SUPPORTING CHRISTIAN MEDICAL COLLEGE, VELLORE, SOUTH … · VELLORE ISSUE No. 147 · AUTUMN 2017...

VELLORENEWSLETTERISSUE No. 147 · AUTUMN 2017

REG. CHARITY No. 209168FRIENDS OF

A Space to Heal - See page 11

SUPPORTING CHRIST IAN MEDICAL COLLEGE , VELLORE , SOUTH INDIA

physician interaction in overcrowded out-patient departments in most low resourcesettings that results in poor understanding ofdisease management. In addition, unstand-ardized health information leads toinconsistent management advice given to thepatient. Thus India faces major challenges inmitigating the impact of a growing diabeticpopulation with all its complications in therural areas.

Christian Medical College (CMC), Vellorerun several outreach programmes serving ruralcommunities. One of these, the Rural Unit ofHealth and Social Affairs (RUHSA), is situated

30km from Vellore town and delivers healthand social development services to the localrural area with a population of 200,000.RUHSA are currently working in collaborationwith the University of Aberdeen and ITexperts from George Institute, Hyderabad todevelop innovative interventions to addressissues related to diabetes management in lowresource settings. Friends of Vellore UK aredelighted to be able to support this excitingproject. You can read more on page 8.

Friends of Vellore have also sent £5455 toCMC’s Department of Ophthalmology toenable them to buy a camera for the

here are several barriers to optimaldiabetes management in India: lackof knowledge and understanding of

the disease, lack of social support, lack offinancial resources (cost of treatment andinvestigations, travel to healthcare facility costsand wage loss), and multiple comorbiditiesleading to depression especially in the rural areas with poor health literacy and lessthan desirable socio-economic conditions.These interrelated factors eventually lead topoor management of diabetes and severecomplications.

Further there is a suboptimal patient-

ENHANCING QUALITY OF LIFEFOR PATIENTS WITH DIABETESIN RURAL COMMUNITIESDiabetes Atlas 2014, published by the International DiabetesFederation, reported that there were 66.8 million cases ofdiabetes in India with an overall country prevalence of 8.6%and numbers are predicted to rise further in the future.

T

Diabetic patients queuing toregister for consultation before

doors open at 7.30am.

I S S U E 1 4 7 • A U T U M N 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.

programmes. However, the current method ofscreening is doctor intensive and soexpensive. The purchase of this new camerawill enable community health workers toconduct a fundus examination using thecamera, which will test for peripheral

neuropathy. The pictures of the eye will thenbe sent to a doctor back at the base hospitalfor review. Those requiring further care andfollow-up due to complications of diabeteswill be referred to respective departments inCMC.

detection of diabetic retinopathy. Thedepartment identified this need as there are alarge number of people living in rural areasoutside Vellore whose diagnosis ofretinopathy was only possible when the teamtravelled to these areas to conduct screening

It was lovely to see some of you at our Annual Meeting in September. We weredelighted that Bishop Michael Nazir-Ali, one of our patrons, was able to join us andshare his insights on ideologies that are threatening freedom of Christians and thechurch. We were also joined by Joe and Denny Fleming, having recently returned to theUK from 19 years serving at CMC, who shared their experiences and updated us on thelatest news from the hospital. Next year’s Annual Meeting will be held on Sunday 7October 2018 at the Holiday Inn, Coventry. Please do put the date in your diaries.

In this issue we have updates on several of our projects and some patient stories totell, demonstrating just how much a difference your funds are making to the lives ofpeople in Tamil Nadu and beyond. We have an article on palliative care written bymembers of the CMC palliative care team and first published in the Journal of ClinicalOncology. We also want to update you with some news from the Christian MedicalCollege (CMC), Vellore. We hope you enjoy reading the newsletter and are inspired bythe wonderful work going on at CMC.

In May 2018 the data protection laws are changing. In order to adopt best practice,we are seeking explicit consent from all our supporters in order to send you furthernewsletters by post and email updates. Please do read the article on page 6 with moreinformation and complete and return the enclosed consent form.

Ruth TuckwellAdministrator, Friends of Vellore [email protected]

GREETINGS! ... I wish to thank everyone who attended our recent annual meeting in Coventry; your presence was truly encouraging. In particular,I must thank those alumni who chose to come and make it a success. Joe and Denny Fleming, fresh from Vellore, gave an account of their yearsin CMC helping to make outstanding contributions to the institution. Incidentally, both the Flemings and Brian and Ann Witchalls have beenhonoured by CMC with an award for making a significant impact on the life of the college campus (read more on page 14).

My heartfelt thanks to Bishop Michael Nazir Ali for his participation. These annual meetings give our supporters an opportunity to meet otherlikeminded folk and promote the Christian Medical College. As demonstrated in the following article, the enormousdifficulties faced by the institution require our wholehearted support and prayers.

Whilst we continue to fund the various projects within CMC, we are looking at the role of CMC in supporting missionhospitals that are in need of improvements.

The time has come for us to seek new trustees to replace those wishing to step down from the Board; if you areinterested please contact Ruth or myself.

Please uphold CMC in your prayers in these critical times.Yours in Christ

Ajit Butt, Executive Chair, Friends of Vellore UK

STORY CONTINUED FROM PAGE 1

DEAR FRIENDS OF CMC VELLORE,

MESSAGE FROM THE CHAIRMAN

Bishop Michael addressing the Annual Meeting.

The Friends of Vellore Annual Meeting.

V E L L O R E N E W S L E T T E R • A U T U M N 2 0 1 7 • I S S U E 1 4 7 3 .........


Sunil Chandy’s five-year term as Director of CMCVellore finished this September. We thank God forhis servant hearted leadership of CMC over the past

five years. Reflecting on his term as Director, Dr Sunil writes: “I havelearnt that our institution is God’s own.One cannot fathom how it works withsuch a high volume of patients andlimited resources. It is the modernversion of feeding the five thousandwith five loaves. There is a divinepresence that serves as a fuel to theengine of our functioning. The resilienceof our staff and their willingness tobroaden their shoulders is simply unbelievable. I thank God forthem, and pray that they will be blessed for the selfless servicethey render.”

