MEDICAL SERVICE VOL. 40 No. 7 AUGUST-1983
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- MEDICAL SERVICE VOL. 40 No. 7 AUGUST-1983
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COMWC’MTY health celj,
326, V Main, I Block
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India
emotions health and behaviour • the right of wife, children and parents
for maintenance • blood transfusion reactions: role of nursing staff
vol 40
no 7
august 1983
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medical
service
official house journal
of the catholic
hospital association of India
"the love of Christ
urges us" 2 cor 5 : 14
vol 40
editorial board
dr c m francis
dr ravi narayan
dr prem chandran john
dr daleep mukarji
mr augustin veliyath
fr george lobo sj
editor
fr john vattamattom svd
no 7
august 1983
contents
1
editorial
2
2
emotions health and behaviour
5
3
the right of wife, children and parents for
maintenance
12
4
blood transfusion reactions : role of nursing staff
15
5
chai news and notes
21
cover design
p m isaac bangalore
published by the catholic
hospital association of India
c b c i centre, goldakkhana
new delhi-110001
printed at kalpana printing
house new delhi-110016
"Articles and statements published in this journal
do not necessarily reflect the policies and views of
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EDITORIAL
Self-reliance and dependence
Our beloved Father of the Nation, Mahatma Gandhiji, wrote : "Inter
dependence is and ought to be as much ideal of man as self-sufficiency.
Man is a social being. Without interrelation with society he cannot
realise his oneness with the universe or suppress his egotism.
His social
inter-dependence enables him to test his faith and to prove himself on the
If man were so placed or could so place himself as
touchstone of reality.
to be absolutely above all dependence on his fellow-being, he would
become so proud and arrogant, as to be a veritable burden and nuisance to
the world.
Dependence on society teaches him the lesson of humility.
That a man ought to be able to satisfy most of his essential needs himself
is obvious, but it is no less obvious to me that when self-sufficiency is
carried to the length of isolating one-self from society, it almost amounts to
sin.
A man cannot become self-sufficient even in respect of all the various
operations from the growing of cotton to spinning of the yarn.
He has at
some stage or other to take the aid of the members of his family.
And if
one may take help from one's own family, why not from one's neighbours ?
Or otherwise, what is the significance of the great saying "The World is my
Family"? (Young India).
Situation in the world we face today is quite different from what was
visualised by Mahatma Gandhiji.
What we need today is developing of a
healthy inter-dependence at all levels. This is not against self-reliance.
But on the other hand, it leads to self-reliance, if properly understood and
genuinely practised.
Man as a social being needs others and the society.
But this dependance of man on his fellow beings should be in accordance
with a healthy growth process and by maintaining one's own self-respect
and self-determination.
Only a selfless inter-dependence can bring about genuine growth.
Man's selfishness can hamper this growth and that is what actually happens.
If we analyse the situation in the world today, we can easily find that
selfishness may be the root cause of all evils.
Under such situation, a real
inter-dependence at various levels leading to self-reliance becomes difficult.
Hence, at various levels powerful groups try to keep the less powerful ones
depending on them at the cost of the genuine growth and self-reliance of
the less powerful ones.
It is obvious that when Gandhiji spoke of inter
dependence, this is not the type of dependence he visualised.
In the type
of inter-dependence he spoke of, he upholds humility, mutual respect,
mutual assistance, etc., which will lead to the integrated growth of man as
individual and in his community, nation and in the world community at
large.
In the fields of various services too, this genuine inter-dependence
should be maintained whereby, when receiving the services, people can
grow in to self-reliance. If we are not careful, our services can lead to
paternalism, which hampers genuine growth. Self-reliance, therefore,
should lead to inter-dependence and inter-dependence should lead to true
self-reliance and genuine growth whereby the world becomes one family I
Announcement
Workshop on "scientific advances of ovulation method" for government/
corporation employed doctors.
including subsidised travel.
October 21st to 23rd in bangalore.
Free,
For application form and details, apply to :-
"crest"—centre for research
14 High Street
Bangalore 560 005.
Emotions, Health and Behaviour
G.R. Subbaraman
Feelings and emotions are natural. We
enjoy pleasant feelings. Distress feelings
upset us. When we are feeling upset our
brains don't work as well as they do, when
we are feeling good. This is true whether
we have just been hurt or whether we have
just been reminded of a time before, when
we felt bad. Because of this we often do
things that don't make sense, that doesn't
make things better for us or anyone else.
The stored up distress feelings affect our
health, lower our ability for coping with the
environment and develop rigid patterns of
behaviour. This process of damage and loss
caused by the distress experiences can be
reversed and the lost ability can be recove
red. Developing a system for discharging
the distress and regaining the natural zest is
discussed in this paper.
From the moment of birth we experience
feelings and emotions. Some of them are
pleasant and wonderful and some are intense
and frightening. We enjoy the pleasant
ones. They also make others feel good.
Grief, fear and anger make people uncom
fortable. We are told 'don't be sad', 'be
happy,' 'don't get angry,' 'anger will raise
your B.P.,' 'it is not nice to be angry,' 'be
bold,' 'there is no reason to be afraid' and
so on. We learned that while good and
pleasant feelings were accepted, approved
and sought after, distressing feelings were
disapproved and should therefore be avoi
ded. The feelings, however, continued, but
with fewer and fewer ways of expressing
them. Scientists found out that holding the
feelings inside makes people sick and devel
ops rigid patterns of behaviours.
August 1983
Some such emotions produce damaging
tension. They are grief, fear, anger, embarr
assment, boredom and physical distress.
They are universal. Regina Sara Ryan and
John W Travis in their "Wellness Work Book,"
state, "Hurts, anger, fear, deep sadnessthese create an energy which will look for an
outlet somewhere in the body, if it doesn't
get conscious recognition or expression.
Some of those outlets might be :
—a nervous habit such as smoking or
over eating
—driving recklessly
—gritting teeth
—'getting' a sore throat or an asthmatic
attack, a headache
—an extra rush of adrenalin into the
blood stream that makes us feel 'wired
—a stress-related condition such
as
constipation, skin disorder, eye fatigue
or ulcer, or
—building defences, by withdraw! and
depression, to keep us from being hurt
again.*'
According to Harvey Jackins undischarg
ed emotional distress is a kind of glue that
holds together an inappropriate and repetitive
pattern of behaviour like drinking, drugging,
gambling, etc., which the individual seems
unable to control. The individual holds most
of the time chronic feelings such as lonely
and not being loved, helpless and timid,
hopeless and pessimistic, powerless and
dependency and ultimately loses all the
initiative.
5
It is seen that often people with no physi
cal symptoms feel bored, depressed, tense,
anxious and generally unhappy. They
wonder why their lives are not richer and
more satisfying. This emotional state often
sets the stage for physical diseases through
the lowering of the body's resistance. Harvey
Jackins estimates the present day adult man
or woman, who everybody thinks doing 'Just
fine' is operating on only about ten percent
of his or her original resources of intelligence,
ability to enjoy other people. The other
ninety percent of his/her vast potential is
covered by feelings of distress and rigid pat
terns of behaviour.
90% Inhibited
By Distress Feelings
And Rigid Thinking &
Behaviour
Only 10%
Functioning.
Psychologists realise that emotions by
themselves are neither good nor bad, they
simply are. It is important to understand
that they are not amoral. Without them life
will be dull and boring. Any human being
is capable of feeling emotions. Becoming
aware of the feelings, accepting them as
normal and developing healthy ways of ex
pressing them is essential. "Feelings are not
to be felt. If they are good feelings, enjoy
them, but not be guided by them. If they
are bad feelings, feel them and discharge
them, but do not be guided by them. Logic
should always be the guide. Regardless of
how one feels, it should always be possible
to determine the right thing to do and do it"
suggests Harvey in his book "The Human
Situation". The release of emotions calls
for reassessment of values and raises ques
tions that might otherwise have gone
unasked.
6
Inherent
Beings
Characteristics
of. Human
Now the question arises : What are the
natural qualities of human beings ? How do
emotions affect them ? Harvey Jackins in his
theory of human behaviour postulates that
man's essential nature comprises qualities of
intelligence, zestful enjoyment of life, loving,
cooperative relationships with others, curiosity
and communicativeness. Specifically our
basic tendency is, to love ourselves and one
another, to act rationally, to enjoy what we
do, cooperate with one another, explore and
discover more above each other and the
environment and communicate with one an
other. All other human behaviour and feel
ings except this innate characteristics are
acquired and not inherent.
