Summer Newsletter 2017 St Luke’s Hospital Hiranpur Dear Everyone, As we write the temperatures are soaring, and the rains have not yet arrived, and yesterday 14th June – the solar power plant stopped functioning. Shubhro has been in touch with the company in Kolkata, and they have tried all sorts of trouble shooting measures, but cannot get it started again. So patients and staff are again sweating it out in the OPD. Still it makes us very grateful for the solar power – which has been working non-stop since it was switched on - on 21st June last year. It is also the Moslem’s fasting month of Ramadan, where they do not even drink water from dawn till dusk, so they suffer even more without the fans. Things continue here at slow pace – progress has been made in terms of the Eye Hospital, where the roof has been entirely renovated and is now no longer leaking. Although the monsoon has not arrived there have been sporadic thunderstorms with torrential rain, and the interior of the eye hospital has remained dry. This means we can progress to doing work inside, in preparation for Eye OPD and inpatient work to commence. The Eye team from Malda will start, as soon as St Luke’s Hospital is again registered. Registration is in progress, and we hope will be completed before this newsletter goes out. We have applied to have a 20 bed inpatient hospital, since this is the maximum we could have by present government regulations. Emergency training in Delhi. We have told you before about the UK/India partnership in a WHO Skills and Drills Training Programme in Emergency Maternal and Newborn care, which both of us have a long association with. We were delighted, that, after nearly 2 years a refresher training course was run in Delhi, and Shubhro and I joined Dr. Helen Allott from LSTM UK to give some refresher training to the Master Trainers in Delhi.

Elisabeth first met Helen when they were Trainers together in Sierra Leone, nearly a decade ago. Helen, a recently retired NHS Consultant Obstetrician and Gynaecologist has a passion for teaching, and with many years of voluntary working association with a rural hospital in Uganda, can understand the challenges of delivering good quality care in a low resource setting.

The Government of India have a long term plan to take this training programme throughout India, and Shubhro and I hope to eventually be involved with training at grass roots level in rural Jharkhand. We know, from working in West Bengal all those years, that delivery of good health care can only be achieved through working in teams with our nursing colleagues. And for this to happen at St. Luke’s Hospital, we need to be continually training all cadres of staff. More staff joining the team at St Luke’s. In our Spring newsletter we told you about a family who are keen to join us. They are still interested, but facing personal problems with one family member in a coma after a road traffic accident - this young man is being nursed at home now, after a few weeks in hospital, where it became apparent nothing further could be done. Another young doctor – she is an ayeurvedic doctor is also very keen to join us, but she only qualified in 2015, and so is in need of guidance, and it would be

unfair to leave her alone working here while we are in Scotland.

Still, with donations from friends in Scotland we have renovated two doctors residence in the hope these two doctors will join us before the end of 2017. The above photos show renovation in progress, and below the transformation.

The first of these is a large bungalow with a two bedroom, living/dining room, bathroom and kitchen, and on the opposite side two separate single accommodation with bedroom, bathroom and kitchen, each with own separate entry (though the doors were absent and doorways required rebuilding!)

About 30 yards beyond this lies the Kennedy Bungalow (so named in memory of Dr Helen Thompson’s mother). This is the most recently built doctors quarter, and did not require much renovation. James (our radiographer) and his entire extended family stayed in the Kennedy Bungalow for a long time, and they were very happy, for the view is next to none looking out towards the hills. Biren and his building team likened it to being up in Darjeeling or one of the hill stations in West Bengal - they found the view and the sunsets especially quite stunning. Still, the renovation of these buildings provides accommodation for two doctors and their families, plus two single doctors. In faith we have made them ready, and now pray for them to be occupied……watch this space.

We are absolutely delighted to welcome another member onto the hospital team. He is Surinder Marandi, and comes from one of the nearby villages from where the majority of our Sunday school children come. Indeed Surinder was the spokesman for the parents who met with Shubhro to discuss their children’s

education. (see page 9) Surinder himself is a skilled worker, having gone through an apprenticeship in carpentry. But he has not worked for some time, and Shubhro discovered the reason for this. A visiting quack came to the village, and through some magic “tests” told Surinder his liver is very bad, and there is not much hope for him. Surinder is in his late 20’s, and is strong and fit, but very depressed with this news, and so had given up hope. With persistent gentle persuasion we asked him to try out working at the hospital for a few days, and see how he felt. There is enough carpentry work in the hospital to keep him in full time employment. After the first couple of weeks, and encouraged by our praise at his excellent craftsmanship, he now has some hope

for the future, and Shubhro managed to bring a smile to Surinder’s face again. He is still showing a tendency to low mood, but we believe with time this will improve. If we can encourage men and women from the surrounding villages to join the hospital team, this will be a blessing to us, and to them also. Surinder pictured here with his young daughter. Rat story and coconuts