John Victor Peter, Professor of Critical Care Medicineand Associate Director (Finance) has been appointedas the new Director of

CMC. He began his five-year term on 23September 2017.

Dr John Victor Peter (usually known asJ V Peter) is an alumnus of the MBBSBatch of 1982. He completed furthermedical training in Adelaide, Australiabefore returning in 2006. He has co-authored several research papers. He isalso a brilliant musician and used to conduct the hospital andcollege choir. His wife Jayanthi is an ophthalmologist, his son Joel isan intern in CMC (batch of 2012) and his daughter Jenita has justfinished school.

Dr J V Peter said he will attempt great things for God and expectgreat things from God. Please pray for God to give him wisdom andguidance as he begins his leadership, and that he might serve in away that brings glory to God.

NEW DIRECTORFOR CMC

Dr

Dr

ast year the Indian Government imposed a new centralisedentrance test for the allocation of places at all medicalcolleges. This removes the discretion, or any other criteria,

traditionally used by colleges such as CMC.CMC has trained Christian doctors and nurses for almost 100 years

with an emphasis on mission. Their graduates have thus been morelikely to work in Indian mission hospitals, often in rural areas, where theneeds are greatest but the rewards are less, rather than take up higherpaid jobs abroad or in corporate hospitals as most graduates do.

CMC’s selection process involves a face to face interview as well as awritten test. The interview assesses whether candidates have a heart formedical mission. CMC’s students are expected to serve a ‘bond’ afterqualifying; to work in a Christian mission hospital, often in a remote area,for a couple of years. Churches throughout India have sponsored thosewho would return to their mission hospitals after qualifying.

Under the government’s new rules, CMC would not be able to selecttheir own candidates, and in particular Christian students with a heartfor mission. Various colleges, including CMC, have taken this issue tocourt. CMC’s petition to be regarded as a minority institution, accordingto the Constitution, and to choose their own candidates was taken tothe Supreme Court in Delhi in April 2017.

The new term for schools and colleges started at the end of June andthere was still no judgement. The Medical Council of India and theIndian government, while openly acknowledging the exceptionalcharacter of CMC, have categorically denied an exemption for CMC.The Supreme Court hearing was adjourned four times over the summer.The case was finally heard on 28 August but no order was passed. Thematter was deferred until 11 October but delays at the court now meanthe hearing is not anticipated to take place until 23 October.

At the CMC council meeting on 2 September the decision was takento suspend medical admissions this year in an effort to protect CMC’sChristian values and objectives. This decision has attracted nationalattention and will hopefully raise awareness of the issues at stakeregarding minority rights. Articles were published in variousnewspapers, and in “The Hindu” newspaper, featured on the front pageof the Tamil Nadu edition.

Professor P Zachariah (former faculty) in his recent sermon in thecollege chapel said, “The current difficulties should not deter orconfound us, but lead us to explore other routes to continue ourjourney without losing our sense of direction. Our vision of addressingthe most vulnerable and neglected in health care through educationcould be and should be pursued in whatever way that is available to us.”

Please continue to uphold CMC’s selection process in your prayers.Dr Sunil Chandy writes: “We have experienced God’s grace thus farand we are sure to experience it again. As we wait, we must fight forour cause in a gracious and dignified manner, together as one body.”Please pray for CMC, that they would stand firm, that nothing would move them, that they would give themselves fully to thework of the Lord, knowing that their labour in the Lord is not in vain(1 Corinthians 15:58).

L

MEDICALSTUDENT

ADMISSIONS

CMC College Chapel



have been really positive. All the communitieshave been very appreciative of the clinicswhich are held in their local area and are veryhappy with the outreach staff who havebecome familiar faces in the communities.The main issues that they face are sanitationand lack of toilets. There is a huge rubbishdump in one area which needs to be removed.CMC will discuss this with the DistrictCollector to see if this can be arranged. It isfrustrating to see the lack of sanitation and thesuffering of the people. The girls especiallyfind it difficult without toilets; they can endup in demeaning and dangerous situations as aresult. Please pray that the Lord would givewisdom to the team in how to deal with this.

Another concern is the challenge thatyoungsters face due to lack of jobs. If onlysome Christian businessman would start abusiness to employ people from the slums...The YMCA campsite in Vellore is located inone of the slum areas and close to the churchbuilding where we hold the weekly clinic.They are keen to help us. Please pray thatsomething would open up here - maybe avocational training centre?

The collaboration with University of Illinois,Rockland is making progress. We are planninga study in the Community Oriented PrimaryCare project of LCECU which should have spin

lectronic chronic disease registriesare currently being prepared, theteam having moved on from paper

collection methods as these were toocumbersome. Data collected on all residentsliving in the five slum areas includes details ofchronic disease recorded against each patient.If any patient is newly diagnosed with achronic disease, that information is added tothe register and the details of their last visitand follow up visit are noted. The team arelearning how to improve their systems toensure that patients are not forgotten aboutbut followed up and given proactive care.

In the morning, the field worker collectsdetails of patients with chronic diseases whoare scheduled to come to the afternoon clinicthat day. This is easily done now the registry isin an electronic format. After the clinic theyrecord attendances and patient details areupdated. Those who did not come are visitedin their homes and plans made for follow up.We are hoping that this will ensure that no-one falls through the cracks. We haveordered three tablets for the field workers tomake information collection and follow-up ofpatients much easier.

We have started community engagementmeetings to discover how the communityfeels about the outreach clinics and whattheir needs are. The three meetings held so far

CARE FOR THEURBANPOOR

Dr Sunil Abraham at the Low CostEffective Care Unit (LCECU) has writtenthis update on the community healthworkers we are sponsoring who areworking in five slum areas in Vellore:

The team including our field worker andoutreach nurse providing access to healthcare.

Patients arriving for a clinic.

Eoffs in the future. It is hoped that LCECU willbecome a centre of research for care of theurban poor.

Thank you for your prayers. God is goodand faithful.