What is Intelligence ?
He defines intelligence as the ability to
create and use new, suitable, responses to
each situation. The intelligence operates by
comparing and contrasting new information
with that already on 'file' from past experi
ences and constructing a response based on
similarities to a past situation but modified
to allow for the differences. Only human
beings have this ability to create and use
brand new, tailored to fit, response that ex
actly match and successfully handle each
new situation. The behaviour of other forms
of life is based on pre-set (instinctive) pat
terns of response. These patterns are fixed
in the heredity of the individual creatures and
are very similar to the patterns of other crea
tures of the same species and the number of
available patterns of responses are few and
finite. This preset, rigid, pattern of behaviour
doesnot cairy high survival value for the
individual. It permits the species to survive
only in association with massive reproduction
rates. The human behaviour is qualitatively
different from the behaviour of other forms
of life.
Medical Service
The essence of rational human behaviour
consists of responding to each instant of
living with a response created afresh at that
moment to precisely fit and handle the situa
tion of that moment as that situation is
defined by the information received through
the senses of the person. During a good and
ordinary experience we continuously receive
great volume of information and this inform
ation is continuously and quickly checked
against the information already on file. Simi
larities are noted, differences are noted. A
response is put together and handed out in
a fraction of a second and the new informa
tion has already been cross-referenced and
understood.
ments like 'when I am angry, I cease to be
man', 'I am so upset, I cannot think' and so
on. These are very accurate observations of
human behaviour in distress because we
cannot think intelligently or clearly, and this
is only the beginning of the loss of intellig
ence. The information input through the
senses during distress is recorded unevaluat
ed and un-understood in fact it is a recording
of what went on during the ‘distress ex
perience.
During good and ordinary experience the
information input is very rapidly checked
against information on file. Similarities and
differences are noted and a fresh appropriate
response is put together. The information
from a good and ordinary experience is 'filed'
What Went Wrong
discretely what computer people might call
If this description (intelligence, zest,
discrete bit storage. One can remember one
loving and co-operative relationship with
item of information from a distress exper
others) of what inherent human is like is true
ience. Besides the sight, sound, etc., re
and valid, then something has gone wrong.
stimulate the old distress recording. A person
The failures to handle the environmental situa in distress or when re-stimulated says things
tion, the terrible feelings which enclose adults
that are not pertinent, does things that are
most of the time, the miserable relationship
not pertinent, does things that are not
that are commonly seen between adults, are
sensible, fails to cope with the situation,
all the results of something gone wrong.
talks foolishly, endures terrible feelings that
What went wrong ? How is our inherent
has nothing to do with the present.
nature often fully or partially obscured ?
This irrational behaviour is quite uhlike
How Emotions Affect
the creative capable behaviour of a clear
thinking person. The brain mis-stores the in
We get hurt physically and emotionally,
formation recorded during distress along with
from very early in life and repeatedly after the negative emotion itself. What is wrong
we meet distresses, indifference, frightening
with a particular person is a unique thing,
events, scoldings, disappointments, obstacles,
the unique result of the unique distress
punishment, ridicule boredom and physical
experience. As a result of repeated exper
hurts like pain, illness, discomfort, hunger,
ience of distresses most people function on
etc. These are experienced as disturbing
a very small percentage of their inherent
emotions such as f^ar, pain, anger, grief,
capacity.
humiliation, embarrassment, shame, etc.
While being hurt our rational intelligence
We have seen how undischarged emotions
affect the health and behaviour. What are
stops functioning. The critical faculty sus
the natural ways of expressing them ? Is it
pends under stress. This in turn slows down
possible to express them without offending
the ability to see things as they are and to
others ? Yes.
find new responses. We often hear state
August 1983
7
The Natural Ways of Expressing
tions
Emo
We are gifted with a natural process of
expressing emotions. This process undoes
the effects of hurts past as well as present
ones. The outward manifestations are very
familiar to all of us and every one of us has
experienced and observed them. A child
after being hurt will cry loudly if permitted to
do so and thereby recover from the hurt very
quickly. After being frightened a child will
scream, and shake and perspire. After being
angered, a yelling, vigorous tantrum will
result. A child given friendly attention after
an embarrassing situation will talk and laugh
about the experience spontaneously until the
embarrassment is dissipated. The expression
of emotions takes place by one or more sets
of physical processes, such as crying or
sobbing, trembling with cold perspiration,
laughter, angry, shouting and violent move
ments (tantrum), with warm perspiration,
interested
non—repetitive
talking and
yawning
often
with
scratching
and
stretching. These are the ways by which
human beings release tensions. Harvey
Jackins termed them 'discharge'.
During discharge the residue of distress
experiences is being recalled and reviewed
(not necessarily with awareness). Rational
evaluation and understanding of the inform
ation received during the distress experience
occurs spontaneously following discharge.
It occurs only to the degree that discharge
is completed. On completion, the negative
anti-rational effects of the distress experien
ces are totally eliminated.
What Keeps
Operating?
The
Discharge Process
There is a fundamental mistake in our
interpretation of these dischajges. Tears are
mistaken for grief, trembling for terror, angry
shouting for anger, etc.
Crying never
8
occurs unless a person needs to cry because
tears free oneself from grief. Similarly,
trembling and cold perspiration releases one
self from terror, angry shouting from anger;
laughter from irritations. In early childhood
all of us were discharging in the spontaneous
ways. Immediately after the distress exper
ience or at the first opportunity thereafter a
distressed person would normally seek the
attention of another human. If he is success
ful, the process of discharge occurs. Unfor
tunately the sound of crying stimulates the
distress of the other and this interrupts the
discharge. In early life children are told
'shut up', 'be a good boy', 'are you a girl',
'don't be a coward'etc. 7hereby unawarely
interrupted the natural healing process. Cul
tural and social organisations also play a part.
In many cultures the expression of grief and
fear by males is strongly discouraged, but
there is a tolerance of expression of anger
and laughter. The customs for females are
quite different. The expression of anger is
severely punished, laughter is suppressed,
but expression of fear and grief are
appreciated.
As we experience frequent external in
terruptions of discharge, we learn to interrupt
them ourselves to avoid the unpleasant reac
tions from others. Repeated attempts of
controlling discharge virtually become auto
matic. We become conditioned to limit or
extinguish discharge entirely so that this self
induced interruption
of expressions of
emotion becomes a pattern.
Now we have learned that suppressing
emotions, judging or repressing them, or
running away can only be harmful to a
person. So we look for suitable and accept
able means to discharge them. For discharge
to occur one needs attention of another
human being. It is our nature to release our
tension, to turn to another person so to
release hurts from our system. Every day.
Medical Service
everyone of us, in some way or other, tries
to reach out to find a listener to be listened
to. We are seldom listened to because of
the international pressure of the other to talk
himself or our distressing events re-stimulate
the other and is likely to break in.
Co-Counselling
Remarkable changes can take place in a
person who is being listened to. It is prefer
able that two people agree to take turns to
listen to each other. 'Yes, I will listen to
you and really pay attention to you for a
while, if you in turn, will do the same thing
for me'. This taking turns is called co
counselling. Here the word counselling does
not mean giving advice but means basically
listening and paying attention. Two people
take turns counselling and being counselled
sharing equal time. The one acting as a
counsellor listens, pays attention, draws the
other out, permits, encourages and assists
emotional discharge. The other acting as a
client discharges without fear of being judged,
without worrying of what is being said is
taken for granted and becomes free of the
rigid patterns of tension and behaviour.
Balance of Attention
Discharge takes place only when the
client's attention is balanced between the
past distress and the present time. If the
client is engulfed in the past distress, he will
become so involved that he is unable to dis
charge it. To ensure this balance the co
unsellor gives his total attention and
encourages the client to give him at least a
part of his attention too.
Creating Safety
A feeling of safety is promoted by the
correct attitude of the counsellor. He should
always hold positive attitude about the loving,
zestful, intelligent, co-operative nature of
August 1983
people. A counsellor .‘with this attitude
takes very different course of action than one
with negative attitude. He draws a clear
distinction between the person as being
basically good and wholesome and the dis
tress pattern, which shows him in a bad light
but which is actually a foreign element like
a parasite in his personality. By making this
distinction one avoids the common mistake
of being critical and negative. The counsell
or must consistently and openly appreciate
the positive traits of the client and helps the
client to maintain a similar attitude towards
himself. Such an attitude gives self-confid
ence and encourages the client to move in a
positive direction and contradicts self-dis**
paraging statements. The counsellors should
avoid interpretation, advice, comparison or
suggestion regarding the problems of the
client. Solutions are no good, unless the
client has worked them out himself. The
counsellor maintains a warm accepting at
titude towards the client, a genuine interest
and relaxed concern. Whatever is shared
by the client is absolitely confidential and
should never be talked out.
