-1- (A Unit of Emmanuel Hospital Association, New Delhi) ANNUAL REPORT 2010 - 11 Chandragodda, P.O. Baramasia, Sahibganj District JHARKHAND – 816 102 Mobile: 09431313291, 09430346486INTRODUCTION:
-2-Prem Jyoti has been working among the Malto tribals in 124 target villages ofJharkhand since December 1996, focusing mainly on their health needs, through anetwork of Community Health Volunteers, peripheral clinics, and a Hospital.Emphasis is on training & empowerment of the community to tackle common healthproblems. The goal is to transform the Maltos into a healthy community.The Prem Jyoti CHDP a unit of the Emmanuel Hospital Association (EHA) wasstarted in December, 1996 as a unique partnership between three major Indianmission agencies: the Friends Missionary Prayer Band (FMPB), the EvangelicalFellowship of India Commission on Relief (EFICOR), and the Emmanuel HospitalAssociation (EHA).Map of Target Area:It serves an area in the north eastern corner of Jharkhand, (Barhait, Borio Pathna andLitipada blocks), with a special focus on the Malto tribal people. Although thehospital has been open to all since 2003, the Community Health program catersexclusively to the health needs of this group. Emphasis is on empowering the Maltopeople to bring about changes such as increased health awareness, improvement inhealth practices, reduction in Maternal and Child Mortality and reduction in the
-3-incidence of diseases such as Malaria, Kala azar and Tuberculosis which havedevastated their population over the past half-century.The Primary Health Care system established so far consists of a network of 86Community Health Volunteers at the grass root level covering 124 villages dividedinto 11 clusters of 10-12 villages, 10 monthly Peripheral clinics covering 10 – 20villages each and a 20-bedded referral Hospital, located at Chandragodda. Theprogram covers a population of 20,000 (approximately 3500 households, with anaverage of 25 households per village/hamlet) spread over Rajmahal Hills. Most of thevillages are remote and inaccessible.The Maltos are a particularly vulnerable tribal group numbering about 100,000 withdiminishing population (until the last few years), pre-agricultural level of technologyand a very low level of literacy.As the mortality and morbidity among the Maltos was very high, with the death rateexceeding the birth rate, the project started with a focus on health related issues, witha small team of five including a Doctor couple, a nurse, a pharmacist and a Labtechnician. The birth rate among the Maltos has now started exceeding the deathrate. The infant mortality rate (IMR) and Maternal Mortality rate have declined, butare still unacceptably high. The high death rate is mainly due to infectious diseasessuch as malaria, Kala-azar, diarrhoea, acute respiratory infections and tuberculosis.The poor economy, lack of knowledge of health issues, poor health seekingbehaviour, lack of availability of quality and low-cost health care services contributeto the high mortality, and are the focus of the community health and hospital work.Our Mission:Prem Jyoti is a community of Christ-centred individuals that reaches out to the poorand marginalized, especially the Maltos, through: o Provision of quality, accessible and compassionate health care; o Empowering communities to take care of their own health and development needs; o Catalyzing transformation; o Developing local leadership and expertise; and o Serving as a model to challenge othersIn order to help communities develop to their fullest potentialOur Vision:Reaching out with the light of God’s love to make a difference
-4-Our Values: Prayer is the key Respect for God’s creation Empowerment Maximum quality Minimum cost Joy in serving Yearning for the Best for the Poorest Ownership Teamwork Integrated Care GENERAL REVIEW OF THE YEAR: 1. Strengthening of Management Committee: The core leadership team of 5 worked together to discuss, plan, review all programmes on a weekly basis. 2. Community Health: Despite having the smallest ever team in CH, supervision has been streamlined and CHV drop-outs have been minimized. A week-long evaluation was conducted by Drs. Beulah Jayakumar and Jeevan Kuruvilla to identify the ways forward. By the grace of God, Tearfund has approved the project proposal for the next 3 years. 3. Networking: There has been a good rapport with the Government. Erstwhile hostile officers have become friendly and supportive. RNTCP & JSY finally became functional! RSBY still has a long way to go. A casual request for a small community hall got approved as a large 2000 sq. Ft training centre. Literally we “opened our mouth wide” and the Lord “filled it”! Global fund TB programme has also been a good platform to network very closely with other like-minded NGOs in the district. 4. Financially moving out of the negative: We started the year with a deficit of about Rs. 8.5 lakhs and were unable to implement the new salary scale. We prayed much for grace to get over this and the Lord provided for the same through a generous grant. Money came in from many unexpected quarters especially from within India, which was an answer to prayer. And so we have
