HHI visit to India, 2018

These are my notes - everything we did, and many of the people we met. All in great detail!

Introduction

It was a good trip.  Things seem to be going in the right direction, and there were no major issues to sort out.

Iain joined me from 20-29 January.

A Rupee is worth just over 1p.  A lakh is Rs. 100,000, so about £1,150.  A cent is a hundredth of an acre of land.  CP=cerebral palsy, MR=mental retardation (not PC, I know, but that is how they refer to it).  Panchayat work=workfare.

I shall deal with the big themes first, then give the travelogue.


Tom

Tom is making a good recovery.  The first impression is that he is back to normal.  He is certainly in good spirits, his old jovial self.  But he still tires quickly: after an hour or two he is exhausted, and has to go for a sleep.  And he is a lot slower and a bit more forgetful.  But after all he is 81 next month. The good thing is that he is living in Special Therapy at Kalathara at the moment.   This means that Philip can intercept any visitors, tell them that they can’t come into an area with vulnerable children around, and tell them to wait outside. That way he can discuss with Tom whether Tom really wants to see them, and Tom can prepare himself mentally for them at his leisure, and maybe finish his kip first.  And the job of telling undesirables to go away falls to Philip, who is a whole lot more robust about it than Tom is.  It also means that Tom is fed and watered regularly, and reminded to take his meds.  Tom is planning to return to Kulappada soon.  If he does so he will lose his protective screen and will have a lot more "customers", some of whom will put pressure on him. 

Special Therapy

The staff have been joined by Sebastian, an Indian who has lived most of his life in New York, and has come back to India to reconnect with his roots.  A confident MBA, he is spending a year with the centre as a volunteer.  He  is helping collect and return children from/to their homes as well as interacting with the children.   He is highly observant, thoughtful and generous – like Tom, he thinks of others before himself.  He is encouraging the staff to have proper records, assessments of the children and objectives for each that are reviewed regularly, and generally trying to give the place more direction.  He will also set up a website that staff will be encouraged to update with stories of the children – something for us to link into and watch.  

There are now three SN teachers as rules require one teacher to 5 children.  There has been some progress; I encouraged Philip to network more with Santhosh, and to benefit from his experience and expertise.

They have a new physiotherapist.  The previous one, had become unreliable in attendance.  The new physio does three full days but costs more. She is also a lot more gentle.

Philip has applied for registration.  Registration would entitle the centre to a Government grant covering food and a bit more.  This has been obstructed by the building owner, whose agreement was needed: he is hoping to sell it.  The current asking price is 140 lakhs (£160,000) which is in excess of what it is worth – even with 90 cents of land Philip values it at no more than 90 lakhs.  As a result, Philip is looking to rent or buy another building.  We looked at one such – a huge place, far bigger than is needed, which has been little used for the last ten years but has stood up to the dereliction remarkably well.  However the price was vague and rather high, and the seller was uncommitted.  The price of land and property has collapsed as a result of Modi's demonetarisation programme (land is down 90% from 3 lakhs / cent to less than Rs. 30,000), so now may be a good time to buy if we can raise the money needed.  Philip is well connected to the grapevine and will continue looking.  Funds could be raised from the return of the deposit on the present building (3 lakhs) and the sale of the buildings at Kulappada (maybe 5 lakhs – although Tom wants to retain Gleave house for crafts).

If the centre can build up to 50 children and have its own building, then it will become eligible for Government funding from the State after 1-2 years, covering all salaries and food.  This is "definite" according to Philip.  Below that, there "may be" funding available from the Panchayat.  50 children would require 10 teachers and 6 ayas – total potential cost £1500-2000 a month.  Maybe we could look for grant funding for start-up costs on the basis of a government grant becoming available in due course.  A building would cost about 30 lakhs (£35,000) including land according to Philip.  So we would be looking at something in the range of £50,000 - £100,000 over two or three years.  Philip will send me a more detailed proposal that we can seek grant funding for.

The centre has a second Omni van.  The two vehicles cover 100+ miles a day between them on punishing roads.

Hospital – Shibu

When we arrived, Shibu was looking after 11 patients and thriving on it.  Two are from Tamil Nadu, and one from the north of India, the rest from Kerala.  All are motor accident victims and aged about 60 – broken legs, arms and backs.  Only three can walk.  They are in plaster casts; for most, operations are not envisaged.  Many are incontinent.  They are "unknowns" - or at least were initially.  They may stay for up to three months.  We were able to transfer three of his long term patients to a hospice run by the Bethany Fathers (they also run Trppadam) which should relieve some of his workload and reduce costs that are getting a bit out of hand with so many patients to feed and care for.  One positive development is that the Junior Communist Party is dishing out 10,000 free lunches each day at the hospital. It involves a bit of queuing, but Shibu collects lunches for his patients and himself.

A nurse has 150 to 200 patients to look after, so is employed full time giving medicines and injections, and has no time for anything else.