Overcoming Control Patterns
Sometimes the lack of discharge may be
due to control patterns. From our earliest
years, we are admonished to stop crying,
screaming, shaking, raging, etc. As a result
we have learned to control the discharge. A
client may hook his feet tightly, grip the arm
of the chair, bite the nails, etc. The counsell
or should insist on that person to uncross his
feet, swing the arm in a relaxed manner or
contradict the distress with proud posture;
discharge will begin as rigid controls are
interrupted.
Goals of the counsellor
The goal of the counsellor is that of free
ing the client from his distress. The only
effective means of doing so is by helping the
9
client to discharge the painful emotions or
Re-evaluation
tensions.
With the discharge of emotional feelings,
information and cognitive process associat
The first and the most important thing for
ed with the distressing event return to awar
the counsellor to do is to listen. Listen with
eness. The distressing feelings and the
full attention and interest. This will encour
age and enable the client to talk about him information contained therein are reassessed
self, about his patterns of distress. He may and re-evaluated. Therefore it is called re
evaluating co-counselling. The discharge
relate them in terms of difficulties or exper
iences that occurred to him. The counsellor results in increased rationality, freer attention,
may at times direct the client's attention to alertness, openness to new experiences,
insight and behaviour change. The indivi
the distress when the discharge slows down
dual exercises greater dominance over feel
or stops. The counsellor can give his full
attention to the client only when he himself ings and behaviour. With frequent discharges
on different distresses, he enjoys the freedom
gets counselling and discharging. Otherwise
the counsellor will often be re-stimulated by to experience a rich variety of alternatives
the client's distress and his attention is and makes the most rational choice among
them. Each gain in rationality is a gain in
interrupted.
HUMAN BEINGS
LOVING
CO-OPERATIVE
ZESTFUL
INTELLIGENT
NOT
HURT
CO COUNSELING
DISCHARGE
10
<
•BALANCE OF ATTENTION
■SAFETY
•ABSENCE OF CONTROL
■PATTERNS
FREE
ATTET ION
Medical Service
the enjoyment of living. Relationship with
other people becomes enjoyable and repro
ductive.
Any two persons can team up together to
help each other in freeing from the distress
feeling and rigid patterns of behaviour left
by hurt experiences of the past. We c an
also integrate this Re-evaluation Counselling
process, in our personal, family and work
situations and exchange effective assistance.
3.
Bernard J Somers 'Re-evaluation
Therapy: Theoretical frame work'.
The Journal of Humanistic Psych ology, 1972 (1) Spring issue.
4.
Thomas J Scheff 'Re-evaluation Co
unselling : Social Implications'. The
Journal of Humanistic Psychology.
12, Spring 1972.
5.
Jackings, Harvey 'The Human Situa
tion', Rational Island Publishers,
Seattle, U.S.A, 1965.
6.
Jackins, Harvey 'Fundamentals of
Co-counselling Manual', Rational Is
land Publishers, Seattle, USA.
7.
Jackins, Harvey, 'The Benign Reality',
Rational Island Publishers, Seattle,
USA, 1981.
REFERENCES
1.
Regina Sara Ryan and John W. Travis
'Wellness Work Book' Ten Speed
Press, P.O. Box 7123, Berkely, Cal
ifornia, 1981.
2.
Jackins, Harvey 'The Human Side of
Human Beings', Rational Island Pu
blishers, Seattle, U.S.A, 1964.
Question Box
When problems are mounting every day, it is not possible to deal with all of them in a
magazine like ours. However, there may be cases in which one would like to get some
help and guidance quicker and even personally. With this in view, we have introduced
a Question Box in our magazine. Your questions and doubts on health matters can be
sent to this question box and you will get an answer directly or through the column
of Medical Service as early as possible. A panel of doctors will deal with the ques
tions, and answer will be given accordingly. Please clear your doubts through this
question box.
Please write to:
Question Box, Medical Service
c/6 Dr. Paul Neelamkavil
Dept, of Dermatology
St. John's Medical College
Bangalore 560 034.
August 1983
11
LEGAL EDUCATION—2
THE RIGHT OF WIFE, CHILDREN AND PARENTS FOR MAINTENANCE
P.D. Mathew
The Right of Maintenance
Chapter IX of the Code of Criminal
Procedure 1973 (i.e. Sections 125 to 128)
deals with the order of a Judicial Magistrate
for maintenance of wife, children and
parents, who are wilfully neglected by the
husband, father or sons. Section 125
confers a statutory right of maintenance to
wife, children and parents and imposes a
legal obligation on husband, father or sons.
This right was formerly enforced through a
civil suit in a Civil Court. Now it can be
enforced through an application for main
tenance in a Criminal Court. The rights
conferred by these Sections are statutory
rights independent of and uncontrolled by
the personal law of the party. These Sections
provide a quick remedy for neglecting and
refusing to maintain dependent wife, children
and parents, who do not have sufficient
means to maintain themselves.
Provisions of Section 125
1. Any person having sufficient means
has a legal obligation to maintain :
a.
his wife, unable to maintain herself,
or
b.
his legitimate or illegitimate minor
child, whether married or not, unable
to maintain itself, or
c.
his legitimate or illegitimate child
(not being a married daughter) who
has attained majority, where such
child is, by reason of any physical or
mental abnormality or injury unable
to maintain itself, or
his father or mother unable to main
tain himself or herself.
d.
12
2 . The Magistrate of the first class can
order such a person to maintain his wife,
children or parents and to make a monthly
allowance for their maintenance.
3. The monthly rate of maintenance
allowance ordered by the Magistrate must
not exceed Rs. 500 on the whole.
4. The Magistrate must satisfy himself
of such neglect or refusal by collecting
adequate proof through court proceedings.
5. The Magistrate may order the father
of a minor child referred to in clause 1 (b), to
make such an allowance until she attains her
majority, if he is satisfied that-the husband
of such a female child does not have suffi
cient means to support her.
From what date such allowance to be
paid ?
Maintenance allowance may be payable
from the date of the order, or if so ordered,
from the date of the application for main
tenance.
Explanation
1.
Sufficient Means : The term means
sufficient property or definite employ
ment, and includes a capacity to
earn money. An unemployed able
bodied man who is suffering from no
infirmity is presumed to have suffi
cient means to support his family.
2.
Neglect or refuse to maintain : It
may be expressed or implied. The
court may infer neglect from the
conduct of the person. The neglect
or refusal must be present. A mere
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offer to maintain in the future is not
sufficient.
3.
Maintenance: It means food, clo
thing and lodging and expenditure
for the education of the child.
4.
Wife: To justify an order under
this action the applicant must be the
legal wife.
A concubine or a
mistress is not entitled to mainte
nance.
5.
6.
Child: The word 'Child' in Section
125 is used with reference to the
father. There is no qualification or
age; the only qualification is that the
child must be unable to maintain
itself.
Unable to maintain itself: It means
unable to earn complete livelihood
for itself without depending on any
other person.
What is the nature of the Order ?
* The order must be for a monthly
payment in money only.
* It can be against the husband, father
and sons only.
* The order can be issued to the husband
or father or sons only if they have
sufficient means to pay the amount.
* The rate of the sums awarded must be
a fixed amount, but it can be altered
from time to time by the Magistrate.
* The maximum maintenance allowance
that can be awarded is Rs. 500/- only.
Justifying grounds of wife's refusal to
live with her husband.
Adultery, cruelty, apostacy, a second
marriage of a Christian or a Hindu husband
with another wife and irremediable breach
between the husband and the wife are good
grounds for the wife's refusal to live with
her husband. If she leaves her husband's
August 1983
house without a justifying cause, she is not
entitled to the relief.
Order when not made or cancelled
A wife shall not be entitled to mainte
nance in 3 cases, viz :
1.
If she is living in adultery, or
2.
If she refuses to live with her husband
without sufficient cause, or
3.
If they are living
mutual consent
separately by
* On proof of any of the above three
grounds, the order will be cancelled by
the Magistrate.