Blessings, Sunil

PS: There has been some good rain inVellore recently. This photo (below) is fromPeriyar Nagar, one of our outreach areas. Theteam could not go into the area as it wasflooded. They informed the people that theclinic will be held on the roadside just outside the slum. The community was veryappreciative and came there for treatment.There were children with respiratory infectionsand skin diseases who needed attention.



alerted by our community volunteer. Dr Sushilvisited her and found her to be very sick so shewas transferred to the main hospital. She wasadmitted in the ICU, treated for a blood clotand three of our staff donated blood for her.After a long stay in the hospital, she is back athome in her thatched hut and well. Her bill was

written off by CMC. This is a great example ofa team work - from the family members, to thevolunteer in the community, the LCECU staffand the various departments in the mainhospital - what a joy it is to be a witness to thehealing ministry of Christ.Dr Sunil Abraham

Yesterday LCECU had a fellowship breakfast in the unit with all the staff, including the house-keeping staff, joining for a potluck breakfast. Itwas a time to thank God and celebrate Hisgoodness and faithfulness. The story wasshared of a lady who lives in a thatched housein a slum. She became very ill and we were

CHRISTIAN COMPASSION IN ACTION

Kumari* and Raman* have been married for 10 years. Although theydid not choose each other, (their families arranged the marriage),

over the years they have become an affectionate couple.

KUMARI

three months, getting worse over the lastthree weeks. She also felt nauseous.Eventually the anxious husband decided thathe must bring his wife straight to hospital. Theonly bus which passes their house comestwice daily. In an emergency they have to walk1 km to the main road to catch the regulartown bus.

Initially they went to the Low CostEffective Care Unit (LCECU), where they hadcome to know and trust the staff. HoweverLCECU realised that Kumari needed moreinvestigations than they could offer so shewas transferred to the main hospital. There itwas discovered that Kumari had developedkidney stones (left lower ureteric calculus).This could be treated by uretero-renoscopyand intracorporeal LASER lithotripsy withstenting, which were done under spinalanaesthesia. She was given antibiotics andmonitored post-operatively. After four days inhospital, she was discharged.

The cost of this surgical care came to £274, asum well beyond the limited means of a poorfamily like Kumari’s. They have no possessionswhich can be used in an emergency and wereunable to make any contribution towards thehospital bill. Through the Person to Personscheme and other funds set aside by CMC thebill was paid for.

When the PTP team made a follow up visitrecently, Raman expressed his great gratitudeto CMC and to PTP for the skilled care andcompassion shown to the family. They caredfor his precious wife as he would have done,but could not afford.

*Names have been changed

aman is proud of the way Kumarimanages the small wage of £25 permonth, which he earns as a manual

worker, loading and unloading vegetables inthe market four days a week. He studied up toelementary level at school. Kumari used towork as a housemaid in two houses earning£100 per month. However she has not beenable to work since she became ill.

The couple have two children. As is thecustom, Kumari returned to her parents’home for the birth of their first child, adaughter. Her second delivery (twin girls) wasconducted in a local government hospital.Sadly the babies died at birth. When sheconceived for the third time, she attendedthe antenatal clinic at the Low Cost EffectiveCare Unit and delivered a baby boy. Now theirdaughter, aged 8, is in second standard atschool and their son, aged 3, attends a balwadischool (kindergarten). Kumari lost her fatherseven years ago; she has an older brother, withwhom her mother lives, and a younger sister.

30-year-old Kumari, her husband and theirtwo children live in a village about 6 km fromthe main hospital. The family rents the housethey live in. It is an old building, with brickwalls, a cement floor and a concrete roof. Ithas only one room (10’ x 15’), of which almostone third has been partitioned off to form akitchen. Three times a week they collectwater from the public tap in the road outside.This family gets 20 kg of free rice provided bythe Tamil Nadu government.

Raman was very worried when Kumaribegan to complain of intermittent spasms ofcolicky pain in her left side. This went on for

R

Kumari.



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DATA PROTECTION LAW IS CHANGING

THE MISSIONS DEPARTMENT IS DEDICATED

CMC SIGNS MOU WITH KOTAGIRI MEDICAL FELLOWSHIP TRUST

NEWS FROM THEMISSIONS DEPARTMENT

role in administering the best care to the poorand marginalised. With various requestscoming from mission hospitals, CMC is

exploring ways of supporting them.The department now has an active team

consisting of Dr Sukria Nayak, Dr Winsley Rose(Deputy Director), Dr Tony Abraham Thomas(Coordinator), Dr Sam David (MissionsNetwork Consultant) and Ms Bency VinithaChhatria (Administrative Assistant). At thededication of the new department, Friends of Vellore UK was publicly thanked forfunding the first three years of the MissionsNetwork Consultant post.

he newly formed Missions Depart-ment was dedicated on 15 May 2017.CMC have had a Missions Office

since 2007 which over the last 10 years hasshown tremendous growth in its services. AtCMC’s January Council it was agreed toupgrade the Office to a Department. This issignificant for CMC’s focus on reviving,rebuilding and restoring mission hospitals.

In a nation where good health care is scarce,the Christian mission hospitals play a central

The KMF trustees have been good stewards,safeguarding the vision of the founders. Thecampus is well maintained and ready foroperations. CMC will now manage the hospitaland explore ways of sustaining and developingit until it becomes self-sufficient.

KMF hospital is known for eye surgery andgeneral medical care. Two doctors (apaediatrician and an ophthalmologist) and an

optometrist from CMC have already joined theteam there. The signing was a joyous momentfor CMC, as it seeks to engage with its networkof mission hospitals to both ensure theirrelevance and revive struggling ones.Please pray for this new venture. Give

thanks for the good infrastructure. Pray forcommitted staff who would be willing to goand work there, in particular doctors inOphthalmology. Pray for wisdom and unityfor the Trustees as they make decisionsgoing forwards.

Other hospitals are also investigatingpartnerships with CMC. You may rememberthat CMC signed a MOU with CSI Erode inJanuary 2016. Please pray for infrastructuraldevelopment there, for staff - doctors andnurses, and for overall development of thehospital and nursing school.

