~ Mr. Victor Emmanuel

Emmanuel Hospital Association (EHA) is a large, non-profit provider of health care in India, having a network of 20 hospitals spread across 12 states of India. EHA's comprehensive health services integrate essential clinical services with primary health care and community-level engagement to address the health priorities of the poor and marginalized people, and to facilitate the development of healthy communities.

EHA Hospitals: EHA’s 20 hospitals are located in the rural and semi-urban areas of the states of Assam, Bihar, Chhattisgarh, Delhi, Jharkhand, Maharashtra, Madhya Pradesh, Uttar Pradesh, and Uttaranchal. Each Hospital of EHA is a separate registered charitable society, which has entered into a Deed of Incorporation with EHA and each other.  This brings about strong lines of accountability with both the centre and in a matrix relationship with peers. It also involves agreement for standard terms of employment, accounting policies and management procedures together with reporting for monitoring and comparison.

EHA’s clinical services include Obstetrics and Gynecology, Ophthalmology, General and Family medicine, Pediatrics, General and Pediatric surgery, Urology, Dentistry and diagnostic services including – clinical laboratories, radiology, Ultrasonography and gastroscopy.  

Hospitals Performance: During the last year, 8 lakh people gained access to health care through hospital out-patient services. 100,000 people received appropriate health care and treatment through in- patient services. 25,000 women in rural communities had access to safe and adequate hospital-based maternity care services and had safe deliveries. 95% of the hospitals revenue came from contributions from the patients, of which 64% are from In-patient services and 36 % from Outpatient services. Major expenses are towards establishment (42%). Pharmacy and other supplies are 22%. Charity given to the patients is upto 10%, across the organization.

Quality Improvement and NABH: All EHA hospitals focus on improving quality of care by implementing SOPs and trainings. Steps are taken to implement NABH entry-level standards and at least four hospitals will be applying. Clinical & nursing audit are key areas to develop.

Changing Laws and requirements: The Clinical Establishment Act is now being implemented in many hospitals. In the states where this act is implemented, Hospitals have registered and applied for license. EHA is one of the founding members of CCHI (Christian Coalition for Health in India) and contributes to it. 

Partnerships and Networking: Hospitals actively partner with Government programs like JSY, RSBY, NRHM, and SBA training to reach out to most needy communities.

Infrastructure Development: Infrastructure development is a focus area across EHA hospitals. It is a critical component for sustainability, providing quality care, creating reasonably good work-environment, complying with required statutory requirements and for retaining professional staff. Hospitals set aside towards capital investments from their revenue from patient services. Last five years, all hospitals gave high priority for upgrading medical and diagnostic equipment’s, construction of staff quarters, wards, ICU etc. This year, 10 hospitals installed digital x-rays which have improved the quality of imaging services. Across EHA, Rs 5 crores was spent on infrastructure development from local revenue.  However, the capital budget for infrastructure development is around Rs 30 crore. The table below shows the requirement towards capital items for the year 2015-16.

EHA Capital Budget for year 2015-16

~ Dr. Ann Thyle

EHA initiated Palliative care services in April 2010 following extensive planning, training and renovation work at the first site, HBM Hospital Lalitpur. Majority of the patients have cancer, the most common in males being head and ne ck , and in women, br eas t or gynaecological. The services also care for People living with HIV/AIDS (PLHA), neurological deficits, organ failure, and complications of chronic illnesses. At present 8 palliative care services are operational at HBM Hospital Lalitpur (from 2010); Shalom Delhi (from 2011); Broadwell Christian Hospital Fatehpur, GM Priya Hospital Dapegaon, Baptist Christian Hospital Tezpur (from 2012); Prem Sewa Hospital Utraula (from 2013); Christian Hospital Chhatarpur, and Madhipura Christian Hospital (from 2014).

WHOLISTIC CARE PROVIDED BY THE PALLIATIVE TEAMS
Total = 2,104 patients; 1,781 with cancer; 323 non-cancer

NEW PALLIATIVE CARE SERVICES 2015
a. Madhipura Christian Hospital started a palliative care service in Aug 2014 but team
building and training took place in Feb 2015.

b. Chinchipada Christian Hospital is already caring for patients with terminal illnesses but will form a trained team this year.

c. Lakhnadon Christian Hospital has provided wholistic end-of-life care to in-patients and will be forming a trained team this year.


ACCESS TO OPIOIDS IS CRITICAL:
The palliative teams spend most of their time at patient homes. Such comments are common:

“The pain is too great, please help me die.”
“I hear my husband screaming all night.”