-5- been able to end the year with a positive balance. Praise be to God alone who has provided our needs. 5. Clinical services: For the first time in Prem Jyoti history, we crossed 500 deliveries in a year – and that too with JSY taking off only in the last quarter. This year we tried having 2 shorter camps rather one for a whole month. Dr. P. D. Koshy (FRCS) and Dr. Viju John were the surgeons. 6. Technical Support: Thanks to the kind help of Mr. Ajit (Central Office), we could purchase a new jeep through CASA. And thanks to tireless efforts of Dr. Sam David, we could re-establish internet connectivity. Praise the Lord!PRIMARY HEALTH CARE1. Community Health Volunteers:The CHVs who were already trained as primary health workers serve their communityby giving Health education, treating simple ailments and early referral of seriouscases. They continue to be the vital link between the medical team and thecommunity. • It was hard work for the CH team with just 1 Project Assistant and 2 supervisors. 1 of them dropped out this year after reaching a good level of competence. Part time supervisors have been tried out to cover unreached areas – with varying success. • Despite these difficulties, the CHV number has been fairly steady. Among the new batch, after an initial drop to 16 (from 22) – the ladies have stuck on through the training and are beginning to bring changes in their villages. • The incentive given to CHVs has been made performance based – this has improved their attendance, regularity of reporting and statistics as is evident from the table in page 7. Whenever a CHV did not make it to the mobile clinic, the supervisor would visit the village and collect the report. • Redefining our target area was not easy. Should villages that have not shown interest in sending a CHV be excluded? Should we stop trying to convince such non-responsive villages? There were no easy answers to these hard questions. The target area has been reduced from 140 villages to 124.
-6- • Evaluation of Programmes – Drs. Beulah Jeyakumar & Jeevan Kuruvilla conducted a week-long programme review with the aim of enabling the CHP team to identify a way forward:Extracts of Conclusions of evaluation:The CHP has intervened in the health status of one of the country’s mostimpoverished and underserved communities, bringing about significant reductions inthe burden of disease. It has introduced these communities to preventive andtreatment interventions, many of them right where they live.Overall, the CHP and Prem Jyoti have changed the power, visibility andopportunities for the weakest. Working in an extraordinarily constrained context, theteam has endeavored in humility and commitment to bring health and hope to those atthe very “end of the road”.The CHP and the hospital are complementary by design, which has ensured that thesupply side of the equation is met for target communities in the context of a very weakpublic health infrastructure. A culture of learning and improvement has enabled theprogram to maximize its reach and effectiveness in the midst of significantconstraints.Given the virtual absence of development work, geographic remoteness of theirresidence, very low literacy as well as their reclusive nature that is slow to warm upto external influence, Malto communities have taken long to respond and that, in apatchy manner.A two-pronged approach will help build such critical mass: strengthen existinginterventions to maximize their outcome, and scale up the geographic reach to matchthe size of the problem. Both of these can only be accomplished by intentionally andmeaningfully co-opting others, including the government, by identifying points thatcreate leverage and by bringing in the right mix of interventions which connect andamplify one another.The scope and size of the problems in health status of the Maltos demand a responsethat is ambitious, well-designed and cognizant of what we already know about what ittakes to reach this people group. However, all of these changes are only possible witha significant increase in staff strength from current levels, and dedicated staff for theCHP.
