Long forgotten . . .

Over the last 2 weeks, I've stumbled on some great information about finger-millets. 

Earlier, we only had information about pearl millet being grown in the communities around. However, we were surprised to know that even finger millet was cultivated here a long time ago.

The information came from two sources. 

The first source was a class I took for few people from the community on nutrition. I was narrating about crops which were cultivated earlier which are not done anymore. While I was narrating about millets, one middle aged man asked me whether I knew about samai, kodo and madwa. 

That was music to my ears. As we discussed, it dawned to me that all three millets used to be cultivated before 40-50 years in the communities of our region.  

The second source was one of our staff, who hails from North Eastern Uttar Pradesh who returned after a short visit to Vellore, Tamil Nadu. I had requested him to get us couple of kilograms of finger millet powder as we were finding it difficult to cope with our kids' demand for ragi porridge. 

He brought us the couple of kilograms all the way from Vellore, but also told us that few people cultivate the thing in his native village, about 150 kilometers from here. However, he also told us that the cultivation of the crop was slowly decreasing. 

Later, I had discussion about the crop with few of our retired staff. They all fondly remembered these crops. Further discussions were very similar to those which our team at NJH had with the local villagers. 

Now, we need to take a call on whether it is worth the effort to try to bring back finger millet cultivation in this region. The effort is going to be massive. 

The major hurdles - 

- In Palamu, it was only about 10 years since the local communities stopped madwa farming. Therefore, the memory of cultivation was very much there. Here, I don't think we would find anybody who'll have any knowledge about the cultivation, leave alone having had a taste of the millet. 

- We'll have to bring the seed from elsewhere. 

- We'll have to develop the taste of the local community to eat foodstuff made from madwa. 

The plus points are many - 

- It gives an alternative to the community in their diets

- Considering that there has been much crop losses due to vagaries of the climate, finger millets are a resilient crop. 

- It is poor friendly as it is not dependent on irrigation. 

- Of course, it is much more nutritious than other cereals. 

- It scores over bajra as it can be eaten all the year around. 

The big question remains on whether it would be worth the effort . . . God gave us success in Palamu . . . Requests your prayers as we plan ahead . . . 

The Lord Cares . . .

For Angel and me, the call to be in a remote mission setting has been a definitive call. It is not uncommon that we get questions about our saneness. The questions have increased proportionately with the increase in our number of kids. Some of the recent ones have been like – ‘4 kids and living in a place where the nearest pediatrician is 120 kilometers away’, ‘how do you manage without an outing to a mall’, ‘3 days to go home and meet your parents, are you nuts?’  

Of course, it’s not uncommon that we look at adverse possibilities.

Exactly a month back, we faced such a situation. Our younger daughter, Hesed, aged 2 years old and the most active of our four children took a jump from the upper deck of our double-deck cot and landed on her right forearm. The hand took quite an impact. She was not allowing us to touch her right elbow.

And we were at Barwadih. The nearest help was about 30 kilometers away and we knew very well that the orthopedician did not deal with such injuries. We had a plan to visit Ranchi the next day. Thankfully, there was no swelling of the elbow although there appeared to be some pain.

Overnight, Hesed did fine. However, the next day as we travelled to Ranchi, we realized that there was a bit of a swelling of the right elbow. It was difficult to find out if there was much of a problem as Hesed was a left hander.

As we travelled, the first thought that came to me was to call up our friend orthopedician, Dr. Kenny David at CMC, Vellore. To our amazement, he was at a place near to Ranchi and was on his way to Ranchi airport to catch a flight.

It was amazing - - - looking from a point of chance. The number of times, we visit Ranchi as a family is only once in 3-4 months. The number of times that Dr. Kenny David will come down to Ranchi is maybe once a year. The chance of one of our children getting an elbow injury is maybe once in a generation. And to have all of them together in such a way that Hesed gets consultation from the pediatric orthopedician of a premier healthcare institute of the country when we are stationed at a remote corner of the country.

Don’t you think this is amazing? We are definite that the Lord was in control and took care of Hesed’s elbow.

Dr. Kenny saw Hesed at Ranchi. We got her X-Ray and then put her on a slab. The X-rays got reviewed by the pediatric orthopedician at Vellore. 

Today, it is one month since the incident.

Hesed is doing well. We thank God . . .

We learnt that how much precious we are for the Lord.

Healthcare Sciences – Opportunity with EHA

Emmanuel Hospital Association gives the opportunity to students to serve in its hospitals through the system of sponsorship to graduate/diploma courses including MBBS, Nursing courses in Christian Medical Colleges, Vellore and Ludhiana. There are quite a lot of a number of people who took this opportunity and went on to leave lasting impressions in the areas they served.

For getting sponsorship, the prospective student would need to visit one of our hospitals for a period of 5 days. I write this post as there seems to very less information about this to most of such students who look for such an opportunity.