I visited on the 18th and saw some of the patients.
Suzan Marina (80) is very withdrawn.  He sleeps curled up.  He has a swollen leg.
???? is a Hindi language man, but does not speak.  Bike accident, broken leg, incontinent, depressed
Gorbalen has a surgical belt provided by the doctors for his broken back.  He comes from Pottapala, near Rani & Johnny.  He may need an op later.  Shibu feeds him with a spoon.
Sukumaran was in the ICU for a month with a broken neck.  No strength in his arms and legs.  He has had one op, and may need another.

I also met Thomas, who is a volunteer barber / shaver.

Outside the hospital was the wife of Gengarvarem, who has taken over his stall.  We provided a wheelchair for G, but he has died.  She ways that she is very happy.  We also met Muniyanda, an ex-patient of Shibu, using the walker that we bought for him.  He was back for a check-up; he is making good progress.   

Tuition groups & counselling

There are now 5 tuition groups.  In November three dropped below 15 children and were discontinued.  The money has been diverted to pay for the third SN teacher at Special Therapy.  A Scottish supporter is raising money for two more groups.  Philip says that he will run ten groups from April onwards.

We visited Pazakali tuition group.  This was a special event rather than a standard class so both morning and evening children were there (10 girls and 6 boys) plus 7 mums.  It has been going for 8 years; early students are now on degree courses.

Thanal
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They now have 30 ladies, which is about as many as the place can cope with.  Over the last year, six or seven have been reunited with their families – one was taken to Bangalore, the others came from Kerala.  They have been replaced with some homeless women from the bus station and discharged patients from the mental hospital.

The old ramshackle dining area has been replaced by a magnificent airy and light hall.  It is tiled so should be easy to keep clean.  It was provided by a pastor and a friend.  The next step is to modify a window into a doorway so as to enable the women to have access to it during the day, not just meal times.  They are talking about an outside enclosure at the back which the women will also have access to – this should be more secure than the area we have created at the front, but smaller and more difficult to construct as the ground falls away rapidly.  The kitchen has been moved back to its original location (previously the family's dining room) and provided with a lot of storage.  A pile of tiles was outside, which will be used to tile the women's rest area – they were waiting for money to pay for mortar and labour.  Iain contributed to this so they should at least be able to make a start.  The tiles were bought with money given by an Indian supporter; initially this was given towards a house for Salini and her family, but Salini asked if it could be used for tiling the women's quarters instead.  Salini and family are now living on site, in what was previously the office.  And the beds that we restored a couple of years ago are still looking pretty good - they appear to be being used daily.

The initial inspection for re-registration was very hostile.  But when rectification of the deficiencies was tested, the next inspector was more sympathetic and has extended the deadline.  It is not clear when there will be a further inspection; the hope is that Salini will be able to demonstrate sufficient progress in the right direction, and thereby gain more time.  Outstanding requirements include, in no particular order:-
A cook.  Salini says that this would cost Rs. 12,000 a month, but Philip and I think that this is on the high side – maybe by a factor of two.
Tiling the women's rest area – floor and walls up to six feet.  They say that they need another Rs. 56,000 – again, I think that this is high.
Not storing food on the floor.  They now have a lot of storage in the kitchen; Salini would like a pantry.
A psychiatric doctor.  One demanded Rs. 12,000/- to come once a month.
Two psychiatric nurses.  The inspector took a dim view of Salini dispensing meds, despite the fact that she has been doing it for years.  Rs. 10,000+ a month each.
Wood for the new doorway, and labour to create it.
A cleaner.  A few thousand Rupees a month probably.
Salini's priority is a cook.  Tom and Philip think that a psychiatric nurse is more important.  Either way, Salini seems amenable to the idea of having staff / outside help.  But that will cost money that we don't have at the moment.


Thursday 18 January

Trivandrum Medical College Hospital.

Then to Kulappada.

Pazakali tuition group.

Friday 19 January

Early morning visitors included the dwarf Cherookanam.  I set him up in business several years ago selling lottery tickets – this enables him (usually) to support himself and his mother, and he has also built himself a house on the proceeds.  An uplifting success story to start the day.

Mercy came with her daughter Simi.  Mercy's husband is sick and Simi's husband has kidney failure.  Simi is having tests to see if she can donate a kidney.  They go to Tom's church.  I gave Rs. 1300 for one dialysis and transport to and from the hospital.

Radha was next.  She has a fantastic testimony of her conversion to Christ from Hinduism and persecuting Christians.  I gave her a Bible a couple of years ago – she says that she reads it every day.  Her brother had a foot amputated recently – he is a widower (we used to provide insulin for his wife) with a married daughter.  CSI.  He does not want a goat.  He can have a small monthly sub.

Neighbour Gunyamole had a stroke 10 years ago.  He is improving as a result of the meds and living costs that we provide.

Baby came.  Her husband Vijaykumar was injured whilst working on a building site and still has limited mobility.   In the past the family had owned a cow, which was sold to pay medical bills.  We subsequently visited the home (20th) and bought them a cow (30th).

