Moving on

A reality in life is the need to move on. And even in a place like NJH, where there are lots of needs, in terms of committed staff and finances, times come when people have to move on. The Lord has brought lots of committed doctors and other staffs to NJH over periods of time and all of them have played a part in the building up of the hospital. We’re proud that many of our former staff are in positions of tremendous responsibility in India and abroad. Over the last three and half years since we’ve been here, we’ve also been blessed by some really committed staff. Few of them are in the process of moving on especially for post-graduation and better exposure.

Committed and qualified staffs have always been a premium for NJH. There are many reasons which most of you probably are well aware of.

I thought that it is time that I put this down so that we could have people praying about it and that the Lord will move the hearts of healthcare professionals that they explore setting apart a part of their lives to serve in areas such as NJH.

Drs. Titus and Grace with SwrD

Junior Medical Officers are the forte of any hospital. We have been blessed to have Dr. Titus Raju serve us for almost two years. Midway through his posting here, he got married to Dr. Grace Mary George that ensured that NJH had extra hands. Dr. Titus plans to do post-graduation in ENT and his better half in the speciality of Dermatology or Anesthesia. Dr. Titus finishes two years of service in February 2014 following which the family plans to take a break to pursue post-graduation.

I know it is quite a difficult thing to attract MBBS graduates to hospitals such as ours in this era. However, I’m sure that whoever had done a short stint in a rural hospital had major changes in perceptions about healthcare and the post-graduation they needed to pursue. And I hardly know of anybody who regretted the decision to do a short period of service in a difficult place soon after their MBBS graduation.

So, what are we looking at? Rather, who should look to apply? I firmly believe that it is the Lordship of Christ in our lives which should help us to decide on what to do and what not to do. We fervently pray for couple of MBBS graduates.

Below are a few things on what sort of work to expect and the opportunities if you plan to work here.

NJH is the place where someone who would go on to do Obstetrics or Pediatrics should work. As of now, there is no obstetrician here who will be able to mentor a junior person. However, there is quite a lot of work. Most of our specialist work in OG and Pediatrics are done with the help of seniors specialists over the phone/internet. Things have worked well so far.

If you plan to do post-graduation in General Medicine, I’m sure that this is the place where you should be. Dr. Roshine has made a great impression here and the amount of learning that you can have from this young lady is tremendous. There are quite a lot of cases which will give you enough exposure to both infectious and non-infectious.

We’ve quite a good laboratory with my better half, Dr. Angeline at the helm which will also give you some amount of experience with clinical pathology. 

The speciality of Community Health/Public Health is not a very favoured subject for graduates. However, I am of the opinion that we need quite a good group in this subject. Considering into fact that we have quite a wide network of like-minded organisations working alongside us and the influence that we have in the theme of healthcare in the region, NJH can provide you a whole lot of experience. In addition, there is a separate Community Health Department who works in the thematic areas of Community Based Rehabilitation for People with disability and Community Based Adaptation towards Climate Change. We are also a Tuberculosis Unit catering to a population of almost 700,000.

So, friends – please spread the message around that we are looking at the prospect of having couple of junior doctors joining us sometime during the next few months. 

Opportunities at NJH

We have few more openings at NJH. We request people with a commitment to serve underserved and marginalised communities to apply. We prefer those with a personal call to such a vocation because of the Lordship of Jesus Christ in their lives.

1. Consultants in Surgery, Pediatrics, Obstetrics  and Orthopaedics. They should be willing to rough it out in a bit of a hostile environment.

2. Masters in Social Work/Develoment graduates with experience in Community Based Rehabilitation/Disability for 2 posts of Project Assistant in Community BasedRehabilitation of the Disabled.

3. Masters in Social Work/Rural Development graduates with experience for 2 posts of Project Officers in Community Based Adaptation to Climate Change.

4. Masters in Social Work/ Rural Development graduates for 2 posts of Project Assistant in Community Based Rehabilitation of the Disabled.

5. Accountant cum Data Entry Operator for the Community Health Projects.

6. 2 Pharmacists with registration in Jharkhand or willing to get registered in Jharkhand.

