VOL: 3 ISSUE: 3 APRIL 2020
Misuse of drugs Special care for special children Summer Health Tips
STORIES POEMS NEWS AWARENESS GALLERY AWARDS QUIZ
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sImtdmW F¶ almhn]¯v C¶v temIw apgph³ `bhpw Bi¦bpw \nd¨ncn¡pIbmWv. hfs¨mSn¨Xpw Aimkv{Xobhpamb hmÀ¯IÄ ]eXpw IqSpX hnja¯nte¡pw AXneqsS hnjmZ¯nte¡pw \bn¡msX IÀt½mÕpIcmbn IqSpX Pm{KXtbmsS, AIe]me\¯neqsS, BtcmKy ]cn]me\¯neqsS \ap¡v B N§eI®nIÄ s]m«ns¨dnbmw. AXn\mbn Atlmcm{Xw {]bXv\n¡p¶ \½psS kÀ¡mcnt\mSpw kZm tkh\k¶²cmbncn¡p¶ BtcmKy{]hÀ¯IcS¡apÅ \½psS ktlmZc§tfmSpapÅ IrXÚX tcJs]Sp¯nsImv BMH Connect-sâ aq¶mw `mKw R§Ä hmb\¡mcnte¡v F¯n¡p¶p. H¸w \½psS cmPyhpw P\PohnXhpw F{Xbpw s]s«¶v ]qÀhØnXnbnte¡v F¯n¡m³ kÀhià³ A\p{Kln¡tWsb¶v {]mÀ°n¨psImv FÃmhÀ¡pw CuÌÀ þ hnjp BiwkIÄ AÀ¸n¨psImv \n§tfhcpsSbpw klIcWw C\nbpw {]Xo£n¨psImv Cu e¡w kaÀ¸n¡p¶p.
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Editorial Team Members: Mr. Saji S. Mathew (C.O.O.), Dr. Shaji Thomas John (Chief of Clinical Support Services), Mr. Jose V. John (Sr. Manager - HR), Ms. Sukritha K. (Assistant Manager - HR), Mr. Kamal K. (Deputy Manager - Branding & Community Connect), Ms. Indu Dayanand (Deputy Manager - Front Office)
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04 - 08 Article Game Zero – A Biological Bomb Opioid Misuse AGAPÉ
09 Health Tips Foods to be included In summer diets
10 - 11 Article
Yogayude Utppathi
12 - 14 Malayalam Poems Prakruthi Lokavasanam Palapookumbole
Our contributions towards Waste Management, Water Treatment, Plastic ban & Bio-medical Waste disposal for environment protection
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Save Energy
20 - 22 Vishu Special Recipe
23 Mahadvachanangal
24
Quiz
25 Awards
26 - 29 Photos
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Game Zero – A Biological Bomb
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Opioid Misuse Dr. Rajesh.M.C Senior Consultant Anaesthesiologist & Academic co-ordinator BMH, Calicut, Kerala
Pain is one of the oldest challenges in medicine and relief of pain is one of the fundamental obligations of medical profession. Opioids are the main stay in both acute and chronic pain conditions. Opioids or Narcotics are a group of drugs which are most commonly prescribed for intolerable pain both in acute and chronic pain settings. But unfortunately commonly misused group of drugs too. Switching over from prescription opioids to heroin is a major public health problem health professionals are facing all over the world. Family physicians and pain specialists play a crucial part in balancing the patient's analgesic requirements and the risk of misuse. Unfortunately in a small group of patients with prescription, Opioids are misused or they get addicted even with best efforts! So what's the solution? Both pain management and misuse (dependence) therapy require a patient centered, compassionate care. There is a need to individualize and monitor treatment regimen, based on patient's review of benefits and side effects. For the policy makers it's always a tight rope walk to balance the efforts to reduce illegal non-medical use of prescribed controlled drugs and not to interfere with appropriate use of these medications. Finding ways to minimize the risk of drug misuse can enhance patient outcome and reduce the overall healthcare costs.
Principles of good opioids prescribing: It is essential to follow state practice guidelines when prescribing opioids. It is also important for the physician to ensure that the pain is properly assessed and managed. Treatment of pain is always a team approach. It is imperative to have a look into the diagnosis before initiating analgesic therapy. What is the cause of pain? Is there anything correctable? All these things have to be answered before taking up the case. There must be close liaison with other professionals involved in patient care. The pain clinic uses a bio-psychological model of pain assessment wherein not only physical but also emotional, social as well as financial implication of pain is probed especially in chronic pain conditions. It is important to understand that opioids are only one aspect of pain therapy that also includes non opioids, physical therapy as well as emotional support. Response of pain to opioids as well as the adverse effects varies from patient to patient, emphasising the need to individualise therapy. Before starting therapy, it is important to discuss with the patient and care-givers about the expected long term goals (even the plan of weaning from opioids in case of acute pain) expected side effects, as well as the need for frequent review to monitor drug effects.
Management of Prescription misuse: It is important to identify patient tendencies and take corrective strategies at the earliest. At risk patients should be subjected to increased review. Any concern regarding misuse should be discussed openly with the patient and caregivers who much be clearly documented and communicated to the other health care workers in the unit. Clinical presentation of misuse is usually with intoxication or withdrawal. Symptoms of intoxication include confusion, miosis, hypersomnia, nausea, euphoria, constipation and decreased pain perception. There will be pin point pupils on examination with the patient bradycardic, hypothermic and decreased responsiveness. Withdrawal patients are agitated with craving and may have abdominal cramps, diarrhoea, anxiety with elevated blood pressure. Clinically heart rate will be elevated with tremors and rhinorrhoea.