-7- CHV Strength & 2007- 08 2008-09 2009-10 2010-11 AttendanceNo. of CHVs 116 108 70 86Attendance at Trg. Centre 62% 59% 47 % 68%Attendance at peripheral 65% 55% 69 % 72%clinic CHV Outputs 2007- 08 2008-09 2009-10 2010-111. Treatment of patients Total 8209 5684 5119 7119 ANC’s 214 103 80 217 Under 5s 1132 920 655 1078 Malaria 3667 2608 2057 2931 Diarrhoea 1529 1056 1031 11942. Reporting of births 434 261 249 3713. Reporting of deaths 144 112 97 1604. Referral of patients 3375 2215 1598 24195. Health Education 2313 1896 4082 64536. Home visits 2919 2513 2417 50047. Safe deliveries conducted 119 (46%) 123(49%) 165(45%) 95 (44%)Human interest stories:Ruth Malto (Mallegoda village) had fever. Her parents never used to mingle withthe rest of the village. So they called the rural medical practitioner (Jhola Doctor /quacks) who tested her blood and said she has malaria. He gave the medicines, butthey forgot the dosage and so did not give the medicine to Ruth. Her fever becameworse. Finally they requested the CHV (Abraham) to come and see the child. Heexamined the child and gave Chloroquine for 3 days. She recovered well. Theparents were very thankful and now they also cooperate with the other villagers.Praise God for the ways in which He uses our CHVs.
-8- CHV Name: Baby Village: Kadagdoni In Simbi village only 8 families were Christians and rest was non-Christians. One non-Christian Sukra Malto had boils in his thigh. He was suffering with that for many days. One day our CHV reached this village and saw this man was suffering with boils. Then she treated him. She washed his boils with boiled and cooled water, applied MSG medicine and gave him Septran (antibiotic) and then she told him to meet her after a week. Sukra’s elder brother, Davud was a Christian, but he hated his non-Christian brother (Sukra). When the CHV came to know about this, she called both the brothers and helped them reconcile with each other. She told Davud to help Sukra. Now both brothers are living happily – in good relationship with each other. After a week Sukra met the CHV and thanked her. His skin infection had cleared completely. More than that, he was also reconciled with his estranged brother. 2. Mobile peripheral clinics: The peripheral clinics conducted by the medical team in the community thrice a week supports the work of the CHV’s and takes secondary level health care as close to the people as possible. The CHVs are actively involved in bringing pregnant women for check-up and under-five children for immunisation. They also motivate women for Copper-T insertion. TB patients have a very good compliance, as they are able to get their drugs at these centres. At present we have 10 mobile clinics every month of which one is “two-wheeler” – i.e. run with a two-member team going on a motorcycle. Attendance at Peripheral CHV’s treating patients have increased. This 2008-09 2007- 08 has decreased 2009-10 the patients coming to 2010-11 ClinicsTotal beneficiaries 5402 3368 4920 3262No. of patients 2395 1546 2562 1211No. of ANC’s & Copper-T 1101 911 1555 1034insertionNo. of children immunized 1904 911 803 1017No. of completers 229 84 47 102
