friends of reg. charity n o. 209168 vell ore ore issue n o. 146 · spring 2017 newsletter friends of...

VELLORENEWSLETTERISSUE No. 146 · SPRING 2017

REG. CHARITY No. 209168FRIENDS OF

Mallika and Paediatric Burns Camp 2016 - See pages 4 & 5

various distraction techniques are required,something which Dinesh is becoming adept at.

Another aspect of the role is to enable asmooth transition from hospital to home.Dinesh will advise on exercises and helppatients and their families to develop copingstrategies, manage the scarring and monitorcontinence. In time he hopes to be able tocarry out home visits to patients who havebeen discharged.

Dinesh is enjoying the role whilst finding itchallenging at the same time. Alongsideworking as an occupational therapist heenjoys art and drawing, hobbies that heshould be able to put to use with thechildren.

We have agreed to fund this post forthree years to enable CMC to assess howeffective it is. If it is proved beneficial, thepost will be incorporated within coredepartmental funding after three years.

inesh is working alongside burnsvictims and children suffering fromMyelomeningocele. Christian

Medical College, Vellore have approximately80 patients with major paediatric burnsadmitted to their five bedded burns facilityannually. Often these are caused by cookingaccidents in the home. Myelomeningocele(MMC) is a birth defect in which the backboneand spinal canal do not close before birth. ThePaediatric Surgery department sees around 70children less than 15 years of age annually withMMC. Following surgery to repair the defect,most children will require lifelong treatmentfor bladder and bowel continence issues andmuscle and joint problems.

Head of Department, Dr John Mathai, isdelighted with the appointment. Workingwith children, and especially patients withsevere injuries, was new for Dinesh, but hehas quickly found his feet and settled in. Thechildren are benefitting from having adedicated member of staff to help themwith their exercises on the ward. Motivatingthe children to perform their exercises canbe difficult as they may be painful and so

RESTORINGYOUNG LIVES

CHRIST I AN MED I CA L COL L EG E AND HOSP I TA L , V E L LOR E , S . I ND IA

Friends of Vellore UK are currently funding the post of an Occupational Therapist to work in PaediatricSurgery. Following interviews in the Autumn, newly qualified Dinesh started as Occupational Therapiston 3rd November 2016. When Ruth visited in January this year, she was able to meet him and see how

he is getting on in his new role.

D

Dinesh with Dr John Mathai and Esther Kanthi, Nurse Manager.

I S S U E 1 4 6 • S P R I N G 2 0 1 7 • V E L L O R E N E W S L E T T E R2..........

together, wemake it easier.

WELCOME TO THE SPRING 2017 ISSUE OF THE FRIENDS OF

VELLORE NEWSLETTERTHANK YOU...

...to all our supporters for your generous donations and prayers for the work at Christian Medical College

(CMC), Vellore. We are so grateful for each one of you and thank God for your partnership in this work.

I had the privilege of visiting CMC for the second time in January this year. I was able to see all the projects

we are currently supporting as well as meet with representatives from Friends of Vellore organisations in

other countries and attend the CMC Council meeting. My highlights included visiting the slum areas to see

one of our new Community Health Workers from the Low Cost Effective Care Unit in action, and the

ceremony to commemorate the start of the building work at the new Kannigapuram campus.

This issue starts with a focus on Paediatric Surgery. It was a great encouragement to meet Dinesh, the

newly appointed occupational therapist we’ve funded for Paediatric Surgery and see how your donations are

making a difference to the children on that ward. We have a report on the burns camp that the department

held in September and a patient story.

You can read about the latest developments at CMC including two major building projects they are

involved in and the effect of the demonetisation in November. We also have updates on several of our

projects and some patient stories to tell, each demonstrating just how much your gifts are blessing the lives

of people in Tamil Nadu and beyond.

The Rehabilitation Institute celebrated its Golden Jubilee in 2016 which features in this edition as well as

a write up by Clara Watkins on her recent medical elective at CMC. We also have an article on Palliative Care

written by Dr Reena George as she first started out in this specialty. Enclosed with our newsletter is a copy

of the December 2016 edition of Pulse, the CMC annual newsletter.

We hope you enjoy reading the newsletters and are inspired by the wonderful work going on at CMC.

Ruth Tuckwell, [email protected]

Ruth in Vellore with her counterparts: Sven from FOV Sweden and Kate fromthe Vellore CMC Foundation, USA.

Dinesh helping a patient.

ANNUAL MEETING: Sunday 17th September

As last year, we are holding an Annual Meetingfor all supporters of Friends of Vellore onSunday 17th September 2017 at the HolidayInn, Coventry, CV2 2HP (just off Junction 2 ofthe M6).

This is on the final day of the CMC AlumniWeekend, enabling Alumni to stay on andothers to join us on the day. The purpose of

the meeting is to update the friends ofVellore about CMC and FOV as well asproviding an opportunity for fellowship witheach other and Alumni.

The timetable for the morning is as follows:• 9:30am to 10:30am: Sunday Chapel Service• 10:30am to 11:00am: Tea/Coffee• 11:00am to 12:30pm: FOV Annual Meeting

• 12:30pm: Light Lunch (sponsored by FOV)

Those attending on the day are welcome tojoin us in time for the service or to arrive inthe coffee break in time for the meeting itself.We would love to see many of you there. Ifyou are able to attend, please let Ruth knowso we have an idea of numbers. (Contactdetails are on the back cover.)

V E L L O R E N E W S L E T T E R • S P R I N G 2 0 1 7 • I S S U E 1 4 6 3 .........


Children at the Pachaikili Play Centre, RUHSA.

WHERE DID YOUR DONATIONS GO?In 2016 Friends of Vellore UK received £105,604 in donations and legacies including gift aid. We

received an additional £36,378 income from investments. We sent £111,973 in grants to CMC and £2,950in grants to individuals visiting or working at CMC.