* The above cases serve as a defence for
the husband, if his wife proceeds
against him for maintenance.
* Section 127 also provides for the
cancellation of the order where it
appears to the Magistrate that, in
consequence of any decision of a
Civil Court, his own order should be
cancelled.
When can the order be altered ?
The Magistrate may alter the allowance
if circumstances of either party change,
provided the monthly rate of Rs. 500/- is not
exceeded (Section 127).
What is the durability of the Order ?
The order remains in force until it is
either modified or cancelled. The mere fact
that the wife has returned to live with her
husband does not nullify the order automa
tically, and on her separation she can again
enforce the order.
In which court should such proceedings
be instituted ?
Proceedings under this Section may be
instituted against any person in any district—
13
a.
b.
c.
where he is, or
where he or his wife resides, or
where he last resided with his wife or
mother of the illegitimate child.
♦ If he has a permanent residence, the
Magistrate of that place has jurisdic
tion.
* If the parties have no fixed place of
residence, the Magistrate within whose
jurisdiction they last resided (even
though temporarily) has jurisdiction.
Evidence and procedure (Section 126)
* All evidence in maintenance proceed
ings shall be taken in the presence of
the husband of the woman or the
father of the child and his pleader and
recorded as in a summons case.
♦ If the respondent (the husband or the
father) wilfully avoids service or
wilfully neglects to attend the Court,
the Magistrate may hear and determine
the case ex parte (in the absence of
the opposite party). Any order made
ex parte may be set aside, for good
cause shown on application within 3
months from the date of the order.
* The Court may also make an order as
to the costs.
* An application for maintenance is not a
'complaint' but a 'petition.'
* Since refusal to maintain is not a
criminal offence, maintenance proceed
ings are not a trial of offences. So
the husband or the father is not con
sidered an accused but a respondent.
* The respondent may offer himself as a
witness and give evidence on his
behalf.
* The proceedings resemble very much a
civil suit in nature.
Is there any appeal against the Order ?
There is no right of appeal from an order
passed under Section 125. The aggrieved
party may move the higher court in revision.
The higher court has jurisdiction to set
14
aside or modify the Magistrate's order in
revision.
How is the order enforced ?
The Magistrate may (if the person so
ordered fails without sufficient cause to
comply with the order) for every breach :
a. issue a warrant for levying the
amount due (in the same way as in
levying fines) and
b. sentence the offender to imprison
ment for not more than one month
for the whole or any of each month's
allowance remaining unpaid after the
execution of the warrant.
* A Warrant will not be issued for reco
very of an amount due for maintenance
unless application is made to the
Court within one year from date when
it became due.
* A copy of the order of maintenance
must be given free to the applicant and
it may be enforced by any Magistrate
in any place where the respondent
resides.
Civil Suit
The wife or a child or parents have
another remedy to secure maintenance. It
is a suit in a Civil Court, in which a decree
may be obtained for an amount commen
surate with the status and means of the
party liable.
Even the arrears of past
maintenance can be recovered in the suit.
An order passed under Section 125 is no
bar to a suit for maintenance in a Civil Court.
A decree for maintenance passed by a Civil
Court which cannot be enforced on account
of insolvency of the husband, is no bar to
proceedings under this Section.
For Further Information in Legal Matters
Contact:
Director, Legal Aid
Indian Social Institute
Lodi Road, New Delhi 110003
Tel. 622379, 624760
Gram : INSOCIN
Medical Service
Blood Transfusion Reactions
Role of Nursing Staff
— Miss Amrit Varsha,
With the advance in the management of
various medical problems , either surgically
or medically, the transfusion of blood has
acquired a greater importance in our country
and the world as a whole.
According to various surveys conducted,
two per cent of all blood transfusions are
accompanied by
unfavourable reactions.
Recently, we have observed haemolytic
jaundice in many patients after blood trans
fusions in postoperative period. In two
patients, it proved to be a fatal outcome in
the surgical ward. This has prompted to
study the various blood transfusion reactions
in detail and give a comprehensive account
of each.
The main complications from blood tran
sfusions are: A. Haemolytic reaction. B.
Allergic reactions C. Bacterial reactions. D.
Febrile reaction. E. Circulatory overload
F. Embolism. G. Transfusion of infectious
agents, hepatitis, malaria and syphilis.
Dr. R.S. Dahiya
vital organs.
failure.
It may ultimately lead to renal
Prevention
1. Evaluation of the potential donor
should be done properly. He should be
free of colds, allergies, hepatitis and
syphilis. 2. There should be proper check
on the patient and the blood product.
3* There should be a double check of all
the blood products with another nurse or
health personnel. 4. The intravenous tubing
must be flushed with isotonic solution before
and after the blood is administered. 5.
After starting blood transfusion, remain there
with the patient for 15 mts. The severe
reactions due to blood transfusion tend to
begin soon after initiation of blood transfu
sion. 6. The infusion should be started at
a slow rate to begin with. 7. The patient
should be encouraged to call in case even
unusual feelings or symptoms occur.
Signs and Symptoms
A.
Haemolytic Transfusion Reaction:
It is one of the most severe complications
of blood transfusion therapy, cause being
donor-recipient ABO incompatibility. The
cause may also be Rh incompatility, but it is
not so severe. Factors which may contri
bute for this are: 1. Improper storage of
blood. 2. Faulty blood transfusion procedu
res.
When a haemolytic reaction occurs, the
agglutinated cells, after the reaction of anti
gen and antibodies in recipient plasma and
donor cells, block the capillaries, thus
resulting in obstruction to blood flow to the
August 1983
1. The onset will be immediate. 2.
Patient will have facial flushing. 3. Will
report burning sensation along the vein. 4.
Patient will have fever with rigours and
chills. Temperature may be 105 degree or
more. 5. Rapid and laboured respiration
will be complained of by the patient. 6.
Patient will complain of chest pain. 7. low
back pain. 8. Headache may also ensue. 9.
Ultimately the patient will go in shock.
Intervention by a Staff Nurse'. The tran
sfusion should be immediately stopped. 2.
Recheck blood slip with unit of blood and
patient to determine if there is any error
15
made. 3. Inform the doctor on duty. 4.
Treat shock if present by giving nasal
oxygen, fluids and epinephrine as ordered by
the doctor. 5. Obtain two blood samples
from a vein which is at a distance from the
site of infusion. One samble is sent to the
blood bank along with the bottle of the
blood transfused and other may be centrifused (Pink plasma indicates haemolysis).
6. Obtain first voided urine to test for
haemoglobinuria. If it is present, the speci
men may be red or black. 7. When renal
involvement is suspected, then prompt
treatment with mannitol is initiated so that
diuresis is there to avoid renal tubular
damage. 8. The fluid balance should be
monitored.
B. Allergic Reactions'. Allergic reacti
ons are thought to be related to the presence
of substance that are capable of interacting
with antibodies present in the donor or
recipient blood plasma.
Prevention
1. Health history is important to be
asked before the blood is transfused. It is
important to elicit information about any
previous transfusions and more specifically
about any allergic reaction to transferred
blood. 2. Administer antihistamine, e.g.,
Inj. Avil 15-20 minutes before starting
the infusion.
Signs and Symptoms: 1. Dyspnoea, 2.
Urticaria, 8. Facial and/or glottal edema,
4. Asthma,
5. Pulmonary edema 6.
Anaphylaxis.
Nursing Intervention: 1. Stop transfu
sion immediately. 2. Inform the doctor on
duty. 3. Treat the life threatening reacti
ons (edema and anaphylaxis). 4. Administer
antihistaminics parentrally. 5. Administer
corticosteroids parentrally.
August 1983
C. Febrile Reactions: These reactions
occur more frequently when equipment is
reused, e.g. glass collection bottles, tubings,
etc. The toxic substances in blood tub
ings and bacterial proteins are among the
offending agents. Now with the invention
of disposable equipment, this possibility is
rare. However, febrile reactions do occur.
The <explanation for this seems to be the
presence of antibodies directed against
leucocytes. Another explanation in develo
ping countries may be ill-equipped hospi
tals and ignorant paramedical staff.
Prevention: 1. The patient should be infor
med during transfusion about this. 2. Admi
nister antipyretics to persons who are known
to have this reaction. 3. Transfusion with
frozen washed packed cells may prevent this
reaction. 4. See that the disposable, prop
erly sterilised equipment is being used for
transfusion.
