Monsoon arrives in Barwadih

Monsoon rains have always been welcome relief. It's a photographer's delight. Whether it was NJH or Kachhwa, there were quite a many snaps.

In Barwadih, we had been quite busy. Still, got the time to take few snaps of the rains.

We thank the Lord for the rains. I hope the water table improves.

Spare a thought

It has been raining all over the country. Friends and relatives from Kerala inform of the non-stop rain. There are floods in the North East. Along with parts of Tamil Nadu, our part of Jharkhand is yet to receive full fledged rains. 

This was a sad sight in our neighbourhood yesterday. 

Almost all the tubewells in the region have dried off. Many families are depending on water-tankers for their daily supply of water. 

Pray that rains will arrive soon. 

Oh . . . Ragi . . .

After quite a long time since we had been trying to reintroduce Ragi into the local diet (since 2011), we still don't have any data to prove that we've made any impact.

However, I keep hearing stories on how many more farmers grow millets in the Palamu region now.

And, on and off we get to eat ragi dishes when I visit mission stations, like the 'Ragi puttu' we were served last week at Chandwa.

I was told that this dish is relished by quite a many of the residents there.

May the tribe of ragi lovers increase . . . 

Mission Millets Cont'd

Now that we know that finger millet used to be a crop in our community some time back, we took the decision to bring back the crop into the local agriculture. 

The first initiative was done couple of days back, where we had an interaction with the farmer community. About 40 people attended, most of them women. There is a great interest especially from farmers who are a bit elderly. They've had millets during their younger age and were quite pleasantly surprised that they have abandoned such a healthy crop. 

Snap from the event .. .. .. 

Points which we garnered from the crowd - 

1. Everybody is quite aware that there is a prediction of deficient monsoon. 

2. Most of the older farmers know that finger millet requires lesser irrigation. 

3. Many of the attendees were small landholders and they were more interested in having varieties of crops in small amounts in their land. 

Below are two pamphlets we made from templates provided from NJH.  

We are excited about this. We request your prayers. Distribution of seeds will start as soon as they arrive from NJH. 

Madwa 2014 . . .

As part of our Community Development project targeting Climate Change, our team has facilitated the reintroduction of finger millet cultivation in the region. Last year (2013), we had about 40 farmers who cultivated in a total of about 4 acres. This year, we had about 230 farmers who cultivated a total of about 12 acres.

Last week, during the US-led “Dialogue on Nutrition” held at the Food and Agricultural Organization (FAO), FAO Deputy Director-General Daniel Gustafson highlighted that "good nutrition must begin with agriculture." 

It was a privilege to have Professor Z A Haider from the Birsa Agriculture University, Ranchi visiting the region, to follow up on our work among the farmers. The program becomes all the more significant in the light of the Fifth Assessment Report of the Intergovernmental Panel on Climate Change – Impacts, Adaptation and Vulnerability. I’m yet to go through the whole report. But, from a  news-item of the same in Down To Earth, the future looks pretty grim.

Snaps of the visit . . . and more discussions later . . .  

At Patna village . . .

Walking into the fields . . . 

Another field . . . Prof. Haider was very much impressed . . .

Prof. Haider interacting with the farmer . . .

This plot of ground was a major revelation for the entire team. More on this in the next post . . .

Going further . . . 

More interaction with farmers . . . 

Field at Charwadih . . . 

Quite a large field at Murma . . . 

The field at NJH campus . . .

Field at Bohita village . . . 

Interacting with people from potential new cultivation areas for the next year.
We had a very interesting dialogue. Shall write in detail about it in the next post.
Looking forward for madwa cultivation in Barwadih block next year. 

Itch, Itch, Itch . . .

Few days back, a mother brought her 10 year old boy to the clinic. Her complaint was that the boy told her that something was wrong with his private parts. I asked him what the problem was. He told that he is having severe itching and there is infected wounds filled with pus in his genital areas.

After quite persuasion, he agreed to let me examine him. His scrotum and penis was covered with pus filled ulcerated areas. There were few lesions which appeared to have healed resulting in quite bad scars in his scrotum and penis. I asked him if there was pain. He told that the pain was tolerable, but what he could not tolerate was the itching at night.

There was only one diagnosis – scabies with secondary infection. However, I had never seen this much extent of secondary infection in scabies. After advising the parents on the possible diagnosis, I got assurance from them that they would come within couple of days after I start treatment for review.

I was surprised to find the boy back after couple of days. He appeared quite cheerful. Once I was inside the clinic, I realized that the parents and his brother also had registered themselves for check-up. To my horror, all three of them had scabies over various parts of their body. And for the boy on whom I had started antibiotics, all the pustular lesions had healed and the lesions which are very typical of scabies was very obvious.

All four of them were started on topical applications to treat the scabies.

However, I was in for another surprise later that day. For the first time in my life, I saw an infant of less than 2 months of age with scabies. Of course, the mother also had scabies infestation on her body. The interesting thing was that the mother never thought of the skin lesions very seriously. Her main complaint was that the baby was crying throughout the night as if he was in pain. Little did she know that the itching was bothering the baby.

Scabies as an indication of poor personal hygiene. 

Yesterday, I was on a field visit with Prof. Haider, Professor of Birsa Agricultural University. It was very obvious during the visit to most villages that the drought has started to affect the daily activities of the villagers. Water was a precious commodity. Taking bath even once a day was a premium. The women were the worst affected.

The issue is that treatment of scabies also involves advise to take bath regularly as well as to wash all clothes, especially undergarments in boiling water. I wonder how this family is going to find enough water to do all that. 