• Sent £30,000 to the Person to Person scheme helping about 480patients. You can read more on page 6

• Completed the second and third year of funding of the post ofMission Network Consultant (£26,714). Further information on thisproject can be found on page 14

• Given almost £20,000 in support of projects at the Rural Unit forHealth and Social Affairs (you can read more on pages 10 and 11)

• Supported three community health workers and a driver working inthe slum areas of Vellore town served by the Low Cost EffectiveCare Unit (£4,789). More details are in the articles on pages 8 and 9

• Funded an Occupational Therapist in Paediatric Surgery (£4,542)• Continued our support for the Palliative Care Department’s Home

Care Programme (£2,000)• Contributed £2,500 to Joe and Denny Fleming’s funding through

Interserve • Supported various Alumni Batch funds through directed gifts from

alumni (£13,000)• Also sent some small gifts for distance learning and supporter

directed funds for student scholarships (£8,000)• Sent £1,500 for the new floor at Rehab.

During 2016 Friends of Vellore has

RestrictedDonations, 44%

InvestmentIncome, 26%

UnrestrictedDonations, 18%

Gift Aid,10%

Legacies, 3%

2016 Income Amount

Restricted Donations £61,790 Unrestricted Donations £24,923 Gift Aid £14,102 Legacies £4,789 Investment Income £36,378

Total £141,982



MALLIKA

er mother had allowed her toprepare part of the evening meal,but not supervised her pouring the

kerosene into their stove. Before she knew it,her clothes were on fire and the skin over herface, neck, chest, arms and thigh hadcompletely burnt away before the family wereable to put the fire out.

First impressions of Mallika revealed abubbly young girl. She was obviously afavourite in the family, as they scurried awayto get things she kept asking for. She wasinquisitive and very bright.

Her treatment was long drawn out andexhausting – both for her and her caregivers.Mallika required several operations forremoval of dead tissue, skin grafting andplacement of intravenous access lines. Thegreatest challenge was to ensure she was ableto use the function of her limbs and neck. Itwas not only painful for her physically tomobilize her joints, but there was a largeemotional connect that was required. She wasa silent spectator to the ordeals her caregiverswere going through – she watched her motherstruggle with the gradual loss of all theirfamily’s savings on sustaining their expenses atthe hospital. Her father walked out on thefamily a fortnight into her treatment, unableto cope. Her uncle, who she was very close to,committed suicide - probably due to mentalillness.

It was in this setting that she formed aninteresting bond with Dinesh, Paediatric

Surgery’s newly appointed occupationaltherapist. Dinesh was not just interested ingetting her joints moving, but was able tokeep her motivated while doing it. As theweeks became months, Mallika became moredifficult to engage. She often refused tomove her limbs, and would throw tempertantrums, once even biting a nurse who triedto change her dressing. Dinesh came up withinnovative ways to engage Mallika, oftenrewarding a short walk out of her room withsome time watching television. As shewatched her favourite cartoons, he wouldposition her head in various ways that helpedstretch her neck contractures. He createdsmall casts and worked on her thick elbowand finger contractures. His wide grin andpatience won Mallika’s confidence andcooperation.

It was by God’s grace that CMC were ableto send Mallika home alive. Medically she hadher fair share of close calls and the staff weregrateful that she made it. However in burns,it’s not just being able to send someone awayalive that matters. The quality of life that theyare able to have by the time they heal withtheir scars and contractures, the body imagethey possess and the daily living activities thatthey are able to perform will help qualify asuccessful outcome. Mallika was blessed bythe major input that Dinesh provided. Hisefforts encouraged Mallika’s mother tobelieve that it would be possible for herdaughter to get back to a normal childhood intheir village, to do the tasks she thoughtwould be impossible - hold a pencil or tie thebow on her dress. She’s not completely backto normal, but definitely on the right track!

It’s an unusual sight to see an older child in the paediatric emergency department with burns, as theyare less prone to accidents than the younger ones. So it was with Mallika (name changed), who

presented with over 60% of her body riddled with deep second degree burns.

Mallika, age 11, at the Paediatric Surgery Christmas party. She is sitting on a blue chair in the front row,next to a young child who is wearing a Santa cap.

H

CHAIRMAN’S REPORTaving spent the past couple ofweeks in Vellore, I was able to see abit of CMC from the inside. The

number of patients is just overwhelming!Staff are very busy trying to cope with thenumbers and, everywhere, it looks like‘organised chaos’, but the systems work andeveryone is seen and dealt with appropriately.

Due to the increasing numbers of patients,CMC are actively building new campuses atChittoor (CTR) and Kannigapuram (KPM). The

former is to be a general hospital serving thelocal population and the latter (KPM) a multispeciality hospital starting with an A&E unit.There was a grand bricklaying ceremonywhere many former and present staff, visitorsand local people were invited. It was good tosee so many familiar faces!

The FOV’s support for projects outlined inthe summary on page 3 is ongoing and we arein talks with CMC about other areas we couldhelp with. Future projects for FOV UK may be

H

Dr Ajit Butt laying his brick.



PAEDIATRIC BURNS CAMP 2016Esther Kanthi, Nurse Manager, Paediatric Surgery reflects on the

burns camp the department held in September 2016.

he Department of Paediatric Surgeryand Paediatric Nursing conducted a“Burns camp” on 10th September, 2016

during “Burns Safety Awareness Week”. Thecamp was held in a recreation hall, 20km fromCMC. It was attended by 25 paediatric burnsurvivors and their families who had beentreated by the department.

Transport by bus from the CMC HospitalCampus was arranged for the children andparents. After a prayer and a welcome address,the day started with a health check-up wherethe children were individually seen by thepaediatric surgeons, plastic surgeons, paediatricsurgical nurses and occupational therapist. Thechildren were assessed and the concerns of theparents and children were addressed by the theexperts. Some of the children who haddeveloped complications such as severe

contractures were advised tocome to the hospital forfurther management. A fewof the health concerns raisedby the parents were regardingsevere itching for which drugswere prescribed. Thetherapist assessed the rangeof motion at various jointsand taught the parents activeand passive stretchingexercises. Following thehealth check-up the groupwas provided with a mid-morning snack.

The nurses then led a health education sessionfor the parents and children on variousrehabilitative aspects necessary formainstreaming. Topics covered included theimportance of a diet rich in protein, nutritionalsupplements, active and passive exercises for theprevention of contractures, skin care; protectionagainst sun, pressure garments, moistening andmassage of the healed burns with oil, surgery ifrequired, continuation of school education andvarious other physical, emotional and socialaspects of care. Exercises were demonstratedand pressure garments and health educationposters were displayed for the parents to see.Prevention and first aid for burns was alsodiscussed in detail.