It is unbelievable that rats are able to run up to the top of the coconut palm, but they do – up the trunk, along the palm and then they chew the stem of the coconut to bring it down. Munshi was keen to stop them getting the coconuts so he

used the bamboo ladder to climb to the top of the palm, and then cut down the palm branches, thus cutting off the rat route to the coconuts. Munshi has no fear of heights (or anything), but Vedka his friend was waiting anxiously below among the strewn palms until Munshi returned back down

Patient stories It was late in the evening when Sarita began to have labour pains. This was her first baby, so she had arranged to go to her sister’s home where it was easier to find transport to the hospital during the night hours. After a few hours at her sister, the pain grew worse, so around 3am, they set out for the nearest government hospital. By this time the pain was quite severe, and

the doctor told Sarita she was definitely going to have the baby. But because Sarita’s contraction pain was radiating up into her chest, the doctor thought she was having a heart attack. He told her he was only a doctor for delivering babies, not for heart attacks, so she would have to go somewhere else. Sarita is only 19 years old, so the chances of heart attack were almost negligible. But Sarita could only do as the doctor suggested, and go to a private hospital where an obstetrician performed an ECG, and told her, there was no evidence of a heart attack. He also told her, he thought she was going to have a normal delivery, but could not guarantee that. If by chance she did need a Caesarean section, then she could not stay in his hospital, because although he himself could do the operation, he did not have an anaesthetist to give the anaesthetic. So poor Sarita, still in much pain was bundled into the car for the third time, to go in search of a hospital which would

accept her for delivery. As they went along the road, the family tried many hospitals, but nobody wanted to admit Sarita. Eventually, she delivered in the back seat of the car, and seeing that her baby daughter was crying, Sarita herself could not stop laughing with relief. Sarita’s husband, who was in the front seat started scolding her, because she could not wait till they got to a place that would admit her, but also because, as he told her “this is no laughing matter”. Sarita was so relived and happy, she continued to giggle. But her baby was still attached to the afterbirth by the umbilical cord, and Sarita could still potentially bleed, if the afterbirth remained inside her. It took another three attempts at literally pleading the hospitals for admission, before a private hospital agreed to admit Sarita, where her placenta was delivered safely. This may seem an incredulous story to those of you reading in the UK, and other parts of the world, but it is an everyday occurrence for young women in India. Sarita was lucky – there were no complications, and her husband could afford a car. Women here deliver in the back of rickshaws, or even on the road, at a hospital entrance or in a corridor, with no privacy, and very little help when things are going wrong.

Grateful patient asks to pay more for consultation. When we ask patients to return for discussion of any investigation results, we do not take a further consultation fee. But one day in June, a couple seeing Elisabeth said they were very happy with the outcome of the discussion, and explanation, and felt that the consultation fee should not be waived. The husband went to the office and simply gave the fee of his own accord. This is the first time this has happened to us in India. In all the years we practiced in Sarenga, no patient ever offered to pay money unless requested to. Many tried to give us money directly (which we never accepted), but nobody previously offered an outpatient or inpatient fee, unless it was requested of them. Girl expecting triplets Reshmi attended our clinic when she was only about 28 weeks pregnant, but her tummy was grossly enlarged, and there was definitely more than one baby head we could feel. She had gone for a scan and the doctor who scanned was unsure how many babies were present, so very sensibly did an abdominal x-ray, which very clearly shows three fetal heads. Reshmi is severely anaemic, and this together with a triplet pregnancy puts her at high risk of going into labour early. Reshmi has had several iron infusions and is now at 31 weeks of gestation. We have also given her steroid injections to help mature the babies lungs. Unfortunately the first triplet is always lying in the same position when we examine Reshmi – lying across her tummy – which means, if she goes into labour she will require an emergency Caesarean section. Caesarean puts her at higher risk of bleeding after delivery, so we have contacted our sister mission hospital Prem Jyoti Hospital, and asked if they would be ready to look after Reshmi for delivery. Prem Jyothi have agreed to this, and we pray that if Reshmi does require an operation, she will survive this, and that at least one of the triplets may be salvaged. Reshmi and her husband already have two daughters, and this triplet pregnancy came out of the blue – she was not on any fertility treatment. Spontaneous triplet pregnancy is a very rare occurrence when it happens naturally, and it does put the women here at very high risk.