Signs and Symptoms: Febrile reactions
are characterized by : 1. Chills and fever that
occurs an hour or more after the transfusion.
2. Headache, tachycardia and {general disco
mfort may be present. 3. These symptoms
may persist for 8-10 hours.
Nursing Intervention: 1. Discontinue
the infusion of blood and notify tne physi
cian immediately. 2. The blood should be
senk back to laboratory for re-examination
for type and cross match as well as culture
and sensitivity. 3. Treat the febrile reaction
manifestations symptomatically.
D. Bacterial Reactions: These
are
caused by the transfusion of contaminated
blood products and may prove fatal if not
treated at once. The organisms which are
commonly responsible for such type of
reactions are:
Pseudomonas, Coliform,
Achromobacteria.
These bacteria liberate endotoxins. These
reactions are very rare otherwise.
17
Prevention: 1. Asceptic collection tech
nique should pe used. 2. Change transfusian
equipment frequently. 3. Do not keep the bl
ood at room temperature unnecessarily. 4. Do
not use blood that has been heated to above
room temperature. 5. Do not prewarm
infusions. 6. See for any haemolysis in the
blood to be transfused.
Intervention by a Staff Nurse: 1. Stop
or slow transfusion, depending on severity of
s^irplos. 2* Prop up the patient. 3. Vital
signs are to be monitored. 4. Administer
diuretics as ordered.
F. Air Embolism’. The incidence of air
embolism has been reduced by the use of
plastic bags, but air may be introduced if the
tubing is changed during the transfusion.
Shock and cardiac arrest may ensue.
Sign and Symptoms: There will be
fever. 2. Hypertension which is very severe.
3. Pain in abdomen and peripheral parts of
Prevention: 1. Avoid air into the infus
body. 4. Dry, flushed skin, 5. Vomitting.
ion system; 2. If air is introduced, stop the
Bloody diarrhoea may be there.
infusion.
Intervention by Staff Nurse: Stop
transfusion immediately and inform the doc
tor concerned if available. 2. Start broad
spectrum antibiotics as directed immedi
ately by the most rapid mode of administr
ation. 3. Treat the bacteraemic shock. 4.
Maintain the vital signs, fluid and electrolyte
balance.
E. Circulatory Overload:
Circulatory
overload occurs?[when the blood or packed
cells are administered too rapidly for the
individual's cardiovascular system to respond
to the additional volume.
Prevention: 1. The packed cells should be
given to persons susceptible to circulatory
over load, e.g. infants, elderly patients with
cardiac or respiratory diseases. 2. There
should be slow infusion with the patients in
a sitting position. 3. J.V.P. and C.V.P. must
be monitored.
Signs & symptoms: 1. Tightness in
chest. 2. Laboured breathing. 3. Dry cough.
4. Crepts at the base of lungs. 5* Pulmonary
oedema. 6. Tachycardia.
August 1983
Signs and Symptoms: 1. Dyspnoea. 2.
Cyanosis. 3* Shock. 4. Cardiac arrest.
Intervention of Nursing Staff: 1. Lower
the head of the patient and turn the patient
on left side. The air will collect in the righht
atrium where it can be gradually released to
the lungs. 2. Treat shock. 3. Treat cardiac
arrest if it occurs.
Follow-up of the Cases
1. The nurse should advise the patient
who has experienced a transfusion reaction
to relate this information to other nurses and
physicians. 2. Measures to maintain a posi
tive state of health should be taught to the
patient who has a chronic disorder which
requires periodic transfusion. 3. The patient
should be advised to keep a neutral or written
record of this and any other transfusion rea
ction. 4. It is also important to teach pati
ents their blood groups and Rh types so that
they too can be observant and knowledgeable
during any future transfusions.
—courtesy The Nursing Journal of India
19
CHAI
NEWS
NOTES
Kerala Social Service Forum and CHA-Kerala Unit
Inauguration of the Office
May 9, 1983
The long cherished idea of having a perma will be given by the Kerala State Housing
nent Centre for the Kerala Social Service Forum Board.
was realized on May 9, 1983, when Rev. Fr.
The group decided to study the project
P. Remigius, Executive Director, Caritas, India,
further. At the same time it was proposed
lighted the traditional Oil Lamp to inaugurate
to take up the construction of 15000 houses
the office of the Forum at Sivarama Menon
all over Kerala for the economically weaker
Road, Pachalam, in Cochin City, Kerala. Rt.
sections in collaboration with the Govt. The
Rev. Msgr. Peter Chenaparambil, Diocesan
group authorised the Executive Secretary to
Director for Social Action and Bishop-elect
prepare a project to Caritas India, with the
of Alleppey, blessed the building. The Most
hope of getting a subsidy of Rs. 1000/—per
Rev. Benedict Mar Gregorios is the Chairman
house. Rev. Fr P. Remigius, the Executive
of the Forum. Fr. Remigius in his Inaugural
Director, Caritas, India, who was present at
address explained the real meaning of
the meeting, promised all possible help for this
"Development". He stressed the need for
joint planning and action in the field of joint venture of the Forum.
development.
The Office of the Catholic Hospital As
sociation of India—Kerala Unit also will
function in this new building.
A business meeting was presided over by
Rt. Rev. Msgr. Peter Chenaparambil. The
members of the Forum discussed ways and
means to co-operate with the subsidised and
aided self-help rural housing scheme for the
economically weaker sections in the rural
areas, Sponsored jointly by the Govt, of
Kerala, the HUDCO, New Delhi, the Kerala
State Housing Board and Voluntary Agencies.
The proposed housing project envisages the
construction of one lakh houses, each costing
about Rs. 6000/—by the beneficiaries them
selves, in sites owned by them, using lowcost methods with locally available building
materials. Technical guidance and assistance
August 1983
Hospital Sunday Celebration 1983more reports
Catholic Mission Hospital, Kalunga,
Orissa: The celebration commenced with
solemn Holy Mass by His Lordship Bishop
Alphonse Bilung, SVD. There was a large
gathering of people from the villages and
also patients present on the occasion. In his
Homily, His Lordship mentioned a few words
about the celebration of Hospital Day and the
theme 'Respect Life. After the Holy Mass,
refreshments and sweets were distributed to
the patients. The last item was a good film
show which all people enjoyed.
St Xavier's Hospital Vinokonda, NirmaIana gar. Guntur Dist., A.P. : The day was
initiated with a High Mass. The celebrant
based His Homily on the healing mission of
21
Christ the Eternal Physician. Fr. Sathyanandam gave an inspiring speech, elucidating the
value of the gift of life and how an agent of
destruction of this precious gift, causes havoc
in human life. Dr. Devaiah spoke on how
to protect life through proper health care. Sr.
Ignatius brought out the value of human life
and the role of the mother in the protection
and growth of life. It was a day of inspiring,
instructive and enriching experience for one
and all.
The Indian Lamp was lit to inaugurate the
function with a small liturgical service. There
was a drama depicting the importance of the
hospital day celebrations. The main message
was 'Respect for Life'. The importance of
not making any difference between male
children and female children as well as the
evils of abortion was impressed on all who
were present.
Good Shepherd Health Education Centre.
Coimbatore : As it was a small dispensary,
St. Joseph's Hospital, NelIore, A.P : The
celebrations commenced with a special prayer the Hospital Sunday was celebrated in a
humble way. People from the village and
service in which all the hospital staff and
patients participated and offered prayers of the parishioners were invited. After the Mass,
all assembled in front of the Good Sheperd
praise and thanksgiving and invoked God's
Statue. There was a prayer song followed
blessings on the suffering and the sick. This
by selected readings from the Bible. Then a
impressed the people very much. The import
passage on the evils of abortion was read
ance of the day was made known to all the
which appealed to and enlightened the people
patients and the hospital staff were instructed
on the necessity of re-dedicating themselves who were present. Sweets were distributed
at the end of prayer meeting.
to the cause of the healing ministry which
takes its origin from Jesus Christ, our Divine
St. Mary's Dispensary. Manavanallur, ThanPhysician. The whole staff was imbued with
javur,
Tamil Nadu: There was a good respon
renewed vigour, enthusiasm and energy for
serving the suffering to the best of tffeir se for the celebration of the Hospital Sunday.