This was followed by a Q&A session where theparents raised various questions such as “Howlong should we continue the nutritional

supplements and exercises?”, “Will the scars everreduce or disappear?”, “Can I send my child toschool?” and many more, for which, the expertsanswered and clarified the concerns of theparents and children.

The parents were appreciated for taking goodcare of their children at home and they weremotivated to perform and continue the aspectsof care they already knew and those which theylearnt at the camp. Then there was a period ofsharing where all the parents shared individuallyabout the burn injury, how it affected them andtheir families, the challenges that they face incaring for their child at home and in thecommunity, the support that they receive,coping mechanisms etc. It was an opportunityfor the parents to learn from each other’sexperiences and helped them to realise that theywere not alone in their struggles.

Various games and activities were organisedby the team to entertain the children. Theseincluded bowling, pin the tail on the donkey,lemon and spoon race, running race and ballgames with prizes distributed for the winners.There was also time for drawing and colouring,singing, dancing and group exercising. Thechildren thoroughly enjoyed the sessions and atthe end all the children were given various gifts.

The camp concluded with a lunch after whichthe families were taken back to hospital fromwhere everyone dispersed. The parents werevery grateful to the department for organisingthe camp. They appreciated the chance to meetother burn-surviving children and their families

and share experiences. The burns camp was also an eye

opener for all of us. We realised thatthe cure does not stop with justhealing of the physical wounds; thechildren and families also needmental, social and spiritual healing. Ittakes time for families to return totheir usual routine and adapt to thevarious changes that the injury hascaused. We hope that this initiativecontinues to make a significantcontribution to the life of thechildren and their families and helpsthem to cope better and lead a goodlife with minimal or no complications.

T

Families attending the burns camp.

Consultation at the burns camp.

in assisting the mission hospitals linked toCMC; we have already helped set up amissions office in Vellore which has its ownnew website. Further involvement willdevelop as and when the mission hospitalsare evaluated by CMC.

Please continue to uphold the work ofCMC and FOV UK in your prayers.

In ChristAjit Butt



IN 2016 WE SENT £30,000TO THE PTP SCHEME!

The Person to Person (PTP) scheme has been making small grants to patients towards the cost oftheir care since 1974! As a result of your donations, FOV UK contributed £30,000 to this fundduring 2016. Many of you give to this fund through us month by month and receive an email

telling you about the person you have helped. This is so worthwhile and even £10 a month goes along way. Do contact us if you would like to be part of this scheme. Below is the story of Praveen

who has benefitted from the PTP scheme this year.

PRAVEENne-year-old Praveen is the youngestof his parents’ three children.Praveen’s older siblings aged six and

four attend a local government school wheremidday meals are provided. They study in 2ndGrade and preschool, known in Tamil as aBalwadi. His father studied up to high schoollevel and works as a farm labourer five to sixdays a week, earning £50 per month. Hismother also studied up to high school leveland stays at home looking after the childrenand other needs of the family.

The family, who lives together withPraveen’s grandparents and uncle’s family,comes from a village called Kulavimedu, about14 km from the main hospital in Vellore. Theyhave their own brick house, nestled at thefoot of a hill. The roof is made of asbestossheeting and the floor is cement. There arethree small rooms, each measuring 10' x 8'.They cook outside the house and there are nobasic facilities like water or sanitation. Waterhas to be collected from a pump, a littledistance from their home. They have freeelectricity and get 20 kg of free rice, providedby the Tamil Nadu government. The familyhas two simple meals a day – cooking onceand having the same food for lunch anddinner.

CMC's Community Health team visits thisvillage once a month and provides antenatalcare. In order for villagers to travel to thehospital, they have to walk to the nearest busstop and catch the bus which is availabletwice a day. In an emergency they have to call

for an auto-rickshaw on their mobile phoneand wait half an hour for it to arrive.

The family brought Praveen to CHAD(Community Health and Development)hospital with complaints of coughing andnoisy and laboured breathing soon after hehad eaten a peanut. When the doctorsexamined the young boy, he was found tohave restricted breathing in his right lowerlung zone. Since he was very sick, he wastransferred to CMC’s main hospital byambulance along with a doctor. Abronchoscopy revealed half a peanut, stuck inhis lung. This was immediately removed undergeneral anaesthesia. Post operatively, he wasmoved to the intensive care unit forventilation and observation since he had beenchoking and his breathing was restricted. He

was prescribed antibiotics and antipyreticsalong with some pain killers. After two days inhospital, he was discharged and referred toCHAD hospital for follow-up.

The cost of hospitalisation for Praveen'streatment came to £318. His fathercontributed some money towards thehospital bill. CMC took care of the young boyin the hope that some kind donor wouldfinance his care and, through a generousdonation, he was helped by the Person toPerson Scheme. Without CMC's timely skilland compassion and this donation, a precious,healthy, young life might have been lost. Theremaining amount was settled by theconcerned unit and the Institution. Thefamily were so grateful for this help in theirtime of need.

O



NEWS FROM CMCCMC are busy working on two major building projects at

Kannigapuram and Chittoor.

pprovals for the trauma centre anda 1500 bedded multispecialtyhospital and teaching facility at

Kannigapuram were granted in August 2016. InDecember CMC were able to turn the sod andcommence the initial phase of constructionof both the housing and clinical facilities onthis 100 acre site. They praise God that thepermissions were granted remarkably quickly.The State of Tamil Nadu wants this newcomplex to be a model for all similargovernment projects. Once again CMC is setto lead the nation of India.

On 20th January 2017 a special brick layingceremony was held. Those gathered includedretired senior faculty, council members, staffand students. It was a time of looking backand looking ahead, thanking God for hisblessing on the project so far, ten years afterthe need for a new campus was firstidentified.

Senior faculty and council members wereinvited to lay a brick. Students were able toleave their hand imprints on slabs of fresh,wet cement. The slabs with the handprints,and the bricks laid by the elders will, at thetime of construction, become a permanentpart of the structure of the new hospital.

The evening, also saw the handing over of5000, personalised stamps, featuring CMCVellore, by Ms Radhika Chakravarthy, Post

Master General of the ChennaiCity Region, to the Directorand various past and presentmembers of the Council.

CMC have a long associationwith Chittoor district; Dr IdaScudder conducted a roadsideclinic there since the 1930s.The new Chittoor campus hasbeen built to serve the peopleof Andhra Pradesh and willevolve into a broad specialityhospital of excellence with anumber of educational trainingprogrammes.