Early marriage and no contraception Dipu was only 14 when she was married. She had been studying at school and had reached class 5 before her parents took her out of school to get her married. She came to us last year in her second pregnancy, having conceived while breastfeeding her first son. Dipu and her family are well below the poverty line, and are exactly the kind of family the government is trying to help by providing free health care, extra nutrition and free medicines. The government rightly are trying to encourage delivery of babies in a health centre or hospital, and the mother is given a cheque following delivery to help with providing for the new baby. But there are a few pre-requisites:- They must attend for at least three antenatal checks during pregnancy. They get free transport to the health facility and back, but in spite of these things, many women prefer to deliver at home, since they equate hospitals with large bills, which will send them into debt. So Dipu ended up by delivering both her sons at home, unattended by any skilled

birth attendant. Fortunately everything went well. But Dipu came to St Luke’s wanting to discuss contraceptive options – with two children under the age of two years, and Dipu herself barely 18 years old, this was a sensible

request. Dipu, nor her mother could tell us the date of her younger child’s birthday, but between Susanna and mother and daughter remembering significant things like the new moon etc. we decided the baby was born on 13th February. Ideally Dipu should have an IUCD fitted free of charge at the government clinic. But there is nobody working there with the skill to insert an IUCD, and those with the skill in the nearby government hospital only offer this service on a private basis. Elisabeth hopes, with the help of WHO, to get a supply of the IUCD, and she would then be able to offer this service free to women, ideally inserting the IUCD within 24 hours of delivery.

Jyothi Do you remember Jyothi, whom we last brought news of in the summer ’16 newsletter. Jyothi and her husband are both HIV positive and doing very well on treatment. You remember last August Jyothi expressed her desire for another child……. She is delighted to be expecting a baby in early September. Her little daughter, who was clearly traumatised by her Mum’s serious condition the first time we met is now a happy mature school going child. She still misses her little sister, whom you will remember died suddenly after a short febrile illness in 2014. Jyothi has not had an easy pregnancy, and we had to give her intravenous fluids and antibiotics in her 7th month of pregnancy. We pray, that by the time her baby is due, we may be able to deliver Jyothi at St Luke’s. It will be a challenge for Shubhro looking after the baby who may already have contracted HIV in utero. Jyothi has been attending the government HIV clinic monthly, but in spite of taking all the medication they provide free, she still has a relatively high amount of the virus in her blood, which puts her unborn child at greater risk of getting HIV infection also. Much to give thanks for, but as ever much to pray on for also…… As we look back over the last 3 months, we have seen many prayers answered and are encouraged to keep going. Summer holiday school – was a great success with the children, but with 40 children ranging from 3-13, it was not possible for Shila to teach them all.

We thank God that a lovely girl called Stanly came forward, and offered to teach the older children in English. Shubhro called a meeting of parents from the villages where children are not being taught in their schools – to find out how many parents would like extra tuition for their children. There was an overwhelming response.

- - this keen lone student came every morning 2 hours before school, and seemed to fill several notebooks with practice writing.

But it was not all school work - we could hear the children’s excited voices, clapping and laughing as they performed short skits, songs and dances for each other. The boys were competing with the girls to see who could get the loudest applause. And another prayer has been answered -

We have found one young man, fluent in English, and willing to do private tuition for a couple of hours each evening throughout the year. Shubhro offered to buy an invertor for the St Luke’s Church, so that the tuition could take place with constant light and fans, but the offer was turned down. So, plan B is to connect up the solar supply to the Hospital Chapel, a good sized building which is just lying empty at present. Eventually we shall get a sound system and projector, so that we could have small student retreats here at St Luke’s Hospital. But for now just whiteboards, pens and a teacher who will educate in English, and we shall see what God has in mind for the future. Pray for an electrician – our electrician from Pakur has sadly got a contract job there, so is no longer able to give us his service. We have been on the look out for an electrician for several months now, but so far have been unsuccessful. Pray for a welder We have had to change plans for maternity site, at least temporarily. It is unreasonable to expect nursing staff to stay out alone in the Women’s hospital, which is quite exposed, without some form of security. The two night security guards left in October 2015. We had our hopes raised at the prospect of a boundary wall up there, and then dashed when the MLA who had made the promise, and begun to release the funds, died suddenly in January. But we sense God’s hand in the planning, so when there is a change of plan there is always a good reason. St Luke’s Hospital has lost its registration, and much water has passed under the bridge since that time, especially lots of government legislation within the Clinical Establishment Act. One such piece of legislation is

