Backyard captive poultry

It is a very well accepted fact that backyard poultry is a very rewarding pastime as well as a source of income. There is enough research which has proved that backyard poultry rearing improves household nutrition as well as empowers women.

However, there are major challenges, especially in rural areas.

As part of our Community Health project aimed at building up resilience in the local communities against Climate Change, our team was involved in exploring opportunities for income generation. One theme that was echoed across almost all sections of the society was backyard poultry. Initially, it was about vaccinating the birds from Ranikhet (Newcastle disease). We got some success by going for vaccination campaigns. But, we found out that there was couple of pertaining issues which needed to be sorted out.

The first issue was of predators which preyed on the birds when they scavenged during daytime and even at night. There were incidents of wild cats entering chicken coops made of mud and killing off entire flocks of birds. The other predators were snakes and various species of rats and mice.

The second issue was of sustained feeding of the birds. Because of irregular and erratic food availability, the birds took time to gain weight and therefore were not economically productive.

The third issue was of diseases - the main disease being Ranikhet (Newcastle disease).

We thought quite a lot about solutions. It was very obvious that with a bit of change in practices and discipline we could tackle the second and third issues without much problem. The major issue with the first issue was to make a cheap chicken coop which will keep out wild cats and snakes. There were quite a lot of designs available in the internet to make quite beautiful chicken coops. The problem was the enormous cost.

While I was in Kerala, I saw advertisements for cage like structures to keep 4-6 chickens that cost about 2500 INR (40 USD, 25 GBP, 35 Euros) to make. The monthly earning of an average family in our nearby village was hardly 2000-3000 INR. And most of the poor earned less than that.

It was obvious that we had to think of a new design. Dinesh, our maintenance manager and I ultimate came up with a design. We decided to try it out ourselves as well as among few families within the campus who consented to try it out. We had no inkling about the success.

The contraption was quite simple. We got 3 feet wide chicken mesh, which usually came in rolls of 50 feet. We made cylinder structures using these mesh with a diameter of 3 feet, height of 1.5 feet and circumference of 9.4 feet. On the top of the cylinder, an opening was made with a mesh door. There was no use of any other frame for this cage. The cost of one cage came to around 650 INR (10 USD, 7 GBP, 9 Euros). And it could comfortably house 6 chickens.

Our family has already kept 4 batches of chicken (each batch of 6 chicks) over the last 5 months. And it has been a roaring success. Many of our staff tried it and are quite happy about it. Then, we moved out from NJH to Barwadih. Quite a lot of people who saw the cages were very impressed.

And slowly people started to enquire on where to procure these cages. And we started off a small industry. The priests at the Catholic Ashram, Barwadih were very helpful. We trained few local boys to make them.

In NJH, we made about 20 cages for the staff and villagers before we moved out and at Barwadih, we made about 40 cages in 2 months time.

Few snaps of what we've doing . . . 

Sukhi - the first person who attempted our theory and succeeded. 

The initial days - one of the first cages being made at NJH

A cage kept by one of the staff at NJH

A cage in one of the nearby homes at Barwadih

The 3 cages we used to have. We used to buy 6 chicks every 2-3 weeks which meant that we had regular chicken to cut

The cages being made at Catholic Ashram, Barwadih

Chicks ready for sale

Ujwal, Amit and Manbodh . . . the first full time experts on the cage . . .

Women . . . empowered . . . 

Going home with the cages

It was not only the women . . . even the men were quite interested in the dynamics

Well, I’m sure there will be people who will be interested to do this in other places. As of now, we’ve this being made at NJH and Catholic Ashram, Barwadih. There are 3 more places where few of my friends are exploring on start promoting this. 

The challenge is to have some funds to start off and to find the right people.

You can contact me at jeevan53@gmail.com or call me at 8986725933 for more details. 

Almost missed . . .

Couple of days back, we got a patient who came in late into the night with vague complaints of abdominal pain and weakness of the limbs. 

He was already seen at multiple places where diagnoses of all sorts were made. 

The history was that JPJ, a 40 year old man woke up at around 3 am in the morning with severe abdominal pain. He was immediately taken to the hospital where the doctors could not come to a conclusive diagnosis.

The relatives took him to a total of 3 places . . . over a period of about 18 hours. 