Already it is a bustling hubwith a full outpatient and a 130bed inpatient facility. They have treated over1000 inpatients and seen 40000 outpatients.There are four state of the art operationtheatres, three of which are currently inaction. Over 500 surgeries have beenperformed during the last five months.

By December 2019 CMC hope to have afully-fledged 400 bedded hospital. They arecurrently establishing infrastructure for theschool for distance education, the College ofNursing, a school of Public Health, a Pharmacy

College and a Dental College.The cash demonetization in

November proved to be achallenging time. However,CMC saw this a anotheropportunity to help the last,the least and the lost. Sincethe discontinuation of highdenomination currency notes,health care services in Indiahave had to rethink theirmonetary operations. CMCpursued innovative methods tomobilise resources and ease thepayment process for itspatients and staff. Inpatientswere allowed to settleoutstanding bills with whateverlegal tender they had at hand.Increased provisions were

made to facilitate the use of debit and creditcards for all transactions, and the CMC ‘ChrisCard’, the in-house e-Health Card.

Acutely ill patients needing critical care oremergency surgery, and women and childrenwere granted adequate concession or freetreatment, as determined by the treatingteam, if they did not have cash ready. Patientsand families who were exhausted whilewaiting in the serpentine queues in front ofATMs and cash counters were provided withfree refreshments. Financially disadvantagedrelatives of in-patients were supplied meals inthe wards. The institution also enlisted theservices of banks to help patients get accessto cash and the banks opened temporarykiosks in the hospital and college campuses.CMC worked with banks to open temporarykiosks in the hospital and college campuses tohelp patients and staff obtain cash.

Despite the cash crunch, staff salaries forthe months of November and December 2016and Christmas bonuses went through withoutdelay; many employees were remunerated inpart as cash. With the exception of a fewpatients travelling from afar who cancelledtheir previously booked appointments, allother patients who came to CMC were welltaken care of despite the challenges.

CMC is also going through a tough phasewith the government trying to interfere intheir selection process for medical students.Please pray for them - to know the will ofGod in the midst of this and for His Kingdomto come.

Dr Sunil Chandy, Director, CMC Vellore, hands the first brickover to centenarian alumna, Ms Anna Jacob.

Chittoor Inpatient Ward.

A



“Defend the weak and the fatherless; uphold the causeof the poor and the oppressed.” Psalm 82:3

he Low Cost Effective Care Unit (LCECU),situated slightly away from the main hospital,aims to provide quality but low cost care to

the poorest inhabitants of Vellore. Patients pay a nominalamount for registration, and then are only charged fordrugs and investigations – even those charges areaccording to the individual’s ability to pay. LCECU areincreasing their work among the poor using CommunityOriented Primary Care. They run clinics in five slum areasof the town to get medical support to the very poorest.This is in addition to the outpatient services and 46inpatient beds at the LCECU base hospital.

We are currently funding a £40,000 project over fiveyears to strengthen the outreach services of LCECU inthe slum areas of Vellore town. The funds aresupporting a driver and three community healthworkers who are educating the community to improvehealth and prevent illness, acting as the interfacebetween the community and the unit, and enablingreferrals to the hospital where necessary. Typically thoseliving in slum areas will not seek medical help, thinking itis unavailable or too expensive. The field workers areproviding health education and health care for theelderly, the disabled, those with chronic diseases andthose with acute illness.

Ambiga, Alfred and Beryl were appointed ascommunity health workers in May 2016. They havestarted mapping every home in the five slum areasLCECU are focusing on, making a registry of people wholive in these areas and a list of patients with chronicdiseases. Anyone over the age of 35 is offered to havetheir blood pressure checked and their sugars measured(many are not keen to find if they have high sugars -they are happy to be ignorant!). Women who never hada pap smear are referred for one, though there is areluctance among many for this.

The outreach clinics have been increased to everyafternoon, so each area has a clinic once a week. Aconsultant and a junior doctor goes out everyafternoon to conduct the clinic and also to touch basewith the community.

The University of Illinois, Rockland, is helping LCECUto organise their data so they can demonstrate that theycan practice effective medicine and primary care at a lowcost. LCECU hope to be a model for the country andinfluence the health policies of the nation. Dr SunilAbraham was recently invited to present on the work ofLCECU at a national government workshop in Delhi. Itwas a wonderful opportunity to acknowledge God whoenables them to do this work. The government priorityareas for the next few years are all in line with the workof LCECU. Dr Sunil wrote: “I came back amazed at thewisdom of Christ, who works in us and through us tobuild His Kingdom out of His compassion for the poor inthe slums.”

T

Vellore's laundry being done in the slums.

A patient being brought to the clinic.

Ruth with Ambiga, one of the Community Health Workers.



“Come to me, all you who are weary and burdened,and I will give you rest.” Matthew 11:28

alaniammal is a 60 year-old lady from Rangasamy Nagar ofVellore town. She is a widow and lives with her younger sister.Her husband, was a market labourer and died about five years

ago due to asthma. She delivered two children but both of them diedin early infancy. Palaniammal andher sister work in a vegetablemarket as labourers, carryingvegetables, segregating goodvegetables from the rotten ones,peeling off garlic etc and earnaround Rs 65 / 80 pence per day.She lives in her own house (twosmall rooms with a tiled roof andno toilet facility) built onunauthorized waste land.

Rangasamy Nagar is anostracized area in Vellore becauseof its past history. Many socialagencies still do not like to workwith those who live here. For manydecades it was an area renownedfor prostitution. The local admin-istration was able to abolish most of the trade but was not verysuccessful in rehabilitating the workers. Some who went back to theirvillages did not find acceptance in their respective communities and asa result had to return. Most inhabitants are unskilled labourers workingin the market or as cook assistants, with poor savings and often ladenwith heavy debts from local money lenders. The houses in these areasare all on unauthorized Government land.

