Farmers' Fair, Satbarwa

Along with the program for People with Disability, our program to mitigate climate change has been making major inroads. Especially, the activity on promoting millet cultivation and use. As I mentioned in my previous post, we could be playing a major role in the district level in this theme.

We held a 'Farmers Mela' in Satbarwa block in association with the Krishi Vigyan Kendra and the Block Development Office. Snaps of the same . . .

Inauguration by the Block Development Officer

Section of the audience

Stall on behalf of the Birsa Agriculture University by the Krishi Vigyan Kendra

Display by farmers

The Stall from the CBR project . . . 

There were prizes given off for the best farmer . . . 

There was a stall selling chowmein, idlis and pooris .. .. made from fingermillet . . . 

Very sick patients - request prayers

There has been lot of Community Health work going on over the last 3 weeks. The Lord has been gracious to us after we got some very favorable responses from few of the government departments. I just returned from a technical week celebrations by the local Krishi Vigyan Kendra and the Zonal Research Centre, Daltonganj who asked us to facilitate one day of farmer training. 

As I reached hospital, Roshine and the ACU staff were struggling and baffled by a 9 month old baby who had turned up yesterday late night very sick. She had kept almost Roshine and the Critical Care staff awake last night and it seems that she would continue to do today also. MK had been having diarrhoea over the last 4 days and she was being managed at home. She had suddenly become unconscious yesterday. 

She was gasping and badly desaturating when she reached NJH. The staff had to intubate her as soon as she reached. This 9 month baby weighed 14 kilograms. She was so chubby and in shock too. Roshine had to put an intraosseous line. She was improving over the day. But, she became worse towards evening. 

She continues to be on manual mechanical ventilation. 

Please pray for her. 

One more person we request prayers. AA, who came about 2 days back. AA had fallen from a height and ended up a paraplegic. Due to lackadaisical care, he developed a bad bed sore which was also neglected. He was brought in a very bad state and with probable pulmonary tuberculosis. 

We were very sure that he needed a miracle to recovery. We told of our limitations. 

They requested a referral to a higher centre. He had already been treated in Ranchi. 

Kindly pray that he would get good treatment in Ranchi and he would get healed. 

Our CBR program has already identified that falling from heights is one of the major causes of acquired disabilities in the countryside. And most of such villagefolk live miserable lives. 

As we explore further avenues of facilitating Community Based Rehabilitation, we pray for more skilled and committed hands . . . Do also remember Dr. Titus, who recently was accepted for post-graduate training in ENT at the Christian Medical College, Vellore would leave us in a couple of days along with his wife, Dr. Grace . . .  

Recognition - CBR

We started off this week with an invitation from the District Disability Rehabilitation Centre (DDRC), Palamu District for leadership in a 3 day workshop for the disabled. Our team had done quite a lot of work along with the DDRC to facilitate the disabled to organize themselves and be self-reliant. 

Our partnership with the DDRC is in it's early phases. However, it was quite a honor to be recognized at the district level for work among the disabled. 

The DDRO was quite kind enough to allot us a stall in the workshop. Staff from the CH department put up a good display about our work among the disabled and also about finger-millet cultivation. 

Our team was enthralled when the Deputy Commissioner, Mr. Manoj Kumar visited the stall. He was quite appreciative about our work and also inquired with officers with him about looking at the option of promoting millets in the district level as well as including it under the ICDS (Integrated Child Development Services) Scheme. 

All glory and praise to the Lord and kudos to the CBR team of NJH who has made quite a lot of inroads into the remote villages of Palamu for standing along with the disabled and facilitating their upliftment . . . 

Snaps from the 3 day workshop . . .

Addressing the inaugural session. On the dais, from the left - Dr. RPG Singh, the Civil Surgeon, Mr. Manoj Kumar, the District Collector, Dr. RP Sinha, the Red Cross Chairman, Mr. Rajesh Kumar Sahu, District Social Welfare Officer, Mr. Vikas, Secretary, Palamu Vikalang Sangh

Chief guest on the final day program . . .

Taking session for the disabled . . .

Newspaper clipping about the 3 day workshop . .. ...

Reminiscing and praising God

It was one of those chilly nights in 2004. Just around Puja time . . . I don't remember if it was before Puja or after. One of us on duty was called for a late night call . . . it was not yet midnight. We were just a group of 4 junior doctors in the hospital for that week. No one senior enough to give us solid guidance . . . 

The patient in question was a young lady, 16 years old . . . with a history which could only be one diagnosis . . . an enteric perforation. With a history of fever of around 10 days followed by severe abdominal pain, vomiting and abdominal guarding, it was point blank . . .

Now, what were we supposed to do? Of course, refer . . . The person on duty called another of us . . . to try to convince the family to take the patient to Ranchi. It did not work . . . the next doctor was stirred up from his sleep . . . we still had no luck . .. ... the fourth one also came. The father was adamant - 'we've spent enough on her treatment. If you don't do anything, we're taking her home'. 