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Opioid misuse patients require counselling and behaviour modifications in addition to pharmacological agents. Pharmacological intervention involves substitution therapy with long acting but less euphoric and addicting opioids. Rehabilitation of these patients involves cognitive and behavioural approaches. These patients should be given the required psychological support required during the maintenance period. Analgesic requirements of these patients should be addressed during the rehabilitation phase. Adding intervention procedures definitely reduces the opioids requirements.
Strategies to prevent opioids misuse: It is difficult to predict which patient is likely to misuse opioids. But in general likely candidates include those with history of depression, post-traumatic stress disorders, family history of alcohol or substance misuse and prior treatment of substance misuse. Patients on malignancy related pain treatment is less likely to misuse opioids than non-cancer related pain. A persistent desire or unsuccessful efforts to cut down or control opioids use, drugs taken for a longer period or in larger amounts than prescribed, frequent visits or unscheduled refill requests, a strong desire or urge to use opioids, not fulfilling major role obligations at work or at home, important social, occupational or recreational activities given up, tolerance, withdrawal are strong factors suggestive of opioids misuse. Doctors should be alert of the fact that those misusing prescription drugs may engage in doctor shopping in an effort to obtain multiple prescription of medications. There are evidence based screening tools for detection of non-medical use of prescription drugs, which can be incorporated into the routine medical visits. Prescription drug monitoring programs in the west, which basically track the prescription and dispensing of controlled drugs is an effective tool for identifying drug misuse.
Misuse by healthcare providers: Drug misuse by health care professionals is a very unfortunate entity because it has curtailed the careers of many brilliant persons. When substance abuse is suspected by a colleague it's critical that concerned and compassionate colleagues intervene to help that person. The intervention plan should be a structured and supportive in a professional manner and not by confrontation. The concerned individual should be removed from his clinical duties in a confidential manner. If the concerned person refuses treatment, it should be notified to the higher authorities through proper channel.
Conclusion A good number of patients on intolerable pain require opioids for proper pain relief. But unfortunately a small number of these patients have a tendency to misuse prescribed drugs. Health care professionals should be vigilant of these tendencies and early identification and taking preventive strategies is important than treatment of misuse. Physicians should see that opioids are prescribed for severe pain conditions only and the medication is discontinued as soon as possible. Diagnosis of opioid misuse should be suspected on the basis of history and physical examinations. At risk patients for misuse should be identified and monitored closely by the physician. They should be subjected to constant review. Current strategies to minimize misuse at the pharmacy includes prescription monitoring programs, preventing medical errors, checking patient identification at the pharmacy and referral to pain specialists. Educating patients and caregivers is important at the time of drug dispersal.
References: 1. Simon G Tordiff,Praveen ganty.Chronic pain and prescription opioids misuse.Continuing Education to Anaesthesia,Critical care&pain 2010;10:158-61. 2. Webster L R.Risk factors for opioids-use disorder and overdose.Anesth Analg 2017;125:1741-8. 3. Kathryn L.Hahn.Strategies to prevent opioids misuse, Abuse and diversion that may also reduce the associated coasts.Am Health Drug Benefits.2011;4:107-14. 4. Millers Anesthesia.9th edition. Elsevier 2020.
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Dr. SHAJI THOMAS JOHN Chief of Clinical Support Services
AGAPÉ No two individuals are alike. Each person is created in a different way. The size, shape, complexion, developmental status, and so on are all different from person to person. The milestones of development of each child is different, even when compared to his own siblings. A child may start walking at any time between one and one-and-a-half years, which is perfectly normal. And parents many a time do panic when they see their neighbour's or friend's child proceed to the next developmental milestone earlier than their own child of the same age. The problems are augmented when they reach school age, because there are many students to compare. One child may start singing songs and rhymes earlier than the other, another may start memorising the numbers quicker than his friends, or still another may recite the alphabets faster than the peers. All these are of concern to most parents even though all the above children maybe within the normal range of development. I am sure that none of us can run as fast as the sprint queen P.T. Usha. But are we handicapped just because our ability to run is less? Or for that matter how many of us can really run in a race? Some children are not so good in sports, some others in mathematics, some others in language and some others have difficulty in writing what they already know well. Yet all of them are considered normal within the range accepted. So, what is normal? The only measurable thing that can be considered as normal in a human being is his temperature. The normal is 37° Celsius. But for that, all other human parameters denote a range of the normal. And that is also applicable to the human intelligence. The Intelligence Quotient (IQ) is again a range. The average normal IQ is taken as 100 and in a regular class of students we get children with IQ varying from 90 to 120 and even 130 or more. A child with 130 has theoretically almost 50% more intelligence than the child with 90. If they are all acceptable in a society, can the child with borderline retardation with an IQ of 70 or 60 be all that bad?
