Second Hand Books

For quite a long time, I had heard about second hand books being sold on Sundays in Chandni Chowk area of Delhi. Last week, I had to visit Delhi for some official work. And I had to arrive on Sunday as we did not have trains later. 

Books in our house is a major thing for children. All three of them have somehow realized that reading books or appearing to read books is something very cool. Most of the days, the last thing we do before they go to sleep is to read a book. And the more books they have, the more they read. 

Now, the problem with children's books is that it is quite difficult to get them as good books are quite expensive and with the sort of our location, it is many a time difficult. 

I used to know a place in Nehru Place, Delhi which sells second hand children's books. Almost all of them were imported second hand books. The quality was quite good. And almost all of our books were acquired at this place. 

During my last 2 visits, I just could not make it to this place. 

This time, I was happy to have discovered this new place. However, I realized that my information was wrong. The second hand books were sold in Daryaganj and not in Chandni Chowk. 

It was a delight for my eyes as I brought quite a handful of Thomas the Tank Engine, Winnie the Pooh, Noddy and other hardbound child friendly second hand books. 

My colleagues who accompanied me also got some very good titles at throwaway prices. 

Therefore, for all those who have got into the habit of reading, a visit to Daryaganj on a Sunday afternoon is quite a profitable venture. 

Joy in a puddle

During our childhood, one of the most enjoyable moments was the time when it rained and there were puddles all over the place. We used to play in the dirt and make paper boats and float them in these puddles. It was not difficult to identify with the dirty boy in those detergent advertisements.

Our children never had this opportunity. First of all, there was no opportunity in a place like NJH as there were hardly any rains and no place for puddles to form. That was till last week . . .

It was quite a pleasant surprise that we found a puddle in front of our home. The truck which came to bore a well had made a huge ditch after one of the tyres got stuck in the mud. It rained the whole night yesterday and therefore the water had collected in this small ditch.

Enough water for us to make couple of boats and put it to sail.

After about half an hour, I had to pull out all the three kids from the fun. 

The next day, I found all three of them going and checking out the ditch for water. Unfortunately, it was empty and it has not rained since. 

Partnerships . . .

Dr. Titus taking a class for the Child Fund India staff

Last week, we were roped into one more partnership with another Non-governmental organisation working in the theme of Child Health in our region. Child Fund, formerly Christian Child Fund has been working along with few local NGOs in the region for quite a long time. It was quite a surprise when we had a visit from Mr. Ashok Panda, Area Manager of Child Fund India to help their partner organisations with training in the areas of Reproductive and Child Health.

The Emmanuel Hospital Association has accepted the principle of working in partnerships with other like-minded organisations in the regions we serve. And NJH has long been following this principle.

In addition to other NGOs in the region, our major partnership with the public healthcare network of the government.

NJH is one of the first Tuberculosis Units under the PPP (public private partnership) program of the Revised National Tuberculosis Program of the Government of India. In addition, we continue to be part of the Rashtriya Swasthya Bima Yojana (Health Insurance Scheme of the government). Earlier, we were part of the Mukhya Mantri Janani Suraksha Yojana. However, it was withdrawn from our side as according to the rules, we had to have specialists in Medicine, Surgery, Obstetrics and Pediatrics.

Couple of months back, we were roped in by UNICEF Jharkhand to facilitate the monitoring of Skilled Birth Attendants and Labour Rooms of Public Care facilities in the districts of Palamu and Latehar. 

Then, we are in partnership with the Health and Development wing of the Catholic Church, both at the state level and the local diocesan level. This partnership has been quite encouraging. We are involved in trainings, specialist consultations, health camps etc. along with them.

There are couple of mission agencies, the Calvary Gospel Mission and Gospel Echoing Missionary Society along  with whom we work in tandem. Recently, we held 2 medical camps along with CGM. We are yet to look at the outputs. I'm sure there will be outcomes too in the long run. There were about 700 patients who came to these camps. 

The consultation for Child Fund India is quite a major step towards extending our influence to a wider population. The challenge is to find more like minded colleagues who would be willing to share the burden and hold hands along . . . 