Palaniammal presented to LCECU with a complaint of stomach painand fever in January 2017. Though she was seen in the community by ourteam, there was a delay for her coming to the hospital as she had no oneto accompany her. Then her niece came with her so that she could beadmitted to the LCECU ward. She was in shock when she arrived andtreatment was initiated immediately along with the necessaryinvestigations including an emergency ultrasound that night at the mainhospital. However she deteriorated and had to be referred to the mainhospital where she was investigated extensively. She was diagnosed withScrub Typhus with Acute Respiratory Distress Syndrome and cardiacdysfunction, and was moved to ICU for a day, followed by a further sevendays hospitalization on the ward. During this period she recovered well

but was concerned about how she would pay the bill on her meagre wage. Her niece stayed with her in LCECU and later in the main hospital to

take care of her. The costs of the medicines were paid from the LCECUfree medicine fund. At the time of discharge her final bill came to Rs

37,000 (£455)! A letter was writtento the medicine unit requesting aconcession so that LCECU couldmeet the rest of the cost. We aregrateful that the unit wrote off thewhole bill for her.

When we visited her house,Palaniammal mentioned that shewould not have survived withoutthe help of CMC. The LCECUoutreach work filled the gapbetween a tertiary hospital and thepoor in the urban slum. Today sheis happy and has gone back to herwork. CMC has been a channel ofblessing for her life.

The story of Palaniammalhighlights the value of one life in a

poor slum area, and the crucial role of Community Oriented PrimaryCare for providing accessible and affordable care for the poor. Servicesare provided by the community volunteer, field worker, outreach nurse,social worker, physician, secondary care in a base hospital for thedefined community, ICU care, tertiary care in a teaching hospital andfollow up after discharge in the community. It has also brought us closerto the community and a developed a new openness among them totrust us and work with us.

Another highlight of the whole episode was the visit of second yearmedical students with a Family Medicine faculty to her house as part oftheir Family Medicine posting. They were obviously moved by the livingconditions of the people there and the need for affordable care forthem. It is also a testimony to the value of support from FOV UK. Yoursupport for the work is doing something often unseen, but verysignificant. It has helped us to plan and focus our work and to gobeyond running a hospital and treat the problems the people presentwith, to looking at ways to keep the people of the community healthy.Thank you very much for your support and prayers.

Dr Sunil Abraham, Professor, Department of Family Medicine.

P

Palaniammal.

Please do uphold LCECU in your prayers. Please pray for:• Christ to be glorified through the work of LCECU• Completion of the mapping exercise and sorting out some glitches in the software for the tablet to enable storage and

accessibility of this information.• Jacob, the driver’s post being absorbed into the regular budget• More junior and senior doctors at LCECU• The collaboration with University of Illinois to study the outreach work which will then be presented to the government. • Praise God that CMC got the approval to start 2 MD seats in Family Medicine. CMC is only the second medical college in

India to have this. Some final paper work and inspection has to happen before May 31st. Please pray for this.



MEDICAL ELECTIVE AT CMC

went to CMC Vellore in autumn2016 and loved every minute! Iswapped grey Aberdeen for sweaty

Vellore, where I was to remain for an 8-weekelective to do research with the EndocrineDepartment. I spent weeks getting lost, buteventually found my way through the maze ofa hospital and the endless throng of colourfulfamilies to the department.

Specifically I was looking into risk factorsfor diabetic foot disease and its complicationsin the female population. I was hugelyimpressed with the department’s world classattitude to learning with the bi-weekly journalclubs keeping everyone up to date, and thequality of teaching I received during clinics.These meetings were made even moreenjoyable by the monthly addition of cake.The food on the trip was a definite highlightand I even managed to (eventually) get thehang of eating with my hand. It wasimpossible to be in the office aroundlunchtime without someone trying to sharetheir pack feast with me. None of myattempts to replicate it since my return havecome anywhere close.

I also spent time with a range of otherdepartments. I found CHAD (CommunityHealth and Development) hugely forwardthinking; each day sending vans to the nearbyvillages to monitor blood pressure and deliverantenatal care free of charge. The people wemet there were all incredibly welcoming andoften tried to invite us back for tea in spite oftheir frequent lack of English.

During my time in the hospital I saw diseasethat I had only otherwise read about, such asleprosy, and couldn’t get over seeing twocases of acromegaly in just one afternoon. Ispent hours in the labour room astonished bythe rate of turnover and how hands on I wasallowed to be.

I stayed in Modale hostel on the maincampus. Within hour of arriving I had madefriends who showed me the ropes. I would goon to travel with these same people everyweekend. We became the joke of theEndocrine Department for travellingsomewhere, an eight-hour train ride away,every weekend. We visited beaches, hillstations, palaces and temples; attendingweddings and festivals along the way. I willhopefully be meeting up with some of thefriends I made there this summer.

I would love to return someday, if only totry and get the hang of the head wiggle.

Clara Watkins is a 5th year medical student at the university of Aberdeen. She received a Friends of Vellore travel bursary to help fund her elective at

CMC Vellore in 2016. Here she writes about her experience.

I

CHAD Mobile Clinic.

CMC Canteen.

HOPE AND HEALTH FOR THE ELDERLYhe Vellore Rural Community Trust(VRCT) is a subcommittee of Friendsof Vellore UK. This Trust allocates

financial support to various health anddevelopment programmes at the Rural Unit ofHealth and Social Affairs (RUHSA). On anongoing basis VRCT sponsors four elderly daycare centres for local elderly who have little orno family support or financial means.

The centres open five days a week andprovide the elderly with a cooked midday meal.Each of the centres are supported by acaretaker and a local women’s Self-Help Group.These women show a keen interest in providingnutritious food for the elders. The caretakerseducate the elders on health issues andmotivate them to visit the hospital when ill.

Various routine activities take placeincluding physical exercise, educational

sessions and pastoral counselling. As soon asthe elders arrive, they are motivated to go fora brisk walk and engage in group exercise forhalf-an-hour. Most of the elders are willing andhappy to participate. Many expressed thatthey feel healthier and have better mobilityon doing this regularly.

RUHSA training officers encourage peerinteraction and give educational sessionswhich provide opportunities for elders tolearn more about themselves, others and theworld they live in. The elders often discusspolitical, economic and social issues. Theylearn more about current affairs through

T



reading newspapers, watching television and interacting with students,staff and visitors.

Pastoral counselling sessions enable the elders to connect withthemselves and society. They also help elders to cope with depressionthrough positive thinking. The Chaplain encourages the elders todiscuss their feelings of suffering in group and individual sessions.Interactions with visitors, the staff and students lifts the elders’ spirits,building hope and happiness.