Sr. Mary gave a talk about the moral, spiritual,
ability. In the evening, a Holy Mass was
physical and psychological evils of abortion.
celebrated in the hospital premises with
With forceful examples of harm, evil and
selected reading for the occasion. All the
death suffered by people in surrounding
patients, staff and guests participated in the
areas who resorted to abortion. The people
Holy Mass and were privilleged to be filled
with the spirit of the Lord. An apt homily in this area live close to nature.and nature's
was preached by the celebrant and many way and do not go in for abortions despite
inducements. Euthanasia is not heard of at
people present were fortunate to hear the
all and no one has recourse to this.
word of God for the first time in their life.
March 27 was set apart as a day of free
service to all the deserved patients who came
to OPD. Medicines were also given free of
cost. About 200 deserved old persons were
given free meals which was very much
appreciated.
St. Joseph's Health Centre, Lourdepuram,
Trivandrum : All the inpatients and MCH
mothers were also invited for the celebrations.
22
Our Lady of Health Dispensary, Pudukkottai. Dist.: The celebrations started in the
morning with the Holy Mass and all the
prayers and Hymns were concentrated and
prepared around the theme '.'Respect Life".
In addition to fancy games which were enjoy
ed by all the people, an exhibition was
arranged on the topic "DO YOU KNOW"
explaining to the people the various stages
Medical Service
of human growth from conception by means
of posters and drawings. To many of those
who were ignorant it was a revelation and
they were astonished by the new knowledge
they got.
In the evening there was a public meeting
which started with a beautiful prayer song.
There were some special items which were
exclusive for Tamil culture such as Kummiyadi and Villuppattu. A small skit on
'ABORTION IS A MURDER' was also staged;
it was a bit jovial but at the same time it
made the people to think a little.
Mr. Chandrasekar who presided over the
function then delivered his speech. He ex
plained how we in India give less importance
to human life and give more importance to
things unlike in other countries. After the
speech, prizes were distributed and the
celebrations concluded with a film show.
Community health worker's train
ing, a new vision of the Diocese
of Dumka
Introduction
This report is about a simple and signific
ant event that has recently taken place in our
diocese. The first session of the Community
Health Worker's Training Programme was
held at St. Joseph's Convent, Cilimpur, from
13t4 to 26th March.
This training course is, in many ways, a
point of arrival, the result of a long process
of evaluation, rethinking and reorientation of
the diocesan health apostolate.
The present situation
The medical field has always been given
priority among the various forms of charitable
works, and much time, energy, finance and
sacrifice have gone into the effort of looking
August 1983
after the sick and bringing relief to the suffer
ing. Most of this work was done on an indivi
dual basis, each congregation running its own
dispensary with often just one Sister-Nurse as
suming total responsibility. But returns have
been too poor for the resources invested. True
enough, many persons have been treated,
and individuals—heads of families and
mothers—are alive and looking after children
who otherwise would have been left orphan
ed. Most of us cherish touching incidents
of lives saved by our timely intervention and
God's grace. All this is good and we are
thankful for it.
But the impact made so far on the health
level of the people in general is negligible.
We have no precise data or statistics to help
us in our evaluation. But we know that in
fant mortality rate and maternal mortality rate
are still far too high and the incidence of
communicable diseases like TB and leprosy
have hardly been affected. A supply of safe
drinking water is still a dream for many, and
the idea of using latrines to improve environ
mental sanitation and prevent disease has
still to dawn.
Our people are ignorant of the real causes
of disease, and,seek help from traditional
healers whose main concern is that of making
money. They put up with sicknesses that
could be relieved with simple inexpensive
remedies, and go for professional treatment
only 'in extremis' and often when it is too
late. In short they have still to be awakened
to the fact that health for all is a,right which
can be achieved if we all work for it together.
Preparatory activities
In August, 1979, at the invitation of our
Bishop, Telesphore Toppo, a team of two
consultants from VHAI spent a few days in
the diocese to assess the health facilities of
the area, analyse the actual situation and help
23
the diocese in further plans of health pro
grammes. This study, made by Dr. K. Cherian
and Ms. Simone Liegeois, was followed by a
seminar for the Health Personnel of the
Diocese, held at Cilimpur, where the report
was discussed.
In September, 1981, another meeting of
the Health Personnel was held at Bishop's
House, to find ways of involving village
people in preventive and promotive health
care. The subject of Community Health Care
was brought up again at the Development
Orientation and Motivation Seminar held at
Jisu Jaher in April 1982. And in September,
1982, a team from CHAI, Sr. Marina and
Miss Lovely, conducted a seminar for Health
Personnel at the Social Development Centre,
Dudhani.
During this seminar, the diocesan approach
to health care, and the Community Health
Programme were presented to the participants
and a Diocesan Health Animation Team
was formed. The decision was taken
to divide the Diocese into five Health
ones with Centres at Guhiajori, Cilimpur,
Sohorgati, Jamtara and Mariampahar, and to
train village women as Community Health
Workers to be placed under the supervision
and co-ordination of their respective Health
Care Centres.
The Trainees
The selection of women for training was
entrusted to the parish priests and Sisters
who had most contact with the villagers. The
number of participants was to be limited to
30; so each parish was asked to send 3
women. It was thought preferable to choose
them from those villages'where conscientisation, primary education and other programmes
for development were already in progress,
so that health could take its proper place in
the plan for integrated development. Other
criteria given for selection were that the
August 1983
women should be married, with children over
the toddler stage, of good reputation and
acceptable to the village community.
And so, on Sunday 13th March we found
ourselves welcoming a miscellaneous group
of women, 25 in all (4 of them from a neigh
bouring diocese), ranging in age from 20 to
50, all married except one. Two of them had
brought their youngest child with them as
they could not leave them alone at home,
and they proved to be very useful especially
during the food preparation demonstrations.
The women varied in their abilities, back
ground, etc., but they had several things in
common. They were all full of enthusiasm
and goodwill, eager to learn as much as
possible so as to be of service to their fellow
villagers, and ready to sacrifice themselves to
achieve this aim. This was shown by the
fact that they left their families for a fortnight
and faced the difficulties of a journey to a
place they did not know, many of them
walking many kilometres to reach Cilimpur.
During the course itself they made great
efforts* studying during their free time, asking
us for notes and more classes : "We have so
little time and so many things to learn".
And all this with no prospect of reward or
remuneration because their service is to be
on a voluntary basis and they were aware
of this.
All this was a great encouragement to us,
so that we too made an effort to give them
of our best.
The Training
This was a matter of learning with them,
getting to know them and the village situa
tion from them, and selecting the material
most suited to their needs and the teaching
methods that fitted their abilities.
The training itself was conducted by a
team consisting of Sr. Grace, S. Crescenzia
25
eventually these training sessions will be con
and Sr. Catherine from Cilimpur, Sr. Bernard
from Guhiajori; Sr. Marina from CHAI and Ms. ducted in the respective Health Centres, and
so it is good for the Sisters to acquire exper
Marcette from SDC were Resource Persons.
ience of how the training is carried out.
There was a basic syllabus to follow, but the
programming was done on a day-to-day
As will be seen from the report, various
basis, taking into account what had been
methods
were used to convey information to
achieved during that day, and our growing
the trainees and to show them how to trans
understanding of their abilities and needs.
mit it, in turn, to the villagers. Teaching was
Sr. Marina's role was that of giving the right
done with the use of flash cards and flannel
orientation, advise about the content and
graph, demonstrations, practice sessions and
help with the ongoing evaluation. The
slide
shows. The women were made to take
classes, demonstrations, etc., were given by
the Sisters from Cilimpur, who already had .an active part through role plays, cooking
demonstrations, discussions, etc. We found
considerable experience in training village
that
while they are good at reproducing what
women for MCH programme.
had just been taught to them, their memory
The classes were prepared on the preced
power is limited and a lot of repetition is
ing evening. The teaching medium being
needed to fix the knowledge in their mind.
Santali, which Sr. .Marina and Ms. Marcette
So, various ways of having them repeat the
do not follow, it was necessary to ensure in
same information were exercised, such as
advance that the instructors, only one of
making them give class with the use of flash
whom is a qualified nurse, understood clearly
cards,
role plays and other methods
the content to be delivered to the trainees.
mentioned above.
In this way, the team itself grew in know. ledge and experience through the contribution
of each of its members, and the hesitation
and apprehension with which we had appro
ached the task have been replaced by
confidence, and an eagerness to repeat the
training for new Health Workers.
A point worthy of mention was the pre
sence of two observers to the course, Sr.