On 30 August 2017, a Memorandum ofUnderstanding (MOU) was signed between theCMC Vellore Association and the KotagiriMedical Fellowship (KMF) Trust. The 50-beddedhospital approached CMC for help insustaining the healthcare services it provides inthe Nilgiris (blue mountains) in the east ofTamil Nadu.

KMF began back in 1937, when Miss MonicaSutton (a lab technician) and Miss Vera Nowell(a pharmacist) converted a cowshed into adispensary. Dr Pauline Jeffrey from CMC, sentby Aunt Ida, joined forces to help the medicalwork. Over the years, many, including CMCalumni, have contributed to bringing aboutsignificant improvement in the health status ofthe region. In recent times however, thehospital has been struggling to keep up withthe demand and so requested CMC’s help.

T

Kotagiri Medical Fellowship Hospital.

KMF Opthalmology Department.



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A RIPPLE OF UPLIFTMENT – THERUHSA COMMUNITY COLLEGE

Wheeler Mechanism, Electric Wiring andMotor Rewinding, Refrigeration and Air-Conditioning and a beautician’s course. Theyare affiliated to the Tamil Nadu OpenUniversity (TNOU) and the National Instituteof Open Schooling (NIOS). Each discipline is aone-year course, designed to provide sixmonths of training at the college byexperienced RUHSA staff, followed by sixmonths of on-site training at a relevant tradecentre. Extra-curricular activities are alsoincluded in the programme to enrich thequality of student life. 4500 youngsters havecompleted their training here. One of themany success stories of former trainees isYuvaraj.

Mr Yuvaraj, one of four children of a farmerfrom the KV Kuppam Block, joined the Four-Wheeler Mechanism course at RUHSACommunity College in 2007, as a sixteen-year-old. He had failed to clear the Grade 10 level inschool and had subsequently dropped out.With a family income that covered very littleof their needs, Yuvaraj began his six months oftraining at the community college, moving onto AGS Garage at Gudiyatham to completethe latter half of the course in on-sitepractice. He started out with a daily wage ofRs. 30 (35p) at this garage, which was raised toRs. 300 after a month, in light of his deftlyapplied learning and skill. He managed to setaside enough from his earnings to enter asavings scheme. So, when the owner of thegarage expressed his intent to sell the servicestation, Yuvaraj, now twenty-four years old,bought it from him for Rs. 80,000 (£930).Today, he makes a monthly earning of Rs.30,000 (£350), and oversees two workers in his

employment. He has been able to afford acomfortable life for his family and is nowlooking to build his own house.

In true CMC spirit, the college has surpassedits commitment to serve its immediatelocality. In 2004, when the south-eastern coastof India was hit by the tsunami, the RUHSACommunity College took in 175 students fromNagapattinam (a coastal district), providingaccommodation, food and training free ofcharge. With help from CMC, more than 60%of them went on to begin their automotivecareers overseas. Such has been the impact ofthis community college, compassionatelyraising a powerhouse of professionals from ahumble corner of the country.

The Beautician training course for girlsbegan in 2014 with funding from the VelloreRural Community Trust, a branch of Friends ofVellore UK. This course has proved popularand since its inception, 36 girls have beentrained. Of those, three have started theirown beauty parlour, making a significantincome. All the others are currently employedin other parlours. We continue to fund theteacher’s salary for this course.

he 2011 Indian census revealed that69% of the total Indian populationlives in rural villages, indicating that

initiatives aimed at boosting employability inIndia require strong rural empowermentprogrammes. In view of this, Prime Minister,Narendra Modi launched the Skill Indiacampaign in 2015, which seeks to efficientlyutilise human resources towards a productiveeconomy.

CMC’s Rural Unit of Health & Social Affairs(RUHSA) Department, having recognised thisneed back in 1982, set up a vocational trainingcentre, which in 2000 became a “CommunityCollege”. The Community College concept isan alternative system of education, aimed atempowering disadvantaged young peoplethrough appropriate skills development aswell as life-coping education, leading togainful employment in collaboration withlocal industries. The RUHSA CommunityCollege offers access to affordable vocationaltraining programmes to create employmentopportunities to underprivileged rural youth.

Five courses are currently conducted:Automobile Four-Wheeler Mechanism, Two-

T

Mechanics Students. Beautician Course.



EMPOWERING FRONTLINEHEALTH WORKERSTO EDUCATE AND SCREENFOR DIABETES AND ITSCOMPLICATIONS

service units) and refer them to RUHSACommunity Health Center using a tablet-based screening tool with managementalerts. Patients are supported to makeinformed choices with the help of an‘Option Grid’ administered by the healthworkers.

Option Grid is a one page, easy to read (orto be read to them), comparison ofmanagement options. Patients are asked togo through the Frequently Asked Questionsin the grid (which have clear evidence basedanswers) and are encouraged to discuss theirconcerns. In low resource settings, this gridcan be administered by nurse practitioners,social workers or community health workersto save the time of incredibly busyphysicians.

The patients are also given colourfulleaflets with pictures and text to educatethem to make informed choices aboutdiabetes management.

This project is based on evidence from

several recent studies reporting that a sharedmodel of clinical decision makingincorporating patient informed choices is thepreferred approach of determining patients’treatment. Also evidence shows thatimplementing a socially accepted ‘patientnavigator’, or community health worker basedhealth monitoring, supported by decisionmaking tools and mobile apps to make thefollow-up structured and simple, will addressliteracy deficiencies, promote early diagnosisand improve compliance to treatmentrecommendations. The patient navigatorscould help communities to comply with therecommended blood sugar screening for atrisk groups, and facilitate diagnosis, follow-upand treatment of diabetes in its earliest stagesin order to prevent damage to critical organsand complications such as foot ulcers, stroke,heart attack and kidney failure.

If this trial significantly improves patientmanagement, RUHSA plans to scale it up tothe surrounding area.

carcity of physicians, overcrowdedoutpatient departments and varia-tions in health literacy make it

difficult for providers to offer best care totheir clients in low resource settings in India.Researchers at RUHSA in collaboration withendocrinologists, physicians and publichealth experts at CMC, Vellore and at theUniversity of Aberdeen together with ITexperts from George Institute, Hyderabadare developing innovative interventions toaddress issues related to diabetesmanagement in low resource settings. Theyare currently conducting a phase II quasi-experimental trial in two Peripheral ServiceUnits (PSUs) and 2 control PSUs. This projectis supported by Friends of Vellore UK, VelloreRural Community Trust and the University ofAberdeen.