Special Therapy does not operate on a Friday so as to enable children to go to school and claim allowances as a result (Special Therapy operates on a Saturday instead).  We visited the home of one pupil, Nikhil (see website, news section).  This is a mud brick house with little furnishing where Nikhil lives with his mother, father, grandmother, brother and sister, who are all normal.  Nikhil has CP, autism and MR, so he does not talk much and walks very wobbly.  The father is a coolie who spends his earnings on alcohol.  Gran had a mastectomy a year ago.  Nikhil was unwell and the meds had left him pretty comatose.

Most of the rest of the day was spent visiting various people whom we support.

Sindhu was next.  We met her last year.  She has kidney failure: we contribute to the cost of her twice-weekly dialysis (Rs. 850 a go plus bus fare) whilst she waits for a transplant organ to become available – she has been waiting two years, and expects to wait for another year at least.  Her husband Saji works in a hotel / restaurant and a coffee shop, but work is irregular, so they have to borrow to fund the dialyses.  A mixed marriage – Sindhu is Hindu, Saji is Catholic – both families have disowned them and the Church gives no help.  They have a daughter in 6th standard and a son in 10th.

Next stop was Subinlal and Sudinlal, two brothers (the similarity of the names confused me).  Their mother had a kidney transplant, but eventually this failed and she died.  Both lads have had kidney transplants as well.  Sudin is in 10th grade, Subin reached +1 then left school.  We contribute Rs. 5,000 a month towards the total cost of meds and tests of about Rs. 3,500 a week (so one third – this is typical).  Their father and uncle provide the rest.  Subin is on Serolimus, which is difficult to obtain.  He also has partial paralysis of his left side from which he is recovering slowly – physio might help.

Then it was off to Sukumaran and Vishalashi.  S was sitting up, alert (a big improvement), but V did most of the talking.  S has one son by a previous marriage, but he does not come and has S's ration card.  They get a government pension of Rs. 1000 pcm and help from others, as well as free meds.  The communist party has wired the house and pays the bills.  They now have a bit more, including a fairly well equipped kitchen with lots of pots and pans.  They spend our support on milk, biscuits and rice.

Paskaran – see above

Mardaren Villa was at Trppadam for three years.  He and his wife get a pension of Rs. 1000 pcm between them.  Our 500 is spent on meds.  Despite the heat (30C plus) he was wearing a sweater, woolly hat and thick dhoti.  It was his 71st birthday, so Sebastian rushed out to buy him some Paisum to celebrate.

Sorbana 47 F had a brain tumour some years ago, which left her with slight paralysis of her left side.  It is much improving, but she still gets pains in the shoulder if she uses it., and also neck pains.   Her husband, a rubber tapper, had an accident and is not fully functional – he has no left eye, the left arm is weak and the balance on the left leg is poor.  A devout Catholic, their house was provided by the Church.  They do not want a goat.

Gobi has a stiff left leg.  We offered him free physio and use of the exercise bike if he came to Kalathara.

Vijayam is much improved – he was sitting up.  His wife works at a petrol station.

Saturday 20 January

Pastor Stephen came.  He has a big Bible distribution network throughout India.  I gave him our spare 8 Bibles, children's Bible stories and Rs. 10,000 of Bible money.

Then it was off to Trivandrum for the monthly distribution of kidney medicines.  Many of the donated kidneys have now failed.  For these we give the cost of one or two dialyses a month.
Vijaya got Rs.1000 and immediately went off to dialysis
Saji and Harinda each got meds and Rs. 1000 to spend on other meds that we didn't have
Abdul is an older bearded man who gave a kidney to his son in 2004.  It has now failed.
Rajendran.  He is in an Ayurvedic hospital.
Philip did all this.  His style is different from Tom's (quicker, less chatting and praying).

Prasanna was also there – see my article in the news section of the website entitled "Nothing in India is ever straightforward".  He had a compound fracture of his leg about 18 months ago (discharged in Sept 2016) - he was pillion passenger on a motorcycle which collided with a car.  We paid for implants and a leg support / caliper.  The original caliper was made the wrong size – we fell out with the supplier when we demanded a replacement.  The bones are not properly aligned, so there has been no real recovery.  They have two sons – one had a kidney transplant in 2007 at age 5; the government pays for the meds until he is 18.  His wife does loom work when it is available; they get help from the community and the local RC church.

Pastor Babysam (45 M) has heart problems – stage 2 diastolic dysfunction.  His stomach is distended by the meds that he is on, and he cannot lie down to sleep.  We paid for his angiogram.  He came with a long wish list of meds – I went of to the pharmacy with him to buy them.  In due course he will need an expensive injection.

Sujima Mol is a 7 year old girl with a bone growing wrongly in her upper chest.  The family is very poor.  They had a CT scan recently at Nedumangad, and a consultation was due on Wednesday (24th).  Doubtless we will be called upon to help if there are significant costs.

At this point Tom and Iain joined us, Iain's flight having been delayed at Dubai by ATC problems.