The snaps of the prescriptions are given below . . . 

Please note the diagnosis - Pulmonary edema with acidosis with cerebral malaria. 

The patient had investigations like widal and chest x-ray

By God's grace, somehow Titus who was on duty suspected that JPJ had a krait bite. There was ptosis. 

In addition to the complaints of abdominal pain and weakness, the team noticed that his respiration was becoming labored. 

After discussions with the rest of the team, we sort of convinced the family that it looked like a snake bite. 

Within no time, he was gasping. We had him hooked onto the ventilator. 

With ASV on flow, he made a slow recovery. After 2 days, we thought that he was ready for extubation. On extubating, we discovered that his larynx was all swollen up. It was only a miracle that we could get him re-intubated. 

The relatives were quite agitated. They just could not accept the fact that he was doing good and suddenly had deteriorated. It was then that we realized that the family was quite well off and had the required good connections in Ranchi. 

After quite a lot of discussions, we told them of the futility of trying to shift him to Ranchi without a mobile ventilator. After quite a bit of conference with the relatives with the help of couple of doctors in Ranchi, the family decided that they stay back. 

He was on the ventilator for 2 more days. 

Today, Dr. Roshine told me that he is doing good and would be going home soon. 

A strong reminder to all of us on how a krait bite can turn out to be. With no bite marks, it is quite a tough task for the clinician to come to a diagnosis. And more difficult to explain to the relatives. If JPJ had come to us early in the morning, we could have also made all sorts of diagnoses. 

It was a lesson for all of us . . . regarding krait bite presentation . . . and how misleading can the history be. 

In addition, a strong affirmation for our service and a glowing example of how NJH continues to be the only lifeline for people like JPJ in this part of the country. 

Christmas Celebrations - 1

These are the snaps from the Christmas program we arranged for villages neighbouring NJH. 

The stage . . .  all set.

Initially the crowd was quite low . . .  and we had quite an anxious time.

Welcoming the guests

The dancing starts . . . 

Skit performed by staff . . . 

Rev. Joseph Lakra sharing from the Word about Christmas . . .

Santa Claus giving gift to the Chief Guest . . . All guests got a Bible as gift

The Nativity Scene enacted by students from Nursing School

The Chief Guest cutting the Christmas cake

The dignitaries on the dias . . . 

Before we see further snaps from the program, a glimpse on the preparations . . .

Packing the cakes . . . Had to protect from rats that rampage overnight . . . 

And this is how we kept the cakes overnight . . . This totalled about 2600 pieces of cake. 

Baking cakes going on . . .  Many of our staff learnt to bake cakes . . . 

The pooris and the vegetable curry being prepared.
We used about 150 kgs of flour, about 100 kgs of potato, 50 kilograms of cauliflower.
We estimated that we prepared about 12,000 pooris.  

The preparations early morning

We distributed about 1000 bibles and tracts about the Christmas story.

The final arrangements in progress

Close up of the cake which was cut by the Chief Guest

Waiting to serve . . . 

The crowds pour in . . . 

Our neighbours . . . but we do not see them often. They are too poor to come to us.
Almost all of them were eating cake for the first time in their lives.

The villagers continued to stream in even after the initial rush for food.

At the end, I could only thank the Lord. It was amazing . . . None of us had any sort of experience arranging such a program. All the calculations for the food was made on faith. The total population of the villages we had invited was about 2200. We expected 1500. We made food for 1500. We made 2500 pieces of cake as we were sure that the demand would be high. 

At the end, the 1500 disposable plates were all used up. There were about 100 pieces of cake left. 

At around 4 pm, we had an entourage comprising of the local Block Development Officer and the Police Station in-charge dropping in. It was good that we had those pieces of cake remaining. 

No food was wasted . . . and no stomach in our neighbourhood went hungry today afternoon.

The best part of the whole afternoon was the sharing of the Christmas message and distribution of tracts about the Christ birth and of course, the Bibles . . . 

A day which would be remembered by most of our staff all their lives . . . 

We praise God and thank all of those who prayed. 

The next program for Christmas . . . the official staff dinner on the 22nd December . . . 

Marathon Cesarian Sections . . . Cont'd

Over the last week, I've tried to pull your attention to the poverty of this region. In addition, there was the day when we had to do 7 Cesarian sections on the trot . . . all of them, Maternal Near Misses.