- 11 - OCP distributed 106 53 59 21 Tubectomy (with LSCS) 7 9 10 35 2. TUBERCULOSIS CONTROL PROGRAMME: 2007- 08 2008-09 2009-10 2010-11 RNTCP Malto Target Malto Target Malto Target Malto Target Activity Non-maltos Maltos Hospital Hospital Hospital Hospital 1. No. of cases at 29 23 32 25 11 16 43 26 0 0 the start 2. No. of new cases 78 46 48 41 13 51 37 19 29 31 3. No. of deaths 2 1 1 1 5 3 0 0 2 3 4. No. of defaulters 19 6 27 9 21 3 18 5 3 12 5. Completers 54 37 40 40 63 36 48 34 5 2 6. Still on 32 25 11 16 43 26 13 6 19 14 treatment 7. Compliance 80 93 64 85 85 84 75 88 83 52 Rate (%) 8. Sputum 10% 15% 17% 18% positivityHuman interest story:Dhaso soren came to OPD with severe breathlessness andfever for more than a week. He took treatment from near-by pharmacy but there was no improvement. So he came toour hospital. We examined him and he had effusion in Rt.Pleural space. When we did pleural tap it was frank pus.So we had to put him on chest drainage. Immediately,around 4 litres of frank pus came gushing out. We startedon antibiotics and ATT. His drainage slowly reduced andhe was discharged. He & KALA AZARmedicines. HePROGRAMME: 4. MALARIA finished his ATT CONTROL hasput on a lot of weight and is now attending school. 3. MALARIA & KALA AZAR PROGRAMMES:
- 12 - 4. SURGICAL CAMP: Activity 2007- 08 2008-09 2009-10 2010-11Total malaria patients seenBy CHVs & CHGs 3667 3286 2057 2924By the medical team 2243 2477 2368 2029Case Proportional rateCHV’s 46/100 47/100 40/100 40/100Medical Team 22/100 36/100 33/100 25/100Cerebral malaria 53 54 56 76Lab investigations – malaria parasiteTotal 2763 2738 1745 2217Positivity 28% 495 (18%) 254 (14.5%) 602(27%)P. Vivax 17% 18% 22 (9%) 88 (15%)P. Falciparum 83% 82% 232 (91%) 445 (75%)Parahit 106/500 - 54/397 (14%) 21/149(14%) (21%)Kala azarNo. of Kala azar cases 125 22 17 38treated (in IP)Lab test for Kala azar K39 25/94 12/59 47/156 (30%) 53/172 (31%)positivity (27%) (20%)By the grace of God we were able to conduct 2 surgical camp, each for 2 weeksduration. First camp was held in October 2010. Dr.P.D. Koshy was the surgeon. Mr.Hardugan, Nurse anaesthetist from Raxaul helped in general anaesthesia. 64 surgerieswere done including 6 thyroid surgeries. Second camp was held in February-2011.Dr.Viju from Asha Kiran,Lamptapur was the surgeon. This time we managedanaesthesia with our nurse anaesthetist. Altogether we did 36 surgeries during thiscamp. 2009-10 October-2010 February- 2011Thyroidectomy 2 6 2Hysterectomy 5 4 0Laprotomies 1 4 3Hernia 19 9 9Minor surgeries 52 41 22 Dr.P.D.Koshi with thyroidectomy patients - Ram kisku- Ileal perforation. Post-operative picture Operated in Feb2011 surgical camp
- 13 -HOSPITAL PERFORMANCE: 2007- 08 2008-09 2009-10 2010-11 No. of patients seenCHVs 8209 5684 5119 7119Mobile clinic 4613 3368 4920 3262Out-patient 8756 7468 6565 7959Admissions 1111 904 985 1365Total 22689 18756 17589 19705Profile of patients admittedComplicated malaria 120 145 78 87Cerebral malariaDiarrhoea 36 21 14 55Severe Anaemia 11 11 14 29Kala azar 120 22 17 35Pneumonia 22 40 38 27Tuberculosis 29 36 36 15Obstetric 292 181 324 506Bed strength 21 21 20 20Bed Occupancy Rate 80% 53% 54% 68%Turn over Rate 54 44 49 69Average Length of Stay 5.5 days 4 days 4 days 4No. of lab tests 8147 10221 8630 12673No. of X-rays 244 295 463 333No. of Ultra sound 58 73 138 100Major Surgeries 55 41 56 126 Udhual singh, a 8 year old boy was referredHuman Interest stories: centre with history of from a catholic health snake bite. When he reached hospital he had respiratory distress and was clinically deteriorating. We started on anti-snake venom and intubated him. Manual ventilation was done for around 36 hours and we were able to successfully extubate him. It was later we came to know that he came on vacation to his uncle’s house and his native is UP.