Tom said that Shibu's mother Solorgena needs a moulded lumbo-sacial corset – a sort of surgical belt.  Tom will investigate the cost: I said that we would pay or at least contribute.  It is in lieu of paying Shibu.

In the afternoon we went to see Baby and Vijaykumar (see above).  V was sitting in a chair.  He has a spinal cord injury which limits his ability to walk and manipulate his hands.  Christian (RC).  Pretty destitute.  They have a daughter who has passed +2; she joined a college but had to leave as they could not pay the fees.  They also have a son who failed +2 English.  He was an occasional tiler but was allergic to cement; then a painter but was allergic to paint.  They have a potential cow shed in which they were looking after Baby's sister's goats – these will be sent back home.  Whilst we were there some bank officials turned up: the family took out a loan of 1.5 lakhs two and a half years ago, secured on part of the house,  but could not repay it, and it has now increased to 4 lakhs.  The family were threatened with eviction, but Philip advised them to stand their ground as the courts will not evict.  

Next we went to see Ambudashi (82) and her daughter Vasanta.  Ambudashi was looking worse, lying in bed and unable to sit unaided, although V dragged her into a chair.  It looks like she is at the end of her life again, but she has proved me wrong on that account in the past so we must wait and see.  Their request was for a bed sheet, which Iain met.  

Sharmala was the final call of the day.  Her daughter, who lives with her, does Panchayat work; her son-in-law is a mental patient.  4+ grandchildren were evident.  

Sunday January 21

We went to Tom's church.  They have a new pastor who measures spiritual power in decibels - on that basis a major revival must be on its way.  Iain sang them a hymn, and I gave a short talk on "How can we know the way?".  Afterwards there was the usual cohort of people needing help.
Radha (not the one above) with her grandchildren.  Their mother had been ill recently (= expense) and their father is a coolie.  We have given Radha a goat in the past.  She has a deformed arm – it used to be worse until it was pinned many years after being broken in an accident.
Gomedy 70 F gets a government pension but Tom tops it up.  No children; she has sisters but they all struggle.
Her sister Sumadi needs expensive meds.  Her house needs a door.  I gave her money to buy a walking stick as she has an injured foot.
???? got a repeat prescription for her asthma spray.  
???? mother of Sreekantham had DVT, pneumonia etc. in 2013.  A MRI for suspected a further venous thrombosis was delayed as she could not pay for it.  Tom gave a chitty for a scan at Metro Scan where he has an account.  It will cost Rs. 3500/-.
Ormena had bad cancer.  She scrapes a living by selling lottery tickets.  She has little family support.  We have helped over the years.
Rekha, an adolescent girl,  has had one operation for breast cancer, but needs another.  This has been on and off since our visit last year – there is always some reason for delaying it.  She was back the next week.  The operation is due 17 February.  
At this point Tom decided that he had had enough, and went to the pastor's house for a lie down, leaving me to get rid of the others with a hundred Rupee note apiece to keep the peace.  

Once Tom had had his kip we went to Thanal (see above).

Monday 22 January

First port of call was Shanti Bhavan.  An unannounced visit found the place running pretty well under the supervision of Omar Kuttan, whom we rescued from a life of disability with the provision of pins for his legs two or three years ago.  

One inmate is Bindu – photos in a brown dress.  She suffers from epilepsy.  Meds are usually effective, but she had had a fit the previous day; at such times she does not know what is happening, falls, and can injure herself.  As a result she is unmarried, has only had one year of schooling, and was abandoned by her family who never visit.  Eight years ago her father called her and sent her over to her uncle to live.  But the uncle's son's wife feared that she would bring back luck on the family and brought her to SB where she has remained ever since.  Her father denies responsibility for her as he has handed her over to her uncle.  She is happy at SB, and helps around the home.

OK asked for a couple of beds to replace broken ones.  Iain and I paid Rani for one each.

Rani, who runs the home, has met with an accident - the bike she was riding was hit by another bike, her bike fell on her leg breaking and dislocating her ankle.  The neighbours rallied round at the behest of the church and paid for metal rods to be inserted and a plaster cast applied; this was 2.5 months ago, and she will be in plaster for another two months or more.  Rani and Johnny live with Rani's parents, who they look after.  I agreed to give them Rs. 20,000 every July and January.  

In the afternoon we transferred three of Shibu's patients to the House of Mercy – or the Psycho-Social Rehabilitation Centre for Destitute and Mentally Ill Persons.  This currently caters for 30 people recuperating from hospital treatment and 85 mentally deficient men.  Max capacity is 125 so it is pretty full.  It seems to be well run.  It has been running since 2008 in a former garment factory which has been extended.  The priest in charge is a very pleasant chap who holds Tom in high regard – he says that Tom and Father Gabriel were the exemplars that inspired him to get involved in this area of work.

Tuesday 23 January

General strike day in protest about the price of petrol.   Compliance was a lot higher amongst people with a monthly salary, who had nothing to lose.  Most shops were open, but traffic was lighter.

Our first task was to transfer across to Kalathara.  We then bought a cow for Prassana (see Saturday morning and my article in the news section of the website entitled "Nothing in India is ever straightforward").  