One patient in Dapegaon committed suicide because of unbearable pain.

Lalitpur, Fatehpur, Utraula and Tezpur have narcotic licences. Chhatarpur can access opioids from Lalitpur and Dapegaon from Cipla Palliative Unit, Pune

Historic Amendment of the Narcotic Drugs and Psychotropic Substances Act of India
1. A uniform regulation for the whole country, instead of each state having a different one.

2. Only a single license is needed instead of the previous 4-5 licenses, each with a different period of validity.

3. The license will require decision by a single agency - the drug controller of the state - instead of multiple Government agencies.

TRAINING
a. Basic PC Course of Indian Association of Palliative Care held at HBMH, Lalitpur from June 23-27, 2014 for 11 nurses and 3 doctors.

b. A Communications Skills Workshop held from Aug 20-22, 2014 with 20 participants from 7 hospi tal s on the bas ics of
communication skills, breaking bad news, collusion, denial, communicating with difficult patients/ families with resource persons, Drs Chitra and Charu from AIIMS, Kochi.

c. A Research Workshop was held from Nov 25-27 with 13 participants of whom 5 were from other organizations with resource persons from Cairdeas International PC Trust - Drs Mhoira Leng, Chitra, Dan Munday and Gurs Purewal.

d. Link Nurse Training at BCH, Tezpur: a second round of training was done with 9 nurses from different hospital wards.

e. IAPC International Conference, Hyderabad: 7 EHA participants and presentations by Drs Saira Mathew & Ann Thyle.

EVALUATIONS
# External evaluation BCH, Tezpur PC service in Feb 2015 by Drs Mhoira Leng; Chitra V; Dan Munday; Gursaran Purewal and Grace Kabaweza.

# EMMS evaluation of 5 PC services by Drs Dan Munday and Erna Haraldsdottir.

MENTORING VISITS:
Tezpur, BCH, and Dapegaon had overseas mentors visit for 10-14 days, helping with patient care, advice, new ideas and team nurturing. The visits were arranged and supported by Cairdeas International Palliative Care Trust.

FUTURE PLANS:
# Form Palliative Core Group as a ‘think tank’for information sharing and scaling up.

# Expand BCH, Tezpur and Shalom Delhi’s palliative care services.

# Focus on upgrading nurses training nationally & overseas.

# Dr Leejia completes the Cardiff diploma in May 2016 & Dr Jerine starts the course this year.

# Strengthen palliative care services at Chinchipada, Lakhnadon and Raxaul.

# Inclusion of EHA Palliative Care Services into Pallium India Directory.

# Study on Palliative Care as a Poverty Reduction Tool starting July 1, 2015.

All Our Palliative Teams Provide Focussed Wholistic Care –
Striving to Serve,
Stretching to Love.

~Dr. Sydney Thyle

Services and Statistics
11 EHA hospitals provide eye services, either round-the-year or intermittently through hospital based camps by inviting EHA teams or eye surgeons from other organizations. A total of 99,804 outpatients were seen and treated in the 11 locations in the last year.

The hospitals provide both hospital-based out-patients services as well as screening camps services off hospital site. More than 100 screening camps were held in the rural area and a total of 13 operating camps on hospital campus. The main surgery continues to be cataract operations and intra-ocular lens implants (IOLs). The use of IOLs remains high at 99.7% with posterior chamber lens being the major lens implanted. And 4 of the hospitals had a 100% rate of lens implants for their cataract patients.

In addition to hospital services, school screening programmes are carried out and a total of 8184 children were screened.

In the non-surgical area, other than regular out-patients, the hospital in Robertsganj screens patients for glaucoma and diabetic retinopathy.

STATISTICS

New Services
With the appointment of an eye surgeon on staff, a round-the-year eye services was started at Sewa Bhawan Hospital, Jagdeeshpur in Chhattisgarh state from September 2014. Outpatients and operation theatre services have commenced. This area is very poorly served in terms of eye care and it is hoped that with the new surgeon the community will be served better.

At the hospital in Utraula in addition to the use of a new operating microscope a new diabetic and glaucoma clinic was started during the year. Regular distribution of Vit.A was also started.

Optical Shops
Six hospitals now have optical shops including the new one started at Jagdeeshpur. These shops are run by the hospitals staff. This eliminates the patient having to travel long distances to buy prescription glasses.

