Integrating

Healthcare

Primary & Secondary

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Visit of John Christensen and Shekar Swamy from C. S. Foundation

Visit of Trustees

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Our Thirumalai Charity Trust (TCT) is a 43 - year old NGO currently working in 315 villages in the Vellore district, providing services in Community Healthcare, Women Empowerment, Disability, De-addiction and Village Development, etc. For the past few years, we have been working on consolidating our activities, and focusing our work in the region on strong and effective community health practices. We have also set up the Thirumalai Mission Hospital in 2010 to offer accessible, affordable and quality healthcare.

As we work towards integrating the primary and secondary healthcare services, we have included the following aspects in our approach to serve as many people as possible.

A few of TCTs past and current beneficiaries have come together to form the village level Community Based Organization called Annam*.

The community selects a Family Care Volunteer to coordinate all its activities.

Our Multi-purpose workers serve the families directly at their door step.

The senior specialists of the Thirumalai Mission Hospital organize screening camps periodically.

Family Care Volunteers, Annam representatives and staff refer patients to the hospital from the field, and they provide follow-up care for the referred cases.

At the hospital, we offer service in the following departments: General medicine, General Surgery, Obstetrics- Gynaecology, Paediatrics, Orthopaedics and Emergency. There is continuous attention to improve the quality of our laboratory service.

We are evolving new methods to provide healthcare to our community. We are fortunate to have a medical and hospital team willing to stretch itself and a field team committed to making a difference to this community. We are adding to our facilities, departments and services.

We have received constant encouragement for our work from our donors, well wishers and friends. We are happy to share our activities and their highlights with you.

For Thirumalai Charity Trust

Bhooma ParthasarathyDirector-Trustee

*Annam is a legendary bird that is capable of drawing the best and leaving the rest from its food. Annam in Tamil also means food. Thus, the name symbolizes the best that can be chosen and in another sense food that is a source of health.

Introduction

ANNUAL REPORT 2012 – 2013

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Thirumalai Mission Hospital under the Thirumalai Charity Trust is a unique attempt to integrate primary level care in the community with a secondary level hospital for patients coming from the community.

Globally, there is inequality in distribution of health care. This is more so in developing countries like India. There are too many caregivers and health care facilities, both public and private, in urban areas and too few in rural areas. There is also a huge social, economic and cultural divide between rural and urban areas. This is reflected in the type of medical problems, willingness to seek medical help, accessibility and affordability of good healthcare. High-tech medicine, therefore, benefits only a small minority.

Before embarking on steps to improve health care in the rural community, it is important to know the attitudes and needs of the community. Common health problems need to be identified and their prevalence assessed. Health care models should be developed based on the needs of the community and the predominant health problems. In an attempt to identify the health needs and common problems in our community, we reviewed the data of men and women who attended the village camps and medications prescribed in these camps.

We have identified some of the major medical problems in the community such as Diabetes Mellitus, Hypertension, Common Infections, Osteoporosis and Obesity. We carry out a screening program at the community level for womens health problems, including cancer of the cervix and breast cancer. Our pediatricians have started providing health care for children in the community who attend Balwadis. We are in the process of streamlining care at the community level through our multi-purpose health workers and family care volunteers by equipping them with BP apparatus and simple equipment (glucometers) to monitor blood sugars for diabetics in the community. We carry out educational programs for all the medical problems that we have identified so that patients from the community get the maximum benefit. The outpatient services are increasingly utilized by the community as reflected by an increase in OP attendance and an increase in inpatient numbers. The laboratory is taking part in the quality control program run by CMC hospital and is rendering very reliable service.

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With the integration of the primary care with secondary level hospital, we hope to provide cost-effective, ethical and good quality care for the community. Our approach has been further encouraged by many physicians and general practitioners in the community who have started referring problem cases for evaluation and management. Our ambulance service has helped many sick patients to reach the hospital in time. For patients coming from the villages that we cover, transportation has been arranged to facilitate access to health care.

We are grateful to all our patients who have continued to use services provided and the many agencies and individuals who have rendered support to facilitate the success of this project.

