introduction to chm

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Serving the people of Chhattisgargh since 1896, providing low- cost, high quality, equitable health care and education.

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Page 1: Introduction to CHM

Serving the people of Chhattisgargh since 1896, providing low-

cost, high quality, equitable health care

and education.

Page 2: Introduction to CHM

Christian Hospital Mungeli (CHM) is a 120-year-old not-for-

profit institution. CHM runs a 120 bed hospital, a School of

Nursing, the K-12 Rambo Memorial English Medium School and

the Springer Community College for 8th grade drop-outs. Located

in the rural area of Mungeli in the central Indian state of

Chhattisgarh, we serve all people regardless of gender, age,

religion, caste, tribe, medical condition or ability to pay.

Introducing Christian Hospital Mungeli

Page 3: Introduction to CHM

We put gender equity and women's empowerment at the center of all our initiatives. Our School of Nursing provides education to young, rural women and offers the promise of

skilled, sustainable employment. Our community college gives women a second chance at education and skills. We ensure that

girls at Rambo School are encouraged to remain in school

We promote a free, democratic, and open society. We offer subsidized medical care and education for children, women,

and men that enables our patients and students to make better choices for their future.

The inequitable distribution of medical and educational

facilities in this frontier region bestows upon us with a unique responsibility to serve those most marginalized by their

extreme poverty. CHM serves families from over a 120km radius (75-miles).

CHM champions equal opportunities. We treat every patient who enters our doors.

Page 4: Introduction to CHM

The CHM medical staff includes five doctors in

the fields of General Surgery, Anesthesia,

Orthopedics, Obstetrics, Gynecology, and Family Practice. Three dentists provide dental care and

visiting ophthalmologists offer

critical eye care. Together with 42 nurses, we annually deliver over

750 babies, perform 2,500 surgeries from

three operating theaters, run two ICUs, treat

30,000 outpatients, and conduct 48,000 lab

tests.

Health Care Subsidized costs: Careful resource management, increasingly high volumes of patients and generous donations of equipment and infrastructure allows us to subsidize costs to poor patients. Last year we offered INR 14 lakhs (US$ 22,000) in concessions to poor patients who could not pay for treatment, despite our subsidized rates. We are the only hospital in this frontier region offering high quality surgical, obstetric, neo-natal and intensive care and also accepting the national health insurance scheme, RSBY, for below-the-poverty-line households. We will soon open the only low-cost cancer center in the state.

Page 5: Introduction to CHM

Maternal and child health: A large part of our efforts now focus on improving the health of women and children. In 2014 we delivered 768 babies. However, 490 deliveries were by C-section because of chronically malnourished mothers, lack of pre-natal care and unskilled obstetric care in the village leading to severe complications during birth. We also treated 20 pregnant women with Hepatitis-B infections caused mainly because of the use of dirty needles by unlicensed village practitioners. Last year, 22 women came to us with eclampsia (high blood pressure in pregnancy leading to seizures) due to lack of pre-natal care. Fifteen infants died post-delivery due to asphyxia, fetal distress and low birth-weight, and intrauterine deaths caused because mothers were brought to the hospital too late and/or had no pre-natal care. We treated 115 newborns with jaundice who required bili-lamps. Patient-centered care: Indian patients are

usually accompanied by family – and we believe that patients get better with loved ones around. So we built a dharamshala (sanctuary) where relatives could sleep and cook at no charge; we offer a canteen service where for INR.15 (US$0.23) one can get a full thali meal; patients are issued a hospital smart card so that their treatment history, scans/x-rays, and lab results are secure, paperless and cannot be misplaced. Poor patients often forfeit a day's wages to come to the hospital or bring a relative. To reduce wait times, the patient receives an SMS when lab results are ready, and the results then appear on their phone. We send SMS reminders for their next appointments to ensure continuation of care. We conduct weekly outreach programs to the surrounding villages, to so that sick people are not needlessly suffering. A new mobile clinic with funding from USAID ASHA will allow us to take high quality health care out to the people.