Community health workers function as‘Patient navigators’ in the rural villages toeducate and screen for diabetes and itscomplications at the point of care (peripheral

S

Dr Rita Isaac, Rural Unit ofHealth and Social Affairs(RUHSA), Christian MedicalCollege (CMC), Vellore

RUHSA Diabetic Clinic.



Mr Sekar, a 43 year old auto-rickshaw driver andfather of two school-going children, is the solebread-winner for his family. He is a knowndiabetic with poorly controlled sugars and

irregular treatment at various clinics. He finally came to the RUHSA department for sugar control and was directed to the

weekly ophthalmology clinic for screening fordiabetic retinopathy.

SCREENING FOR DIABETICRETINOPATHY

both eyes. At the last visit his vision hadimproved to 6/24 in both eyes (moderatevisual impairment, according to the WHO

classification). He was however, unable toreturn to his previous occupation of a driverand was forced to seek other unskilled labour.

All this could have been prevented had hereceived timely control of sugars, regular eyescreening and treatment for diabeticretinopathy in the initial stages. Currently, themost needy patients may not take advantageof the available healthcare due to barrierssuch as lack of awareness, out-of-pockethealthcare costs and poor access to healthsystems. The fundus camera we have boughtfor CMC will enable an affordable door-to-door tele-screening system for these patientswho are otherwise doomed to a life of visualdisability due to a preventable cause.

Sekar was found to have a pro-liferative diabetic retinopathy,which is the most advanced

stage of the disease, in both eyes and wasreferred to CMC’s Department ofOphthalmology for further treatment.

His vision in both eyes was 3/60 which isdefined as blindness by the World HealthOrganisation (WHO) classification. Hereceived pan-retinal photocoagulation (a typeof laser treatment) in both eyes for hiscondition. The advanced stage of hisretinopathy required him to undergo furthersurgery - vitrectomy (an advanced retinalsurgery requiring sophisticated instrument-ation costing approximately £500 per eye) in

Mr

Mr Sekar following his surgery.

Undergoing an eye examination.

commitment to the department and to theinstitution. She was always very humble andunassuming and lived a very modest life. Shehelped many people in various ways in herquiet manner. Being an only child she had toreturn to Scotland in 1968, sooner thanoriginally planned, to take care of her ailingfather. After returning to her home town sheworked part-time as an anaesthetist and part-time as a GP. She found great joy andsatisfaction in such service. During the 80s shelearned Mandarin and spent two terms in Xiangteaching English to the medical students. She

always kept in touch withCMC alumni and her homein Livingston offered warmhospitality to any Vellorianwho happened to passthrough her part of the country.

She was a superior human being and I hadthe privilege of knowing her as a verydependable colleague during which time shehad also become part of our family. We willtruly miss her.

George Varkey (batch of 1950), London,Ontario, Canada

We thank God for the life of Dr MargaretRiddoch, who died on 20 September 2017 atthe age of 89. She worked at CMC during the1960s and since then has been a long standingmember of Friends of Vellore, at one timeserving on the board of trustees. Dr GeorgeVarkey, who was head of the Department ofAnaesthesia at the time Margaret workedthere, has written the following:

Dr Margaret Riddoch joined the Departmentof Anaesthesia at CMC in 1964. She was a verycaring competent anaesthetist and within ashort time she proved her loyalty and

OBITUARY: DR MARGARET RIDDOCH

UK to start the Air India Office in London.Maneck was Air India’s regional director (UK)

from 1959 – 1977. When he started the twiceweekly operations for Air India in 1948 inLondon, only eight airlines operated out ofHeathrow Airport, which was only a collectionof huts – one of them being Maneck’s office.After retiring from Air-India, he was managingdirector for the Tata group of companies inthe UK from 1977-1988.

Among his many public duties, Maneckchaired the Bharatiya Vidya Bhavan (a centre

for Indian arts and culture) in London for 40years until 2011. In 1997 he was awarded an OBEin the Queen’s birthday honours for servicesto community relations in respect of hisfounding and being a patron of Bhavan UK.

He and his wife Kay attended TwickenhamMethodist Church for about 65 years. Heserved faithfully as a church steward for manyyears and used his business experience to helpraise the finances for building the new church.Our thoughts and prayers are with Kay and hisdaughters, Suzie and Caroline.

It is with great sadness we inform you of thedeath of our patron Maneck Dalal OBE whodied at the age of 98 on 6 March 2017.

Maneck Ardeshir Sohrab Dalal was born inBombay on 24 December 1918. He came to theUK to study as an undergraduate at TrinityHall, Cambridge, where he captained theuniversity tennis and squash teams and methis wife, Kathleen (Kay) Richardson. Hereturned to India with Kay in 1945 and joinedTata Airlines (Air India) in Delhi in 1946. Two years later in 1948, he was sent to the

OBITUARY: MANECK DALAL OBE



Located separately in the town, CMC's Eye Department is situatedin the Mary Tabor Schell Hospital, the first hospital established in

1902 by Dr Ida Scudder, the founder of CMC.

ONCE I WAS BLIND, NOW I CAN SEE!

of their own, with kitchen and outside toilet.They have five grown up children - two sonsand three daughters. No doubt they hopedthat the children would look after them intheir old age, but that has not been the case.Their two sons married girls of their ownchoosing, and left home. Two of theirdaughters married and rarely visit. Their third

daughter, unmarried, works in a school andtakes little interest in her parents.

Thiagarajan and his wife are faithfulmembers of their local church. When the EyeCamp came to Ambur, church memberspersuaded Thiagarajan to go for an eye check-up, to see whether anything could be donefor his failing sight. On examination he wasfound to have advanced cataracts in botheyes, but his right eye was the worst. He wasgiven a referral slip for Schell Hospital andasked to report to the Eye Hospital. Thus afew days later Thiagarajan, accompanied byhis wife, took the hour long bus journey toVellore. Three days later he would bedischarged, having been re-examined onMonday, operated on the right eye onTuesday, and discharged on Wednesday. Hiswife stayed with him in hospital.