We had to operate. Drs. Nandamani and Vikram were going to operate. . . One medical student who had come to visit, Atul also volunteered to assist. Johnson and myself were to be on floor . .. ... We decided to document so that if there is a medicolegal issue at a later stage, it could be of some help. Nobody really knew what to do or why we were doing it. 

Nandamani suggested that we call up Dr. Bala, the surgeon who had recently left us after completing his service obligation. With few pearls of surgical knowledge transmitted over the telephone and some quick reading, we were ready to take the plunge. The surgery was uneventful .. .. ..

Snaps from the documentation . . . do remember, the snaps are dated 4th October, 2004. 

Praying before the start of surgery

Everybody interested in what is going to show up

There was faeces in the peritoneal cavity

The rent in the intestine

The tension was quite palpable . . .

But, post-operatively the wound had become infested and we found out that we were in a soup. A fistula had developed. 

A long period of admission of about 2 months followed. Nandamani would only think about this patient for almost 2 months. You can very well see from his discharge summary on how relieved he was when she was ready to go home. There was so much of prayer which went into this girl. 

Whenever we talked about miracles we witnessed in 2003-04, we regularly used to remember this case. 

Fast forward to 16th February, 2014 . . . One of our doctors was seeing a antenatal patient who had a very peculiar request. She wanted details of a surgery done about 10 years back. The concerned doctor came to me and told about the request. The patient was having her antenatal care at our sister hospital - Jiwan Jyothi Hospital, Robertsganj. 

I could not believe my eyes when I looked at the outpatient card . . . the lady in front of me was the same Sarita Kumari on whom we had done the surgery 9 years back. Married about a year back, she was just into the second trimester of her pregnancy. 

I could only praise God that we novices were involved in saving the life of this lady 10 years back . . . whereas she would have died if her father took her home if we had refused to intervene. 

We broke lot of rules 10 years back . . . quite a complicated surgery without any surgeon, anesthetist or any sort of consultant, two pints of blood by UDBT (Unbanked direct blood transfusion). 

10 years later, I wonder if we would have taken up this lady for surgery. Times have changed with regard to medical practice. Really . . . for the poor . . . no . . . not much has changed. 

The other day, when Dr. Nandamani was here, I told about 6 patients with acute abdomen who needed surgery and we did not take them up for surgery since he was away . . . 

People in developing regions die more because of easily treatable conditions . . . Of course, we also have rare conditions . . . but the idea about people dying of easily treatable/preventable conditions is really troubling . . . The question is about more people like Drs. Roshine, Nandamani etc. who are ready to venture into areas where a simple intervention could save more lives than a complicated intervention . . . 

And when people venture to such difficult situations, we've always seen miracles in the lives of our patients as well as ours . . . and reasons to praise God when we become a blessing to countless lives and families . . . 

Post-burn contracture - Hand

About a week back, Dr. Nandamani was here for his bimonthly visit. Although it was a shorter visit than usual, we had quite a many surgeries. 

Of note, was a young man who was from one of the target villages of the Community Based Rehabilitation for the Disabled. This young man had approached our staff with a post burn contracture of his fingers which were quite expensive for him to get operated. 

Unfortunately, he did not have a RSBY card . . . however, we operated him for a cost of about 5000 INR although the actual cost was approximately 13,000 INR. 

Snaps of his hand before the surgery . . .

And the surgery in progress .. .. ..

Dr. Nandamani would be coming next on March 31st. He would be continuing his bimonthly visits till March 2015 when he would join the hospital back for good. 

There was one more young lady who also had a burn contracture of the finger following a neglected burn injury. A surgery has been done on her too. 

Please pray that both these young people would be able to use their hands well after the surgery. 

Both these surgeries may be quite simple ones for experienced hand surgeons. However, the fact remains that there are quite a many patients with such conditions who would never think about visiting a specialty centre where such surgeries are attempted - the first reason being the logistics of such a travel and the second being the cost . . . 

Surgeons such as Nandamani who chose to serve in underserved areas like ours are a blessing to countless people like these young people . . . 

I would also like to invite surgeons and other consultants who would like to come to us on a short-term period and do similar surgeries . . . Of course, the best time to visit would be from September to March .. .. .. well, December and January only if you can adjust to the severe cold. 

Promoting Millets, Advocacy and CBR

Last week, we had one of the major melas in the region - the Dubiakhand fair. We had set up shop here last here. This year, we decided to go out full steam with a major aim to promote finger millet usage in the local communities . . . And of course, then there were sub-sections on advocacy and promoting rights of the disabled. 

Snaps from the mela, which is also known as Tribal Kumbh Mela . . . 

A view of our stall . . .

The District Councillor visiting the stall

A view of the fair before it became really busy and crowded

One of our hired chefs who made puris and noodles made out of finger-millet

Another view of the stall . . .

Satyaprakash explaining to a person with disability

Learnings from the stall .. .. ..