Page 6: Introduction to CHM

Critical care: We see the outcomes of extreme poverty, poor living conditions and cultural traditions in cases including farmer suicides, poisonous snake/scorpion bites and dowry related injuries. Farmers make up 15% of the state’s population but at least 32% of the suicides.10 We can never forget the violence against the women and children caused when an earning head of household takes his life; in India widows are cast out of their homes and neglected by society. In 2013 we saw 112 suicide attempts, with 17 men arriving during the same week. Poor living conditions (mud houses, lack of footwear, sleeping in the open, open defecation in fields/forests) exposes people to deadly snake

and scorpion bites. During a six-month period we treated 32 people (mostly children) for snake and scorpion bites. Thanks to our ICU facilities and vigilant staff, not a single person died. Saving lives with ICU care means that now even more people come to CHM first, rather than to a traditional healer. When a woman's husband or in-laws harass her for dowry – which is illegal under Indian law –the woman is either driven to commit suicide, or is injured or murdered when she is deliberately doused with kerosene and set aflame. Last year we treated 20 victims of dowry-related bride-burning who required intensive care in our burn unit.

Page 7: Introduction to CHM

Surgical care: Our surgical facilities offer relief to some of the most desperate patients living with needless suffering. Last year we operated on 603 general surgery cases and 518 Obstetric and Gynecological cases including a large number of cervical cancers caused by multiple pregnancies at a young age, improperly spaced births, and sexually transmitted diseases (such as Human Papillomarvirus which is common among migrant labor communities). We operated on 190 patients requiring orthopedic surgery due to road and work related accident, with a larger proportion of men and young children. Since 2004, CHM has restored sight through cataract surgeries to 1432 'curably blind' people, who can now see again.

Page 8: Introduction to CHM

Science and technology: Our use of science and technology has allowed us to improve efficiency and offer high quality treatment. We are the only rural hospital for over 120 kms (75 miles) with a CT scan, color doppler, C-arm for orthopedics and urology, ultrasound and 500 mA x-ray. CHM maintains the only Picture Archiving and Communication System (PACS) in the region for economical storage and efficient access to medical imaging from various sources. Our labs are fully automated and connected to the electronic patient medical records to reduce human error in copying lab results in to charts. Solar panels run hot water in all wards and laundry.

Page 9: Introduction to CHM

In our own small way, we are: Helping to solve the worldwide problem of maternal and

child health; Strengthening the local public health system;

Improving access to quality health care by offering outreach services, and medical and surgical care that is

otherwise unavailable in a rural area; Increasing the capacity of the health system through our

School of Nursing; Constantly innovating in this resource-poor-setting, utilizing m-health initiatives and renewable energy;

Working with government schemes, making public/private partnerships work more effectively for the

marginalized at the 'base of the pyramid'.

Page 10: Introduction to CHM

The School of Nursing began in 2010 as CHM began to recognize and address the shortage of qualified nursing staff in the rural area. We graduated our first batch of 19 nurses in 2014 in our nationally accredited three and one-half year course in General Nursing and Midwifery. We accept Chhattisgarhi women from any religion, caste or

economic background. Our students come from challenging backgrounds with families making great sacrifices to provide them higher education. We try to remove the financial barriers by offering subsidized fees and an employment guarantee payback plan. The entire 3.5 year course costs INR 136,000 (US$2130) including internship. For those who cannot pay, CHM pays their tuition, and we guarantee them employment, so they can pay back this interest-free loan. Many young girls tend to be taken out of school and are married off at a young age with child bearing as their only option. The CHM School of Nursing has given girls and their families affordable higher education opportunity in the rural area. The opportunity for high skills and lucrative employment has given hope to many families, and many more are now willing to allow their girls to reap the benefits of an education. Our nurses are also our front line staff in village outreach services. The aim is to empower 'home grown' talent to give back to their communities and inspire other women.

Education School of Nursing

Page 11: Introduction to CHM

The creation of the School of Nursing addresses the shortage of nurses and provides career opportunities for rural women. Yet its success has created two immediate needs: housing and classrooms. While authorized to accept 30 students a year, we can only take in 20 due to a lack of hostel accommodation. The Indian Nursing Council requires a dedicated facility for study and instruction. We are looking for partners to help construct both a hostel for 220 nursing students and graduates, and a Nursing School building to allow us to grow and offer more women a chance at education and employment.

Page 12: Introduction to CHM

The Rambo Memorial English Medium School is the only not-for-profit school of its kind in this rural area. We took over its management in 2004, growing the student body from 70 to 800 students in just eight years. We have 27 local teachers, and 47% of our students are girls. Our students come from a variety of family backgrounds including Underprivileged Scheduled Tribe (36 students), Scheduled Caste (285 students), Other Backward Castes (277), and General Category (204). These communities are termed by the Government of India as 'educationally backward' due to generations of marginalization. The Rambo School treat children from different backgrounds are equally, each with dignity, respect and equal opportunity to shine. They interact without prejudice, and we believe this positive environment can help overcome caste barriers from a young age.