We spent the afternoon in Trivandrum buying crafts etc.

Wednesday 24 January

The day was spent with Pastor Wilson in the Neyyar Dam area.

Much of Wilson's work has collapsed and he was not his usual cheerful self.  He used to get a lot of funding from the Netherlands, but he doesn't have ANBI (some sort of Netherlands tax exemption certification) (hardly surprising as he is Indian not Dutch) and so funding from that source has dried up.  Only we support him now, he says.  So no more wells, goats, water tanks, or tuition groups.

As regards work for the leaf painters, Tom proposed a much reduced leaf painting operation plus some bracelet making.  He says that he can find an outlet for their work; I am doubtful, but maybe he knows best.  Wilson said that he will help explore sales areas.  

I agreed to fund start-up costs of a jewellery making business for some more ex-leaf painting women.  It is costume jewellery, similar to what AKA make.  The components can be bought cheaply in Tamil Nadu, strung up at the Neyyar Dam, and sold in Tamil Nadu and/or locally.  Iain gave Rs. 18,000 for this and I promised a further Rs. 32,000, enough to employ 15-20 women initially.  If Wilson reinvests the profits that he is confident of making, he should be able to build up the business and employ more women over time.  I made it clear that we were not going to subsidise it after the initial start-up.

Tom has stopped paying his part of the cost of the animators for the credit unions, Rs. 8,000 a month, for various reasons.   As a result the animators have been reduced to three, the groups from 217 to 164, and the salaries have been reduced as well.  No-one is happy about all this, but we don't have the funds to pick up the slack.

The current "hospital" feeding programme, 400-500 meals a week, is actually at a rural health clinic.  It is on Tuesdays and Saturdays when blood pressure and glucose tests are offered.  It is funded by a Rs. 80,000 gift.  Salaries are Rs. 350/- a day x2 so that should last some time.  Wilson did not push for the expanded programme that he emailed me about some time ago, and I did not mention it either.

Wilson's guest rooms are underutilised.  I offered to advertise them on our website.  I also told him about airbnb.  If he can make a bit of money that way he may be able to support a bit of charitable work himself. 

Sumi, whom I have been putting through uni, has married.  Her husband is "not interested in study".  Further study would involve going back to the start of the course.  Her sister is studying, and her father has died.  I have been asked to support her sister through uni.

We visited some people whom we have been helping, and others that Wilson would like us to help.  He had a long list – I said that we would see the two or three in the greatest need.

Sorbana 55 F has had a mastectomy.  The other breast has been hurting for a few months - she is on pain reducing meds, with the prospect of another op in the future.  Her husband Sukumaran is a coolie - work is sparse.  Their daughter does Panchayat work and their son-in-law is another coolie.  They are poor but not desperate.  They have loans from medical bills secured on the house.  She needs a check up every three months at a cost of Rs. 3500 (KIMS hospital).  I gave Rs. 1500 towards the next.  I have said that we will make this regular.

Bindu's psoriasis is much better but it still flares up from time to time.  One such recent attack led to her being in a private hospital specialising in dermatology for 6 days at a cost of Rs. 5,000.  Flare ups used to be the whole leg, now they are more localised.  She can stay on the list for another year.

Her mother's heart problems continue - if she misses a single dose of meds then she gets chest pains.  Meds cost Rs. 1200 pcm so she can stay on the list.  Surgery is a possibility but she is too fearful.

Amakutti 90F lives in a mud brick house.  She is blind.  The whole government pension goes on meds.  Her son and daughter provide food but otherwise she is on her own.  Reasonable kitchen, tatty clothes.  If we gave her money I am not sure how she would be able to spend it as she is unable to get out of the house.  Wilson suggested a sub, cow or goat – but could she look after an animal?

Arunda Veli is much more mobile than on our last visit three years ago – all fingers and right arm and leg are all moving thanks to the Ayurvedic medicine which our sub buys.  However she can still not stand or walk.  She still lives with her father who has mental issues.  Arthritis makes everything painful.  She is still poor.  Locals bring food: whilst we were there a young man came with a carrier bag full of food.  Keep them on the list.

Kamalachi's leg was amputated 3 months ago due to diabetic complications of a wound that did not heal.  The other leg is going the same way.  She also has circulation problems.  She is completely withdrawn and unresponsive.  She lives with two daughters - one divorced and the other unmarried.  The latter had a job last year, but no longer works.  She needs a second op to seal the leg, and has also needed surgery to deal with bed sores - even with an air bed.  Three meds are prescribed - the family can only afford one.  We gave Rs. 4000 for a third dose of human albumen (it's not clear how many more will be needed) and Rs. 900 for an impregnated gauze to help deal with the bed sores.  I intimated that we might pay for a bit more human albumen if it was needed.

After that lot we needed, and got, something a bit more uplifting - a couple of credit unions.  The Karnalastary one had 15 people.  They have just repaid a 2 lakh loan from the bank in 30 months.  The regular sub is Rs. 20--50 a week.  Most members have had a loan at some point over the group's 8 year existence.