7. X-Ray technician.

8. Warden for Nursing School hostel. 

9. Occupational Therapist for the Disability Project. 

10. Electrical Engineer for the Hospital and the Community College. 

Please note that this is a updated post and all previous opportunity announcements stand cancelled. 

Disappointment . . .

As we look forward for our Golden Jubilee celebrations, we have been quite encouraged by the response from the local community towards the care we give at NJH.

The local health authorities have also been showing quite encouraging signs one of which has been the meeting for training on maternal mortality review.

Close to the heels of the session, I was informed by one of the officials that due to technical reasons, the government would not be able to renew its' contract with us for the implementation of the Janani Suraksha Yojana. (JSY)

Without doubt, the JSY has played quite a significant role in improving maternal health care in the region. The technical reasons were quite dubious from the scenario of Indian healthcare especially in relation to the rural areas of the country.

The technical reason for the refusal to renew the contract was that there we did not have any consultant in obstetrics, pediatrics or anesthesiology. For the same technical reason, none of the other private institutions in the region has been authorised to implement the JSY.

The same day there was a news item about the number of quacks operating in Delhi. The same system who cannot ensure that non qualified people do not practice medicine is trying to ensure that only specialised doctors deal with obstetric care through which almost all families go through at least once in their lifetime.

Leave alone Delhi - look at the number of quacks in Kerala - which boasts of world standard health indices.

One needs to visit many of the district hospitals in many of our states in the night with a complicated pregnancy and find out how many of them have a obstetrician, an anesthetist and a pediatrician on regular call readily available to rush in any emergency.

I have enough cases which tell me that there isn't enough specialists available in our public health facilities. Even if there are specialists available from a statistics point of view - how many of them would be ready to work in places like Latehar, Palamu or Garhwa - the nearest 3 district headquarters to NJH.

And more than the availability of specialists, I would like to press my case with regard to the availability of all 3 of them together at a given point of time. I've seen many times when complicated pregnancies were turned away because one of the three specialists (obstetrician, pediatrician, anesthetist) supposedly needed during the intrapartum care of a patient is on leave.

On one side, there were efforts from the side of the government to start a course called Bachelor of Rural Medicine and Surgery targeted to improve healthcare in the rural areas - whereas on the other side they stiffle efforts taken by qualified doctors to improve healthcare in these needy areas by bringing in draconian rules.

Now, when I've mentioned about this problem which has occured with us - I need to bring your attention to another law which is called the Clinical Establishment Act which is already in force to its full extent in states like Assam and Orissa. One of the most draconian rules under the CEA ensure that unless specialists are available in a healthcare centre - the concerned procedure cannot be done in the said hospital.

Which ultimately means that if you do not have an obstetrician, no deliveries can be conducted in your clinic. You would not be able to do any surgery unless you have an anesthetist. And you can ultimately end up interpreting the rule to such an extent that a surgeon may not be able to even treat his own child for a respiratory tract infection.

Meanwhile, we end up in a situation where quacks and RMPs flourish whereas a qualified MBBS graduate would be worrying whether he will end up in the hands of the law if he does certain procedures which are part of somebody elses' speciality.

This again brings me to plead for the inclusion of the speciality of Family Medicine as a recognised speciality under the Medical Council of India. There is already a Diplomate of the National Board for which exams are conducted. However, we need to move beyond that and ensure that there is Masters and Diploma degrees in the speciality.

I understand that there is staunch resistance from the professional bodies of specialist doctors. Their fears are unfounded. Many of them are afraid that they would lose their earnings to the new found specialist group of Family Physicians. However, it is very evident that the nation would gain very much from a cadre of Family Physicians in the healthcare system.

That is exactly what we have at NJH. We have only one surgeon. The rest of us are all family/community  physicians. All of us can give spinal anesthesia, resuscitate a baby, do a cesarian section - take decisions on ventilating a patient etc etc. If we had waited for many of our patients to go to a specialist they would have been long dead.

If taken in the right spirit, the speciality of Family Medicine would be the toughest and the most exiting speciality in the realm of healthcare academics. The major challenge will be ensure that the MCI takes a positive decision on this as well as develop a syllabus which is robust enough to transform graduates of medicine to family care specialists dedicated to the cause of holistic care to patients.