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 . . . 

Cont'd - Dangerous Obstetrics

Yesterday, we had quite a crowd in our Labour Room. Over the last 5-6 months, we've had a fall in our Labour Room statistics. We presume that the fall has been due to the opening of multiple nursing homes and hospitals in the small towns from where patients usually came to NJH. Most of these hospitals are manned by nurses or junior doctors, but has names of consultants from the nearby cities on their rolls. 

Of course, we still continue to have our share of eclampsia and rupture uteri. Yes, I've sort of stopping writing about them for some time. You can read the following posts which I had put up some time back about our high risk obstetric patients. 

1. Dangerous obstetrics. 

2. Maternal health care . . . quo vadis.

3. Obstetric Care stories . . . cont'd

4. Weekend diaries

5. Best posts on RCH

We continue to have such patients regularly, although I've not written about them of late.

However, I was quite surprised by yesterday's rush. We had 6 labour patients coming in of which we ended up managing 5 of them. 

The first to arrive was SabD, a 32 year old G6P5L3D2 who had a Cesarian section to deliver her last child. She was in labour and had been trying to deliver at home. By God's grace, she had progressed to quite an extent. But her hemoglobin was only 8 gm%. Considering the prolonged labour, I offered to do an emergency Cesarian section if blood was arranged. The family went to arrive blood. However, the lady progressed well and delivered vaginally by late morning. 

We were glad, but the family was downcast. The reason - - the baby was a girl and the family already had 3 girls, and no boy. They were expecting a male baby. I counselled them to do off a tubectomy, but the family nor the patient would have nothing of it. 

The second patient was PrD, a 20 year old who was pregnant the third time. She had lost one baby earlier due to premature delivery and one was spontaneously aborted in the 2nd trimester. 

To our horror, PrD was leaking for more than 2 days. She was being managed elsewhere, was told that everything is fine and was discharged. Soon after discharge, she started to have fever. The family thought of a second opinion. PrD had a hemoglobin of 9 gm% and she was in full blown sepsis - -  a total count of 40,000/cu mm. She was only 136 cms tall and on per vaginal examination, there was hardly any space along the pelvic outlet. We had to do a Cesarian. 

Per operatively, on opening the uterus, the entire endometrium and the baby was stinking. It was hard to believe that the baby was still alive. So far, the mother and the baby have done well. 

The third patient was SanD, a 23 year old primi who had an uneventful labour and delivered normally. 

The fourth patient was AnwD, a 20 year old G2P1D1, who had a previous LSCS, but no live issues. She had been trying to deliver at home since evening and had ended up with a rupture uterus. The rupture was quite a bad one and very uncharacteristic of previous Cesarian ruptures which usually occur only along the suture line. 

Below is the snap of the rupture after the suturing was done. Since she has no issues, we have not done tubectomy. We pray that she will conceive and deliver a healthy baby later. 

The fifth patient was RekD, a 25 year old, G2P1L1 with previous Cesarian section who came in with labour pains as we were doing surgery on PrD. According to her dates, she was only of 32 weeks gestation. The baby looked quite small and I thought of suppressing her labour. However, the pains just increased. We had told the relatives of the non-availability of specialist facilities should she deliver. 

She did not respond to any of our treatment, but, almost after 6 hours of good pains, she was not progressing. There was a danger of going into rupture uterus. The doctor on duty thought of screening her by ultrasound and found that the baby was in fact term. Yes, the baby appeared to have low birth weight. 

Off went RekD for Cesarian and she delivered a Low Birth Weight baby. RekD had a hemoglobin of only 7.8 gm%. She is yet to receive a blood transfusion.

There was one more patient - the sixth one who did not stay on with us. IikD, a 26 year old wife of a army jawan. The poor lady was leaking since the last 2 days. They were trying for a normal delivery at home. She was G3P2L2 with the first delivery done by Cesarian and the second one a home delivery !!!. Her husband wanted an assurance that we would ensure that she has a normal vaginal delivery. 