I’m sure that I would be seeing a lot more of scabies over the next few weeks. I would also be interested to see what other diseases can a drought bring about. With an obvious issue with food security, my gut feeling is that we would be seeing an increase in the number of chronic infections especially tuberculosis.

Climate Change . . . What an association

We’ve been working quite hard in the area of bringing resilience in our surrounding communities towards climate change. The strategies have been manifold.

The major strategies being aimed towards equipping families to alternative livelihoods, facilitating the cultivation and acceptance of drought resistance crops like millets, group formation aimed at co-operative agro-based livelihoods and forest conservation.

It was surprising to read in the BBC about a study published in Science with research done at the University of California, Berkeley, which says that shifts in climate are strongly linked to increases in violence around the world.

This makes lots of sense to a place like Palamu where NJH is.

Palamu has been famous for the periods of irregular drought and unpredictable rainfall. Even as the rest of the nation celebrates a good monsoon, Palamu has been in the throes of an bad drought.

The study brings out the fact that it is all the more important that the government and civil society organisations think seriously about ways to mitigate the effects of climate change.

And the key I believe is to look back at the way our forefathers have tackled changes in climate. Many a time, we have come to conclusions that forceful interventions in the name of development and modernisation has brought about more challenges than solutions in the long run.

A simple example is that of the Green Revolution which had been touted as the long standing solution to food insecurity. However, on looking back, we see that it caused many a damage to traditional dietary habits of communities. At least in the Palamu region, this holds true as communities which depended on millet crops which are drought resistant were forced into or enticed into water dependent crops of rice and wheat.

I’m sure we need to look more into this aspect of climate change, but one cannot take away the fact that people like me do not find it difficult to accept such a research. 

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 . . . 

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.

Fibre Crop . . . Any idea . . .

Yesterday, I happened to stumble upon a plant which was used as a source of natural fibre in this part of the country. In the local language, it is called GHUDRUM. Natural fibres such as jute, sunn hemp, mesta etc. are quite popular and a major source of agricultural revenue.

I could not find any more information about ghudrum in spite of searching the net.

Below are the snaps. I would appreciate if anybody could provide additional information. 

Seeds of the plant

Rope made from the fibre . . .

Like the millets, the major advantage of this plant is that it needs less water. In the olden days, it used to widely used for all purposes that we use a coir rope or jute rope. It has fallen into disuse as processing it is quite energy intensive and there is no known mechanised processes as seen with jute or coir. 

I wonder if this could be a good source of income generation for this impoverished region. 

And I'm also yet to receive good information about kodo, the vanishing millet crop. 

Tuberculosis - Are we winning the war?

The two X-Rays shown below are of two ladies – the one on the left is that a very young lady, MD with a 2 year old child and the one on the right is that of an elderly lady, LD with adult children.

Both these ladies came in during the later hours of Saturday evening. They must have come in as the OPD was closing. It was very evident from both the histories that they have tuberculosis. The reason we took the X-rays was because I was unsure of how much healthy lung tissue they had left. I’ve already started them on anti-tubercular treatment without waiting for a sputum test as the sputum test will happen only on Monday morning.

The RNTCP higher-ups have been going gaga about the success that RNTCP (Revised National Tuberculosis Control Programme – www.tbcindia.org ) has achieved in bringing tuberculosis under control. RNTCP is a highly acclaimed programme run by the Government of India aimed at the control of tuberculosis in the country. Quite a lot of clinicians have many misgivings about the programme – but that is another story.

NJH has been partnering in implementing RNTCP since its inception – as a Microscopic Centre catering to a population of 100,000 since 2001 and as a Tuberculosis Unit since 2006.

I need to say this – we have been having an increase in the number of patients whom we are diagnosing tuberculosis over the last 2 weeks. Even as I write this (10:40 pm), I’ve a patient who’s just come in and it looks like tuberculosis. I’ve 4 patients in the inpatient wing waiting for sputum AFB tomorrow morning. We’ve had quite a number of patients over the last week who had been diagnosed as malaria or enteric fever outside and we came to a diagnosis of tuberculosis – and they’ve improved after Anti-tuberculosis treatment. Unfortunately, they include quite a number of children.

I’m not sure of the reason for the sudden increase in the number of tuberculosis suspects. One reason which I can think of is the drought situation which has been prevalent in the region for the last 3 years by which the poverty among the communities have worsened. This has been followed by very heavy rains over the last 3 months – which has increased the incidence of water and vector borne diseases.

Most probably what is happening is that the other diseases  like malaria, dengue, diarrhoeal diseases etc are occurring which is decreasing the already poor immunity of the impoverished population making them susceptible to flaring up of tuberculosis infections to which quite a lot of the population is exposed to.

The reason I suspect is because of a very peculiar history which we notice in many of the patients whom we ultimately diagnose to have tuberculosis. They come with a history of fever 2-3 weeks back following which they are treated at a quack’s place (http://jeevankuruvilla.blogspot.com/2011/08/quacks-rmps-registered-medical.html) usually with artemether or levofloxacin or a combination of both – following which they are asymptomatic for about a week after which they again get fever. Initially, it does not give the peculiar symptoms of tuberculosis – but over a week, they have the pattern of evening rise of temperature, loss of appetite etc. Unfortunately, many a time, we do not get a positive report on sputum – most probably because of unscrupulous use of Ciprofloxacin and Levofloxacin, both of which have anti-tuberculosis bacilli activity. We conclude based on typical X-Ray finding of apical consolidation and cavity formation. And of course – the best support - history of exposure to another case of tuberculosis.

I would definitely like to hear expert comments. Of course, I’m quite interested in the stories of KD and LD and will try to put them up in a later post. I’m sure this would be quite interesting especially from the perspective of the socio-cultural and economic set up of the region.