Many of the elders enjoy and get actively involved in gardening,assisting in cooking and playing traditional games. Some entertain theothers with their talent in traditional folk songs, dancing and storytelling.The centre at Seetharampet benefits from the Pachaikili children’s playcentre which is in the same building and also supported by FOV UK. MrPerumal, an elder from Keelalathur is actively involved in paper bagmaking to generate income. During 2016 he made 1023 paper bags!

Various special activities are carried out during the year including anannual picnic at Periyar Park, Vellore and the celebration of WorldElderly Day. In 2016 the theme was ‘healthy aging’. The elders weremotivated to think positively, eat healthy food and be physically active.The celebration at each centre ended with a delicious lunch. TheChristmas celebrations included a special meal on Christmas Eve in eachcentre. As part of the CMC Christmas Cheer Fund, ‘Dhoties’ for menand ‘Sarees’ for women members were distributed to all the elders.

INTEGRATED FARMERS’DEVELOPMENT PROJECT

The Integrated Farmers’ Development Project improves the socio economic status of marginal farmers inK.V. Kuppam Block and promotes organic methods of cultivation.

staff identify distant ruralvillages where employment

opportunities are few and far between, andlocal men are unable to earn an income becausethey don’t have the capital to invest in a smallbusiness. With the support of VRCT (the VelloreRural Community Trust, part of FOV UK),deserving farmers are provided interest freeloans to purchase cows. Unlike other loans,RUHSA’s repayment schemes are affordable and,as the funds come from charitable sources, therepaid funds are re-invested partly back into thefarmers’ clubs so more members can earn anincome, and partly to the elderly welfarecentres, which provide much needed support toelderly, impoverished villagers and are run by local women’s self helpgroups. This means that one donation from VRCT benefits three needygroups of people in rural India – poor farmers, vulnerable elderly andlocal women.

Over the last four years, VRCT funds have provided loans to fivefarmers’ clubs - each with around 15-20 members. The repayments havegone on to support members in a further five farmers’ clubs,contributed to the meals in five elderly welfare centres, with the self-help group women who run these centres receiving a valuable incomefor doing so.

In addition to the purchase of cows, RUHSAhas provided educational support and trainingfor organic farming methods to maximize useof sustainable resources. For example: coconutand teak plantations and marketing techniques;soil testing; pachagavya preparation (an organicproduct made from cattle waste with both aceremonial value and a role in increasingproductivity in organic farming); mushroomcultivation and access to local agriculturalexhibitions.

As an outcome of the training on organicfarming methods, Mr Anandan from Velambutfarmers’ club has prepared organic manurecalled the Panchagavya. Panchagavaya is a

traditional Indian method of preparing manure and is very sustainable.It is prepared by combining cow dung, cow urine, clarified butter (ghee),curds, milk and banana. This mixture can be added when the land isirrigated and Mr Anandan plans to use it for his rice cultivation.

We would love to support more farmers’ clubs as the benefits of thisproject extend far beyond the value of the initial loan. RUHSA hasproposed the support for four more farmers’ clubs at a cost of £1800each. The purchase of a single cow is £360. If you are interested insupporting this work please contact Ruth Tuckwell in the FOV office(contact details on the back page).

RUHSA

The table below provides information about the four centres:

Programme Details

Attendance

Gender Male Members

Female Members Total No. of MembersNo. of times Egg was providedNo. of times Meat was providedNo. of times Special Food was providedNo. of Elders lacking food security1

Nutritional 1) < 18.5 BMI

Assessment 2) 18.6 to 24.9 BMI

3) > 25.0 BMIFree Hearing Aid provided Free Spectacles providedFree Cataract Operation doneOral Cancer ScreeningSpecial education sessions Pastoral Care (Individual & Group Counselling) Withdrawal of membershipElderly Mortality New Members admittedNon-receivers of Old Age Pension

Keelala-thur

99%421253612144

39%61 %0 %23124864376

Kavas-ampet

93%520252412192

52 %48 %0 %0452870111

Rama-puram

96%2182030214

24 %41 %35 %00120931122

Seethar-ampet

84%6410754561

89 % 11 %0 %0000865380

OverallOutput

93%176380165714011

46 % 46 %8 %277463322108189

1. An assessment on Food security was to done to identify Elders who could not afford to make orbuy food for breakfast or dinner and during weekends. It was found that four such Elders inKelalathur were provided dinner by a voluntary organisation. In other centres, a few elders whorequired food were supported by the caretakers and community members.



REHAB CELEBRATES ITS 50THANNIVERSARY

The Department of Physical Medicine and Rehabilitation (PMR) celebrated the Golden Jubilee of theMary Verghese Institute of Rehabilitation on 26th November, 2016.

Mary Verghese, who was amedical student at CMC, sufferedspinal cord injury following a road

traffic accident which led to paraplegia,leaving her wheelchair-bound. She wastreated by Dr Paul Brand, the then Head ofOrthopaedics and was sent for rehabilitationin Australia, where she was trained to beindependent using a wheelchair.

On her return to India, she found that therewere no centres of rehabilitation in thecountry and took up the challenge to pursueher studies in Physical Medicine andRehabilitation in New York. She subsequentlyreturned to Vellore and started theDepartment of Physical Medicine and

Rehabilitation at CMC, Vellore andsubsequently the Rehabilitation Institute in1966. Soon, patients from all over India startedcoming to meet her to get treated andrehabilitated.

Popularly known as ‘The Surgeon on Wheel-chair’, she was a source of inspiration andstrength to all who came to her for treatment.For her pioneering work, the nation honouredDr Mary with a Padma Shri award in 1972.

The institute that began with two roomsadmitting 16 patients, now has 83 beds andtreats about 900 patients annually. Patientswith spinal cord injury, brain injury, stroke,children with cerebral palsy and amputees areadmitted for rehabilitation. Apart from

doctors and nurses, the multidisciplinary teamincludes physiotherapists, occupationaltherapists, speech therapists, psychologists,social workers, engineers and prosthetists andorthotists. The institute has been designatedas the WHO collaborating centre fordevelopment of rehabilitation technology,capacity building and disability prevention.

To commemorate the journey over the lastfive decades, CMC commissioned a bookentitled You Raise Me Up to More Than I CanBe, compiled and written by Dr PippaDeodhar. The plaque for a new Golden Jubileefloor was also unveiled by Dr Sunil Chandy.FOV UK was given much praise and thanks forthe help given to Rehab over the years.