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And the method of determining the IQ is not always reliable. Even an intelligent child may only gaze at building blocks like an idiot if he has never seen it before, whereas a child with an intellectual handicap who is used to playing with it, will quickly play and build with it. Similarly, the child's exposure to the environment will modify the response when his IQ is tested. So, an intelligent child, if confined to the four walls of his house, will behave like a subnormal child, whereas a subnormal child if properly oriented and supported will definitely perform better and be able to overcome his handicap. So, the conclusion that we are able to draw is that our environment can definitely modify the basic nature of every human being. And that is the reason why we come across hard working average people who fare better in life than lazy more intelligent counterparts. A child with low average intelligence may have to repeat his lessons two or three times more than his so called 'better' counterpart to come up at par with him. If that is so, then his still more unlucky friend with border-line intelligence can perform equally well with still more hard work and repeated studies. The whole concept of the outcome of a child's intelligence in life is thus relative. The first and foremost aspect is to accept the child as he is, with his plus and minus points. I am sure none of us have the brain-power to be a nobel laurate like C.V.Raman or Hargobind Khorana, nor the muscle power to be like Thara Singh, nor the agility and efficiency to speed ahead like P.T.Usha. But then we want our children to be the super human beings of our dreams. That is where we falter. A child with a handicap is still different, different as all children are, but in a special way. We should not be ashamed to acknowledge him. Just as each child is different from one another, so is this child different in a special way. A child with a handicap needs all the special care that is possible, to make him stand on his own feet, to help him take care of his needs, and to help him get along in this world that look down upon him. Let us try to understand the positive qualities in him and extend a helping hand to him. Baby Memorial Hospital has been running a clinic for children/persons with Down Syndrome since 2000. Down syndrome, medically known as Trisomy 21, is the result of an alteration in the number of chromosomes, resulting in 47 instead of 46 chromosomes that we all have in our body cells. Almost 1000 children with Down syndrome have been benefitted from this clinic in BMH. The DoST Support Group organized by the Down Syndrome Trust (DoST), meant for their parents and caretakers, has been functioning since November 2000. They have been meeting very regularly on every second Sunday in the hospital premises from 3 PM to 5 PM, thanks to our Chairman Dr. K.G. Alexander. The April 2020 meeting is the only meeting since its inception that was conducted without the physical presence of the participants, due to the Lock down brought in by Covid 19, and a ZOOM meeting was organised instead. The World Down Syndrome Day (WDSD) which falls on March 21st, is observed every year by BMH and DoST, was also cancelled this year due to the Lockdown. We have been able to make a whole lot of difference to a large number of people with Down syndrome and their families. Ms. Dhanya Vijayan, a versatile Bharatanatyam exponent, is a person with Down syndrome and is a dance teacher in Calicut. Ms. Anita Menon is a model and a cover girl, now in Pune. (Her mother was responsible to make me sit up and start the DoST) Mr. Gopikrishnan is now acting in a full length feature film, about to be released shortly. (His parents shifted to Calicut just to get the needed therapies) Ms. Lizma John is working in the ULCCS Foundation for the betterment of people with intellectual disabilities. We even have a person with Down syndrome working in our hospital ! (I wonder how many of us are aware of that) These are just a few of the outstanding persons from Calicut. Let us not fail to give them the needed love and care, as to any other child. And still more, to help them conquer their handicap. Let us recognize their special needs and do the best to facilitate them for an early start, to do the best we can, to help them face the world. Nothing is impossible if we are determined to do the best for the child. "Agape" (unconditional love) is what they need to bring out their full potential and we need the patience to see them through. The satisfaction of having done our duty to these children to the best of our ability; is the best reward that we can cherish in the years to come.
HEALTH TIPS
Ms. Ashia Julka Safar Clinical Dietician
FOODS TO BE INCLUDED IN SUMMER DIETS Summer foods should be all about foods that keep you hydrated as well as healthy at the same time. Summer is often accompanied by dehydration, skin sensitivities, mineral deficiencies etc. Therefore, our primary goal should be to include summer foods that fulfil this criteria.
for boils, rashes, fungal infections etc. which are pretty common in summer season. 7. CURD AND YOGHURT A wonderful coolant perfect for summer eating. It also adds a dose of probiotics, beneficial bacteria that keeps your digestive system running smoothly.
Wondering what to eat in summer to keep your body 8. COCONUT WATER cool? An inexpensive powerhouse of nutritional benefits. Out of all the amazing summer foods, we have Coconut water has electrolytes that makes it one of shortlisted few of them to let you enjoy this summer the best hydrating agents. vacation in the most healthy way. 9. FENNEL SEEDS 1. MANGO The "king of fruits" is enriched with fibre which helps in digestion and keeps you full. Zeaxanthin, a pigment present in mangoes, protects the eyes by filtering out harmful blue rays.
This seed helps to flush out excess heat thus giving a cooling effect on the body. 10. MINT This inexpensive easily available herb not only keeps your body temperature under control but also gives you a refreshing effect.
2. WATERMELON This fruit is a hydration hero. Its high water content Thus, include these food items in your daily diet and keeps you cool and hydrated. It also contains you will definitely feel the difference. So have fun lycopene, which protects skin cells from sun this summer!!! damage. FOOD TIPS TO BEAT INDIAN SUMMERS 3. ORANGE * Drink plenty of water and fluids so that loss of This sweet citrus fruit is rich in potassium, a nutrient water can be compensated. that's crucial in the summer. Eating oranges * Always go for light diet which can be easily replenishes your potassium supply and keep muscle digested by our body without much effort. cramps away. 4. CUCUMBER This refreshing vegetable and its high water content works great for skin by helping in skin problems and also in cleansing body by removing toxins. 5. ONION Red onions are loaded with quercetin- a natural antiallergen. Adding onions to your daily diet helps in protecting you against the sun stroke. 6. BITTERGOURD This easily available vegetable is known to be good
* Oily and junk foods should be avoided. * Avoid too much of tea and coffee as it contains caffeine which results in dehydration. * Switch to green tea as it contains antioxidants which are great help to body during summer seasons. * Do not eat spicy, hot and extremely salty foods as they are hard to digest and will have ill effects on the skin.
