India

Telengana/Andhra Pradesh India Report 2015

Tony Males (GP) and Caroline Louis (OT) represented EMMA for a two week trip to Telengana and Andhra Pradesh states from 7^th to 22^nd November. We contributed to two church meetings on Sunday 8^th, teaching in the Sion Disciple Training Centre (SDTC) on 9^th and 10^th, a prayer day on Divali (11^th November) in Hyderabad. Then after an overnight train journey we helped to run “medical camps” on the East Coast from 13^th to 19^th, with a couple of evening meetings and a Sunday service between clinics. 20^th and 21^st November were off duty days.

Local co-ordination was provided again by Pastor Prem Babu of Sion Fellowship Church in Kukatpally, Hyderabad and the team consisted of four students from SDTC, two young leaders from the Bowenpally branch church, four senior leaders from the Kukatpally main church, together with pastors and their families from the villages we visited. Prem’s father-in-law and uncle provided invaluable support by prescribing and dispensing drugs respectively.

The mission field was a rural area on the East Coast with the backdrop of the Eastern Ghat mountains. Two days were spent in villages near Srikakulam and four in the Vizakhapatnam area. We had expected Prem to have recruited doctors and nurses from this area, and apparently a few agreed but pulled out at the last minute. The whole project seemed to have been hastily cobbled together once confirmation of our visas had been communicated to Prem, despite a clear message that our involvement was to be peripheral and supervisory. Therefore Caroline and Tony needed to take on key clinical and leadership roles from the outset, improvising a system for the dispensing of ready-made glasses while medical cases were seen by Prem’s father-in-law, who is not medically trained but has many years of experience as a Government official in the area of public health. The total number of patients seen over seven clinics was estimated to be 1500.

1220 pairs of glasses were purchased wholesale. A total of 393 pairs of glasses were given out on clinic days 1 to 3, and 502 on days 4 to 7. This leaves 325 pairs left in stock for future camps / clinics and are stored at Blessington House in Bowenpally.

In conclusion, the trip was worth making but we are not convinced that Prem and his team took our concerns and feedback seriously, owing to cultural factors and a naïve approach to medical mission. Our recommendation is that EMMA focusses on its projects in Africa and considers new locations, but leaves India to the local churches who should work on identifying and discipling Christian health professionals within their congregations in order to recruit a volunteer workforce for future missions.

Tony Males

November 2015

Telengana Report 2013

Date: 2nd - 16th November 2013

This is the third EMMA mission to India. The Pinninty family spend long periods of time in Nalgonda, East of Hyderabad, where they have recently opened an orphanage. They joined the UK doctors on Sunday 3rd November.

Team members from UK:

Tony Males
Lynda Tempest
Mike Clayton
Nyati Lobo
Sarah Pinninty
Sunda Pinninty
Timothy, Isaac and Ethan Pinninty

Team members from Hyderabad:

Prem Babu
Neelima Babu
Abishek and Rachel
Sravani Reddy
Joseph Bhageerath
Neharika
Hydernagar church youth
Chitibabu
Two nurses
Reddy the driver
Staff of Blessington house, Bowenpally

Team members from Nizamabad District

Samuel and family
Peter and family
Abraham and family
Youth from the various churches

Villages / communities visited:

Manikbandar: Tues 5th
Borgam: Wed 6th
Nandipet: Thurs 7th and Fri 8th
Aloor: Sat 9th
Armoor: Mon 11th
Pragathinagar: Wed 13th
Bowenpally: Thurs 14th
Hydernagar: Fri 15th

Church meetings attended:

Bowenpally: Sun evening 3rd
Manikbandar: Mon evening 4th and Sun 10th
Nandipet: Fri 8th evening and Sun 10th
Hydernagar leaders’ meeting Thurs 14th

Statistics

Approximate numbers (taken from data sheets completed each day):

*not including patients triaged by Tony and Sravani who only needed medication and / or glasses.

Range of pathologies:

Musculoskeletal problems
Refractive errors and cataracts
Anaemia / nutritional deficiencies
Skin problems including a few wounds and ulcers needing dressings
Respiratory infections
Dyspepsia and GORD
Diabetes (mostly known, a few new diagnoses made)
Hypertension (ditto)
Chronic disability (both paediatric and geriatric)

Overall the mission was successful in that the extended team worked well together, understood each other’s roles, attended to both the physical and spiritual aspects of people’s health and only a handful of patients were unhappy with their treatment. The local pastors said that the clinics provided them with an opportunity to connect with new people. There seemed to be visitors to both the Sunday church meetings on Nov 10th and many responded positively to the gospel, especially in Nandipet when about 60 people stood up to say a prayer of commitment.

There was one incident of illness within the team: Mike needed a day at the hotel to recover from a GI upset. There was one gravely ill patient in Armoor, a middle aged man who had had a stroke the night before we arrived and lay all day on the floor of the church. Several team members tried to persuade the family to take him to hospital. Three team members visited a member of the Hydernagar church in intensive care in Hyderabad. Soon after our return to the UK we heard that he had died.