Pilatus

Last week, someone called to ask about the kitten which had made our hospital it's home. 

It was only then that I remembered that I had not followed that post up. 

We named him PILATUS. Latin of Pilate . . .

Why we selected the name? I don't know. 

For some reason, it was so difficult to take a snap of his. 

Till our new Administrator, Ms. Meghala joined.

To start off, he stole her snack couple of days back. Then, he allowed her to take his snap. 

It's not difficult to capture the 'thief look' in his eyes . . . 

I had been trying to get his snap for quite some time, but without any success. 

Of course, we have no more mice in the hospital. He's also taken off all the lizards from the hospital. Last week, I found him eating flies and beetles which came attracted to the lights in the night. 

However, considering the amount of work that he has put in over the last year, this year is going to be quite an easy one for him. 

Unique Experience

On the 15th of August, (last Thursday), I had the unique experience which not many would live to tell. 

I got hit by lightening. 

We're almost sure that we would be going in for a drought this year. However, on the evening of 15th August, we had a very heavy downpour. There was a bit of accompanying thunder and lightening. 

The downpour was quite a good one that there was a lot of water flowing in from the road. I was quite concerned about our pond which is in quite a sorry state as of now. Unless we get at least half a dozen of similar showers, all our plans of fish farming for the year would go awry. 

I wanted to ensure that the drains which bring in water from the roads were all clean and water was flowing in. As I walked to the gate, there was the most spectacular lightening I ever saw. Along with that was a numb feeling of tingling I felt from my head to the toe which lasted for a fraction of a second. For a moment, I thought it was the second coming of the Lord. 

I felt quite dizzy and sort of stunned. I could not open my mouth. I held on to the wall near the gate. And said a small prayer. Soon, I was sort of back to my senses. I had brought with me one of our maintenance helpers to help out with clearing of the drain. I realized that he did not realize what had happened. 

I was also into one bout of a viral fever, that there was quite a lot of confusion about what was happening. By night, there was severe body pain. I took an ECG to find out if there was any conduction abnormalities. Thankfully, there was none. 

Today morning, as I opened the newspaper, the front page told me very well that I was very very much blessed to have escaped the lightening strike.

The news said that 23 people died following lightening strike the same evening in different parts of the region. 

I know very well that I am very much blessed. The Lord has been so gracious. All praises to Him and Him alone. 

Cerebral Malaria .. .. ..

Mr. R coaxing his son Mr. P to smile as I took his snap

Talking about ventilators, one of our latest success stories is that of Mr. P who was in the ventilator after he was diagnosed to have Cerebral Malaria. When Mr. P came about a week back, very few of us had much hope his surviving.

To make matters worse, when we intubated Mr. P, we found out that he had a wedge of turmeric wedged in his throat. Apparently, his relatives had put the turmeric piece in between his teeth when he had a seizure.

It was almost fatal.

Mr. P was in the ventilator for about 2 days. However, he made a remarkable recovery. Another of the umpteen patients who are alive just because of the cheap anesthesia ventilators we have at NJH.

In addition, Mr. P's father, Mr. R was also diagnosed to have Falciparum malaria one day after his son was admitted. It was a joy to see both of them doing well. 

Nevertheless, as I mentioned in my previous post, of late, we have been having patients who would have done better if we have a full fledged adult ventilator.

Once more, requesting prayers and funds for the same.

Disabled in rural India

Last week’svisits to the villages have been to look at the work that has been going on as part of our Community Based Rehabilitation of the Disabled.

Below are few of the major aspects about the disabled in rural India which sets them apart from their counterparts in towns and cities.

1.       The hardworking villagers in the rural parts of the country do not have much time to think about the disabled in their communities. The classic story is that of our enquiry about the number of disabled in our nearby villages and our staff replying that it would be a surprise if we cross a single digit number. Now, after the end of a survey, the number stands at over 800. I still have reasons to believe that we’ve still some more numbers to count.