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\nXyPohnX¯n tbmKbpsS kzm[o\w t\cs¯ kqNn¸n¨Xpt]mse tbmKohcy·mcpw ap\oizc·mcpw am{XamWv tbmK A`yknt¡Xv F¶ A_²[mcWbn \n¶v km[mcW¡mcnte¡v tbmK F¯nt¨À¶Xv hfsc ASp¯ Ime¯mWv. tbmKimkv{Xw `mcX¯nsâ ss]XrI k¼¯mWv F¦nepw, tbmK A`ykn¡m³ `mcXnbtc¡mÄ IqSpX Xmev]cyw ImWn¨ncp¶Xv hntZinIfmWv. F¶m B ØnXn hntij ¯n\p Ct¸mÄ amäw h¶tXmsS {]mbt`Zsat\y PmXn, aX, enwK hyXymkanÃmsX FÃmhcpw tbmKsb Adnbm\pw ]Tn¡m\pw ssZ\wZn\ PohnX¯nsâ `mKam¡m\pw {ian¡p¶pv. IqSmsX kzImcy taJebnepÅ Nne hnZym`mk Øm]\§fpw hyhkmb Øm]\§fpw AhcpsS hnZymÀ °nIÄ¡v thnbpw sXmgnemfnIÄ¡p thnbpw tbmK ]cnioe\w \S¯n hcp¶p. C´ybn sam¯¯nepw tIcf¯nse Nne kÀhIemimeIfpw tbmKbpsS {]m[m\yw a\knem¡n kÀ«n^n¡äv tImgvkpIfpw Unt¹ma, Un{Kn, ]n.Pn. tImgvkpIfpw Ct¸mÄ \S¯nhcp¶p. tbmKbpsS imkv{XobX AwKoIcn¡s¸Sp¶p F¶XmWv CXn \n¶pw a\knemt¡Xv. am[ya§fpw Cu hnjbs¯ Ipdn¨v [mcmfw teJ\§Ä {]kn²oIcn¨p hcp¶pv. Cu henb amäw tbmKsb km[mcW¡mcnte¡v F¯n¡m³ IqSpX klmbamhp¶pv. FÃm hÀjhpw Pq¬ 21mwþXobXn A´ÀtZiob tbmKm Zn\ambn Bncn¨phcp¶p. PmXn, aXw, kv{Xo, ]pcpj³, _me³, hr²³ F¶o hyXymk§fnÃmsX GsXmcmÄ¡pw A`ykn ¡mhp¶ H¶mWv tbmK. Hcp hyànbpsS BtcmKyw. IÀ½IpieX, ZoÀLmbpÊv F¶ KpW§ sfms¡ tbmK ]cnioe\¯neqsS hÀ²n¡p¶p. AXnep]cn Hcp hyàn X\n¡pw IpSpw_¯n\pw kaql¯n\pw kÀthm]cn cm{ã¯n\pw Hcp apX¡q«mhm³ tbmK ]cnioe\w klmbn¡p¶p.
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IhnXbmbv Rm³ ]mSnSmsa³ lrZbs\m¼c Ko-XnIÄ ]Icphm\nÃXnsemcn-¯ncn tamZtaIpw hm-¡p-IÄ
`m-kv-I-c³ Xn-tb-äÀ A-kn-kväâv Hm-¸-td-j³ Xn-tb-äÀ
shbnep \ÂInb ITn\-Xm]w ia\amsbt¶mÀ¯p \mw apInep ]Icpsamc{ip X¶n Ipfncp tImcnbncn¡-th {]fbPeambv hs¶m-cmag scu{Z\r¯¨phSp-ambv Akpc XmÞhamSnsb§pw `oXn hnXdn adªp t]m-bv]Sp¯pbÀ¯nb kz]v\saÃmw \oÀ¡W§Ä XIÀ¡th hgnbSsªmcp Pohn-X¯n³ IZ\IYIÄ _m¡n-bmbv {]IrXnbmw {]Xn`mkan-hnsS X\Xp \oXn \-S¯th angn Xpd¡Wan¶p \½Ä ]p\ÀhnNn´\taI-Ww ImSp sh«nbIän am-än Izmdnbm¡nb ae-Ifn ag sNmcnsªmcp \oÀ{]-hmlw Xm§n \nÀ¯m\mhptam acSp ^vfmäpIÄ XoÀ¯nSm-\mbv `cWIqSsamcp§nbm ]pgIÄ hänbpW§nbn-hnSw a\pjyhmkakm[yamw thsXms¡sbmcp¡n \ÂIn {]IrXn tZhnbsX¦nepw BÀ¯n XoÀ¡m\nÃsX¶Xþ dnªnSm¯hcmbv \mw {]IrXn \ÂInbsXms¡ \½Äþ s¡mcpatbmsS Im¯nSmw IcpXtemsSsbmcp¡n-Smao PohnX¯n³ ]mXIÄ
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A\q]v- hn.sI F¨v. BÀ. Un-¸mÀ-Sv-saâv
hnSXcnI hnS-XcnI hnSpX sImoSphm³ DStemSpeIn \n¶pbc§fnte¡v Rm³ aS¡anÃms¯mcp ZoÀLbm{X t]mboSphm³ IStemfapsÅmsc³ B{Klsams¡bpw hyÀ°kz]v\ambv Bg¯nemfth Adnbp¶p AcnInembv F¶psa³ \·IÄ AIemXenbmXSbmfamsa-¶nse IÀ½\ncX\mw a\nXs\ ImWpI HmÀ¡pI a¶hm \n¶nse ImgvNIÄ Ipt¶mfsa¦nepw Ip¶n¡pcphmbv Nmc-ambv Hmf§fmg¯nte¡v Xmgv¯oSth F¶nse Rms\¶ `mhta sNmÃpI C\nsb´v _m¡n C\nsb´v ssIhiw agbmbpcpfmbv hcĨbmbv XfÀ¨-bmbv temIta ImÀ¶nSpw \n¸bpw sImtdm-Wbpw Ipªns\ Xns¶¶pw ]{XsagpXnsbmcmdpw HgpInZqtc¡Iept¼mgpw skÂt^mWp Xn¶p hni¸v ian-¸n¨p I¼yq«dn XeNmbv¨p-d§p¶ ]pXnb temI¯n¶hXmcta \ns¶ CcpImenarKsa¶p hÀ®n¨nSs« Rm³ ]pdta Nncn¡nepw AIta \odps¶mcm Rms\¶psNmÃp¶ \n¶nse ImgvNIÄ CcpfpXn¶ps¶mcm ]Iens\t¸mse AkvXan¨oSphm³ Im¯ncn¡pt¼mgpw HmÀ¡pI a¶hm a®ns\ hn-®ns\ \ns¶ krãns¨mcm `qanbmw A½sb ssIhnc s\t©mSv- tNÀ¯v\o sNmÃpI aXaÃ, ]WaÃ, \ndaà `qanbn \· \ndsªmcp a\amWv ku-µcyw b{´ambv amdnb ImÂhnc a-®ns\ ]pÂIn XtemSn \S¶nSm³ kab-ambv temImhkm\ambv h¶nSq t]mbnSmw XncnsIsbmcp bm{XbnÃmsX \S¶nSmw Zqtc¡p Zqtc¡p ]pXnsbmcpZb¯n\m-bv
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BINDU S.