Tony Males

Andhra Pradesh Report 2012

Date: 3rd - 17th March 2012

The Team

GP, Cambridge (team leader)
GP, Newcastle
Emergency physician, Auckland, NZ
Primary care nurse, Margate
Occupational therapist, London

Supported by a general physician from Hyderabad, who joined us for the second week.

Our hosts were the pastors of churches belonging to or in relationship with the Sion Fellowship Ministries network. Students from the Sion Disciple Training Centre in Hyderabad took time out of their course to serve as translators and general helpers. Pastor YS Premkumar Babu (Prem) was the local coordinator, with whom Tony Males has worked on his previous visits.

The “hub” of the mission was Guntur where the team was accommodated in a comfortable hotel. Clinics were mostly held in villages between 10 and 30km from the town, except for one held in a small maternity hospital in Guntur itself and another in a large church building in Ponnur, a smaller town about 50km to the south.

The middle weekend of the mission was spent in coastal Chirala, when the team stayed in a beach resort and enjoyed some rest as well as conducting a Saturday clinic and contributing to a Sunday service.

Ponnur and Chirala

Most clinical days were followed by an evening outreach event held in or just outside a local church. One included performances of solo and group worship songs, and dances by a group of children. The visiting clinician sang and performed dramas at several meetings. Tony gave gospel presentations and there seemed to be responses from between 10 and 30 people each time, although it was hard to tell if these represented conversions or re-commitments from established believers.

Feedback after the mission from Prem indicated that the communities served were very grateful for their treatment and the local pastors were pleased with the raised profile of the churches.

The clinics themselves ran from late morning to early evening. We developed a triage system with Shanti Thumaty using her native Telugu to sort patients into those with optometric, musculoskeletal and medical problems (although many patients presented with more than one problem). There were then sub-waiting areas for the three clinical needs. Tony mainly saw those with visual problems.

Equipment and Drugs

The team members provided their own diagnostic equipment and collected around 1000 unwanted glasses. A similar number of ready-made glasses were purchased in Hyderabad in advance of the mission and drugs were obtained from local wholesalers. Supplies of both were topped up during the mission as needed. We had anticipated basic lab facilities as per the 2011 mission but unfortunately lab technicians were not available. As it turned out, there were no seriously ill patients apart from one girl with suspected typhoid. There were many anaemic women and the one piece of equipment that would have been useful was a haemoglobin level machine for reading capillary blood. We were able however to perform simple near-patient tests such as blood glucose, pregnancy tests and urine analysis.

Common presentations

Eye problems: 1020
Musculoskeletal problems: 452
Gastrointestinal: 163
Anaemia (mostly women of childbearing age): 86
Respiratory :66
Skin, including minor trauma and ulcers: 46
Cardiovascular: 44
Diabetes (only a few as new diagnoses:) 28
ENT: 28
Women’s health: 25

A grand total of 2360 patient encounters were recorded.

Dr Tony Males Team leader 2012

Andhra Pradesh (AP) is a state in South India with a population of around 200 million. It is dominated by the city of Hyderabad which has grown considerably over the last 15 years, incorporating several surrounding districts, one of which is nicknamed Cyberbad for its IT and call centre industries.
The majority of AP residents live in small towns and villages and work as farmers. On the east coast there are also weaving and fishing industries. Crops include rice, lentils, corn, chillies, fruit and vegetables. Many people keep cows, buffalo and goats, mainly for subsistence.
The climate is semi-arid with monsoon rains arriving in mid to late June. The weather has been less predictable in recent years, leading to crop destruction, particularly in the coastal areas. Poverty is the norm and good quality healthcare is beyond the means of most families.
The vast majority of the population are Hindu, with a significant minority of Muslims and a small proportion of Christians. There are long-established denominational churches as well as new churches that developed during the charismatic movement.

The mission was split in two halves: six days of fairly intensive clinical work in three locations in rural areas about 50km west of Hyderabad (days 1 to 6), followed by evening evangelistic events in public open spaces supported by local pastors, musicians and singers.

On the Sunday the team members contributed to two congregational meetings.

The second week was based in the city and involved clinics in “slum” areas for two days and the diagnostic centre for the third day (days 9 to 11)

The team saw about 2000 patients with nearly 2,400 conditions. This is based on written summaries kept by each clinician for each clinic. Some patients were seen by more than one health professional in the same clinic (typically GP and OT). It has not been possible to avoid double-counting in some clinics so the data over-estimates the number of patients to a certain extent.

There were a few specific infections diagnosed (mumps, laryngitis, leprosy and osteomyelitis – one case of each) and a few suspected pulmonary TB patients, but we saw no malaria or typhoid nor did we suspect HIV in anyone who attended the clinic. “Other” includes headache, non-specific or viral illnesses, weakness, dietary problems and illegible or ambiguous entries. The most common presentations were aches and pains attributed to manual work and refractive errors. An optometrist or ophthalmologist would be invaluable on future missions to this area.

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