It was a miracle, he said. He felt like theblind man who Jesus healed; "Once I was blind,now I can see!" He is full of gratitude to thosewho have given him back good sight: the staffat the Eye Hospital and those who, financially,have made his surgery possible. To anyonewho would listen he sang a Tamil lyric, "Jesusfor me".

ormerly teams of staff from Schellwould go out on "Eye Camp"outreach clinics twice a week. They

would set up camp in a school hall, or someother suitable building, and carry out cataractsurgeries for up to 100 patients each time.Now-a-days better roads and cheap transportmean that when the teams from Schellconduct Eye Camps, people can be seen andreferred to Schell Hospital for the surgery. Theteams go out four days a week and referralslips are given, so that patients screened inCamp are treated at no cost to the patient.

74 year old Thiagarajan and his wife live inAmbur, a town about 40 km from Vellore. Thisis the farthest distance that the EyeDepartment travels to run eye camps. Once amonth church members organise an eye campwhich staff from Schell conduct. Thiagarajanhad spent his life working as an agriculturallabourer, but with failing eyesight and physicalfrailty he is no longer able to work. His wife isstill able to do some casual labouring, whichbrings in a little money.

As part of a government scheme for givinggood housing to low socio-economic families,the couple live in a two roomed, brick house

F

74 year old Thiagarajan.



A SPACE TO HEALReena George and Ramu Kandasamy

Soon we reached the rustic hamlet where thepatient lived. She had three other adult childrenliving in the same village, but they had withdrawnfrom the patient when the disease becamemessy and smelly. They no longer visited orprovided money or food. Only the one daughterhad taken the mother into her home andpersuaded her to come back to the hospital.

The patient lay on a thin mattress on the floor.

There was a waterproof drawsheet to preventvaginal discharge from soaking through. It wascut out of inexpensive plastic material, similar tothat which the street dwellers used as a roof.Part of an old soft cotton sari provided abreathable layer near the skin.

Our service could not afford to providespecialized equipment and incontinence diapers.However, morphine for the pain, dailymetronidazole for malodor, and mirtazapine forsleep had made things bearable. The patient nolonger cried in pain, so the family could sleep.The patient did not smell, so the family couldeat. The eating and sleeping for six peoplehappened within a 150-square-foot, two-room

hut. Food may have been scarce, but the son-in-law did not begrudge a part of the family budgetbeing spent on a dying woman.

We finished our visit and moved toward thelow doorway. Peeping into the hut was a youngman with a small head, vacant eyes, and a hesitantsmile. The smile brightened to light up his eyeswhen the patient’s daughter stepped out.

The young man, we learned from our socialworker, was not a relative. Microcephalic sincebirth, he had wandered (or been sent away) fromhis village more than 40 miles away. He walkedthe streets for a long time, begging for food.When he reached this hamlet, this family ofstrangers had taken him in. He had lived withthem for many years now. He had even learnedto take their cow to graze. A lost sheep foundshelter and became a good shepherd.

The young man must have encounteredhundreds of people in his travels, yet it was thisfamily with little money or space to spare thathad taken him in. Suddenly, I could see thestrength in this tearful daughter whosedesperate pleadings had sometimes drained me.The same inability to turn away from another’spain that had made her stay by a dying motherhad made her take in a simple vagrant. Hervisceral empathy made it difficult for her toaccept incurability. It was a courage transcendinganxiety that made her come repeatedly to theclinic despite hearing bad news. This realizationreminded me that we know so little about whatmotivates our patients’ caregivers.

In many interpersonal relationships, thebehavior that we find difficult in a person mightonly be the flip side of a good trait. A heart thatwas so open to another’s need was a heart that

ne day, two women sat under theplastic sheet in happy conversation. Ithad rained heavily the previous night,

and I wondered what happened to their worldlypossessions when water from the skies and dirtfrom the streets inundated their “home.” Thewomen looked unworried. Perhaps there had notbeen much to protect. Besides, today’s skies wereclear, and the breeze was cool. Today was good.

There was space enough, in home and heart,for these women to provide shelter for a stray. Adog and two puppies occupied a corner of the 10x 10-foot awning. I looked at my fellowpassengers on the staff bus. It was unlikely any ofus would have taken this dog into our homes, yetshe was safe with the street dwellers.

A few hours later, we were ready to leave thehospital for palliative care home visits. I reviewedthe notes of the first patient, thinking that sheshould not be facing terminal cancer. She hadoriginally been diagnosed with stage III cervicalcancer, but she had discontinued pelvicradiotherapy and came back a year later with anincurable recurrence. I found it distressing whenher daughter pleaded at each visit for a curebecause the opportunity for a cure had beenlost. It was hard to respond when she fell at myfeet, sobbing that her mother should not die.“Your mother did not need to be facing death,” Iwould think to myself as I waited for the tears tostop. I would then focus on what could be done.We could help with her mother’s pain. Inaddition, because the daughter appeared sodistraught and vulnerable, we took a little extratime to ensure that she had understood how themedications should be given. And yet the tearsand pleas continued.

O

We pass them every dayon our way to thehospital, the street

dwellers of our town inIndia. Their homeconsists of a plasticsheet suspended

between four poles onthe pavement.

Reena and Ramu visiting a patient in her home.

journey had brought her to a dark andbewildering intersection.

When she had wept in my clinic, I could havelooked beyond dissecting problems toacknowledging her strengths. I could have takenher hand and journeyed with her, until she toofound what she had created for another – aspace to heal.Reprinted with permission. © 2016 American

Society of Clinical Oncology. All rights reserved.George, R et al: Journal of Clinical Oncology

Vol. 34, 2016: 3349-3350.

