 

This could spell disaster for the place. We had some heavy rains over the in the early part of June. 

Now, we see clouds go over our skies. It looks as if it's going to rain and then the next thing we notice is a clear sky. 

I snapped this photograph while on a visit to the village. You can see the heavy clouds, but there was no rains. 

Kindly pray that the Lord will bless us with enough rains over the next 2 weeks.

Thank you

2 months back, I had a very surprise call from Dr. Mathew George, the then Managing Director of Duncan Hospital, Raxaul. Raxaul had realized that they did not need the 200 KVA generator anymore as the requirement of the hospital had increased. 

And the leadership at Raxaul was kind to consider donating it to NJH. 

That was a great blessing for all of us at NJH. We have been praying for improving our electricity supply for quite a long time. 

There was a change in leadership in Raxaul and the new leadership under Col. Boby Joseph was kind enough to keep the promise.

We sent Mr. Ilias last Sunday to Raxaul to pick up the machine. 

We thank the Lord as well as each of the staff and leadership of Duncan Hospital, Raxaul for donating us the transformer. 

Busy, Busy . . .

Quite a few of you may be wondering why the long silence about the clinical work at NJH. It's just that it is so busy that I just don't find time to do any posting. 

The last week, we had Nandamani and Ango for 10 days. Then, Roshine had been with us since the last 2 weeks. The response from the local community was astounding. 

Nandamani and Titus

Roshine, our new consultant in Internal Medicine

Ango looks glad to be back

And we have the Regional General Body meetings . . . something I was planning to give a slip considering the amount of work we have at NJH. I'm yet to start with preparing the presentations. The only thing that is ready is the Annual Report for the previous year. 

A beneficiary farmer with his bed for Ragi

Then, there is the major work of the Community Based Adaptation towards Climate Change. We are facilitating System of Rice Intensification in about 50 acres of Satbarwa block. And about 5 acres of Ragi (finger millet) cultivation. 

Today, morning, we've had three patients in ACU who did not make it - a young boy with features of viral encephalitis, a middle aged man who had Acute Myeloid Leukaemia and a Maternal death.

In addition, we have one more eclampsia patient with renal and hepatic involvement who is waiting for delivery and one middle aged lady with cobra bite on the ventilator. 

For a change, we had the cobra being brought in live to hospital. It seems that the family took the services of the traditional snake charmer to catch the culprit reptile alive. 

The snake charmer with the snake inside his bag

The live cobra

Demonstrating the fangs

I'm not sure if I would be able to post something for the next 10 days till I'm back from the RGB. Please remember the very sick patients especially the lady with the cobra bite who still is on the ventilator. The next week will be difficult, but I'm sure the Lord will see us through.