Associate Professor, College of Nursing
]Isecnªp sImgnªphogp¶ t\cw Cchnen¯ncn CSthfthWw hdpXnhnX¨vsh´ ISen\n-¯ncn I\nhv In\nbp¶ ZmlPewthWw XWp¯pdªp \n¡p¶ [\pamkcm{Xnbn ImewsXän, ]q¡Ä _m¡nbmb ]meact¨m«n H¶ncn¡Ww NohoSpIfpsS Akzmcky§sf AhK-Wn¨v KÔÀh·mcpsS kwKoX¯n\v ImtXmÀ¡Ww \nimKÔnIÄ shÅie`§-fmbn Npcpfgnªp hnScp¶Xv ImWWw e£yanÃmsX ]d¡p¶ ]£n¡q«§Ä BImi¯n tImdp¶ AØncNn{X§Ä hmbns¨Sp¡Ww ]me¸qaW¯neen-ªv\oemImiw km£n-bmbv \nemhkvXan¡pt¼mÄ Ccpfns\ ]p-WÀ¶v Häs¡mcp In\mhvImWWw aªp¯pÅnIÄ s\änbn Cäp-¶Xpw ]ns¶ aª ]pX¨vsIm¶ ]q¡p¶Xpw
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Mr. Viswanathan, Thekkinath
Our contributions towards Waste Management, Water Treatment, Plastic ban & Bio-medical Waste disposal for environment protection
Manager, House Keeping & Laundry Baby Memorial Hospital is fully committed to achieve and maintain minimum impact to the environment through the ISO 9001 &14001 Quality and Environmental Management Systems respectively, at the same time, delivering compassionate and empathetic medical care which is affordable and accessible to all persons from all walks of life. Our hospital was able to achieve all of this by pursuing quality at all levels and ensuring that set protocols are followed strictly. To conserve and sustain the environment for our future generations, BMH has set up several facilities and protocols. We have been presented several awards for substantial and sustained efforts in Pollution Control by Kerala State PCB and thrice we were awarded for Excellence in Safety Management of Hospitals in Kerala State by National Safety Council (Kerala Chapter). We could achieve all this and more only because of the firm commitment of the Top Management and strong integration of various certifications and achievements. Some of the feathers in BMH's cap are described below:
1.Waste Management. Many of us are not aware that managing waste in a large hospital without generating any infection or occupational hazard is one of the most difficult tasks to perform. In BMH, the management of waste is carried out as if like clockwork: Three Types of waste generated in the Hospitals: l Bio-medical waste: Wastes generated during treatment & diagnosis. l General waste: Food waste, paper waste, carton boxes etc. l Liquid waste: Waste water generated from Housekeeping, Laboratory, Hand washing and body fluids.
Bio-Medical Waste Management Process (a) Segregation: The segregation of Biomedical waste is carried out at source itself i.e. Nurses Stations with the help of colour coded bins. The medical staff is fully aware and trained to use the correct colour coded bins for each type of waste. (b) Collection: l Yellow & Red bags containing waste are tied with cable ties and collected in a trolley. l The White container is sealed by tightening its lid when it is three fourth full and then collected. l The contents of the Blue bin is emptied into a blue coloured container and carried in a trolley. (c) Transportation : The Bio-medical waste is collected by the housekeeping staff twicedaily from each nursing station and transported in a trolley to the temporary storage area. (d) Storage: Asuitably sized closed room is available in the yard of C block for the temporary storage of BMW. A different enclosure is available for each type of waste and are colour coded. This is easily accessible to the vehicles coming from IMAGE (Indian Medical Association goes Eco-Friendly) facility for collection. (e) Transport: Each day a closed vehicle of IMAGE comes to collect the waste and transport the same to the CBWTF (Common Bio-medical Waste Treatment Facility) located at Palakkad. (f) Treatment &Disposal :At the CBWTF yellow coloured bags are incinerated without even being opened whereas the red coloured bags are opened, autoclaved, shredded and sent for recycling. White coloured bags containing Sharps(metallic) are disposed off in the secure land fill. Blue coloured bags containing Sharps (Glass) items are sorted and sent either for recycling or incineration.