Over the last 3 years, I get flooded with calls/inquiries about the exposure visits during Feb/March. There are of course deadlines for such visits. Every year, it is the 30^th of March of that year by which the exposure visit needs to be completed.

We’ve a rush of students coming to be with us over the next 2 weeks. However, it would be much easier for us if the visits are planned much in advance. Only one student had come to us in December over the last 3 years.

Therefore, this post is mainly for all those who’ve just finished their 10^th standard exams or going to start 12^th standard (+2). We appreciate if you could come for your exposure visits in a much more planned manner.

Please do share this information with your friends and relatives who could find this beneficial. For more information, you can visit the EHA website and also write to sponsorship@eha-health.org  

100 days at NJH

This is a guest blog from our Physician at NJH. She responded to my request for a post after she completed 100 days of selfless service at NJH. We had been praying for her for quite a long time and it was a dream come true for me when she joined NJH. 

Dr. Roshine Mary Koshy completed her graduation and post-graduation in Internal Medical from the Christian Medical College, Vellore. She hails from Kerala and was a topper in the State MBBS Entrance Examinations. Her father, Rev. George Koshy pastors the Marthoma Church, Krishnarajapuram, Bangalore. I hope her former school mates from the Marthoma Residential School, Tiruvalla and Mathews Mar Athanasius School, Chengannur will appreciate her work. 

After her graduation she had also served at Marthoma Hospital, Chungathara and the Fellowship Hospital, Kumbanad. 

Over 3 months into working as a consultant physician in NJH has been an eye opener for me. This write up is an attempt on my part, as someone new in this field, to share my experiences and observations/musings over the past 3 months in the hope that anyone who might be interested in getting involved in improving health care in North India might have something to ponder about and those who intend to be spectators might want to take a closer look.

I feel that a great challenge as a health care provider is being able to identify the population with greatest need and to constantly focus on allocating all available resources within our constraints for their benefit. Just a few months experience and I know this is easier said than done.

Who are the poor that this hospital takes care of?  It is a heterogeneous group and the two distinctions I make are purely based on my observations as I care my patients and talk to their families in a hospital setting.

There are the real poor. They are hardly seen in the hospital because the hospital is their last resort to which they often don’t reach on time. But I remember a few of them who did come to us. They come really sick, treated by traditional healers, wanting their loved one’s life saved. If I were to tell them the critical condition of the patient and paint the obvious bleak outcome, they would rather take the patient home than get treated. But if they do decide to get treated and the patient gets relatively well in a day or two, they want to be discharged immediately because they can’t bear the expenses of the remaining days. They get better, go home very happy and never beg for charity.

I learnt this the hard way. 8 year old Reena came to us with GTCS for almost half an hour. There were no beds in the ICU. We controlled her seizures and I explained that they would need to take her to a higher centre. It seemed reasonable enough to me. It never dawned on me that the nearest higher center is Ranchi, a 5 hr journey with an expense of 6000 Rs if the family makes it both ways with additional expenses in Ranchi. I was happy to see them arranging a vehicle with the referral letter in hand. I am grateful for one of my colleagues who happened to notice the scene and told me that they were taking the child home. It took only a little extra effort to arrange a bed and manage her medical problems. She turned out to have TB meningitis, developed partial lateral rectus palsy while in the ward which resolved with treatment and she went home a happy little girl.

The thought that if this health service had not been available for her, that she would not have lived was a hard truth for me to swallow. After seeing the health status of the poor here, having been able to save a life does not appear heroic to me. It just speaks volumes of the complacency of my profession in fulfilling its solemn duty to society.

The not so poor patients, I have grouped together because though their socio economic status varies, they have something in common. Their health issues have not been properly evaluated; they have been extensively and unnecessarily investigated and treated. I find this to be one of the greatest challenges while working in this part of the country, the fact that the practice of medicine is not a science but a trade. I sensed it during my first month when my patients were very offended because i seemed to be ‘probing’ into the history of their clinical complaints. Listening to their history and examining them before ordering an investigation was unusual. It was more frustrating to me when healthy patients came asking purely for investigations because they wanted to confirm if they had ‘typhoid’. 

Working in a rural area and ensuring that the practice of medicine is both science and art is challenging but extremely rewarding. I am grateful for my training in the Christian Medical College, Vellore, for the privilege of being mentored by excellent clinicians. For those young doctors who think that working in a secondary set up in a rural area is dull, I thought I would just give you a list of a few of the medical problems that we encountered in the past 3 months.

Snake bites both poisonous and non-poisonous, Organophosphorus poisonings, meninigitis, strokes, tetanus, neurocysticercosis, pneumothorax, staphylococcus empyema, rheumatic heart diseases, tuberculosis, connective tissue disorders, apart from malaria, rickettsial infections and the like. Being able to clinically diagnose them with basic supporting investigations and manage them is very satisfying. As for scope for improvement, the area of critical care has great potential in our area and we are focusing on it.