2.       The disabled are thought of as being an aberration in the community. Therefore, no thought is given about any of their welfare. Many of the villages we visited, the villagers were quite inquisitive about the reason why we were interested in the disabled. According to them, the normal people in the village had so much of issues with poverty and under-development that the disabled who are of no apparent use was of not much of a value.

3.       The worst group of sufferers are the mentally challenged. There are lot of beliefs and myths associated with psychiatric illness. One wretched practice is that of marrying off the mentally challenged with the belief that it would make them well. It was heart-wrenching to see them being made to perform like jokers in few of the villagers.

4.       In impoverished communities as ours, the very thought of getting some money in the form of a disability pension is quite music to the ears of many a family. However, the benefit hardly reaches the beneficiary. Rather it is used off by the other members of the family.

5.       The mortality rates of the disabled are quite high. The village headman (mukhiya) who took us around had a child who died few years back. And death within the disabled populations is well accepted. It’s rather seen as grace for their lives.

6.       One major cause of disability is birth asphyxia caused by home deliveries. In fact the mukhiya’s child appeared to have cerebral palsy as a result of birth asphyxia. I wonder if someone can do a study on the burden of birth asphyxia caused by home deliveries in the community. When birth asphyxia happens and the baby dies, nobody bothers as it is deemed that the baby was weak (kamjor) and therefore it was good that the baby did not live and suffer for the rest of his/her life.

7.       In the midst of all these, there are isolated amazing stories of the disabled being able to stand on their own feet. There was this young man in the village we visited last week, who was disabled because of polio. But, he was quite motivated, hard-working and was into dairy business. He had his own vehicle which he used to ferry milk from the village to the nearby town.

The final word – The disabled in rural India hardly finds any acceptance, leave alone any sort of support from their fellow human beings. There is a lot to be done to mainstream them into the society. Considering into fact the healthcare issues in rural areas which are yet to be well taken care of, it may seem quite a tough and humongous task.

However, I’m encouraged by the efforts that our team has been able to put through in reaching this marginalized group. We value your prayers, support and advice. 

Geriatric Care . . . cont'd

The elderly lady sitting in front of me in the medical camp couple of days back in a village near Panki was the epitome of all what stood for geriatric care in rural India.

The rugged creases on her face and forehead would have been the delight of any professional photographer. She had such an artistic expression of the ruggedness of the countryside.

Then I looked carefully into her face. Both her eyes were glazed, caused by hypermature cataracts. I wondered how long she has been blind. I looked more carefully. In addition to the cataracts, she had pterygium in both her eyes.

Then I noticed that she was feeling her surroundings with her hands. I was having the glass of 

Sprite which was on table while she was helped to the patient’s chair by one of the volunteers.

As I helped her hands on to the table, I was horrified to see that both her hands were stiff from the shoulder down. The elbows were bent and fixed at an obtuse angle. The muscles had obviously wasted away. I asked her about her hands. Small pox . . . that was the answer.

The best thing I could do was to help her out with her cataract. However, the volunteers told me that she had come alone. They could not trace anybody who knew her. Tracing her home could take some time as people from more than 50 villages had come for this medical camp.

I wrote on her case sheet. - Bilateral cataract. However, no relatives to help with decision.

I gave her some multivitamins. And, a dosage of deworming medicine.

She got up to take leave. She wanted to know if she got some medicine. I told her I have written some. She was happy. She gave me a toothless smile . . . very similar to the one that a baby gives you when you give her a cuddle.

And as she stood up, I was horrified to find out that she was bent over. She had  a very bad spinal gibbus. It needed quite an effort from her to change her position. 

I once again asked the volunteer to ask her about her relatives. She had overheard me. She waved her hand and told me that nobody bothers about her. So, there was no point in asking that.

A very simple condition like a cataract was a major challenge for her. We were ready to treat her, provided she had someone to take care of her during the peri-operative period.

The sad state of our society where the elderly find themselves at the margins with nobody to turn to for help says quite a lot. 

(The snap used in the post is not that of the lady mentioned in this post. This has been googled.)