A second group nearby had also had a 2 lakh loan from the bank which they repaid in 25 months as their subs are higher.  11 ladies were present.  In a moment of enthusiasm I promised Julie a sewing machine which I will pay for.

Thursday 25 January

I went with Sebastian to Asha Kiran Ashram for the day.  It's a long haul, and I don't recommend it in a single day.  At least I have visited often enough that I could guide Sebastian.  The visit was unannounced, and was truncated because Santhosh wasn't there.  

There were 28 children (give or take one or two: they didn't stay still for long enough to be counted accurately) present.  Typically there are 33-34, I was told, out of 42 on the roll.  15 are residential (2 young boys and 13 girls).  There are 5 classes with 5 teachers (2 qualified, one probationary, one student, and one ???) plus 3 ayas.  

Classes were in full swing, so it seems to operate well even when we aren't there to pay a state visit.  The co-ordinator Jessie turned up after a bit.  She is the heir apparent of Asha Kiran (Santhosh said as much), and she seemed to be pretty knowledgeable about everything that was going on.  She is an MBA who is undergoing a divorce.

Beulah was away at a temple function.  I gave the supporter's letter to Jessie for her to pass on. But it sounds like she may be at home longer term: her father has died, and her mother wants her at home.  Her legs were still at AKA.
Arunya, the girl with a deformed foot, is now resident at AKA.  Her mother died, her father is a drunkard, and her grandparents are geriatric. The window of opportunity to sort her foot out has probably passed now.  IQ is normal but delayed.  ("Normal" IQ can be pretty low, it seems).
Meena's dropped foot has been corrected.  She is now able to stand on it, and walk a bit.
There were two new boys and four new girls since our last visit.
Rajish Veri has no speech, cannot walk.  MR & mild CP.  Getting physio.
Dormudy.  Downs Syndrome.  Walks but unresponsive.  
Batma Kokleam.  CP.  Speech & IQ normal.  Dwarfism, problems with fingers, cannot stand.
Siva Sangary – Downs' syndrome and heart problems.

I asked for some success stories.
Subin would not move or interact when he arrived.  After physio he now interacts well, moves, and will say things like "that's enough food".  He was hyperactive; but now he will sit and act normally.
Mala used not to speak.  Now she shows motherly instinct – if younger children are upset she comforts them.
4 older boys came in during the holiday for vocational work – jewellery making and Phenoyl (cleaning material) production (diluting concentrate and bottling it; next stage is making it from scratch).  They have sold some of the Phenoyl.
Panarmassi has been to two schools, but always cried.  Now she gets up for school even at weekends.

The physiotherapist, Dr Vijay Kumar, was not there - he had sprained his back.  But he was there the previous day.  Physician heal thyself!  He had visited Mayakannan's home to demonstrate exercises.  He may send a student or sidekick as a substitute - it was not clear if this would be cheaper.  

There are 4 residential staff, all female – 2 full time, whilst the co-ordinator and one teacher also stay at nights.  One room has 4 kids, the physio room has one, and the rest are in the main hall.  There is an adult (staff or volunteer) in each room.

Tanga Ratina 14 F is one of the most disabled children.  Most of the time she lies on the bed.  She can move around it a bit, and likes the net "house".  Some toys have been arranged to dangle over her: she interacts with these a bit - Liz Gittings' doll is popular.  She sits up for physio, but after a few minutes it becomes painful.  Her parents, who live half an hour away, are compelled to come every two months - they do not come willingly - and get a big smile from TR when they do.  She has never met her siblings.

Another very disabled child is Myakunnan 3.5 M.  He also wriggles around.  He has MR and 100% CP.  Since arriving 6 months earlier he has learned to stretch his legs, and interacts more with his environment.  He used to cry a lot, but has become happier - he likes baby powder.  The hope is to get him sitting, and to use TV to get concentration.  The only thing that he will eat is Marigold biscuits.  The parents visit monthly for all of 10 minutes.

I dished out Iain's teddy bears to the children that the staff suggested.  They seemed very appreciative of them, as well as of the Strathaven toffee that I took for Iain.

Friday 26 January

First port of call was Trppadam, where Tom was greeted by Mutti, whom Tom had taken to Trppadam many years ago.  He comes from North India and has his name and address  tattooed on his arm.  Despite this he has never been taken home.  There are 25 men and 25 women like him there – people with mental problems.

The priest in charge welcomed us and showed us a video about Father Gabriel (1925-2006) with whom Tom worked for many years.  He also showed us the chapel which has a reliquary containing a hair of Mother Theresa.  

We then visited Santhosh who was at Chullimanoor.  He had come for a wedding, but had gone down with suspected pneumonia.  I talked to him on the phone earlier in the week and he was very croaky – by this time the antibiotics had kicked in and he was recovering. ESR was 70: it should be about 15.  He is feeling his age (57) and looking at succession planning.