1. Finger-millet, although it was commonly used in this part of the region long back is not thought of as a food for the common man. There are quite a lot of misconceptions. I heard one lady say to her child who begged to get him a packet of ragi biscuits that it was not a good thing for him. Even though our staff explained about the benefits of the cereal, the lady appeared quite apprehensive. We sold about 40 plates of noodles, 20 plates of pooris and just 2 plates of idlis. Lot more work needs to be done . . .

2. There were quite a lot of people who came interested in RTI act, books on advocacy etc.

3. It was quite encouraging to see people with disability frequent the stall and learn more about rights of the disabled and the avenues of opportunity they have in a changing social scenario. 

Dr. Howard and Becky were quite supportive and encouraging about the initiative. Dr. Howard is the first Executive Director of Emmanuel Hospital Association (1972-77). 

Dr. Howard and Becky having Ragi noodles for breakfast. Later, we went to the police station in Daltonganj to foreign citizen registration. And on the way back, they had Madwa pooris for lunch

And we got some free publicity on television and radio, especially with regard to promoting millets and the Community Based Rehabilitation for the Disabled. . .

Mr. Satyaprakash and myself got to do couple of television interviews . . . 

Tomorrow (19th February, 2014), we are planning a Krishi Mela in the local block where the focus would be Finger Millets . . . Please remember the initiative in your prayers . . .

Irritating . . .

It was one of those very cold winter mornings. I slipped into the Acute Care Unit to find the previous night's Cesarian section patients doing quite well. The babies, cute and rosy, being sung lullabies to. The mothers blissfully proud of having delivered baby boys in deep sleep.

However, it was not difficult to diagnose the richer one of the two patients.

The lady on one bed was an epitome of affluence. Mink blankets . . . a separate mattress for the baby . . . brass spittoon . . .  a mini lakme make-up set on the bed-side table . . . a servant girl to hold the baby when the family is tired . .  . The male relatives were quite flashy . . . Ray-Ban glasses, leather jackets, one guy with a Nokia Xperia .. .. .. As I went about with the morning routine, I found out one of the relatives getting into a Scorpio. Sweets were distributed . . .

The other patient was a classic example of our average patient. Cannot be called to be poor as a church-mouse. They had food . . . it was quite simple. Lentils, rice and roti . . . The clothes were not less than at least 3 years old . . . there was quite an evidence that the quilts they used had seen at least a decade. There was no servant to hold the baby . . . the grandmother of the baby could be seen dozing off with the baby in her arms . . .  the male relatives were daily wage laborers .. .. .. Cell phones . . . yes, cheap duplicates of flashy mobile phones . . .

Well, you may wonder why all this description . . .

Just because, the former patient had a RSBY Smart Card signifying that she came from a family in the Below Poverty Line category and the latter had none . . . I came to know of it later in the afternoon, when I found that the first lady was shifted to General Ward . . . she was not eligible for Private Ward if the patient needed RSBY benefit.

It's not very often that we find such rich patients with RSBY card, but it is not rare.

I'm fine with everybody having an RSBY card, but it pains when we find patients who cannot afford one square meal a day not being included in this welfare scheme.

Which brings us back to a cardinal question being asked all over the world . . . at whose expense have the rich become rich? One need not have much sense to come to a conclusion . . . Yes, the rich are rich at the expense of the poor . . . those who live in the shanties and slums in the metropolitan cities, just outside the walls of those gigantic factories spewing smoke and what-not, farmers in the villages growing food for us but having no share of the big profits made by middlemen . . .

And now . . . welfare schemes being kept so much away from the real poor and marginalised . . . only to be used by the middle class and to a certain extent by the upper class . . .  

Amazing Ways

The below snap looks quite simple. Dr. Howard Searle, the first Executive Director of Emmanuel Hospital Association (1972-77) giving a memento to Mr. Babbu, the senior foreman of the team who constructed the water tank in our hospital campus. 

It was quite later Dr. Howard told me the amazing story of how Living Waters started to help EHA Hospitals build water tanks in their campuses. 

Few years back, Dr. Howard was part of a tour party which was visiting the Holy Land. During the visit, there was a time of sharing among the team at Jerusalem, where Dr. Howard shared about the work of EHA in North India. After the time of sharing, another member of the tour team introduced himself to Howard and told him that he would like to facilitate better water supplies in the areas served by EHA. 

And thus began the great partnership where quite a many villages in and around many of the EHA hospitals got access to clean drinking water and quite a few campuses got a water tank . . . 

I'm amazed at how the Lord has used Dr. Howard to be a blessing for the organisation even after more than 35 years after he left India.

On top of the water tank . . . 

Visiting the borewell handpump in Kamdih village

Nursing School Graduation and Capping 2014

Snaps from the 41st Capping and 39th Graduation Ceremony of the Nursing School at Nav Jivan Hospital, Tumbagara. We were blessed by the presence of the first director of EHA, Dr. Howard Searle and his wife, Mrs. Becky Searle.