Dr Reena George and Mr Ramu Kandasamy are partof the Palliative Care team at CMC, Vellore. Reenais Head of the Department and Ramu is a socialworker. Friends of Vellore UK send funds tosupport the home care programme which cares forthose in their home who are unable to travel tohospital. The money we send (£3,600 in 2017)covers the running costs of the vehicle,medication, social rehabilitation and supplies suchas mattresses and mosquito nets. Socialrehabilitation includes non-healthcare relatedsupport especially for the family - for example:school books for children, food, small seed grantsfor income generation.

could hurt, that could not bear to see continuedsuffering. I thought about these simple, poverty-stricken families who had taken in strays, humanand canine. Would they have been less poor, less vulnerable, if they had not openedthemselves to another’s need? The hand ofempathy, in most of us, is sheltered by the gloveof self-preservation.

But here was a caregiver who touched theworld with naked hands – hands that wereexquisitely sensitive, like a blind person’s handsthat can fathom the nuances of Braille. Her




A year ago, one of our Trustees, Dr Koppada RajaRatnam, visited the Jawadhi Hills to see how Friends of Vellore(FOV) UK might get involved in a project there. Here is his report:

entry of the forest we passed through a checkpost manned by the forest guards who readilyrecognised the doctors. One of them happenedto be Dr Rose’s patient.

The road is closed overnight for publictransport in order to prevent illegal logging andsmuggling of forest produce which is rife on thehills.

CK Job Centre: Situated in Veerapanoor villageand accessible by vehicle, the building serves as aclinic/basic hospital. It is provided withelectricity and water. There are dedicatedenclosures for a clinical lab, x-ray facility etc.There is land around it for extensions whenneeded. Sadly there were no patients at the timeof my visit because they were tending to theirfarms or working as labourers to earn theirlivelihood. Most of them are on daily wages andas the sole provider for their families can’t affordto ignore their jobs.

I met three smart and confident yet pleasantstaff at the clinic who work as clinic/nursingassistants and caretakers. The nursing assistant isa tribal girl and happens to be the only educatedgirl from her village. Her training was fundedthrough the Dan Mission Project. The staff aresterling examples of the effort being put in bythe two organisations in not only preventingmigratory labour but also empowering thenatives to get involved in welfare schemes fortheir own community.

A few yards from the clinic is a smallwatchman’s dwelling. CHAD is keen to developthe surrounding land for accommodation fordoctors and paramedical staff. With staffresident on the hills the clinic could be run earlyin the mornings and late afternoons thusavoiding the conflict with the labourers’ workinghours. In addition, field staff would be able tovisit less accessible villages and meet people intheir homes when they return from work.

CHAD regularly engages the villagers in opendiscussions on their welfare schemes andconsiders their points of view. These meetingstake place in the evenings and are facilitated bythe respective village-headmen. I was fortunateto meet one such village-head. I heard himconsulting with the doctors to arrange a meeting

I met Dr Jasmine Helen, Head of CommunityHealth and Development (CHAD) at CMC, andher colleague, Dr Anuradha Rose, who co-ordinates the departmental activities in JawadhiHills. They gave me an overview of how thedepartment has been involved in the welfare ofthe people of Jawadhi Hills for over 40 years, thefollowing being some of the milestones: Early 1980s: start of the outreach program for

the control of Hansen’s disease (leprosy) amongthe tribal communities. This led to theestablishment of mobile clinics but they servedonly a few areas accessible by road.2007: a health survey conducted through

funding from DAN Mission revealed thecommunity’s health and other welfare indicatorsto be significantly below par. 2014: CK Job Tribal Health & Development

Centre was established as a response to thesurvey to try to improve the health of thecommunities. The land and the building belongto Don Bosco Institute for Tribal Welfare andhave been leased out to CMC for a period of fiveyears. The building is modified to function ashealth clinic.

Dr Rose and Dr George took me on a tour of theJawadhi Hills which lasted for about five hours.Terrain: A range of verdant hills spotted with

small villages on the slopes located far apart. Wetravelled along a single-track tarmacked roadwhich winds among the hills and valleys. At the

1 November 2016

2 November 2016

HEALTH AND WELLBEING IN THEJAWADHI HILLS




supporting the activities of CHAD on the hills.FOV Germany has funded some studentsponsorships; Australia has supported thepurchase of an ambulance vehicle as well as anultrasound unit; the USA is supportingcommunity development works, specifically theModel Village Programs.

Friends of Vellore UK is keen to support aproject in the hills that is in line with ourcharitable objectives: to promote heath andwholeness in individuals and communities givingspecial concern for the disabled, disadvantaged,marginalised and vulnerable. A pressing need isfor living quarters for staff. This wouldsignificantly enhance CHAD’s scope of offeringprimary care to the population. In addition itwould enable CHAD to reach out to the moreinaccessible villages either late in the evenings orearly in the mornings.

CHAD and Don Bosco are already contributingto the educational needs of the community,

both individually and in collaboration. CHADsupports primary education, runs night schoolsand summer camps. Schools and hostels run byDon Bosco are highly regarded by the tribalcommunities. This basic education opens upopportunities for the local youth to train furtheras field workers, health aids, auxiliary nurses,laboratory technicians etc. This vocationaltraining will offer the youth an alternative tomigratory labour. Funding is required for runningthese programs, supporting students withscholarships and retaining staff with salaries. It ispossible that expertise from RUHSA’scommunity college (see article on page 7) couldbe harnessed for this work.

Friends of Vellore wait with CMC for thepurchase of the land to go through. Please prayfor this process, that it would happen quicklyand there would be no more hurdles toovercome. When this is in place, we hope to beable to finalise our area of support.

to evaluate the toilet scheme and rubbishcollection which were implemented recently(incidentally I know the local language). This ispart of CMC’s initiative in establishing modelvillages with funding from FOVs. I was impressedto see how receptive the villagers were to theseschemes. I was also impressed with the effectivetwo-way communication that exists betweenCHAD and the villagers.

In an area like Jawadhi hills where welfareindices are very low, a medical approach alone isunlikely to yield the required results. It is equallyimportant to implement programs to alleviatepoverty and improve the standard of living ofthe local population. It is heartening to note thatthere is good collaboration among the NGOsworking on the hills and they are able to harnessthe benefits of the state government initiativesto the people.