Santhosh suggested a temporary physiotherapy hall between the residential unit and the kitchen.  If a permanent physiotherapy hall is built later then this could serve as a dining hall.  The old roofing and trusses from the school room could be reused, so it could be built for one lakh.  I agreed.  

A permanent building would cost about 10 lakhs.  Santhosh could raise 2 lakhs.  A government grant is unlikely – the regular grant is pending: 7 or 8 lakhs are due, but corruption means that there is no money to pay it.

Back at Kalathara, we had a visit from two ladies from the Aksheya organisation, who wanted swing machines, eye camps, etc.  They seem to be doing good work, but their finances were healthy and I saw no reason to contribute.

Then we went shopping at Nedumangad for table and chairs for Special Therapy, and to investigate computers – the centre's computer is pretty geriatric and does not do internet (although I suspect that it could).

Saturday 27 January

We had a good look at the potential building for Special Therapy.

After that we went to CDSA at Idinjar.  I had been expecting the children to be there all day, but there had been a strike one day that week and a public holiday (Republic day) another, so it had been declared a normal school day and the tuition was on weekday timings.

10th standard students arrive at 7am, the others at 8am.  There are about 80 in total.  The 10th standard group is the largest; they come only in the morning at present as the school is giving extra tuition until 8pm in preparation for the SSLC.  Classes cover 1-3, 4-5, 6-7, 8, 9 and 10 standard.  Children attending have had a 100% pass rate at the SSLC since 2013 - an outstanding achievement.  There are about 20 tribal students and two tribal tutors.  One is Asha, whom we met: she was a student at CDSA for 5 years, went on to take a degree in English, and has been teaching at CDSA for two years.

At the time of our visit the 9th standard class had 17 children, and the others (in descending age order) 6, 8, 6 and 8, making a total of 45 children on that particular day.  Classes seemed pretty well run, with help for individual children.  Ajayan was teaching the older children maths - it looked fairly serious stuff.

The vacation classes cater for about 40 students from 8th to 10th standard.  Attendance can be irregular.

Chandra Babu told us about the history of CDSA.  The children go to school at Peringmala, about 9km away, by bus.  His plans / dreams are of satellite tuition groups in other nearby settlements.  

The centre also has a surgery twice a month.  A recently qualified doctor from Trivandrum MCH comes from about 3pm to 5.30 and sees 25 patients - mostly the same ones.  Meds cost Rs. 4,000/-.  Mainly high blood pressure and diabetes, with fevers in the monsoon.  CB asked me to fund more visits, but I am not convinced that more visits would be cost effective if it just means the same patients being seen more often.

The sewing centre has three functional machines for 4 students.  This can cause problems.  The European (Fritzer Rossman) electric machine that I took out three years ago failed after six months, and CB has not been able to get it repaired.  As it was a Saturday it was not operating.

Sunday 28 January

All Tom's regular autorik drivers were at a wedding, so we went to church by bus.  As is usual in India, it was full when it arrived, but we squeezed on, followed by a good proportion of the local populace.  Fortunately it was only a few miles, and one of our fellow passengers was someone whom we had helped by paying for an operation for hair lip - it was successful, and he was very grateful.  At the church we met Bindu who is the aunt of Sandhya, who we helped in the past.  We helped with the cost of an operation and chemo for breast cancer a year ago.  She continues to need injections for swelling of the operation site.  As she gets violently sick if she travels by road, she walks into Trivandrum: if she leaves at 6am she can arrive by 1130.  Tom helps with her daughter's school costs.

At the service I spoke about adding to your faith from 2 Peter 1.

Afterwards there were the usual requests for help.

Sugandi is on insulin.  She is a "regular".  I gave Rs. 200 for her electricity bill.

Shanti 31 F, children aged 13 & 11, fell out of a tree whilst trying to pick jackfruit, causing some minor fractures of the vertebrae in her back.  She came all strapped up and with a host of x-rays and scans, many irrelevant.  I gave her Rs. 200 to cover the cost of a hospital visit.

Phanu Nadar needs meds for asthma and diabetes.  He does not work.  His wife Lila is on meds for mental problems; these are reasonably effective.  Rs. 100.

Lilly Bhai has asthma.  She also has three daughters and no sons; her husband labelled this a "disaster" and deserted her.

???? (male) has kidney failure for which he is on dialysis whilst he awaits a transplant.  He was in need of a blood transfusion - I gave Rs. 300 for the donated blood to be tested.

Radifar Beevi used to have a tea shop – this stopped when her husband died, but she would like to restart it.  Tom will get costings – it would be good to help her.

?? F got an inhaler refill.

Thankayyam came for meds for his wife Suma who is in hospital.  She is epileptic.  Rs. 100 for hospital expenses.

Sandhya's mother is unemployed.  She is on the list for Panchayat work but none has been offered yet.  Rs. 200 to keep body and soul together.

The mother of Srikant (whom I met in hospital last year) came. Tom arranged to meet her at the hospital for a scan for Srikant.  In the event the hospital could not do the scan, so Tom filled in one of his chitties to get them a scan at a private hospital in Trivandrum.  Rs. 3500.

