Prem Jyoti Report 2010 11

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(A Unit of Emmanuel Hospital Association, New Delhi)

ANNUAL REPORT 2010 - 11

Chandragodda, P.O. Baramasia, Sahibganj District
JHARKHAND – 816 102
Mobile: 09431313291, 09430346486
INTRODUCTION:

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Prem Jyoti has been working among the Malto tribals in 124 target villages of
Jharkhand since December 1996, focusing mainly on their health needs, through a
network of Community Health Volunteers, peripheral clinics, and a Hospital.
Emphasis is on training & empowerment of the community to tackle common health
problems. The goal is to transform the Maltos into a healthy community.

The Prem Jyoti CHDP a unit of the Emmanuel Hospital Association (EHA) was
started in December, 1996 as a unique partnership between three major Indian
mission agencies: the Friends Missionary Prayer Band (FMPB), the Evangelical
Fellowship of India Commission on Relief (EFICOR), and the Emmanuel Hospital
Association (EHA).

Map of Target Area:

It serves an area in the north eastern corner of Jharkhand, (Barhait, Borio Pathna and
Litipada blocks), with a special focus on the Malto tribal people. Although the
hospital has been open to all since 2003, the Community Health program caters
exclusively to the health needs of this group. Emphasis is on empowering the Malto
people to bring about changes such as increased health awareness, improvement in
health practices, reduction in Maternal and Child Mortality and reduction in the

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incidence of diseases such as Malaria, Kala azar and Tuberculosis which have
devastated their population over the past half-century.

The Primary Health Care system established so far consists of a network of 86
Community Health Volunteers at the grass root level covering 124 villages divided
into 11 clusters of 10-12 villages, 10 monthly Peripheral clinics covering 10 – 20
villages each and a 20-bedded referral Hospital, located at Chandragodda. The
program covers a population of 20,000 (approximately 3500 households, with an
average of 25 households per village/hamlet) spread over Rajmahal Hills. Most of the
villages are remote and inaccessible.

The Maltos are a particularly vulnerable tribal group numbering about 100,000 with
diminishing population (until the last few years), pre-agricultural level of technology
and a very low level of literacy.

As the mortality and morbidity among the Maltos was very high, with the death rate
exceeding the birth rate, the project started with a focus on health related issues, with
a small team of five including a Doctor couple, a nurse, a pharmacist and a Lab
technician. The birth rate among the Maltos has now started exceeding the death
rate. The infant mortality rate (IMR) and Maternal Mortality rate have declined, but
are still unacceptably high. The high death rate is mainly due to infectious diseases
such as malaria, Kala-azar, diarrhoea, acute respiratory infections and tuberculosis.
The poor economy, lack of knowledge of health issues, poor health seeking
behaviour, lack of availability of quality and low-cost health care services contribute
to 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 poor
and 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 others
In order to help communities develop to their fullest potential
Our Vision:

Reaching out with the light of God’s love to make a difference

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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

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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 CARE

1. Community Health Volunteers:
The CHVs who were already trained as primary health workers serve their community
by giving Health education, treating simple ailments and early referral of serious
cases. They continue to be the vital link between the medical team and the
community.
• 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.

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• 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 most
impoverished and underserved communities, bringing about significant reductions in
the burden of disease. It has introduced these communities to preventive and
treatment interventions, many of them right where they live.
Overall, the CHP and Prem Jyoti have changed the power, visibility and
opportunities for the weakest. Working in an extraordinarily constrained context, the
team has endeavored in humility and commitment to bring health and hope to those at
the very “end of the road”.
The CHP and the hospital are complementary by design, which has ensured that the
supply side of the equation is met for target communities in the context of a very weak
public health infrastructure. A culture of learning and improvement has enabled the
program to maximize its reach and effectiveness in the midst of significant
constraints.
Given the virtual absence of development work, geographic remoteness of their
residence, very low literacy as well as their reclusive nature that is slow to warm up
to external influence, Malto communities have taken long to respond and that, in a
patchy manner.
A two-pronged approach will help build such critical mass: strengthen existing
interventions to maximize their outcome, and scale up the geographic reach to match
the size of the problem. Both of these can only be accomplished by intentionally and
meaningfully co-opting others, including the government, by identifying points that
create leverage and by bringing in the right mix of interventions which connect and
amplify one another.
The scope and size of the problems in health status of the Maltos demand a response
that is ambitious, well-designed and cognizant of what we already know about what it
takes to reach this people group. However, all of these changes are only possible with
a significant increase in staff strength from current levels, and dedicated staff for the
CHP.

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CHV Strength &
2007- 08 2008-09 2009-10 2010-11
Attendance
No. of CHVs 116 108 70 86
Attendance at Trg. Centre 62% 59% 47 % 68%
Attendance at peripheral
65% 55% 69 % 72%
clinic

CHV Outputs 2007- 08 2008-09 2009-10 2010-11
1. 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 1194

2. Reporting of births 434 261 249 371

3. Reporting of deaths 144 112 97 160

4. Referral of patients 3375 2215 1598 2419

5. Health Education 2313 1896 4082 6453

6. Home visits 2919 2513 2417 5004

7. 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 with
the 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, but
they forgot the dosage and so did not give the medicine to Ruth. Her fever became
worse. Finally they requested the CHV (Abraham) to come and see the child. He
examined the child and gave Chloroquine for 3 days. She recovered well. The
parents were very thankful and now they also cooperate with the other villagers.
Praise God for the ways in which He uses our CHVs.