that a hospital must have one doctor per 10 beds. So we are going to have to start small, when we open to inpatients. We have applied for registration with a 20 inpatient hospital. In faith, we hope that once more staff join us we can start surgery at St Luke’s. Elisabeth is keen to train the younger doctors, but we need to have a proper theatre area. From previous newsletters, you know that we have identified an area in the Women’s Hospital where we can build a theatre. For the time being however, if we get the go ahead for 20 beds, and also a couple of doctors, then we shall have the theatre in the main hospital block, and the delivery area just next to this, on the wing opposite the OPD. Thus we have started renovating one of the old theatres for this purpose. This was another area where the roof was leaking, and tree roots growing down into the main wall. Following renovation of the roof, the builders from Sarenga have re-plastered the walls, and the next job is to make a false ceiling, in which we shall place multiple LED lights. There is no operating light in St Luke’s, and this is a very expensive piece of equipment, hence the plan for ceiling lights. The building team from Sarenga were unable to persuade their welder to accompany them such a long distance, so we still don’t have the false ceiling, or the electrical connection, but everything else has been done ready for theatre to go into action. Thanks for the encouragement our Sunday School children bring

The little ones at Sunday school are flourishing – we have had 29 children on a Sunday. Elisabeth had been praying, especially as the numbers rose, for a helper.

Not that the children were out of control – they are as good as gold. It was rather that Elisabeth felt they were getting a raw deal Sunday after Sunday with a teacher who told a Bible story in their mother tongue, but so hesitantly and with wrong pronunciation. The answer to that prayer came in the form of Susanna. Susanna had been helping Elisabeth get the correct pronunciation, and spent a couple of hours weekly, doing this ever since Sunday School began last year. But recently, during one of these sessions, Susanna offered to come to the Sunday School herself to read the Bible story in Santali. This is a kind gesture, since it means Susanna does not get to stay in church for the service. The children have taken to Susana and love her, and Elisabeth is at peace knowing they are hearing and enjoying a properly spoken story. Sunday school is an all day event – the children arrive around 9.30, and depending on the length of service and arrival of the preacher, is sometimes not finished until 4pm. Shubhro will usually be reading inside when they arrive, but the children find him out and flock to him. The attraction is not just Shubhro, but the fact that he is often looking at things on his laptop ! Here they are all around him enjoying whatever is being projected on the laptop.

And, since they are coming several miles walking we decided t start giving them lunch also. A simple meal of rice lentils, egg and potatoes, with plenty ghee (clarified butter) mixed in to increase their calorie intake. Pray that we would have patience dealing with Government We continue to be harassed by Government legislation - a small example X-ray machine requires registration under the Goods and Service Tax (a new tax taking effect from 1st July 2017). The Hospital received a registered letter on 14th June, stating that application for the GST number must be received by 31st May. The aforesaid letter was sent by courier postmarked 30th May, so it was impossible to complete the application by 31st May.

Pray for the Family of Sue Choudhury Sue died on 24th May, and we remember in particular her son Robin and daughter Vanessa. Sue was a dear friend, so faithful in prayer, always putting others before herself, encouraging, loving and caring. She remembered the children in Hiranpur, prayed for their families, for the staff, for the various challenges we face at St Luke’s. And she knew her prayers were heard and answered. Sue was blessed with children and grandchildren whose lives were closely bound up in her own. We can only pray they will be comforted and assured of the truth, that for Sue, her life is not ended, for she

knew the Author of life, and is now at home with Him for ever more. Thank you to those of you who prayed for a better internet connection The internet connection has been much improved since the second week of May, and is as a result of this that we were able to prepare the Summer newsletter in time. We are also very grateful to Moira McKenna, a GP in Perthshire who offered to upload the newsletters on the website quarterly, and also upload any other information pertaining to St Luke’s Hospital. We have never met Moira in person, but she contacted us when she heard St Luke’s was again open…..Moira had done her medical elective here back in the 80’s, and she is still in contact with other doctors who spent time at St Luke’s during their medical training. Thank you to those who are praying for Elisabeth’s registration with MCI Elisabeth has made some progress with the registration with Medical Council of India – please pray on that this will be completed before the end of 2017. Thank you to Fiona Fairlie, who has sent us a special blood pressure monitor. This is no ordinary monitor - it has a “traffic lights” warning signal, when the blood pressure is dangerously high. We use Fiona’s machine when we get an abnormal reading with the ordinary BP monitor. Patients are convinced they need to take medicine when they see the red or orange light flashing. And the staff love to be able to explain the significance of it to patients. Thank you to all of you who continue to give so generously We are so grateful to the many of you who continue to support us here financially. How we pray that soon we shall be able to use some of this money to support two full time doctors, and thus enable the work here to go on all year long. How even more grateful we are for those who faithfully pray - pray that all our plans may be blessed, and that God will close doors where we are planning things not in His will, so that your money may be used wisely.

Please continue to pray God would pour out His blessing on all the people who come here daily - the following photographs show patients and staff going about their daily routine. And this comes with our love and appreciation - as ever we could not do this without you all. Shubhro and Elisabeth