Community Based Adaptation

This is a guest post written by my colleague, Mr. Avinash Biswal who serves as a Project Assistant in the Community Based Rehabilitation Project. This is in response to queries from readers about Community Based Adaptation towards Climate Change. Mr. Avinash is a graduate in Psychology who has done Masters in Social Work from Manipal University. This is his first assignment after his Masters. 

Community Based Adaptation (CBA) in simple terms is an approach which facilitates the communities to adapt to the Climate Change. Climate Change enhances hazards like Floods, Cyclones, Droughts, erratic rain fall etc. Even though it is a global issue, its impact is falling excessively on poor communities as they are highly vulnerable. In order to adapt to the Climate Change, many new and effective technologies have been developed and new developmental strategies have been adopted but all this is immensely failing to reach the most marginalized and vulnerable communities in today’s world. Therefore, CBA projects are especially focusing on the most vulnerable communities and work to empower them in increasing their resilience towards the impact of the Climate Change.

Ancient communities have extensive knowledge on climatic conditions and since many generations, they have been using their own strategies to adapt to the changes in climate. But due to reasons like Unsustainable Development and Irresponsible Planning, complications in climate have been increased drastically. Thus it has gone beyond their capacity to adapt to the present Climate Change. Hence, CBA in its strategy never encourages communities to adopt outside strategies, instead it facilitates communities to develop local strategies and enhance their capacity in the adaptation to the Climate Change.

Nav Jivan Hospital has recently undertaken the CBA project in the local community. The target is 30 villages with an approximate total population of about 40,000. The community is severely affected by droughts whereas most of the members of the community depend on the agriculture for their food as well as income. The organisation is working with the community to cope with drought by helping them to adopt drought resistant crops and alternative livelihood. 

Community Based Rehabilitation

This is a guest post written by my colleagues, Ms. Rachel Belda Raj who serves as a Project Officer in the Community Based Rehabilitation Project. This is in response to mails from readers about what Community Based Rehabilitation exactly is. Ms. Rachel is a Masters in Social Work from the Madras Christian Collge and has served at the Physical Medicine and Rehabilitation Department, Christian Medical College, Vellore before joining NJH

Disability has been an age old problem in our societies and would continue to be present. People with Disabilities(PWDs) have always been excluded from the mainstream society. As human rights developed, PWDs started raising their voices for their rights but it has been limited to the educated society who are aware of their rights but the majority continue to live in ignorance of their rights and under discrimination. But approaches to disability have evolved and view of disability have changed from giving charities to a medical perspective and finally to an empowerment model. Hence the development of the Community Based Rehabilitation.

The Community Based Rehabilitation Project, as the name suggests involves in working in the community using the community resources as opposed to an institutional based rehabilitation where more focus is on the medical condition. Hence, CBR involves Persons With Disabilities (PWDs), along with their families, community they live in and the respective government including policy makers and implementers. The dream of the CBR project would be to facilitate a just society where PWDs are given equal opportunities in all spheres of life. The first step towards this goal would be for PWDs to know and access their rights and move forward into the mainstream society.

This project facilitated by Nav Jivan Hospital is the first of its kind in the area and covers a area of 10 blocks with a population of approximately 1.5 million. The initial feel from the field reveals that ideas about disability are still very raw. Therefore a community based project would be a good start in dealing with disability in the area. 

Plastic Surgery . . .

The term 'plastic surgery' conjures up images of perfect smiles, chin lifts, ironed out crease lines of the forehead, smoothened wrinkles for most of us . . .

We've been privileged to have Dr. Ron Hiles from England coming almost every year to teach and facilitate our surgeons to do 'plastic surgery'. Most of the time, it involves straightening out contracted limbs following accidents . . . especially burns . . . most of them neglected when they should have been well taken care of. 

Accompanying Dr. Hiles is Ms. RuthAnn Fanstone, an accomplished Physiotherapist, also from England who specialises in burns management. 

Since Dr. Nandamani is away on a long leave, we've requested him also to be around when these special surgeries take place. This year, it's going to be another milestone for us as a new physiotherapy graduate, Ms. Sheron Mathew from the Christian Medical College, Vellore would join us.

And for the first time, we tried some advertising on the radio. For most of us, it's a forgotten means of communication media. But, it still holds fort in remote areas such as ours. 

We've already got about 15 patients lined up only for the 'plastic surgery'. Cases as severe as the burn contracture in this one year old child . . .

. . . to the love-stuck young man who realised the folly of permanently tattooing his first love's name on his forearm. 

There would be quite a lot of patients who would not be able to pay for their surgeries. If you would like to make a contribution to help us subsidize the cost, please get in touch. 

The big killer . . .

Come spring, and we have quite a spurt in the number of patients with respiratory diseases. And quite a good number of them would be tuberculosis patients . . . A selection of cases .. .. ..

The first one, a young lady who has been on and off treatment. The first 3 X-Rays here are her's taken over one year. It's very obvious that the second film is a bit better than the first one . . . but that was when she had stopped treatment after she was feeling better after about a month of treatment. Then, she was quite sick after the winter. And the third X-Ray was taken after that.

The next one is that of a middle aged lady who also has been on irregular treatment. 

The one below is that of a young man, who had been sick for about 5 months now. He had stopped tuberculosis treatment after 2 months as he was feeling better. Now, he has about one third of his total lung left. 

And the final one- A 10 year old who has been sick for almost 1 year. He has been sick on and off. The main finding . . . he weighs a measly 15 kilograms. 

The common links between all the 4 patients . . .

All of them are poor and there is a major issue with food security in all the four families. 

I've written quite a lot of poor nutrition last year. As the number of poor patients who access our facility increase, the strong association between poor nutrition and disease is very much evident. 

We've focussed quite a lot on Human Immunodeficiency Syndrome which is a cause of an immuno-compromised state (all 4 patients are HIV Negative). I wonder how long will it take for healthcare providers and policy makers to understand that the most common cause of an immuno-compromised state is M A L N U T R I T I O N . 

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 . . .