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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
Clinics
Total beneficiaries 5402 3368 4920 3262

No. of patients 2395 1546 2562 1211
No. of ANC’s & Copper-T
1101 911 1555 1034
insertion
No. of children immunized 1904 911 803 1017

No. of completers 229 84 47 102

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SECONDARY HEALTH CARE AT THE HOSPITAL:
1. Reproductive Health

2007- 08 2008-09 2009-10 2010-11
HOSPITAL
DELIVERIES

TargetMalto

TargetMalto

TargetMalto

TargetMalto
Hospital

Hospital

Hospital

Hospital
Total 240 52 151 30 281 34 460 46
Normal Vaginal 156 40 120 192 290
Twins 6 0 4 2 9
Breech 6 1 4 6 10
Instrumental 30 4 12 55 90
Craniotomy 1 0 0 3 2
Caesarean 41 7 39 57 105
Maternal
10 2 3 6 5 17
Mortality
During
4 0 1 2 2 5
pregnancy
During delivery 1 2 0 2 2 7
Post partum 5 0 2 1 1 5
Delivery
Outcome
Live birth 205 49 142 254 269 461
Stillbirth/IUD 38 4 10 39 48 54

Community of patients delivered in the hospital

2007- 08 2008-09 2009-10 2010-2011
Malto – target area 48 (16%) 30 (17%) 34(10%) 46(9%)
Malto- non target 5 6 8 3
Santal 81 (28%) 38 (21%) 82 (26%) 139(27%)
Others 158 (54%) 107 (59%) 191 (61%) 318(64%)
Total 292 181 315 506

Family Planning:

2007- 08 2008-09 2009-10 2010-11
Copper-T Insertions 223 213 249 356

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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%
positivity

Human interest story:

Dhaso soren came to OPD with severe breathlessness and
fever for more than a week. He took treatment from near-
by pharmacy but there was no improvement. So he came to
our 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 started
on antibiotics and ATT. His drainage slowly reduced and
he was discharged. He & KALA AZARmedicines. HePROGRAMME:
4. MALARIA finished his ATT CONTROL has
put on a lot of weight and is now attending school.
3. MALARIA & KALA AZAR PROGRAMMES:

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4. SURGICAL CAMP:

Activity 2007- 08 2008-09 2009-10 2010-11
Total malaria patients seen
By CHVs & CHGs 3667 3286 2057 2924
By the medical team 2243 2477 2368 2029
Case Proportional rate
CHV’s 46/100 47/100 40/100 40/100
Medical Team 22/100 36/100 33/100 25/100
Cerebral malaria 53 54 56 76
Lab investigations – malaria parasite
Total 2763 2738 1745 2217
Positivity 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 azar
No. of Kala azar cases
125 22 17 38
treated (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 weeks
duration. 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 surgeries
were done including 6 thyroid surgeries. Second camp was held in February-2011.
Dr.Viju from Asha Kiran,Lamptapur was the surgeon. This time we managed
anaesthesia with our nurse anaesthetist. Altogether we did 36 surgeries during this
camp.

2009-10 October-2010 February- 2011
Thyroidectomy 2 6 2
Hysterectomy 5 4 0
Laprotomies 1 4 3
Hernia 19 9 9
Minor surgeries
52 41 22

Dr.P.D.Koshi with thyroidectomy patients - Ram kisku- Ileal perforation.
Post-operative picture Operated in Feb2011 surgical camp

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HOSPITAL PERFORMANCE:

2007- 08 2008-09 2009-10 2010-11
No. of patients seen
CHVs 8209 5684 5119 7119
Mobile clinic 4613 3368 4920 3262
Out-patient 8756 7468 6565 7959
Admissions 1111 904 985 1365
Total 22689 18756 17589 19705
Profile of patients admitted
Complicated malaria
120 145 78 87
Cerebral malaria
Diarrhoea 36 21 14 55
Severe Anaemia 11 11 14 29
Kala azar 120 22 17 35
Pneumonia 22 40 38 27
Tuberculosis 29 36 36 15
Obstetric 292 181 324 506

Bed strength 21 21 20 20
Bed Occupancy Rate 80% 53% 54% 68%
Turn over Rate 54 44 49 69
Average Length of Stay 5.5 days 4 days 4 days 4
No. of lab tests 8147 10221 8630 12673
No. of X-rays 244 295 463 333
No. of Ultra sound 58 73 138 100
Major Surgeries 55 41 56 126

Udhual singh, a 8 year old boy was referred
Human 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.

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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

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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.

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 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 year

Respectfully submitted,

MR. DEEPAK THORAT DR. R. ISAC DAVID
Hospital Manager Senior Administrative
Officer

Prem Jyoti Report 2010 11

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