I told him that that assurance cannot be given. The family went off in a huff with the jawan shouting all obscenities about the staff and the hospital. It was sad to see that an army jawan just not understand my reasoning and wanted to rather have his way without looking at the possible adverse outcomes. 

Now, all except one patient were very very high risk obstetric patients. 

In fact the 5 of the ladies who delivered yesterday, had lost a total of 4 babies earlier (5 if you include the present rupture uterus too).

5 families . . . 14 pregnancies . . . 5 dead babies . . . one more could have died if we had not intervened on time (PrD).

As I mentioned in one of my previous posts, the status of obstetric care in the region is so bad that we've not still got into the process of looking at neonatal outcomes. 

I'm proud that we've been entrusted by the UNICEF with the responsibility of supervising obstetric care in the district. 

However, to do justice to this responsibility, I need more help. One of the major challenges we have is the unavailability of an obstetrician and pediatrician. And there is always the dangling sword of the Clinical Establishment Act and non-understanding officers who could stop us managing such patients in the near future. 

Please spread word about the urgent need for consultants in the specialities of Obstetrics, Pediatrics and Anesthesia without which quite a number of hospitals such as ours would not be able to be the sort of blessing we are now to many a families. 

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. 

Pangasius

Last week, we got some new type of fish which is being promoted by the Government of India. It's called Pangasius - the common name being Vietnamese Cat Fish.

Pangasius fry which we procured last week

You can read more about it in Wikipedia.  

However, the reasons which attracted me are much more . . .

1. The fish was being promoted by government of Jharkhand.

2.  They are touted to grow well in not that clean water.

3.  As you may have read, these fish reach a size of 1 kilogram in a period of 6 months, which is quite fast for any variety of fish.

4.  These fish have less number of bones which make them quite table friendly.

5.  The meat is quite tasty and ranks quite high with regard to consumption.

Yes, there is a risk involved. However, since we are doing it in our pond which gets completely dry at least once in 2-3 years, we can always phase it off if we feel that Pangasius is somewhat of a threat to the environment to the ecology. 

We wait with quite a lot of expectation from this new venture. And it could be the beginning of a new chapter in the history of inland fish farming in Palamu region. 

Snap of the fish being sold in a market in Vietnam (source - Wikipedia)

The Palash Trees

I've written and put snaps earlier about the Palash trees which dot our landscape during this season. They make quite a good scenery. You must have noticed one snap in the post on the visit of Dr. Nevin where you can see them. 

Below are few snaps I managed yesterday when I had gone to Ranchi to pick up Dr. Ron Hiles. 

You can see the trees far away . . . giving a orangish glow to the forest

A memorial to freedom fighters who gave their lives for the region

A Stray Leopard . . .

I wonder if anybody had read about a stray leopard which entered a house in Daltonganj, our nearest town. It sent quite a shivers down many a spine here, as our hospital is very much in a heavily forested area. I never thought that the news was in the internet till I saw the reports in TOI. Of course, it was big news in the local press. 

There had been quite a lot of deforestation and the very bad drought over the last few years had dwindled the wild animal population. 

However, the recent intrusion of this wild cat is an indication that the wild animals may have returned to the Palamu Tiger Reserve. Newspapers later reported that the foresters estimated that there were over a 100 leopards in the reserve area. There was much joy about a year back, when the forest officials reported rare sightings of the animal in trap cameras set in the reserve. 

Good news for wild-life, but frightening for many of us here. The leopard has been released back into the reserve. 

Now, we would need to be careful about venturing out in the dusk . . . especially going for calls etc. in the night. 

I would definitely like to see one. But, not inside the campus . . . roaming around. 

Bandh . . . Time for a break

We have been having quite a lot of problems in our region which has been reported quite a bit in the media. I’m not here to comment on who is right or wrong . . . but a bit on how life has affected us at NJH, because of 2 days of bandh which has been called tomorrow and the day after, It is true that we’ve not had general strikes for almost 3 months since September 2012.

However, I have a hunch that things are not going to be the same at least for some time. There are multiple reasons for the same.