Fatal viper bites

Over the last 2 days, we’ve had 2 patients with viper bite with whom we had major issues of clinical care.

The first was 50 year old SD, who was bitten by a viper sometime in the evening. By the time she came, she was pouring out quite a lot of blood. And then, she was in shock. We started her off on Anti-Snake Venom.

After which, she went into a refractory shock, which was totally unresponsive to Dopamine or Adrenaline. She was ventilated for almost 24 hours. At last she passed away today morning, after her heart became totally unresponsive to any medications.

Within a couple of hours came the next patient with a viper bite - a 15 yr old girl from the nearby government school. She was promptly started off on ASV. However, as time passed, she started to deteriorate. Her clotting time was prolonged. She was already bleeding from her gums and nose when she arrived.

She appeared to be going into myocarditis. She went into a respiratory arrest. We hooked her on the ventilator. But, soon, she was bleeding profusely from her gut. Her nasogastric tube brought out copious amounts of blood. Then, we realised that she was going into pulmonary edema.

One of the major issue which we’ve faced with the anesthesia ventilator is the inability to give high pressure ventilation which is needed in condition like pulmonary edema.

Over the last couple of weeks after Roshine joined us, we have been planning to invest in a full fledged adult ventilator. It’s quite expensive for us. And considering the situations of power supply and oxygen procurement, we need to think twice before such an investment twice.

But, we’ve been quite unanimous in our acceptance of the need for a full fledged adult ventilator. The approximate cost for a low end adult ventilator will be about 650,000 INR which will include transport from the place of purchase.

We request help from people who would interested to support this endeavor. Below is what we dream to have. 

You have the unique chance of being history as this would be the first full fledged ventilator in this whole region . . . the next ventilator to the east is in Varanasi which is about 300 kilometers away, the north, Gaya which is about 200 kilometers away, Ambikapur (200 kms) to the south and Ranchi (130 kms) to the west. The total population we would cater would be about 5 million.

(PS: The 15 year old girl passed away today morning)

Disaster in waiting

Last week, there was a news item about tuberculosis being the leading cause of death in the government hospitals in Mumbai city. One of the comments in a newspaper was that this could be misleading for the whole population as the data was available only from the government hospitals.

Of course, only 20-30% of Mumbaikars use the public healthcare facilities. It would be interesting to know about tuberculosis rates in the private hospitals.

Many a time, it is a challenge too as many a time most tuberculosis patients attending private healthcare facilities like to keep it confidential. To make matters worse, quite often, it becomes difficult to make a diagnosis of tuberculosis with convincing evidence.

It is not uncommon for us to find quite a few of our patients with long standing cough being put on partial treatment for tuberculosis.

With quite a few of the newer and commonly used antibiotics having good amount of anti-tubercle bacilli activity, there is temporary suppression of tuberculous infection followed by a flare up at a later stage. This is also accompanied by drug-resistance.

Most areas of the country especially those with high prevalence of tuberculosis has poor facilities for microbiological culture and drug sensitivity testing.

And the ultimate problem – the disease which was commonly thought of as a problem of only the poor and the impoverished is making inroads into the upper echelons of the society.

To top it all, we’ve recorded cases of healthcare professionals succumbing to the drugresistant forms of the disease. . . obviously contracted from their patients.

All of this calls for some sort of an emergency response to tackling the disease.

The first step would be to do some sort of a drug sensitivity pattern of the tubercle bacilli in different parts of the country. This would also involve setting up of centres for culture and sensitivity studies in every part of the country. The second step would be to convert the thrice a week regimen to daily regimen as soon as possible. Of course, gaps in drug availability etc. would need to be sorted out in a war-footing. The third step would be to step up the health education campaign about the disease.

The information which has come out from the records of government hospitals in Mumbai is a matter of great concern.

I hope our public health professionals in the government sector are serious about this. 

Village Visit - Latehar District (2)

Few more snaps from our visit to Latehar . . . cont'd from the previous post.

The walk through the green corn fields was refreshing

Entrance to a village

Ploughing fields

More agriculture work

Scene from a village . . .