- 14 -HUMAN RESOURCE DEVELOPMENT: i. Mr.Christopher attended CDO refresher training in Patna. ii. Mr.Ajose reuben attended training on malarial slides in Patna for 2 week iii. Ms.Teresa Jayakumar got selected for M.Sc (paediatrics) in CMC vellore iv. Ms.Mary malto & Esther malto went for 6 months IGNOU certified course for lab assistant in Kachwa v. Dr. Vijila attended TOT for sahiyas module-5 in Gadchuroli,,Maharashtra. vi. Dr. Benedict is pursuing PGDFM course with DEDU-CMC Vellore.vii. Dr.Isac And Francis attended RSBY training in Delhi.viii. Dr. Benedict Joshua could help out in Madhipura Christian Hospital for 2 weeks to replace the doctor who was on sick leave.SPIRITUAL ACTIVITIES: 2 days spiritual retreat for single staff was held. Mr. Subhir Barwa was the resource person. 3 days spiritual family retreat for married staff was conducted by Rev. Prakash George and Dr. Jamila George from EHA central office. VBS was conducted for neighbouring Malto villages in which 272 students participated and got blessed.VISITORS: • Mrs. Margaret Kurien – regional director of EHA Eastern region visited us in April, which was very meaningful. She interacted with many of the staff and gave us very valuable guidance and insights • Mr. Jason (Finance Director, EFICOR) visited for 4 days to train Mrs. Pancy and to give his expert advice regarding financial procedures • Dr. Sam David (Prem Jyoti trustee) visited for 2 days to encourage the team. • The trustees meeting was held on November 9th and 10th and we could review the various aspects of the Community Health and Hospital programmes and plan future directions. We are thankful to Dr. Santhosh, Rev. Kennedy, Mrs. Carol Motuz, Dr. Sam David & Mrs. Margaret Kurian for sparing their
- 15 - valuable time to be with us and give us their inputs and insights. We appreciate their willingness to be involved… • Mr. Ravee, finance Manager, Duncan Hospital (Raxaul) visited us and helped the Accounts staff to sort out issues. He studied the cash-flow from various sources and recommended that we could proceed to implement the new salary scale. • Mr.& Mrs. Paul & Sue East visited us in December & March which was an encouragement. • 6 theological students (2 from Marthoma Seminary, Kottayam and 4 from Bishop’s college, Kolkata) spent a few weeks with our team for mission exposure. They conducted a children’s retreat for our staff children for 2 days. • Dr. Adeline Sitther, missionary doctor in Papua New Guinea visited us for 4 days. It was good to hear about missions in another country, also among tribals. There are so many similarities. • Dr. & Mrs. Abraham Ninan visited us for a day – though the time was very short, we were much encouraged by their first visit. • Dr. Aletta Bell – Canadian missionary doctor to India for several decades and a great support to Prem Jyoti especially in the first 7 years of its inception, visited us for 3 days. It was a joy to fellowship with her again and we were mutually encouraged. • Mr. Jan and Ms. Maresa, elective medical students from Germany spent 3 weeks with us. They shared that it was a new experience for them. • 4 medical students from Tirunelveli Medical College visited for 4 days. These were boys who are seriously considering missions and it was good to spend time with them.Special acknowledgements: To our Lord Almighty who has led our team as a shepherd through our ups and downs in the last year To our families & praying friends who have faithfully held us up in prayer. To EHA Canada who have generously provided funds for the CH program. To Dr. Sam David who took much effort to get the V-Sat installed after a long wait; we are also thankful to Jenny Gibson’s church in UK who provided the support.
- 16 - To Mr. James Wells & EMMS- UK who helped us with funds to run the program and cover financial deficits To Mr. Ravikumar – District Magistrate, Sahibganj District who took personal interest in our programmes and helped us this year with the 15 lakh budget PCC road and 11 lakh budget training hall, which is nearing completion. To Mr. Ajit (Central Office), who helped us purchase a new jeep through CASA. To Herbertpur Christian Hospital who helped us financially for part of the cost of the new jeep (Rs. 2 Lakhs) To HBM Hospital, Lalitpur – for kindly donating a motorbike for our CH programme To Baptist Hospital, Tezpur – for lending a helping hand to enable us implement the new salary scale. (Rs. 1.5 lakhs) To Jiwan Jyoti Community Hospital, Robertsganj for a 62K grant used for purchase of medical equipment. Most importantly to our team who have worked tirelessly and enthusiastically through yet another eventful yearRespectfully submitted,MR. DEEPAK THORAT DR. R. ISAC DAVID Hospital Manager Senior Administrative Officer