Working in rural areas which have been neglected and among communities that have often been exploited can be very frustrating because good intentions can be looked upon with suspicion and appreciation for the work that one does is often hard to come by. The advice that my colleague gave me is something worth contemplating and I end my ramblings with the wise words of Oswald Chambers.

“If we are devoted to the cause of humanity, we shall soon be crushed and broken hearted, for we shall often meet with more ingratitude from men than we would from a dog; but if our motive is to love God; no ingratitude can hinder us from serving our fellow men”.

Painful Ritual

These snaps were taken during my stint in the Christian Medical College, Vellore.

This young man has lemons pinned all over his upper torso as part of some ritual.

Would appreciate if anybody has information on these rituals.

Tiger spotted . . .

We've great news in the wildlife front from the Palamu Tiger Reserve, which is about 10 miles from our place. Newspapers reported today about a tiger being snapped up by the automatic camera within the reserve. 

English translation: The camera trap at Palamu Tiger Reserve, Betla took the snap of a tiger on last Sunday at 9:41 pm. The forest staff has identified the tiger to be 'Maharaja'. Previous to this, the camera trap had photographed a tiger on 21st February. Over the last 2 months, tigers have been spotted thrice in the Betla National Park. It is difficult to comment on how many tigers are there. But there are tigers here.

By the way, we would going there along with the students from the Christian Medical College, Vellore sometime this week. The students are visiting us for a week under the secondary hospital program. Dr. Shubhankar Mitra from Medicine 4 is the consultant in charge.   

Focus . . . Snakes and snake bites . . .

Last week, NJH was part of a group of hospitals who were invited by the Christian Medical College, Vellore to look into snake bites and their management . . .

I leart quite a lot of things. It was a privilege to rub shoulders with who’s who in herpetology. Romulus Whitaker, Gerry Martin, Dr. Oommen V Oommen, Dr Bawaskar, Dr Punde . . .quite a lot of big names in the field.

Yesterday, I was talking to my staff in Community Health and Development about how fast we draw conclusions without looking into evidence.

Over the last month, I had put up the post on the clientele we serve at NJH. And later something about neurocysticercosis and their cause. Regarding the former topic, quite a good number of our staff thought that we serve a higher number of poor. I got quite a number of feedback about the ‘new information’ they received in the post on neurocysticercosis.

The common aspect about snakes and snake bites are the myths that surround them.

Couple of the myths that I harbored for long were given the boot after the meeting.

The first one . . . I was under the impression that a venomous snake bite late in the night or early daybreak would be less venomous compared to a bite in the evening. The reason . . . the snake would have already spent it’s venom on a prey and therefore a lesser amount only would be available to inject into the next victim. The same logic applying to snake bites on two consecutive victims by the same snake. The second victim would have lesser venom injected thereby causing lesser envenomation in the second victim.

The venom is the saliva of the snakes. Even after a biriyani, you’ll continue to secrete saliva if there is ice-cream after that. Similarly, the snake would continue to secrete the venom irrespective of the fact whether it had a prey before biting a victim.

The second one . . . a non-poisonous snake in your backyard means no poisonous snake in the same area. Absolutely wrong. Any snake seen means more snakes in the area. It was reported that it is not uncommon for a venomous and non-venomous snake to share the same hole!!! I remember someone tell me that it is not good to kill a non-venomous snake as it’s place in the habitat may be taken by a venomous one.

There is nothing like a territory for a snake. . . the way they have for tigers etc.

The third one . . . which is quite frightening. I used to believe that use of chemicals such as phenol would help keep out snakes. And after we had couple of snakes inside the house during our first year at NJH, we’ve not seen them inside after we started to regularly use phenol to wipe the floor. In fact, there is no evidence to support the fact that snakes dislike phenol. However, snakes don’t like clean places. They love dirt and areas with things like papers, leaves etc. piled up. The fact that snakes are not entering the house is because of cleanliness that accompanies a daily wipe with phenol and not the smell of the chemical.

However, the best ones . . .

Kindly see the snap below. The blue bordered regions are places where a proper taxonomy of existing snake species has not been done. Quite an exciting thing for mission hospitals in North India such as ours as we can be base for quite a lot of work on getting to know more about these creatures.

The final straw . . . The snap below. Kindly note the thing written in red. This is the number of vials of antivenom that will neutralise the maximum possible venom that is injected during a bite of the concerned snake.

The question is now going to be about how WHO has come up with a protocol of 20 vials to be used for any sort of snake bite. . .For units such as NJH, this has major implications . . . as a low dose protocol should theoretically be enough to salvage viper and krait bites . . .

We’re quite excited of the future . . . we could be part of path-breaking research on snake bite syndromes and their management.

Pray for us . . . 

Reminiscences . . .

A continuation of my recollections of our days in the Community Health and Development department of the Christian Medical College, Vellore . . . 

First, the 'konna' flower (Cassia fistula). It's a visual treat during April every year ..  .. ..

Couple sites where stone benches are put which have been the hot spots for some great discussions . . .