Coming back to the way things go haywire at NJH when there is a bandh. . . or do we get a well deserved break as one of my friends recently put it.

We had registered a team of our hospital staff to go to the Christian Medical College, Vellore for a training in Critical Care. With the amount of very seriously ill patients whom we’ve been dealing with of late, I had been planning this since last year. 

Now, the team of 4 was supposed to leave on Monday to board their train from Ranchi. Because of the bandh, the team had to leave today for Ranchi. Now, they would be sitting jobless for the next 2 days in Ranchi.

Then, we were planning to visit Ranchi on Tuesday for some major purchases. However, the bandh for two days means that Tuesday would be a busy day in the hospital. Which would mean that I’d rather be in hospital on Tuesday.

In addition, I realised that it would be a rather relaxed day in hospital on Monday. So, I could take a chance of doing the work in Ranchi on Monday.

Presto, I had to take a decision on Saturday afternoon. To go to Ranchi in a short notice of 3 hours . . . or not. I remember that my better half and the kids had been looking at the prospect of couple of days away from hospital. I suggest that we all go together.

Well . . . you can imagine us getting the 3 kids ready with all the packing for 3 nights away from home. Angel is quite well adapted to this sort of sudden planning. So, there was not much problems.

I had quite a lot of work to settle in the office. I was out by 3 pm and the whole family plus the critical care team was out of the hospital campus by 3:30 pm.

We reached Ranchi by 7 pm and had dinner at one of the hotels which was not a very good experience for the money we spent. 

But, we were surprised by the fact that it was less cold in Ranchi than it was at NJH. It was a welcome relief for all of us . . .

Am I relieved that I’m away from NJH ? ? ? Well, that’s something we’ll decide once we return back. Because, when I left the hospital, the Acute Care was full. There was no bed left. Then as we drove, I got a call about a boy who had come with an overdose of Bhang . . . a local form of canabis.

More on the Bhang and the patients in Acute Care in my next post. 

I shall relax for the next 2 days.

(This post was written on Saturday, 12th January, 2013 and was not posted because of poor internet connection)

Mismanaged Diarrhoea . . .

The above snap is of medicines that this 18 month old baby had been having since the last 3 days. The list includes - - -

1.       Cefixime with Lactic Acid Bacillus Dry Syrup

2.       Ofloxacin with Ornidazole Syrup

3.       Nutrolin B Syrup

4.       Furazolidone and Metronidazole Oral Suspension

5.       Nitazoxanide and Ofloxacin Oral Suspension

6.       Ondansetron HCl Syrup

7.       Acetaminophen Oral Suspension.

The worst part was that there was no Oral Rehydration Salts prescribed. So much for all the awareness being spread about this intervention, which has been proved to have been one of the most effective life saving interventions ever invented.

And to complicate matters, the child weighs a measely 7 kilograms. And therefore, she is malnourished like the 54% of under fives of this state.

If a doctor with a graduate degree does not know how to manage a case of diarrhoea properly, you cannot blame them going to quacks . . . However, part of the blame is also with patients who believe that more the medicines prescribed, better thedoctor and faster the recovery.

However, this is much better than the last one which I had posted aboutmismanaging diarrhoea.

Last maternal death of 2012

The sad part was that she was one of our regular antenatal patients and she had delivered her first baby also with us. Interestingly, her first pregnancy was also complicated. She had enteric fever, later viral hemorrhagic fever and ultimately had a premature birth. 

However, for her second pregnancy, she her her regular check ups elsewhere. However, she came with a very bad urinary tract infection with false labour pains more than 2 weeks back. We had to admit her and manage her aggressively to control the infection and the pain. 

She was well controlled and later took a discharge saying that she can continue her treatment in her town. 

She had an institutional delivery at a Primary Health Centre (PHC) on the morning of 31st December. Within half an hour, she had an episode of seizures which was managed at the PHC. She was at the PHC till around 2:30 pm, when the family was told that she appears to become sick. 

We do not know the details. But, she was brought dead at around 4 pm at NJH . . .