There are a number of projects which requireexternal monetary support. Various FOVs are

underwent surgery to realign the bonefracture and Elastic Stable IntramedullaryNailing (a minimally invasive technique for thetreatment of fractures) of the right femurunder general anaesthesia.

He was subsequently operated for a lyticlesion (destruction of an area of bone) which

was diagnosed as a non-ossifying fibroma (abenign bone tumour). Curettage and bonegrafting were performed. On his thirdadmission he was given two cycles ofappropriate injections.

Subsequently, he was admitted for furthermanagement. He was administered threedoses of injections and his calcium levels weremonitored. After three days of hospital-ization, he was discharged and advised tocome to the Paediatric OrthopaedicOutpatient Department for review.

The cost of this fourth admission came to£50, which was taken care of by the Person toPerson scheme. This was possible onlythrough the generous donation of a kinddonor. CMC, Pasupathy and his family are sograteful for the generosity of those who giveto the PTP scheme. If you would like to set upa PTP donation, you can do this using thedonation form on the back cover, just indicatePTP as the area you would like to support.

The house consists of one room, a hall and akitchen. His father is illiterate and works in alorry shed as lorry builder, managing to earn£45 per month. His mother has studied up tohigh school level and stays at home lookingafter the other needs of the family.Pasupathy’s father also has to support hisaged parents. They have three simple meals aday. They do not possess any other propertyto be used at the time of need.

Four years ago, Pasupathy had a fall while hewas playing football with his friends andsustained a closed injury to the right thigh. Hedeveloped swelling and pain over the thighand was unable to bear weight. Initially, he wastaken to a local government hospital where anx-ray was taken and a fracture of the rightthigh bone was diagnosed. Slab (a supportcreated from plaster material) was applied andhe was referred to Christian Medical Collegefor further treatment.

He was evaluated in CMC where he

PASUPATHY13-year-old Pasupathy is the only child of his parents. He is studying in 9th standardin a local government school where free midday meals are provided. He lives with

his parents in a rented brick house with electricity and sanitation facilities inShenbakkam, 7 km from the hospital.



ALUMNI AWARD OFDISTINCTION 2017

The Alumni Award of Distinction is awarded by CMC annually in August to appreciate staff whohave made a significant impact over the years. This year, it was jointly awarded to Joe and DennyFleming and Ann and Brian Witchalls, two UK couples with close links with FOV UK who haveworked at CMC for many years. Below is an abbreviated version of the write-up they received.

DR DENNY AND DR JOE FLEMING

Joe Fleming joined the Department ofClinical Biochemistry in 1998, where he played asignificant role in introducing StandardOperating Procedures for laboratory tests.Extremely meticulous in his work anddocumentation, he was responsible for theNABL accreditation of Clinical BiochemistryLaboratory. Joe was actively involved in

teaching, research, serving on several researchprojects and supervising doctoral candidates.

The Colleagues and staff of bothdepartments appreciate and value the love,dedication, integrity and humility that markedtheir professional work and life. As Dennywould remark, “Do what is right in God’s eyesand He will take care of you and theDepartment.” They have been involved with thespiritual nurture of the community, speaking atretreats, leading Bible studies for students, andserving on the College Chapel committee.

Their home was open to staff and studentsand many have found a second home in theirwarmth, love and generosity. Denny and Joe havetruly exemplified the love of Christ in their livesand work with their belief that our lives must be‘spiralling steadily around and towards Jesus.’

Denny Fleming joined the ClinicalPharmacology Department in 1998. She wasinstrumental in initiating the development ofthe Modern Therapeutic Drug MonitoringServices and the Clinical PharmacologyLaboratory in CMC. She patiently trained thefaculty and technical staff in the operation ofthe highly technical HPLC Equipment and theapplication of pharmacokinetics.

She was associated with the InternationalAssociation of Therapeutic Drug Monitoringand Clinical Toxicology (IATDMCT) whichenabled the department to host two nationalconferences. Over the past two years, she hasbeen integral in setting up the assay andprocess for detecting inborn errors ofmetabolism; an example of the dedication andcommitment that Denny embodies.

MRS ANN AND MR BRIAN WITCHALLS

Ann also worked in the Public Relations Office,helping produce several annual publications.

Both Ann and Brian were actively involved incollege life. Senior alumni fondly rememberthe cake and other treats that were always andreadily available in their home!

In 1983, they returned to the UK for theirsons’ tertiary education. While in the UK, Annbecame a trustee of Friends of Vellore, UK. Shehas been particularly active in the Person toPerson (PTP) scheme.

Since Brian retired in 1999, they have beencoming back to CMC for five months everyyear. Brian continues to help with theEngineering Department, using his expertise toset up water reclamation and recycling systemsin the campus. Ann continues her work withthe Friends of Vellore and the PTP scheme.

Ann and Brian have given so much ofthemselves - their time, skills, talents,resources; things that cannot be priced but areinvaluable to the building of an institution anda community…. ‘to building God’s kingdom’ asAunt Ida eloquently put it.

The Alumni Association and the CMCcommunity thanks Drs Denny and Joe Fleming,Mrs Ann and Mr Brian Witchalls for theirimmense contribution to the Christian MedicalCollege, its staff and students through theirdedication and commitment, and is proud tohonour them with the Alumni Award for theyear 2017.

Brian Witchalls arrived in Vellore from the UKin 1962 and was asked to take charge of theTransport Department. Two weeks after Annarrived, Brian and Ann were married in St John’sChurch, Vellore. Their sons Nigel and Jeremyattended Vidyalayam, the school for childrenof CMC staff.

Brian became more widely involved inengineering in CMC from 1966. He set up thefirst refrigeration section and was involved invarious building projects. He was in charge ofCollege Maintenance for a number of years,focusing on improving the water supply to theCollege Campus. Brian also served as theDeputy Superintendent for Engineering for sixyears.

Initially, Ann helped in Vidyalayam and wasalso in-charge of the St John’s Sunday School.She helped to start the Foster System, whichprovides a home from home for students andis one of the highlights of campus life in CMC.

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SUPPORTING CHRISTIAN MEDICAL COLLEGE, VELLORE, SOUTH … · VELLORE ISSUE No. 147 · AUTUMN 2017...

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