Sheela and Sr. Alyamma. Both of them had
trainees for their Health Centre at the course,
and both found that attending the course had
given them a good insight not only into the
training itself but also into what they could
expect of their Health Workers and what they
could do to support them.
It is hoped that during future training pro
grammes. Other sisters will come as observers
at least for a few days. This helps to start the
relationship between the Sister and her
collaborators. Moreover it is planned that
26
This variety, together with song, an occa
sional dance, and chatting with the women,
helped to maintain a cheerful, relaxed at
mosphere which is congenial to learning. The
participants were all satisfied and happy with
the training, and eager to start applying their
newly-acquired knowledge.
And this is where the Training Course can
be considered as a departure point.
Looking forward
Health care in our Diocese is taking a*
new turn. These women are being prepared
to promote health and prevent sickness in
their villages, and alleviate illness by simple
means, where possible. But their training
being an ongoing process, their knowledge
has to be reinforced and their mistakes
corrected. They also need support, encour
agement and an occasional push.
Medical Service
It is the Sister-in-Charge of the Health
Centre Dispensary who is in a position to
fulfil this role, through regular meetings with
her Health Workers and visits to the villages.
These matters were discussed during the
meeting of Sister-Nurses held at Cilimpur
during the last three days of the Training
Course. The diocesan plan was outlined and
a programme drawn up for the next year. The
Central Health Team will do its best to give
the necessary help and support to the Sisters
so that the plan can be put into effect.
This report is itself an effort in this direc
tion. It is written mainly for those Sisters
who could not be present during the training
course so that they can have a written
account of what the Health Workers have
learnt and what is expected of them. The
narrative form of the day-to-day report has
been adopted to give the readers an insight
into the dynamic process of the training : the
growth in mutual understanding, leading to
a better appreciation of these women's
abilities and limitations, and a greater respect
and love for them. It is hoped that the
Sisters will enter into the same spirit, and
continue to reinforce the teaching that was
given to the Health Workers.
There may be other remedies useful in the
treatment of common ailments, and other
methods of dealing with particular situations,
but we trust that the Sisters will use only
what is written here. Moreover, what they
practise in the dispensary will be in keeping
with the basic principles of our new approach.
This will avoid confusion and accelerate, the
reorientation proeess. The Health Workers
have asked for some notes on the diseases
and the remedies for them. This is being
prepared in Santali, and the English version
of it will be published later.
The last part of the report contains an
account of the decisions reached at the Sis
ters 'meeting and the diocesan plan of action,
August 1983
and also the words spoken to us by the
Bishop when he came to visit us at Cilimpur.
Word of Thanks
It is natural that at this point our hearts
are filled with gratitude for all that has been
achieved so far. In this spirit I would like to
express a word of thanks to Bishop Telesphore for the vision he has presented us with;
to Fr. Richard for his faith and determination
which conceived the plan for health apostolate and brought it to light, and for his
encouraging presence during the course; to
the Superior, Sr. Guglielmina, and the Com
munity of St. Joseph's Convent, Cilimpur,
for their hospitality and indispensable help;
to all the Sister-Nurses in the Diocese, to the
Health Workers, and to all the people with
whom we are working and will work to build
a better, healthier community worthy of
human dignity.
A blossom is opening out, and is entrust
ed to us to nurture that it may flower and
bear fruit.
To the Lord from whom all good things
come we raise our prayer of thanksgiving.
May He bring to completion the work He
has started with us and among us.
Marcette
Diocesan Health Care
Coordinator
M &R.F. Hospital, Naganahalli,
Mysore, launches out a pro
gramme in Community Health
Naganahalli, a remote village, is considered
to be a backward Taluk in the whole of My
sore Dist. A decade ago, Naganahalli, was
known for its wild life, ft is in this village
that M & R F Hospital has been functioning
since 1975. In 1978 it extended its service
taking up outreach programme of M.C.H. for
27
50 beneficiaries of surrounding villages.
Since then these villages have much improved
in health conditions. Now the hospital focu
ses its attention on community health and
school programme.
A week's training programme from 5th to
11th June, 1983, for 10 dais from 4 villages
was organised with the help of CHAI Health
Promoter Sr. Marina and the staff of M & R F
Hospital, Sr. Concepta, PHN, Dr. V.N.K. Pra
sad, MBBS, and Sr. Irene, the staff nurse.
These dais and 3 men as supervisors were
exposed to the needs of the common disease
cure like diarrhoea, scabies, sore eyes by
indigenous medicine, much more to the cause
and prevention, by means of flash cards,
discussions and role play etc., some problems
of the village like child marriage, joint family
system, normal and abnormal pregnancies.
It looked as if these women were well
versed in indigenous medicine, yet upgrading
is needed in cleanliness and conducting
deliveries. These women will work now as
community health workers in their respective
village and the supervisors will get a report
of their work. A follow-up of all the work
will be done from the Centre.
Inauguration of holy redeemer
health centre.
The 15-bed Holy Redeemer Health Centre
is the first of its kind in the Diocese of Kohima, Nagaland. This Centre is situated at
the foothill of Nagaland, about 16 Km. from
Dimapur.
On the 31st January, 1983, the In-patient
Department of this Centre was officially
inaugurated by His Excellency Mr. S.C. Jamir,
Chief Minister of Nagaland, in the presence
of a very large gathering of priests, sisters,
August 1983
friends, officers, well-wishers and the people
of the locality.
Mr. Pralie Peseye, the Chairman of the
Town Council, welcomed the guests and
expressed his gratitude to the Bishop and the
Catholic Church for starting an Institution of
this type in Nagaland, and particularly at
Chumukedima.
Rt. Rev. Abraham Alanjimattathil, D.D,
Bishop of Kohima, Nagaland, blessed the new
building constructed by the aid from German
Misereor. The Out-Patient Department was
inaugurated by him earlier on the 19th July,
1982, when Dr. Sr. Adele Thaliyan, M.D.,
joined the staff. The day-to-day manage
ment of the Health Centre is entrusted to the
Sisters of Charity of Sts. Bartholomia Capitanio and Vincenza Gerosa whose headquar
ters are at Calcutta.
In his inaugural address the Chief Mini
ster expressed his great appreciation for the
work done by the Catholic Church in Naga
land, particularly in the field of health and
education. He donated a sum of Rs. 10,000
for the initial expenses of the Health Centre
and promised further help.
In his homily Bishop Abraham stressed
and exhorted the congregation present to be
the 'Good Samaritans* to the sick. He invited
the sisters to bear witness to the love of the
Crucified Lord to all who come under their
care.
After a light refreshment
came to an end.
the function
The work of the healing ministry is flouri
shing from this Centre, and thousands of sick
are benefited every month. The love of
Christ is shared with all who come to this
Centre named after The Most Holy Redeemer
of us all.
29
Medical Uses of Iodising Radia
tion—Radiation Hazards— Pre
vention for—
In its Notification No. T. 20014/1/83NMC dated 19.1.1983 the Directorate
General of Health Services (Nuclear- Medicine
Cell), University College of Medical Sciences
Campus, Ring Road, New Delhi-110029, has
informed that a Radiation Medicine Division
has been established in the Directorate to
plan radiation protection measures at the
national level. Ail health authorities/institutions are requested by the Directorate to ensure
that their radiation installations, i.e. X-ray,
Radio-Therapy and Nuclear Medicine Depart
ments are surveyed by the Bhabha Atomic
Research Centre, Bombay, and their recom
mendations implemented as early as possible.
Personal monitoring of all Radiation Workers
must also be taken up if it has not been done
so far. The survey of the installations and
SI. No.
1
Name and address
of the authority/
Agency
2
personal monitoring is done by the BARC,
Trombay-Bombay-400 085, free of cost.
This survey should be repeated every five
years.
If any case of Radiation Hazards has been
reported in any institution, details thereof are
required to be communicated to the Directo
rate as early as possible and also ensured for
future too.
Under the Atomic Energy Act, it is the
responsibility of the employer to ensure that
all radiation workers properly observe Radia
tion, Protection Norms and personal moni
toring of the radiation dose received is
recorded fortnightly with the help of the
Film Badge Service of Department of Radia
tion Protection, BARC, Bombay.
The present position in respect of the in
formation called for vide paragraphs 1 & 2
above is required to be communicated to the
Directorate immediately in the following
prescribed proforma:
Cases of Radiation
Hazards with facts
Jan. '82
to Dec.
