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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, 09430346486INTRODUCTION:

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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; ando Serving as a model to challenge others

In order to help communities develop to their fullest potentialOur 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 EmpowermentMaximum quality Minimum cost

Joy in servingYearning for the Best for the Poorest OwnershipTeamworkIntegrated 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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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.

CHV Strength & Attendance 2007- 08 2008-09 2009-10 2010-11

No. of CHVs 116 108 70 86Attendance at Trg. Centre 62% 59% 47 % 68%Attendance at peripheral clinic 65% 55% 69 % 72%

CHV Outputs 2007- 08 2008-09 2009-10 2010-11

1. Treatment of patientsTotal 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 95 (44%) 119 (46%) 123(49%) 165(45%)

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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.

CHV’s treating patients have increased. This has decreased the patients coming to Attendance at Peripheral Clinics 2007- 08 2008-09 2009-10 2010-11

Total beneficiaries 5402 3368 4920 3262

No. of patients 2395 1546 2562 1211

No. of ANC’s & Copper-T insertion 1101 911 1555 1034

No. of children immunized 1904 911 803 1017

No. of completers 229 84 47 102

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Human Interest Stories:

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SECONDARY HEALTH CARE AT THE HOSPITAL:

1. Reproductive Health

HOSPITAL DELIVERIES

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

Hos

pita

l

Mal

to

Tar

get

Hos

pita

l

Mal

to

Tar

get

Hos

pita

l

Mal

to

Tar

get

Hos

pita

l

Mal

to

Tar

get

Total 240 52 151 30 281 34 460 46Normal Vaginal 156 40 120 192 290Twins 6 0 4 2 9Breech 6 1 4 6 10Instrumental 30 4 12 55 90Craniotomy 1 0 0 3 2Caesarean 41 7 39 57 105

Maternal

Mortality10 2 3 6 5 17

During

pregnancy4 0 1 2 2 5

During delivery 1 2 0 2 2 7Post partum 5 0 2 1 1 5Delivery

OutcomeLive birth 205 49 142 254 269 461Stillbirth/IUD 38 4 10 39 48 54

Community of patients delivered in the hospital

2007- 08 2008-09 2009-10 2010-2011Malto – target area 48 (16%) 30 (17%) 34(10%) 46(9%)

Malto- non target 5 6 8 3Santal 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 2010-11Copper-T Insertions 223 213 249 356

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OCP distributed 106 53 59 21Tubectomy (with LSCS) 7 9 10 35

2. TUBERCULOSIS CONTROL PROGRAMME:

Activity

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

Hos

pita

l

Mal

to T

arge

t

Hos

pita

l

Mal

to T

arge

t

Hos

pita

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Mal

to T

arge

t

Hos

pita

l

Mal

to T

arge

t RNTCP

Mal

tos

Non

-mal

tos

1. No. of cases at the start 29 23 32 25 11 16 43 26 0 0

2. No. of new cases 78 46 48 41 13 51 37 19 29 313. 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 3 125. Completers 54 37 40 40 63 36 48 34 5 26. Still on treatment

32 25 11 16 43 26 13 6 19 14

7. Compliance Rate (%) 80 93 64 85 85 84 75 88 83 52

8. Sputum positivity

10% 15% 17% 18%

4. MALARIA & KALA AZAR CONTROL PROGRAMME:

3. MALARIA & KALA AZAR PROGRAMMES:

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 finished his ATT medicines. He has

put on a lot of weight and is now attending school.

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4. SURGICAL CAMP:

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- 2011Thyroidectomy 2 6 2Hysterectomy 5 4 0Laprotomies 1 4 3Hernia 19 9 9Minor surgeries

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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

- 54/397 (14%) 21/149(14%)106/500 (21%)

Kala azarNo. of Kala azar cases treated (in IP) 125 22 17 38

Lab test for Kala azar K39 positivity

47/156 (30%)25/94 (27%)

12/59(20%)

53/172 (31%)

Ram kisku- Ileal perforation. Operated in Feb2011 surgical camp

Dr.P.D.Koshi with thyroidectomy patients - Post-operative picture

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HOSPITAL PERFORMANCE:

No. of patients seen2007- 08 2008-09 2009-10 2010-11

CHVs 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 292 181 324 506

Bed 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

Human Interest stories:Udhual singh, a 8 year old boy was referred from a catholic health centre with history of 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 DAVIDHospital Manager Senior Administrative Officer