They all got discharged without any sort of complications except for the babies of KD and AF. 

Below is the chart once more. This time, I've added 2 columns . . . which shows the final bill and the charity we ended up giving.

Name	Time and date of surgery	History	Final management and comments	TOTAL BILL (INR)	CHARITY (INR)
RtD	20th july, 11:00 am	Previous LSCS, had come for ANC on 20 june, Hb: 8 gm%, never bothered to arrange blood	Boy baby, apgar 9 and 10. Had waited almost a day for the blood	13162	3979
SMD	20th july, 12:36 pm	Obstructed labour since previous day 8 pm	Boy baby, apgar 6 and 10. Almost a rupture	16101	6851
MD	20th july, 2 pm	Primi at 40+6 with labour pain since previous night. Later obtained history of leaking 4 days. Irregular fetal heart.	Girl baby apgar 8 and 10. Well off patient – did not go to Ranchi.	15658	490
AF	20th July, 3:14 pm	Labour Pains since yest afternoon and leaking, short 136 cm, obstructed labour	Sick girl baby, apgar 1 and 4. Died later, Almost a rupture	16541	3109
KD	20th July, 5:24 pm	Prev LSCS  with iud and Hb 8 gm%	Dead girl, Hysterectomy for placenta percreta	17320	6524
RnD	21st July, 2:17 am	G4P3L2D1, pedal edema 2 weeks, headache followed by seizures 2 pm, 20th july	Baby boy, apgar 6 and 10. IUGR	16498	1053
SrD	21st July, 3:30 am	Short primi, pedal edema > 2 weeks, was having laboru pain since 12 pm on 20th July, BP 140/100. Urine alb 3+	Cervix edematous and head high, inadequate pelvis – lscs, boy baby apgar 3 and 7. Gr 3 Meconium Stained Amniotic Fluid	19235	2438
	TOTAL			114,515	24,444

Well, why do I have to show this . . . When some hospital asks for a small amount and people don't pay, they make into the newspaper. I know of quite a number of healthcare institutions who do quite a lot of charitable work and do not even find a mention anywhere. Just imagine, almost 20% of our costs going into charity . . . This is a fraction of a day's work. 

As I write this, I've 2 patients who are in the ward for whom I would have to give full charity. . . 

The first one, NK, who delivered her first baby and was brought to us about 5 days back with a history of seizures after she delivered a baby about 5 days back. We've not been able to bring down the blood pressure. We tried to refer them the first day. But, to no avail. Today, the father came to me. He requested me to discharge the patient as they did not have any more money with them. He told, 'I will take her home and then we would wait for her to die'. I've told them that we shall continue treatment for 2 more days and they need not pay any more money . . .

The second one, RD was operated 5 days back. Stuck by polio at the age of 3 years, she had got married to a blind young man from her village. She had a pregnancy 3 years back - she had a normal delivery, but the baby was dead. I wonder how she delivered with both legs stuck with polio. When she came to NJH, it was not a classical Rupture Uterus. On operating, it was like someone had done a Cesarian section without opening the abdomen. 

The family does not have even one rupee with them. We'll have to write off the entire bill . . . 

The consequences of such charity work can be terrible on an institution such as ours . . . But, then, there is no other option for most of our patients . . . I wish we had some sort of support .. .. .. 

Obstetric care . . . The stories continue . . .

It has been quite some time since I posted a post on obstetric care at NJH. After the empanelment of NJH into RSBY, it has been quite busy. Today morning, as I visited NICU, I was surprised to find a baby wailing and quite hungry. The reason I was surprised. Couple of days back, we had delivered this little fellow and we had hardly any hope that he would make it. The story of LD’s mother will mirror the stories that I’ve been sharing through this blog over the last 8 months.

LD’s mother as well as SD, about whom I shall share in the latter part of this post comes from Garhwa, the western most district of Jharkhand. It is one of the most impoverished regions in the entire country with stories of hunger and exploitation quite common but hidden from the rest of the world. As part of the overall backwardness of the district, the health services are also very poor. Due to some reason, almost 80% of our complicated patients especially in obstetrics come from this district.