Shanta is one of the bracelet / camera strap makers.  Her husband has Parkinson's and a stroke, so needs pretty constant attention.  We provide meds.  This sort of home working is ideal for such as her.

???? has speech problems.  Rs. 100.

We saw Chris's well.  This has been given to Sabila and her son Mudib - I handed over the final instalment of Rs. 2000 plus Rs. 100 for hospital transport.

After this we visited Pastor Ray to discuss the possible purchase of the building that we had looked at.  The meeting was inconclusive.

We went to Chandra Babu for dinner.  I photographed the accounts, and learned the difference between Republic Day and Independence Day.  His older son is studying automotive engineering in the Punjab, there being no suitable course in Kerala - he is on the second year of a four year course.  He would like a career designing cars, but I suspect he will end up in something a lot more mundane.  His second son, in the 8th standard, is not academic.

Monday 29 January

We spent the day at Special Therapy seeing what is going on.  20 children came for the day, and others came for physio, speech therapy or acupressure.   I went with Sebastian on the morning pick up, thereby getting to meet a few of the children whilst providing a second adult in accordance with regulations.

First pick up was Rehan who has CP.  His mother is divorced and has gone back to her parents; the ex fails to pay alimony.

Next was Paul Christy and Kessiya, two young siblings with MR who have made sufficient progress that they will go into mainstream education next school year.  Their mother comes to the Centre as a volunteer.  Kessiya needs an op for kidney problems.  Paul Christy is good at drawing, and seems able to write fluently.

Then Shaheen, who does not speak, just makes noises; Ayana who is autistic and MR; Alameen with Downs Syndrome; Amusree who has CP and a leg deformity, problems with muscle coordination and speech problems.  With their bags the Omni van was pretty full!

Back at the Centre, Vishnu (spastic CP) can now sit against a wall - before he could not do even that.  Physio has developed some lateral support and has learned to feed himself with a spoon.   The fingers of his right hand are very deformed; the left hand is more normal but he has little control over it.   The next stage is to get him some calipers so as to develop legs and standing; these are available free, but the parents need to work their way through the bureaucratic jungle and have become discouraged.  He has two normal younger brothers.

Shaheen was on the parallel bars.  He has a normal younger brother.  At home he is just locked up.

The older children have little scope for academic learning, so the focus is on more vocational things.  Anousha has learned to make tea, and the aim is to teach her some more elementary kitchen skills.  Two older boys, Sharm and Alusa, were sweeping up the leaves outside and watering the plants - most inexpertly.

Kalyani (3.5 F) comes for physio and acupressure only.  She has CP which makes her walking very wobbly – but when she came first she could not walk at all.  She is gradually learning to talk, but has only got as far as odd words.

Anouba has bad CP and is completely floppy.

Kiran is highly autistic.  He seems to suffer stomach pains and spends most of the time crying – sometimes he can be distracted enough to stop yowling for a bit.  He demands constant attention which ties up one person pretty well full time.  He has been around for a month.

Anousha has a high pitched voice which she is very self-conscious about, and is disinclined to speak as a result, leading to her becoming very withdrawn.  I'm not sure why - it's not that squeaky.  The staff have made some progress with getting her to come out of her shell.

Nikhil has learned to clap.

Romance is in the air, or at least arranged marriage.  Sharm's and Serenia's parents want to marry them off.  They are distant cousins who live next door to each other, and they have started going to the same church.  If it goes ahead they would probably move in with Sharm's family.  

Philip completed a course on acupressure whilst we were in India, but he has yet to take the exam.  He also tries his hand at physiotherapy.  Maybe he can save a bit of money that way.  If so, it will be all to the good.

We finished off the day with a visit to the Cheropoly tuition group which has been running for six years.  They have a total of 20 children on the books, of whom 10 (5 girls and 5 boys) were present for a normal session.  Numbers were down as it clashed with a weekly dance class.  The group meets for two hours in the evening, evenings only – parents prefer to send all their children to the same session.  I did suggest that this should mean half the salary: this was regarded as a joke (it wasn't).   This evening they were learning Malayalam – reading a passage and testing comprehension.  The children were reading fairly confidently, with occasional stumbles.  Tuesday is English, Wednesday is Maths, Thursday Science, Friday Social Studies, and Saturday (a longer session) Hindi and General Knowledge.

Iain left at about midnight.  We insisted that Tom did not come to see him, or me, off, and Tom acquiesced.

Tuesday 30 January

Tom, Philip and I went to Thomas Kutty (the tax advisor) in the morning to move forward some issues that have arisen.

In the afternoon we went to buy another cow, this one for Vijay Kumar.  It was much more straightforward than the other one.  The cow has been delivered of its first calf and is producing 8 litres of milk a day.  The calf, a female, was included in the purchase price of Rs. 40,000.  The family needs it.

In between I remedied my vitamin D deficiency on the roof of Special Therapy.  An hour in the tropical sun was enough to give me mild sunburn.

I left about midnight.