Rambo Memorial English Medium School

Education has the power to put children on a path of independent thought

and free them from the crushing cycle of poverty and caste discrimination.

Page 13: Introduction to CHM

All our students are the first in their family to receive an English medium education, and most of their parents have never been to school or never completed school. English medium schools tend to be private, profit-making institutions that charge high tuition fees and are located in urban areas. To reduce the financial barriers to high quality education, the Rambo School through CHM, offers subsidized tuition fees - as low as Rs.2000 (US$31) per year for primary and middle school to Rs.3000 (US$46) for Class 12.

Page 14: Introduction to CHM

Distance, lack of transportation and poor roads in this rural region can be a deterrent to sending children to school on a regular basis as parents are forced to hire transportation at high costs. We provide six school buses that travel up to 60Kms daily on unpaved roads to collect children. We are now able to transport over 500 children to school and back home every school day.

Page 15: Introduction to CHM

The Rambo School's popularity is growing as the local community sees the benefit of sending their children for and English Medium education, but we operate out of cramped, 1920s, dark and dingy buildings. The lack of space means we now have to turn children away. To meet this increase demand we are trying to secure funding to expand the school building to three stories enabling us to grow the school strength to 1000 students, include library and lab facilities, a recreation area, and an exam hall. Using our own funds we have financed the foundation and construction of the first floor and toilets. We are seeking funds to complete the second and third floors.

Page 16: Introduction to CHM

We believe that education is essential for both improving

the quality of life for people for sustainable economic development of the nation. Education has the power to

put children on a path of independent thought and free

them from the crushing cycle of poverty and caste discrimination.

Page 17: Introduction to CHM

Our most recent initiative is the Springer Community College for 8th Grade drop-outs. It is named after Mrs. Eva Springer, a nurse who arrived in Mungeli in 1927 at the age of 51 to start a new life after having lost her husband. She was an entrepreneur at heart and built many of the hospital's existing wards and worship areas. It is her resolve and entrepreneurial spirit that we honor through this community college. The college is affiliated to the Indian Center for Research and Development Community Education in Chennai. We aim is to provide skill-based learning, employment and entrepreneurship to lead in to gainful employment. We currently offer four courses aimed toward certificate in computers, hardware and networking; certificate in sewing, tailoring; certificate in physiotherapy; and certificate in nurse's aid program. These courses cover a year of training, six days a week resulting in 480 class hours.

Springer Community College

Page 18: Introduction to CHM

Dr. Anna Gordon, an American missionary, founded CHM in 1896. In 1924, Dr. Victor Rambo, an American born in India, came to CHM after completing his medical degree in the US. He grew CHM to a 120 bed surgical hospital specializing in treatment of eye diseases. From 1947 to 1957 he shared his time between CMC Vellore, CMC Ludhiana and Mungeli and finally retired in 1962. In the 1970s stricter VISA policies caused most missionaries to leave India, and many mission hospitals, including CHM fell in to disrepair. In 2003, with CHM averaging about four in-patients a day, Drs. Anil and Teresa Henry, a general surgeon and anesthetist, both graduates of CMC Vellore, arrived after spending 10 years practicing in rural India and four years in the US. Their leadership and vision have revitalized and grown CHM.

History and Background

Page 19: Introduction to CHM

CHM is located in the rural area of Mungeli, in the Bilaspur District of Chhattisgarh – a central Indian state with some of the worst socio-

economic and health indicators in the country.

− Chhattisgarh has a population of

25 million1, and half live on less than US$1 a day1. Chhattisgarh is one of eight Indian states whose poverty exceeds that of 26 of the poorest African countries1

− 80% of the population is from the tribal, dalit , or Other Backward caste communities. The tribal population suffers greater marginalization, with 50 to 60 % living below the official poverty line compared with 25% of the general population1

− Less than half of women (45%) are literate (6 years of schooling)1

− Only 8.3 % of all girls pass Grade 104

− Chhattisgarh has the highest gender literacy gap in the country- about 20 percentage points4

− 34% of girls between the ages of 15-19 are married and pregnant4

− The secondary school dropout rate for tribal, dalit and OBC children is 80%1;

− Only 17% of tribal women give birth with the assistance of a skilled health professional which can lead to severe complications for mother and child4

− For every 100,000 live births, 275 mothers die-the second highest ratio in the country4