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Segregation of Bio-medical waste. For easy identification and segregation, all Biomedical wastesare segregated and disposed off in four colour coded containers. The segregation pattern is shown below: Yellow : post operative body parts, placenta, plaster of paris, pathological waste, cotton waste, dressing materials, beddings, body fluid contaminated paper and cloth, face mask, cap, cytotoxic, expired & discarded medicines, microbiology, biotechnology lab waste. Red : Syringes, IV set, catheters, gloves, urine bag, Dialysis kit, IV bottles. White : (Sharp Metals) Needle, syringes with fixed needles, blades, scalpels. Blue : (Sharp Glass)Broken glass, Ampoules, Lab slides, scalpels, (Metals) Nails, Metallic body implants, Scissors. The collection bins located at each nurses station is shown below.
General Waste: Two Types of general wastes are generated in the hospital - Bio-degradable & Non Bio-degradable. Sl. No. Type of waste 1. Food waste, fruits, vegetables, leaves, wet paper, etc. 2. Paper, Tissues, wrapping paper, cardboard, medicine boxes 3. General waste: plastics, PET bottles Packing materials, syringe & glove plastic covers, aluminum foils, Milk cover, chocolate cover, plastic wrappers, thermocol boxes, PVC, glass items, etc.
Category
Generating area
Restaurant Biodegradable Dietary Cafeteria Dining room Restaurant Dietary Biodegradable Non Bio- Stores, Pharmacy, degradable Restaurant, Wards
Disposal Kudumbasree - through Corporation Garbage system Recycling agencies Recycling agencies
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Selected biodegradable waste like food waste, vegetables, leaves are transferred in to the Bio-gas plant. However, food waste mixed with other waste like lemon, orange peels, fruits are handed over to corporation.
Liquid Waste: Waste water generated from Housekeeping, Laboratory, hand washing etc is sent to Waste Water Treatment Plant and after treatment it is used for flushing and gardening. This plant is one of the largest plants in any health care facility in Kerala.
The details of the Treatment Plant is given below:l Type : MBBR (Moving Bed Bio Film Reactor) l Capacity : Sewage - 2 Lakh Litres Max. Sullage - 2 Lakh Litres Max. l Cost of Treatment : 2.67 paisa/Litre l End Use : Flush Tanks, Gardening & Soak pits l No of Flush Tanks : Approx. 600 Toilets
Ban on Single Use Plastics Government of Kerala has banned single use plastics with effect from 1st January 2020. There is a complete ban on manufacture, transport and sale of following single use items:l Plastic carry bags irrespective of thickness. l Plastic sheets (Sheet used as table spread). l Plates, cups and decorative materials made of thermocol/Styrofoam. l Single use plastic utensils like cups, plates, dishes, spoons, forks, straws, stirrers. l Plastic coated items like paper cups, plates, bowls, carry bags. l Non woven bags, plastic flags, plastic buntings. l Plastic water pouches, plastic juice packets. l PET/PETE bottles of drinking water of capacities less than 500 ml (applicable only for drinking water) Branded juice PET bottles of all sizes and drinking water PET bottles of 500 ml and more will come under EPR regulations.
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l l l
Garbage bags (plastic). PVC flex materials. Plastic packets.
Guidelines to Patients: In pursuance to the latest Kerala State Government orders, with effect from 01 January 2020,BMH has excluded the use of single use plastic and plastic coated items including cups,plates,spoons,straws,nonwoven bags etc within the hospital premises. l All patients' rooms have been provided with 3 waste bins for (a) "Dry Paper Waste" (b) "Food Waste” (c) "General Waste" Disposal of wastes in the respective bins only. l To discourage use of plastics, each room has been provided with a set of 2 glasses, 2 cups, tray and jug. Same is returnable on discharge. l Patients should desist from bringing such plastic to the hospitals. In case one brings these items, the same should be taken back as they will not be accepted in the hospital for disposal (including coconut shells). l Delivery of food from external agencies is not permitted as they increase plastic waste generation Dial: 8603/8604 to avail F&B service in your room. l Metallic utensils/food carriers are used to carry food from Restaurant etc. These carriers can be purchased from the "Gift shop" or same can be obtained from the Restaurant on paying a refundable deposit. l Usage of Red and Yellow waste bags will be continued. Since these bags are being taken back to IMAGE for incineration/disposal. l Procurement of Green and White waste bags has been stopped forthwith and the waste being collected in these bags shall be disposed directly into waste bins. l Non-Woven carry bags used by Pharmacy, cafeteria, restaurant etc has been/is being replaced with paper/Bio-Compostable bags. (However nonwoven bags are being used for internal purposes till stock lasts - for repeated use). l Usage of disposable cups and plates has been discontinued and compostable/paper cups and glasses shall be used wherever possible steel glasses/cups shall be used. l Plastic stirrers have been replaced with wood equivalent. l Net Disposable draw sheet used in CT/MRI and procedure rooms will be replaced with tissue paper roll. l Usage of sheet plastic transparent will be continued and the disposal of same will be in Red bags. l Usage of press lock polythene covers for sending the lab samples will continue but will have a red lining since the disposal of same will be in Red Bags. l Procurement of water bottles below 500 ml stopped. l Mail has been forwarded to the Vendors/Distributors of items supplying goods in plastic covering/packaging to take back the packing material.
Say No To Single Use Plastic Reduce, Reuse, Recycle Go Green with BMH
Energy Tips
Lt. Col. Sunny Thomas (Retd.)