LD was pregnant for the first time. She had couple of antenatal check ups from Daltonganj which is the district headquarters of Palamu, Garhwa’s neighbouring district. She even had an ultrasound scan sometime in the 32nd week saying that the baby has an abnormal lie. However, her family claims that she had a check-up at some place couple of weeks before where she was told that the baby has come into the normal position.

LD came to us late night on 26th March. She had started contracting sometime around the evening of 25th and her membranes had broken sometime early morning of the 26th. When she did not deliver by late morning, she was taken to the nearest health centre from where she was referred to Daltoganj. However, they came to NJH straightaway. She was told that the baby is coming legs first.

I saw the patient as soon as I had finished a Cesarian section on SD. The first thing I noticed was how small her abdomen looked. On per vaginal examination, it was obvious that the baby’s shoulder had presented and the hand was on its’ way to slip out. I had to do a Cesarian immediately.

The best part was that on Cesarian section, it was obvious that she had received umpteen number of oxytocin injections. It was already tonically contracted over the baby and there was hardly a drop of liquor. I feared the worst with a compound presentation. The head and the torso was folded over each other with the back presenting at the site of the uterine incision. I had to ultimately end up putting an inverted T incision on the uterus.

On delivery, the baby was flaccid like a rag doll. There was no pulsation of the cord. Only the heartbeat was there. I was sad . . . we were going to end up with a dead baby after a LSCS. Dr. Titus was there for the resuscitation. He went through the motions of resuscitation, thanks to the classes from Wendy of Grace Babies. After about 5 minutes, there was a whimper and then a small cry . . . By the time, I closed the skin, the baby was wailing. However, there was grunting and I had asked the relatives to take him to a higher centre.

It was good to see the baby live and healthy after such an uncertain and dangerous period. Which, could have been avoided. That’s my point. Home deliveries are such a bane to the developing world. More so in countries such as India where there is no skilled birth attendants. However, even when there is a skilled birth attendant, I’m sure that a home delivery is such a dangerous thing. Many of you may be quite aware of a growing following of people who promote home deliveries, even in the west!!! Recently, I came across people writing about this.

Well, one should realise that the most common causes of maternal mortality and death are complications like excessive bleeding, obstructed labour, infections for which nothing can be done in a home delivery. Few months back, one of my friends lost his wife in a delivery done at in a small hospital in a big city. She developed a complication for which there was nothing available in that hospital. . . not even a laryngoscope for intubation or ambu-bag to mechanically ventilate. You can imagine the predicament if it was a home delivery.

The patient, SD on whom I had done the Cesarian section before LD had arrived was more terrible. She was 140 cms tall and had a Cesarian for her first delivery. She had been having contractions since early morning of the 25th, leaking since 25th evening…she had been trying to deliver at home and ultimately came to us sometime on 26th evening when nothing much was happening. To make matters worse, she had seen one of the best obstetricians in town and in her prescription, it was clearly written that the next pregnancy would be an Elective Cesarian and one pint of blood would need to be arranged.

I was thankful that SD’s Cesarian section went off uneventful. It was quite surprising that even after so many risk factors present in this patient, the relatives were quite careless as there was no blood arranged and we took quite a long time to convince the relatives of the need of a Cesarian section.

She could have died of a rupture uterus any time.

Talking of maternal deaths, I just remembered about someone making a statement sometime that one of the most common causes of female deaths of the reproductive age group in developing countries is tuberculosis. I remembered it because we’ve a 30 year old mother of five in acute care, who has come to us with one of the most terrible Chest X-Rays I have seen recently. She can hardly lie down as she is quite breathless and has a saturation of only 70% even with oxygen in full flow… The snap below is that of her X-Ray . . . 24th March was World TB Day, which we celebrated in the district. A post on that later . . .

GJ Celebrations - The Non Contact Tonometer

The second part of the Golden Jubilee celebrations on the 28th October comprised of the inauguration of the Non-Contact Tonometer in the Ophthalmology Department by Dr Mark Kniss.

The purchase of the machine was facilitated by the kind donation from the families of Mrs Betty Goodwin and Mrs Ivy Kerr of the Cambray Baptist Church, Cheltenham, United Kingdom. We acknowledge the role played by Dr Colin Binks, our former surgeon, in chanelising the funds to NJH.

We are very much appreciative of this donation and pray that it would be a blessing to the patients who visit our ophthalmology department.