− For every 10 infants that die, 7 die within 7 to 29 days after birth1

− For every 1,000 children under five years of age, 75 die – not that far behind sub-Saharan Africa (95 per 1,000)1

− 53% of children are malnourished which can lead to severe motor and learning deficiencies;

− 50% of rural children are fully immunized with girl children four times less likely than boys to receive immunization; Revealing the lack of health education, 20% of families felt that their child did not need immunization4

Page 20: Introduction to CHM

The Rambo Committee has continued to demonstrate our ability to leverage successful partnerships and long lasting relationships of trust and mutual understanding with premier educational institutions and their staff. Most recently the Executive Director

of the Rambo Committee, Inc. facilitated a Memorandum of Understanding (MOU) with the Virginia Tech Carilion School of Medicine (VTCSOM) that brought the Dean and Founding President, Dr. Cynda Johnson to Mungeli in 2013. Since then four VTCSOM doctors and faculty have visited CHM and the first two fourth year medical students arrived for a three-week rotation in February 2014 with four students doing rotations in 2015. American medical students assist in our village health outreach programs, data collection and research. As a show of their commitment to the international medical rotation program to CHM, VTCSOM alumni have endowed a scholarship that will send at least two fourth year medical students to Mungeli for years to come. Additional alumni, learning of the program in Mungeli, now have advanced the program and contributed funding for additional students.

Recent Partnerships

Page 21: Introduction to CHM

In 2015 we further expanded our links with high profile American institutions, and we recently finalized a MOU with George Washington University School of Health Sciences. The Academic Dean of Jefferson College of Health Sciences, Roanoke, VA, made a site visit to Mungeli in February 2014 and plans to bring her Physiotherapy, Occupational Therapy, and Nursing students to Mungeli after formalizing our relationship. Undergraduates from Butler University will be coming to Mungeli to teach English to the school children and nursing students in summer of 2015. Eureka College will continue to send its presidential scholars for the third straight summer to Mungeli for pre-med undergraduate internship. Culver-Stockton College in Canton, MO is planning a students’

trip to Mungeli in 2016. We regularly have students from CMC Vellore learn and practice at our institution, as well as organize workshops for doctors and nurses in our area. Demonstrating their belief in our efforts and capacities, we have received important grants from prestigious public and private entities and trusts, including a grant of $600,000 from USAID ASHA (American Schools and Hospital Abroad) for a mobile maternal health clinic, and neo-natal and surgical equipment; $600,000 for the cancer therapy machine from the Atomic Energy Research Board; $50,000 for the Cancer Center from Life Insurance company of India; $24,000 for the school bus from the Swiss India Trust; $16,830 from Richard and Rosamund Bernays (The Bernays Trust); $10,000 from Hindustan Petroleum.

Page 22: Introduction to CHM

We are honored by, and grateful for your

support and contribution to our efforts to bring to bring health education and

sustainable livelihoods to the rural people of Chhattisgarh.

Page 23: Introduction to CHM

Footnotes:

1 Office of the Registrar General Census Commissioner (2011). Available at:

http://censusindia.gov.in

2 Planning Commission of India (2014) Report Of The Expert Group To Review The

Methodology For Measurement Of Poverty. Available at:

http://planningcommission.gov.in/reports/genrep/pov_rep0707.pdf

3 Oxford Poverty and Human Development Initiative. India Country Briefing (2011).

Available at: http://www.ophi.org.uk/multidimensional-poverty-index/mpi-

2014/mpi-country-briefings

4 International Institute of Population Studies (2006). National Family Health

Survey 3 (2005-2006). Mumbai. Available at:

http://www.rchiips.org/nfhs/report.shtml

5 World Bank (2009) Secondary Education In India: Universalizing Opportunity.

Available at:

http://web.worldbank.org/WBSITE/EXTERNAL/TOPICS/EXTEDUCATION/0,,c

ontentMDK:22339000~menuPK:282424~pagePK:64020865~piPK:149114~theSi

tePK:282386,00.html

6 World Bank data (2013). Available at www.data.worldbank.org

Page 24: Introduction to CHM

www.chmungeli.org www.facebook.com/ChristianHospitalMungeli www.chmungeli.org/about/video-what-we-do-here/ http://chmungeli.org/resources/social-services/ www.globalministries.org/sasia/overseasstaff/christian-hospital-mungeli.html www.globalministries.org/sasia/projects/mungeli-hospital-1.html www.globalministries.org/celebrating_nursing_students_success