BMHÂ DuÀP D]tbmKw
Ipdbv¡phm\pÅ 15 h-gnIÄ BMH t]mepÅ h³InS Bip]{XnI-fn DuÀP¯n-sâ Imcy£aamb D]t`mKw Hcp shÃphnfnbpw AtXmsSm¸w Xs¶ hfscb[nIw {i² sNept¯ Hcp taJ-ebpw IqSnbmWv. AWp_m[ \nb{´Ww, DuÀP¯nsâbpw shůnsâbpw A\nb{´nXamb D]tbmKw, FÃm Znhk§fnsebpw apS§msXbpÅ {]hÀ¯\§Ä XpS§n Bip]{XnIfnse DuÀP¯nsâ D]t`mKw aäv kwcw`§sf At]-£n¨v XnI¨pw hn`n¶amWv. BbXn\m Xs¶ DuÀP¯nsâ D]tbmKw Imcy£aamt¡Xv A\nhmcyamWv.
tcmKnIfpsS kpc£ Dd¸phcp¯p¶Xnt\msSm¸w kpKaamb NnInÕm kuIcy§Ä Hcp¡p¶Xn\pw b{´kma{KnIfpsS {]hÀ¯\w IrXyam¡p¶Xn\pw IqSp-X DuÀP£aX ssIhcn¡phm³ R§sf \nÀ_ÔnXcm-Ip¶p. BtcmKykwc£W¯n\pÅ NnehpI-fpsS hÀ²\hv, ]cnØnXn kwc-£-Ww, IqSmsX Øm]\¯nsâ kpØncX F¶o ImcW§fm DuÀP¯nsâ D]tbmKw ]camh[n Ipdbv¡p¶Xnt\msSm¸w Imcy£aX hÀ[n¸n¡p¶Xn\mbn GhcpsSbpw klIcWhpw ]¦mfn¯hpw Dd¸phcpt¯Xpw BIp¶p. CXn\pth \S]SnIÄ amt\Pvsaânsâ `mK¯p\n¶pw Bcw`n¨pIgnªp. Cu ZuXy¯nsâ e£y {]m]vXn¡mbn FÃm Poh\¡mcptSbpw klIcWhpw Iq«mb {]hÀ¯\hpw XnI¨pw Bhiyambncn¡p¶p.
BMHs\ IqSpXÂ ]cnØnXnkulrZam¡m³ Xmsg ]dbp¶
15 Imcy§Ä ]men-¡pI. 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15.
FbÀIojWÀ D]tbmKtijw Hm^v B-¡pI. IgnhXpw {]IrXnZ¯amb hmbpk©mcw Dd¸m¡pItbm, ^m³ D]tbmKn¡pItbm sN-¿pI. F.kn 24 Un{Knbn skäv sN-¿pI. F.kn {]hÀ¯n¡pt¼mÄ P\Â, hmXn Ch ]qÀ®ambn AS¨n-SpI. kqcy{]Imiw IS¡mXncn¡m³ IÀ«³ C-SpI. D]tbmKansæn sseäv, ^m³ aäv D]IcW§Ä F¶nh Hm^m¡pI. sshZypX\ãw Hgnhm¡m\mbn ¹Kv, AUm]väÀ aäv D]IcW§Ä F¶nh Ignbp¶nSt¯mfw D]tbmKanÃm¯t¸mÄ {]hÀ¯n¸n¡mXncn-¡pI. D]tbmK tijw FÃm I¼yq«dpIfpw Hm^okv D]IcW§fpw "F\ÀPn tkhnwKv ' tamUnem¡n kzn¨v Hm^m-¡pI. BhiyapÅh am{Xw {]n³dv FSp-¡pI. I¼yq«À D]tbmKanÃm¯t¸mÄ kv{Io³ tkhdn {]hÀ¯n¸n¡cpXv. 2 \neIÄ hsc Ibdp¶Xn\v en^väv D]tbmKn¡mXncn-¡pI. b{´§fpsS Akm[mcWamb {]hÀ¯\w dnt¸mÀ«v sN-¿pI. b{´kma{KnIfpsS B\pImenI ]cntim[\ kabmkab§fn \S-¯pI. Ahkm\s¯ Poh\¡mc³ t]mIpt¼mÄ FÃm D]IcW§Ä, sseäv F¶nh Hm^m¡m³ \S]Sn kzoIcn-¡pI. DuÀPkwc£Ww FÃmhcpsSbpw D¯chmZnXzamWv. AXn\mbn Hs¯mcpan¨v {]hÀ¯n¡mw.
Recipe
C-µp Z-bm\-µv sU]yq-«n am-t\-PÀ {^v Hm-^okv
hnjp kvs]jy _oävdq«v ]¨Sn BhiyapÅ km[\§Ä 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12.