New Equipment
Jiwan Jyoti Hospital at Robertsganj acquired a new AMO Phacoemulsification machine with their own funds. This will greatly enhance the quality of surgery at the hospital. Prem Sewa Hospital in Utraula acquired a new operating microscope with their own funds. CBM funded equipment include a lensometer, keratometer and applanation tonometer for three hospitals.

~ Mrs. Manjula Deenam & Mr. Vinay John

NURSING EDUCATION:
EHA Nursing schools strive to be an equitable, effective and interactive learning community that makes a difference to education and human development through excellence in teaching, scholarship and service. EHA has invested on educational areas and therefore highly educated faculty is working in all seven nursing schools. Most of them are M.Sc. and Post Basic B.Sc. nurses, bringing 97% results in EHA schools.

NURSING SERVICES:
A Nursing Leaders Workshop was held at Herbertpur Christian Hospital on 1st-5th December 2014 for all Nursing Superintendents, Principals and Vice-Principals. The theme was; "Aligning Nursing Education with Practice - How we can make it Happen". The aim of the workshop was to bridge the gap between nursing education and services. The conference was attended by 19 participants and 9 resource people; throughout the workshop there were lively discussions on all aspects of the topic.

In the clinical area we are focusing on preventive, promotive and curative roles. Various practices have been carried out in the last year for ident i fying the prevalence of various communicable and non-communicable diseases. In-service training program are regularly conducted to upgrade the knowledge of our nursing staff.

RCH (REPRODUCTIVE AND CHILD HEALTH CARE):
Virtually all EHA hospitals provide Ante-Natal care through OPD, Delivery and Post-natal care for mothers and children. In past year, more than 28,000 women underwent deliveries in EHA hospitals. In an attempt to ensure that these women and their babies get the best treatment possible, the Reproductive and Child Health (RCH) unit was established to improve the skills of nurses to provide quality RCH care in spite of the personnel crunch. The RCH unit has been attempting to provide additional training and skills to nurses as they try to cope with the increasing work load. The aim of training the nurses is to strengthen the concept of ‘task shifting’ (nurses working as middle level health care givers providing safe and up to date midwifery care in the absence of an obstetrician) or ‘task sharing’ (where staff work alongside obstetricians).

NEST (NEONATAL SURVIVAL TRAINING PROGRAM):
April 2013, EHA-Canada provided a grant for a project called NeST - neonatal survival training. It is EHA’s effort to reduce neonatal morbidity and mortality in the areas that we serve. In the second year, master trainers were trained in basic and advanced neonatal care in EHA hospitals at Raxaul, Fatehpur, Chhatarpur, Utraula, Makunda, and Champa. After that they are responsible for providing training to all health care givers in neonatal care. As per the proposal we have
completed six master trainer courses from April'14 to March'15. (Approx. 15 doctors and 65 nurses have participated). In the third year 2015-16 master trainers in each hospital will start training other nurses and doctors in their hospital under an expert's supervision.

NURSING EXCHANGE PROGRAM:
An agreement has been signed between the Saskatchewan Institute of Applied Science and Technology (SIAST), the University of Regina (U of R) CANADA and the Emmanuel Hospital Association (EHA) INDIA: 2 Canadian nursing faculty and 8 students will be visiting Herbertpur Christian Hospital for community course in September 2016 for 6 weeks.

DIL SE:
Phase 1 Completed: Dil Se commenced on September 2011 with the orientation of the 2011-2015 batches of nursing students and has rolled out each year of workshop alongside these students. The final workshop for the 19 graduating students was held at Duncan Hospital Raxaul from March 23 - 25, 2015 and focused on preparing the students for their transition to being Staff nurses. Phase 2 Rollout: 3 Schools of Nursing - Duncan Hospital at Raxaul, Christian Hospital, Chhatarpur and Baptist Christian Hospital, Tezpur have signed on to participate in Phase 2 of DilSe commencing with orientation of their 2015 batches in August (Tezpur) and September (Raxaul & Chhatarpur). Around twenty-five Tutors from all three participating schools have now completed the two part training program which has introduced them to the core DilSe modules. In addition they have completed the Introduction to Adult Learning Module and demonstrated their new knowledge by facilitating several modules of Heart and Change in their own context.

LOOKING AHEAD:
# Nurse-patient ratio to be maintained (1:5, 1:3,1:1)
# Reviewing of the nursing standard
# Well established skills lab in all seven nursing schools
# More enrollment for in-house nurse upgradation training program

We thank God for His provision and all EHA units, CHDP, nurses, visiting lecturers, and guests who have helped us. We express our gratitude to donors/sponsors from India and abroad who have faithfully provided support.