Dr

SHE WAS LIKE ME…

the Rehabilitation Institute(affectionately known as Rehab),a highlight of the year is the

Rehab Mela: three days in February whenother work slows down, and the organisationfocuses its resources on providing check-ups,investigations and consultations for formerpatients, mostly living within a 100km radius.On the medical level, this is a highly practicalsolution to the challenge of follow-up check-ups and investigations for patients who wouldotherwise have to make several journeys. Butthe Rehab Mela is much more than that. It hasthe atmosphere of a big, three-day party: atime to re-engage with old friends and makenew ones, to celebrate achievements and toshare experiences with people whounderstand. The Rehab sports areenthusiastically attended, with great pride inthe Vellore Wheelchair Basketball Team: all itsmembers former or present patients at Rehab.Each day ends with a vibrant evening event,mostly performed by people with disabilitiesthemselves.

It was at this year’s Mela for spinal injuries

that I met Ramajayam: one of the few patientsstill around who knows what it was like to betreated by the legendary Mary Verghese:Rehab’s visionary founder, injured in a roadaccident as a young surgeon, and confined forthe rest of her life to a wheelchair.

Ramajayam is a victim of one of India'sdeep, uncovered wells. Some of these areobvious gathering points, hard to miss.Others, you may come upon unexpectedly,perhaps concealed in bushes or lurking in anovergrown field. In 1975, aged 22, Ramajayamfell into one of these hidden wells and injured

his spine. Admitted to hospital in Chennai, hewas treated and sent home with instructionsto come back for rehabilitation. He didn'tcome. What was the point? His legs wereparalysed. Almost certainly he would neverwalk again.

From being strong and active, he was nowtotally dependent on his family. He didn't goout. He was getting no better. The daysseemed endless. Gradually his friends stoppedvisiting. So what was the point of anything?He sank further into depression, stoppedworking and made plans to kill himself. Thenhe developed pressure sores, and wasadmitted to the Rehabilitation Institute atCMC Vellore. None of the family had muchhope that it would make any difference.

In the event, Ramajayam stayed in Rehabfor a year. The bedsores were treated.Diagnosed with a T12 spinal injury, he hadphysiotherapy, occupational therapy andvocational training. He learnt tailoring, whichhe found really enjoyable when learning in agroup. But above all, he was treated by MaryVerghese, and it changed his life. “Other

Ramajayam’s Story by Gillian Paterson PhD

At

Ramajayam.



people helped too,” he says. “Whenyou come here you feel supported.But Dr Mary was special. Of courseshe got angry if you didn’t followinstructions. And some people wereafraid of her. But she knew how it was.She was like me: she was in awheelchair, and she would never getbetter. And that made all thedifference.”

From then on, Ramajayam neverreally looked back. He did, for a while,manage to walk using callipers andcrutches, but in general he managestoday with a wheel chair and a trolley.His tailoring skills have improved further. Backhome, he also learned to practise herbal

medicine and other skills. Increasingly wellknown in his area, he was elected to the local

council. All these things keep him incontact with other people. “SometimesI think about how I might have been,”he says, “and the dreams I had when Iwas young: but I have learned not todwell on these thoughts.”

So what would he say to MaryVerghese if she walked through thedoor now?

“I would say thank you,” he says. “DrTharyan and Dr Suranjan too: theyhelped me when I needed it, andwithout them I would be dead. But DrMary: she was like my hero.”

Many (perhaps most) of the rehabpatients speak of this being a spiritual journey.Certainly Ramajayam did.

ying awake in pain one night, I remembered T.She was a patient I had seen in my first palliative careclinic in India. An oncologist by training, I had returned

earlier that week from a month’s introductory course in palliative care.It had taken four years of hesitation to come this far, and I knew thatunless I made some professional commitment, I would not have thecourage to get further involved in this field. Hence this clinic, eventhough it was the day before Christmas, 1998.

She was a frail seventy year old woman, with a carcinoma of the scalpthat had recurred after radical surgery and radiation therapy. Despitethe fungating ulcers, partially alopecic scalp and frayed clothes, she hada quiet dignity. I learnt that by the age of thirty five she had lost herhusband and children. She had no home, and supported herself byworking as a migrant daily wage laborer.

One of her troublesome symptoms was insomnia. Exploring thisfurther I enquired, ‘‘And what do you do, when you are not able tosleep?’’

I was surprised by her response,‘‘I just keep repeating, ‘Please look after me Lord, I have no one else.’’Would it not have been more natural, I wondered, if one was able to

pray at all, to ask, ‘‘Why did you take my family away Lord, leaving mealone? What will I do when I am too ill to care for myself?’’

Over the next few months she became increasingly unwell, had tobeg for her food and soon would be too ill to travel to hospital. We hadno facility for long-term beds, no palliative outreach program, and I feltguilty that we were leaving her to die alone and homeless. I wondernow, was I in some subtle sense assigning to myself the role of the Godshe had entrusted herself to?

Not long after, I learnt at a conference that an organization hadrecently opened the first hospice in our state. They offered to admit Twhen the time came.

I asked her if she would be willing to move to the hospice. She readilyagreed, asking only, ‘‘I have another set of clothes, a plate and a glass.Can I take those with me?’’ I nodded, eyes stinging, not trusting myselfto speak. Early that morning, I had packed away box number twentytwo, as I made preparations to close my house in order to move toEngland.

We left the same week, I to train in palliative medicine in the UK, andT to live her last weeks in the hospice.

During the eight years I had spent in oncology, even the wealthiest ofmy patients had not been able to access an inpatient hospice bed.Inpatient hospices are rare in a country that is struggling to develop lowcost palliative care clinics. Yet for T, there was a free long-term bed inthe first hospice in the state. Utter poverty and simple trust seemed tohave allowed the seemingly impossible to happen.

Elusive oral morphine too had become available to her. At that time,oral morphine was difficult to obtain in most parts of India. T was ableto take with her a two month supply of the drug, tablets that had beendispensed to a colleague’s aunt when she was treated abroad forterminal cancer. That patient had recently died in India, and we hadbeen left with her morphine.

EMPTYHANDSReena George

L

Atmospheric big three-day party evening event.