Another small lake which we passed through

More rice fields

The Wrong One . . .

Yesterday, we had 2 patients turning up with dead snakes after having been bitten by them.

The difference from all the previous instances of patients turning up with dead snakes was that in both these instances, the snakes were non-poisonous.

Of course, it is well known that there are more non-poisonous snakes than poisonous ones. 

And the same is true when a snake bites you . . . the chance of a non-poisonous snake bite is much more than a poisonous snake bite.

Unfortunately, people are quite ignorant when it comes to distinguishing between poisonous and non-poisonous snakes. This is what exactly happened with both our patients who came yesterday.

The first one was a young man who was bitten by the snake in the snap. He came to us within one hour of the snake bite. His friends told him that the snake looked like to be a cross-breed of a krait and a rat snake. However, we very well know that the rat snake has a way of mimicking a krait by having such a design in the first half of it’s body.

Close up of the head

The second snake was mistaken to be a cobra. It was quite surprising that the victim identified it as a cobra. The snake which is a type of water snake is commonly seen in our part of the country. In fact, this snake is very commonly seen in fishermen’s net. And of course, its favourite feed is fish.

Killing non-poisonous snakes especially in a rural setting can be quite a negative thing as these snakes keep a tab on pests such as frogs and rats which ruin agriculture. 

I appreciate if someone could correct me if my findings are wrong . . .

Village Visit - Latehar District (1)

Last week, we had a supervisory visit to Latehar district as part of the Community Based Rehabilitation of the Disabled. The scenery of the villages we visited was awesome. Few snaps from the visit. 

I had real difficulty in selected the best snaps . . .

A river through which we had to wade across.

Sr. Banosa, Rachel, Sunita along with villagers walking back

The stunning snaps of the rice fields. The hills of Mahuadand are in the background.

A small lake which we saw on the way . . .

Snap through the windshield of the jeep. 

Rice grown by the Systemic Rice Intensification method. 

The visits included long walks through such paths . . .

A snap which I got on the drive back . . .

Amazing . . . isn't it? 

The snaps are quite evident of how beautiful the place is. 

Medical Camp, Panki

Couple of days back, we had a medical camp at Panki. One of the major strategies at NJH over the last decade has been networking with like-minded non-governmental agencies, churches and para-church organisations. 

The partners for today's medical camp was the Calvary Gospel Mission and the Wycliffe Bible Translators. 

Snaps from the event . . .

People waiting for their turn

Another snap of the camp site

Dr. Kumudh seeing a patient

Mr. Arun and nursing students dispensing the medicines

Ms. Meghala and Mrs. Julita helping out with registrations

It started to rain. And the people waited patiently

Another view of the crowds

The team getting ready to return to NJH

The statistics . . . we saw over 350 patients. A team of 12 staff including 2 doctors participated. 

We're quite interested in the diagnosis of patients who came to the camp. I shall put up more information in a later post.

Photo Post . . . 6th August, 2013

Miscellaneous snaps from NJH .. .. ..

Our new boundary wall coming up. The moment we all feel like little 'Nehemiahs'

Lemon tea . . . in Asansol

An electric burn caused on touching a live wire. The burn was so bad that we could see the burnt bone.

We continue to wait for rains. It's become quite a common sight to see rain laden clouds passing over NJH. 

A baby bat who fell down from it's perch in the Banyan tree

Children . . .

Assorted snaps of Shalom, Charis and Chesed doing various things . . .

2 weeks back, we had a short visit to Kolkota. It was a sort of a new development for
Shalom and Charis as they decided to get onto the upper berth without much fuss. 

The return journey was better as they insisted on sleeping on the middle berth

Here is Charis waiting to milk her cow. Hope you did not miss the
gross mismatch between the bucket and the cow. 

Shalom started guitar classes 2 weeks back. 

The trio watching cartoon in my old laptop

Talking about cartoons, the daily roster for cartoons. We implemented it after
there were regular episodes of debating on what to watch.

More snaps later . . .