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18 Dec 2019

Kojawara Clinc - Providing crucial medial care

John and Felicia Pheasant are associated with the Friends of Seva Mandir UK and come to Seva Mandir every year, making regular trips to the communities we work with. Here, they share their experience from our Kojawara Clinic.

We were to visit a country hospital in Kojawara, in a village some way off the highway. The hospital was built in the late ‘90s on land donated by a local and run by Seva Mandir. On previous visits we had found it doing its best with local staff to offer a health service to people walking in from miles around, but it had proved difficult to attract doctors, who tend to be reluctant to venture out from the city two hours' drive away. Seva Mandir has now entered into a partnership with a not-for-profit organisation set up by doctors to help solve this problem. The organisation, Basic HealthCare Services, helps SM run the clinic, provides training and, crucially, sends one of a team of doctors to run a surgery once a week. Three nurses live on site and offer a 24/7 service.

61 patients had come to see the doctor the day before, and the nurses see 30+ patients on non-doctor days. They examine them, do tests (urine, blood sugar, blood pressure, haemoglobin etc), dispense medicines, and there are beds for patients who need to stay in for treatment, as well as an emergency room. More serious cases are referred to the district hospital some distance away. The Kojawara hospital attracts people from a wide radius, in part because its staff are reliable and well trained - government clinics do not always have the staff needed on duty at all times. The hospital's services are not free: patients have to pay 50 Rupees (approx. 50p/70 US cents) for treatment and medicine and R100 if hospitalised. As with all Seva Mandir's services, the nurses use their discretion, as even these modest sums are sometimes way beyond what these tribal people can pay, particularly if they are on regular medication such as insulin. (We saw one patient taken in and given urgent treatment for his diabetes which was out of control as he had run out of insulin.)

The hospital at Kojawara was impressive. Some surfaces may need a fresh coat of paint following heavy monsoon rains, but the place was clearly running efficiently and providing a much-needed service. Our guide, Alka, the Seva Mandir secretary for the whole of the large area (or ‘block') in which the hospital lies, had recently moved her block's administrative office from rented premises to unused rooms in the hospital, thus making much better use of space and precious funds, and reinforcing the presence of staff at the hospital.

We saw patients lining up to see the nurses and learned that there is a spike in malaria cases after the abundant rains, and also a continuing problem with TB. As throughout the region, the nurses see many malnourished and underweight children, a problem that is rife throughout Seva Mandir's work area and the focus of one its major programmes. Nutrition-rich foods are given to these children, and mothers advised about how to care for and improve the health of these little ones. The most severe cases are referred to the Malnutrition Treatment Centre about half an hour's drive away, but of course hardly any of these families have access to cars, so it becomes more complicated to take a malnourished child to one of these centres. Not to mention the fact that children may have to stay in hospital for up to 10 days in order to be treated, and parents have agricultural work that they cannot drop, and other children to be looked after. Hence Seva Mandir's newly devised regular camps, run by their trained local health workers in the villages, to treat children in the community wherever possible.

Later in the day, a story that unfolded provided a dramatic demonstration of the nature and value of the work Seva Mandir does in these villages.

We learned that someone had rung the ChildLine number, which adults and children can call to report any case involving a child who needs help. The line is operated for the government by Seva Mandir. The caller reported two young children who were struggling. A Seva Mandir car had been sent to pick them up from their home, along with a woman who runs one of the government's child day-care centres (many of which Seva Mandir is working to improve, but that's another story). The woman had seen the children's condition and took matters into her own hands. She may very well be the person who rang Seva Mandir's ChildLine. With the boys, aged 7 and 5, came their old grandfather. It emerged that the boys' father, son of the old man, had died some years before, as had their grandmother. Their mother had remarried and gone to live with her new husband (as is so often the case, as husbands do not generally want to take on other men's children). She had left her boys in the care of her former father-in-law. The old man was struggling to cope with the boys and had come to plead with the hospital staff to find a shelter which could look after them properly.

The little boys themselves were a heart-breaking sight, clearly very underweight, with huge eyes and tiny frames. They were miserable and clearly ill. The old man was very gentle with them, but felt unable to look after them. The first thing Alka did was to get the kitchen to make the boys some fresh rotis and give them water, and the grandfather gently helped them to eat and drink and then wash their hands. She then started to persuade the grandfather that the boys needed emotional care as much as physical, and explained that she would help him to apply for a government benefit which would provide money to help him look after them. The family had to go home to look after their farm animals, so she arranged for them to be driven home and then brought back to the hospital the next day and to stay overnight for tests, before being referred for further treatment, which she would arrange. As they left, she gave the grandfather a bag of nutritious ingredients (taken from the supplies destined for TB patients) and the nurse explained to him how to prepare the food. We can only hope that the old man was capable of cooking for his little family, as the ingredients on their own would be no use without proper preparation.

As they left, we saw the younger boy struggle to climb a single low step, pushing on his knee to help him up, and clearly drained by the effort. He, at 5 years, weighs 10 kg (western expectations would be around 18 kg) and the 7-year-old weighs 12 kg (around half what his western contemporaries might be expected to weigh). They were feverish and may well be suffering from malaria, and possibly also TB, which sounds likely to have killed their father and other members of the family.

The joined-up way in which Seva Mandir's services will, hopefully, change the lives of these mites, and the humanity of its staff (which we have witnessed over and over) are inspirational. This case alone shows the benefits of the ChildLine service, the rapid action of the NGO by sending a car from head office to collect the family and bring them to its hospital, the gentle care of its nurses, and the thoughtful intervention of Alka, who was prepared to bend rules and use all the information and power at her disposal to try to find the best solution for these needy souls.

There is currently no donor for this hospital, so Seva Mandir uses its central funds to keep it running. These core funds are used to develop, test and implement projects which are not donor-funded. We are actively seeking dedicated funding to keep the hospital running.


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