Progressive painful cancer, disfiguring malodorous lesions, thedeaths of people we have cared for, financial pressures, unrealisticexpectations and professional loneliness are some of the stresses weexperience in oncology. These pressures are not necessarily less in thefield of palliative care or in the developing world.

In the face of such distress, our resources, personal and professionalmay seem frighteningly inadequate. It is too painful then tocontemplate the reality that many of our patients and their families areexperiencing similar pain, and far more intensely. It is tempting instead,either to turn a blind eye or to resort to tunnel vision, relentlesslypursuing a fragment of the whole - be that a refractory symptom or anunresponsive tumor. With T, I was unable to do either - my hands, likehers, remained starkly empty and powerless.

Yet I am grateful to her, because I learnt from her that life cansometimes transcend and transform what seems available, that ourpoorest and most desperate situations can enrich our lives, and that toappreciate this I need to be open to the inexplicable.

Surely our universe is larger and more wondrous than ourexplanations of it. In oncology, more than in many other medicalspecialties we can admit to our unknowing, for despite our cumulativebody of knowledge there is much about cancer that we do notunderstand and cannot control. There are patients who do well,

despite our limitations or errors. There are others who relapse evenafter optimal treatment. And through the apparent medical failures ofdying and disability, there are many who find meaning, beauty andgrowth.

Clearly, this is no reason to be negligent or fatalistic. It remains ourprofessional responsibility to be well informed and conscientious inour own work, and to work together with other colleagues. But I realisenow that healing is not limited by my clinical acumen or activity, myerrors or my exhaustion, that sometimes in my powerlessness, I can letgo and not feel guilty.

This discovery is tremendously liberating. It helps me take myselfless seriously and paradoxically therefore, gives me courage as I return,in many ways still empty handed, to the palliative care clinic in India.

T was seen in Vellore between December 1998 and April 1999. Thestory was written, as a personal reflection, in 2000 when Dr ReenaGeorge was training in Palliative Care with Dr Robert Twycross inOxford. In 2002, the parish of Holy Trinity, Headington Quarry,Oxford gave the first donation that enabled CMC to start thePalliative Care subsidy fund. Gifts have continued since then, throughFOV UK. The article was published in the Journal of Palliative Care in2002: J Palliat Care. 2002 Fall;18(3):200-1.

2016 we completed the third year offunding of the post of MissionNetwork Consultant. Dr Sam David

who undertakes this role has been building linkswith mission hospitals who might benefit from apartnership with CMC and raising the profile ofmission hospitals within CMC, encouraging moreto serve in this way. He supports staff from CMCwho have gone to work in mission hospitals onshort or long term placements. FOV UK are keenthat these smaller hospitals are helped to flourishand benefit from the experience of CMC.

At the January 2017 CMC council meeting itwas announced that, following the success ofthis post and in order to fulfil their desire todevelop partnerships with mission hospitals,CMC are creating a missions department. Theyhave already appointed a deputy director and anadministrative assistant. FOV UK were publiclythanked for our support and also for funding themission hospitals website which was launched inJanuary.

Dr Sunil Chandy, the hospital director,appealed to council members to support thenew department. Dr Sam has one year left in hispost so CMC are looking for a successor. FOV UKhave agreed to fund the first year of Dr Sam’sreplacement to enable a substantial handoverperiod.

Do take a look at the new mission hospitalswebsite: cmcvelloremissions.org. It will act as asingle hub for all missions hospitals enablingnetworking between hospitals and facilitating

the sharing of equipment and needs. It will alsoinform junior doctors choosing mission hospitalplacements as part of their training. The site hassections covering missions heritage, news,conferences and Continuing Medical Educationas well as devotional material and a messageboard.

The Missions Office conducts an annualthree-day prayer conference, ‘Shiloh’. Thetheme in 2016 was “Come follow me.” 1200students attended and were challenged toconsider a life in missions. The highlight of thisconference was the John Scudder Oration, inhonour of individuals who have committed theirlives to missions. The oration this year wasdelivered by Dr Iris Paul, who pioneered work inremote tribal regions of Odisha and has beentransforming lives for over 40 years. In heraddress, she brought up the harsh realities ofpoverty and disease in rural India, appealing to

the delegates to respond to this challenge. The CMC Missions Interest Group meets

regularly to increase awareness about the lifeand needs in mission hospitals. CMC continuesto send graduates to mission hospitals onservice obligation.

In 2016 CMC signed a memorandum ofunderstanding with CSI Erode hospital, whichincludes a nursing school. They formally tookover in July. The building dates from the 1930sand is in need of restoration;, however, morefunds are needed for this. There are issuesregarding shops at the front, which are in theway of future development. Please pray for thatit might be possible to remove the shops, for thenecessary funds to be found and for enthusiasmfrom CMC – it has been discouraging so praythat those involved don’t lose heart.

CMC is also exploring partnership possibilitieswith five other mission hospitals. Dr Sam Davidand his team have been visiting and assessing theneeds. Each has its own strengths andweaknesses. Some are adopting a modelwhereby CMC support from behind the scenes,while others are looking for a completetakeover. Prayers for funds and overcoming legalissues would be appreciated as well as patience– these things take time! Please pray that the new Missions

Department at CMC would be used for God’skingdom’s sake and that Christian staff atsmaller mission hospitals would be a faithfulwitness to the patients they treat.

InMISSION HOSPITALS UPDATE

Mission Hospitals website.

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Are you receiving our E-Updates?In addition to the twice yearly newslettersthat we produce, I am aiming to send outemail updates four times a year; two sentout at the same time as the newslettersand two in-between. If you are notcurrently receiving these and would like to,it may be because I don’t have an emailaddress for you. Please do get in touch soI can add your details to the list.

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Do you have a spare Nintendo Wii? The children’s rehab team make use ofNintendo Wii games as part of theirmotivation strategies for performingroutine exercises. This is something thePaediatric Surgery department could alsobenefit from. Dinesh, the occupationaltherapist we are funding, could use it withthe children on the ward as a reward fordoing their exercises and also as part oftheir exercises. If you have a Nintendo Wiiand/or some hand held controllers thatyou are no longer using and would bewilling to donate to CMC, we would loveto hear from you. Ann Witchalls, one ofour Trustees could take it with her toVellore in October.

friends of reg. charity n o. 209168 vell ore ore issue n o. 146 · spring 2017 newsletter friends of...

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