_oävdq«v (hepXv) þ 1 ssXcv þ 1 I-¸v\mfntIcw NnchnbXv þ 1 I-¸vISpIv þ 1 Sokv]q¬ PocIw þ 1/4 Sokv]q¬ C©n þ 1 sNdnb I-jvWw ]¨apfIv þ 2 F®w Idnth¸ne þ 2 häÂapfIv þ 2 F®w shfns¨® þ 1 tS_nÄ kv]q¬ shÅw þ 1 I-¸vD¸v þ Bhiy¯n\v
]mNIw sN¿p¶ hn[w _oävdq«v \¶mbn hr¯nbm¡n sNdnb IjvW§fm¡n apdn¨v 1/2 I¸v- shÅsamgn¨v Hcp Ip¡dn thhns¨Sp¡pI. NqSmdnbXn\p tijw anI-vknbpsS sNdnb Pmdn ]IpXn Achn Acs¨Sp¡pI. aq¶v- apX F«p hsc tNcphIÄ AtX Pmdn C«v \ÃXv t]mse Acbp¶Xv hsc Acs¨Sp¡pI. \à ]pfnbpÅ ssXcv t^mÀ¡v D]tbmKn¨v I« DSs¨Sp¯Xn\p tijw amän h¡pI. tijw ]mXn Acs¨Sp¯ _oävdq«pw Ac¨ \mfntIc¡q«pw \¶mbn tNÀ¯nf¡n 3 apX 5 an\näv hsc thhns¨Sp¡pI. AXn\ptijw sNdpNqSn ssXcv tNÀ¯v \¶mbn Cf¡pI. tijw Hcp ]m³ h¨v AXnte¡v Hcp tS_nÄ kv]q¬ shfns¨® Hgn¨v 1/2 Sokv]q¬ ISpIn«v \¶mbn s]m«nbXn\v tijw häÂapfIpw Idnth¸nebpw tNÀ¯v hdp¯v tImcpI. X¿mdm¡n h¨n«pÅ _oävdq«v ]¨Snbnte¡v CsXmgn¨v Bhiy¯n\v D¸pw tNÀ¯v Cf¡n \à ]n¦v \nd¯n B¡n hnf¼mhp¶XmWv.
Recipe
Sruthi P Lab Technician – Laboratory
shfp¯pÅn ]mbkw
tNcphIÄ shfp¯pÅn iÀ¡c \mfntIc¸m _Zmw IZfn¸gw s\¿v Ge¡mb s]mSn km_q³[m\ C©n\oÀ An¸cn¸v, Inkvankv
: : : : : : : : : :
150g 750g H¶mw]m 1 I¸v-, cmw]m 4 I¸v-, aq¶mw]m 4 I-¸v50g 1 25g 1/2 tsp 10g 1 tsp 10g
X¿mdm¡p¶ hn[w: sNdpIjvW§fm¡nb shfp¯pÅn I¡w tNÀ¯v thhn¡pI. tijw s\¿n hgäpI. tX§bpsS aq¶mw]m iÀ¡c ]m\nbpambn tNÀ¯v Xnf¸n¡pI. tijw s\¿n hgänb shfp¯pÅn tNÀ¡pI. Xnf¨p hänb tijw cmw]m tNÀ¡pI. CXnte¡v Ac¨ _Zmw, km_q³[m\,Hcp IZfn¸gw F¶nh tNÀ-¯v häns¨Sp¡pI. \¶mbn Xnf¨p hänb tijw Hcp Sokv]q¬ C©n\oÀ tNÀ¡pI. tijw H¶mw]mepw Ge¡ms¸mSnbpw tNÀ¯v sNdpNqSn Xnf¸n¡pI. s\¿n hdp¯ An¸cn¸pw Inkvankpw tNÀ¯v kzmtZmsS Ign¡mw.
Recipe
JACKFRUIT SABUTHANA PRADHAMAN
Ingredients Jackfruit Pulp Soaked & Cooked Sabuthana Thick Coconut Milk Coconut Milk (2nd Extract) Coconut Milk (3rd Extract) Jaggery Ghee Ginger powder Cumin Powder Cardamom Powder Cashews Raisins
: : : : : : : : : : : :
1 Cup 2 Cups 2 Cups 2 Cups 2 Cups ½ kg 100 ml ½ tsp ½ tsp ½ tsp 10-12 no's 10-12 no's
Recipe Pour jaggery syrup through a strainer in the cooked jackfruit pulp. Mix well in a low flame. Add 2 cups of 3rd extract of coconut milk and stir till the mixture thickens. Add 2 cups of 2nd extract of coconut milk and stir well. Add 2 cups of soaked and cooked sabuthana in the mixture and stir well till it thickens. Add 1 cup of thick coconut milk and stir well. Add ginger powder, cumin powder and cardamom powder. Stir the mixture well and off the flame. Garnish the pradhaman with fried nuts and raisins and serve it.
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Quiz
Q. Benchmarking determines……………………………………………….. A). How company is doing relative to others B). Process capability C). Customer requirements D). Getting ISO 9000 audit done
Answer to the previous quiz: Q. Service Quality cannot be managed when: Customer expectations are not known
Send your anwser to hrd@babymhospital.org before 20 th april 2020 (The correct answer will be published in the next Magazine and the winner will be awarded a prize)
Awards
Awards
Lt Col Sunny Thomas (Chief Administration Officer, BMH) and Mr Sukumaran (Senior Security Officer, BMH) receive the National Safety Council (Kerala Chapter) Award for the Safest Hospital from Hon. Mr Justice Devan Ramachandran – Judge High Court Kerala.
Baby Memorial Hospital received AHPI Award for Excellence in Healthcare in the category 'Quality Beyond Accreditation'.
Photography
Dr. SHAJI THOMAS JOHN Chief of Clinical Support Services
For the Rich and the Famous
Windermere, Lake District, UK
The Creek, Dubai, UAE
For the Bold and the Beautiful
Pattaya, Thailand
Bali, Indonesia
For the Young and the Ambitious
Honeymoon at Uluwatu, Indonesia
Night life, Hong Kong
But now, The Bottom line
Waiting for Covid 19 to set‌..
Awaiting the dawn of a new era‌..
Indira Gandhi Road, Kozhikode - 673 004, Kerala, India. Call: +91 495 2777777 | www.babymhospital.org