1982
Jan., '83
to date
3
4
Type of
Hazards
Period of
working
with
Ionising
Radiation
Remarks
if any
5
6
7
The Directorate has stressed that this may please be treated as 'MOST IMMEDIATE'
and the required information be sent to them on priority basis.
30
Medical Service
From the field
Impart Study of Community
Health Programmes
1.
Jammuon: (Varanasi Diocese)
In 1982, the Community Health Depart
ment of CHAI had assisted Fr. Ivon Joseph
of Varanasi Social Service Society to integrate
Community Health Programme with the
existing development
programmes
at
Jammuon Mission.
Two members of the team visited the area
this month and had personal discussions with
the Community Health Workers and project
personnel, including visit to all the villages
covered by the programme. Health educa
tion and environmental sanitation is looked
after well, and by this alone, the Community
Health workers claimed that they could
control cholera in two villages. We found
that husbands and other family members
also joining the community health workers in
organizing the villagers and solving commu
nity problems and some time family problems.
.The health workers and supervisors work so
much hand in hand that a good rapport is
established between the people and the
centre. They have formed Mahila Mandals,
Balasabhas etc., and credit unions are func
tioning well.
The team felt the need for refresher cour
ses for the community health workers from
time to time and also a little more creative
supervision on the part of the supervisors of
the programme.
We wish the programme every success.
2. Community health programme in the
Diocese of Rourkela:
Two members of the Community Health
Department team visited Rourkela to plan out
follow up for the Community Health Workers
trained by Community Health Department in
August 1983
January, 1983. A thorough study of the
programme and detailed discussions with the
personnel concerned revealed to us the need
for more orientation and systematic planning
of the whole programme. At the moment
the programme is carried out in five parishes
of the Rourkela Zone. We proposed to take
up a three days Orientation Programme for
Priests of those Parishes and 2 Sisters from
each health centre. After this programme,
second phase of the training for Community
Health Workers will be carried out—it was
mutually agreed.
3.
At Balasore Diocese:
The team visited two health centres in
Balasore, at Jaleswar and Rangiam. The
Diocese is planning to launch a Community
Health Programme in 40 villages in the
circumference of these two health centres,
run by visitation Sisters. Training of 30
village health workers is planned, and the
construction of the training centre is nearing
completion. We offered our service for a
one week team training session for the
priests and sisters in the project area.
With the present enthusiasm of the ener
getic and young sisters and the untiring
support of Monsignor Jacob Vadakkevettil,
the Programme - we are sure - will bear
much fruit and good luck.
4. Orientation and Planning Programme
at Berhampur Diocese:
From 1978 onwards, Community Health
Programme is effectively carried out in the
Diocese of Berhampur. But for the past few
months the Bishop and the people concerned
have been thinking for a re-orientation and
new planning of the programme.
Three members from the Community
Health Department of CHAI attended a one
day meeting of Sisters working in the Health
31
Centres, convened by the Bishop. 17 Sisters
participated in the meeting. The bulk of the
time was spared for reflecting on the social
reality around us, the call of the Church and
the State for Community Health approach in
the Health Care system and also the urgent
and important need of the hour for a relevant
and meaningful Christian response to this
situation.
After discussions in groups, for practical
conclusions, the group assembled in the
general session and made the following
decisions.
a)
To convene a meeting of all the Sis
ters engaged in Community Health
once a year. This will be done by
the Bishop.
b)
Two co-ordinating committees were
constituted for the two zones of the
Diocese with three Sisters engaged in
Community Health and Bishop will
appoint one priest from each zone for
these committees.
c)
These zonal committees will meet
once in 4 months to encourage, eva
luate and plan for the zone.
d)
To have a 5 days orientation pro
gramme for all the Sisters in the field
of Community Health, at the earliest.
e)
To take up regular follow up and re
fresher courses for Community Health
workers.
We hope this get-together and planning
will initiate a new process in the Community
Health Programme of the Diocese of Berhampur, and we are also looking forward to a
healthy competition between the two zonal
committees...... 1
PRE PUBLICATION ORDER
Proceedings of the First International Congress for the Family of Asia and Australia,
Madras - India.
— All the Papers, Reports of the Workgroup and The World Round Up presented at
the Congress are available in a book :
Within India
Cost per copy
: Rs. StyMailing Cost extra
Rs. 10/Recorded Cassettes of the Presentation at the Congress.
Cassettes (C-60) cost per cassette
: Rs. 35/Cassettes (C-90) cost per cassette
: Rs. 45/Mailing cost extra—per cassette
: Rs. 2/Full set of 29 cassettes
: Rs. 1,000/Mailings cost extra for a set of 29
Rs. 50/For further details and order, please contact:
Tamil Nadu Family Development Centre (Asian Section)
278 Kaleel Shiraji Estate’
P.O. Box No. 768
Fountain Plaza
Pantheon Road
Egmore
Madras-600 008
August 1983
33
An Integrated Approach to Health and Development :
HOSKOTE—Bangalore
— CHAI Team
CSI Hospital, Bangalore, can be really
proud of the Community Health Programme
it started in Hoskote, wh:ch is situated at the
outskirts of Bangalore.
Dr. Ravi Raj who is the pioneer of this
programme, had started his work 8 years
back covering about 50 villages in and
around HOSKOTE. The Community Health
Department of CHAI studied the process and
the evolution of this programme and found
it worth sharing with all those who are enga
ged in building healthy communities.
This programme is functioning in a '3 tier
system* — i.e.
i)
Micro Centre — situated at the heart
of every village
ii)
Mini Centre — each catering to
villages around and
iii)
Macro Centre — situated at HOSKOTE.
The Macro Centre is situated at HOSKOTE
and 2 doctors are in charge of it. Dr. Ravi
visits the Mini Centres at least once a week
and Micro Centres occasionally. His encoura
gement sustains his health team to render
efficient services by being vigilant and avail
able all time.
Some of the other salient features of the
programme are:
a)
Promotion of local leadership: The
social worker attached to each Mini
Centre helps the villagers to identify
the local leader in the village. And
these leaders are assisted by the
social worker to form youth clubs and
other organizations and also to take
up concrete actions like medical
camps, construction of roads, deepe
ning of ponds, etc.
b)
Skill survey is taken in all the villa
ges, and accordingly training facili
ties are provided in their own places
to improve their skills.
c)
Agricultural programmes are taken up
for farmers, and incentives like loans,
pumpsets, cattles, seedlings, fertili
zers, etc., are given. The repayment
of the loan is upto 85%.
d)
The project has ensured the involve
ment of women in the health educa
tion programme . and running of
Balwadis. The mothers contribute in
kind towards the feeding of the
11
A local woman, selected by the people
and trained by the Doctor and his team, is
placed at the Micro Centre as the Health
worker. Her role is vital in the whole pro
gramme and she is given the freedom to use
the traditional medicine as well as a few
simple and selected drugs. Through her,
early detection and treatment of diseases is
made possible.
Two ANMs who are placed in charge of a
Mini Centre are given a special one-year
training by the Doctor at the Macro Centre.
During this time they are taught to look after
the patients, with a few selected and simple
drugs. In this way they gain self-confidence
34
to be in charge of the Mini Centre which
looks after the health needs of 11 villages.
Medical Service
children in the Balwadis and also
they serve the Balwady by turn.
The people are cooperating with the pro
grammes to their level best. They have
contributed land for putting up Mini Centres.
Dr. Ravi and his team love and respect the
people they serve. Through this health pro
gramme they have started the process of
awareness building and people are encoura
ged to make organised efforts for their rights.
40TH NATIONAL HOSPITAL CONVENTION AND EXHIBITION
Theme
:
"Respect life"
Venue
*
St. Pius X College, Aarey Road
Goregaon East, Bombay 400 063.
Date
6th—10th November, 1983
(Special programme on NFP and Family Welfare on Nov 10th)
Registration Fee
Rs. 250.00 per head
(Rs. 30/- extra for the NFP programme on 10th)
Payable by cheque/draft drawn in favour of 'National
Exhibition'.
Hospital Convention and
Stall Booking for Exhibition and Booking of Advertisement space in the convention
Souvenir is on.
Last date of :
Registration/Booking of Stall/Advertisement 15th October, 1983
For further details and Registration Forms, etc.,
please contact:
The Executive Director
Catholic Hospital Association of India
CBCI Centre, Goledakkhana
New Delhi 110001.
Tel : 310694, 322064
August 1983
35
Position: 2170 (10 views)