The relatives were in a hurry to take the body home. So, I did not get the details.

I've informed the same to the concerned people. However, I'm not sure if there would be any sort of follow-up on this matter . . . 

It was a like a message for us . . . Maternal and child health continues to be a major concern of the region which we serve. It was a bit unbelievable, but year 2013 also started off with a case of maternal near miss for us which I would narrate later. We have a long way to go. I'm sure that year 2013 is also not going to be any different. We would continue to deal with extreme obstetric care. My biggest wish for 2013 is that we would be able to involve ourselves in child survival a bit more than what we are doing now. 

Wish you all choicest blessings for 2013 .. .. ..

Schooling at NJH

Whenever one has to serve at remote locations like ours, one of the first questions that people like me with young children usually ask is about a good school in the nearby vicinity. The popular notion was that there was no good school near NJH. And was many a time quoted by people who had worked there as a major challenge to get qualified people there. 

I knew that there was a good Catholic school in Daltonganj during my previous stint at NJH. However, being a bachelor and having had not made much of any plans of coming back, I did not give much thought to this matter. 

However, on reaching back and having a young boy who was almost ready to go to school, I had to take a call. We had to send Shalom a year earlier to school as he was quite insistent that he goes to school. And we also thought that we will get a feel of how good schooling is at Daltonganj. 

The school has been the alma mater of quite a few of our staff kids who have gone to well placed positions in life. I hope that many of them would respond to this post.

Managed by the sisters of the Sacred Heart congregation, the school completed 43 years of it's service to at least 2 budding generations of Daltonganj and it's surroundings. As has been the major contribution of the church in education throughout the country, the school has lived up to the standards and is a prestigious institution to get admitted into. 

We are thankful that the school has been a blessing to many of our staff over the years. 

The reason I thought about putting this post was the quite impressive performance the teachers and students under the able leadership of Sr. Jossy Mathew, put up in their recent Annual Function. 

The theme of the program was 'Sangam' - a portrayal of religions in India . . . Below are the snaps . . . 

Sr. Jossy Mathew, Principal accompanying the Chief Guest, Bishop Gabriel Kujur to the dias

Lighting of the lamp

The first dance . . .  Quite a spectacle

Creation story by the tiny tots . . . Note Adam and Eve standing on the right  side

Jharkhand tribal dance . . .

Dandiya dance .. .. ..

Jain dance . . . 

Showcasing the Budha

Sr. Jossy addressing the gathering . . . 

The English choir . . . 

Bioscope . . . which I thought was the best program

Another dance . . .

Quwwali . . . 

The Hindi choir . . . 

English drama . . . Merchant of Venice. 

The Christmas story . . . 

Western dance . . .

Another one . . . 

The Bhangra dance . . . 

Closing program . . . the sangam

Overall, it was a very a nice and well arranged program. 

One more anecdote about schooling for staff at NJH. I was quite concerned about Shalom travelling about 50 kilometers every day to attend school. About a year back, I was narrating this to one of my friends. He told me that I was lucky. Why? His son was travelling about 10 kilometers one-way by bus everyday through the dusty roads of Delhi every day . . . but the journey took more than a hour due to traffic. And that was almost two and a half hours of travel everyday through a very polluted environment. 

Kids at NJH do the journey in about 40 minutes . . . and the journey through a very pristine environment. 

So, that's for people who are resisting from joining us on account of poor educational opportunities . . . 

Fog at NJH . . . Snaps

Winter is usually very bitter in NJH. Our thermometer registered 1 degree celsius yesterday. And being surrounded by forests only make it feel most chilly. However, the campus looks very beautiful and romantic especially when there is fog in the morning. Few snaps I captured the day we had the cases of carbon-monoxide poisoning and the very bad eclampsia patient. 

The view from my home . . .

A far shot of the church and water tank

The church

The view of the road to the highway . . . 

The shot of the church from the other side . . .

A farther shot . . . 

The snap from the emergency door to the hospital

Well, I still remember that I need to write about the very sick Eclampsia patient who came the same day. 

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 . . .