For Thirumalai Mission Hospital

M.S. SeshadriMedical Director

24-hour Ambulance Transport for Patients

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Mrs. Bhooma ParthasarathyDirector

Thirumalai Charity TrustRanipet, Tamilnadu

Mr. S. SanthanamDirector

Ultramarine & Pigments Ltd.Mumbai

Mr. R. SampathChairman & MD

Ultramarine & Pigments Ltd.,Ranipet, Tamilnadu

Mr. C. Antony SamyAdvisor

Worth TrustVellore Dt., Tamilnadu

Mrs. Shanthi RanganathanDirector

TTK HospitalChennai, Tamilnadu

Mr. D.K. SrinivasanSecretary

Hindu Mission HospitalChennai, Tamilnadu

Dr. R. BalasurbramaniamFounder & President

Swami Vivekananda Youth MovementMysore, Karnataka

Dr. Arjun RajagopalanTrustee & Director

Sundaram Medical FoundationChennai, Tamilnadu

Mr. K. ThirumalaiAdvisor

Thirumalai GroupChennai, Tamilnadu

Mr. S.SridharJt. Managing Director

Ultramarine & Pigments Ltd.,Mumbai

Mr. R. ParthasarathyManaging Director

Thirumalai Chemicals Ltd.Ranipet, Tamilnadu

Trustees

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I. Primary HealthcareOur activities spread over 315 hamlets, 50 Panchayats, covering a population of nearly 160,000 in 35000 families in Walaja and Katpadi Taluk of Vellore District of Tamilnadu.

Promotion, education, detection and screening, referral, treatment and follow-up activities have been organized for different target groups under the following:

► Maternal and Child Health► Paediatric Health► School Health► Adolescent Health► Women Health► Support for Senior Citizens ► Disability and Mental Illness► Alcoholism► Treatment for Common Ailments &Injuries ► Chronic Health issues

The training in the previous years enabled us to organize the activities with a better focus to track the individuals health and the progress of the activity.

In order to provide integrated primary and secondary healthcare service to the community, we redesigned our rural healthcare as a project. To make this shift possible, the health workers moved from the health centers to villages and organized mobile clinics. Multi-purpose workers, who are in regular contact with families assigned to their care, support these health workers. The Family Care Volunteers and the Annam members enable service delivery at the community.

To understand the needs of the community, a family survey was conducted in all the villages. The common health problems identified in the survey are given here.

1 Arthritis 5954

2 Women Health Problems 4191

3 Alcoholism 4080

4 Blood Pressure 3580

5 Eye problem 2665

6 Dental Caries 1703

7 Diabetes 1294

8 Ulcer 663

9 Skin Disease 516

10 Asthma 498

11 Heart problem 309

In a focused effort, all individuals above 30 years were surveyed to study presence of any symptoms of diabetes and also the prevalence of diabetes in their immediate family. In the 48,387 people above 30 years who were surveyed, 6,750 were believed to have symptoms of diabetes and 3,408 were already known to be diabetics.

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A survey of all disabled people in the area was done to assess their needs for assistance. A total of 1,217 disabled people were surveyed. The type of disability is grouped in the table below.

1 Orthopaedically Handicapped 615 2 Hearing Impaired 124 3 Speech Impaired 28 4 Mental Retardation 143 5 Cerebral Palsy 131 6 Visually Impaired 66 7 Mental Illness 203 8 Hearing and Speech Impaired 62

Following these surveys, those requiring the services that TCT provides are listed, and the Multi-purpose workers follow up with them regularly. The survey has thus been a starting point for identifying those with needs.

TCTs Core belief is that development must come from within the community. To translate this belief into practice, TCT utilizes community based women volunteers and action groups. The impact of this practice has reaped rich dividend for the community over the years. As we redesigned our approach, we took stock of the many human resources we have created in the community in the last thirty years, and decided to leverage our strength with them. We created a unique integrated nodal delivery point for our action with volunteers. After a series of discussions with the community and staff, this manifested in the evolution of the new community-based organization called the Annam.

In every village, the composition of Annam is an average of 15 members drawn from TCT trained Volunteers, Health Committee Members, Disability Self Help Group and Federation Members, in addition to a few interested beneficiaries of TCT programmes, Panchayat representatives, local Government functionaries and Village informal opinion leaders. New Family Care Women Volunteers selected by the community actively coordinate the activities of the Annam and provide local support in implementing the programmes in many villages, While the results of this new initiative are yet to be seen, the initial progress of the Annam in the organization of their local meetings and the community participation in the programmes is indeed very encouraging. To facilitate their participation and involvement, we attend these meetings and provide training.

In villages with more than 100 families, we organize these Annam Community Based Organizations. We have formed 90 such groups. In other villages which have lesser number of the families, the Family Care Volunteers (one each for 50 families) provide service supported by village elders and beneficiaries. We have 520 Family Care Volunteers in 315 villages. It is indeed a great step forward to have this cadre available to enable reach of our programmes.

Annam: Our New Community Based Organization

Ms. Jhansi Organizing the Formation of Annam

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Maternal and Child Health

Our Multi-purpose Workers identify ante-natal mothers during home visits, with the help of village health nurses, volunteers, beneficiaries and Annam members. The ante-natal mothers are educated on nutrition, immunization, the need for calcium and iron supplements, the importance of institutional delivery and family planning. Our Health Workers in their monthly mobile clinics measure their weight and blood pressure. They also see the record of sugar, albumin and haemoglobin levels and apprise the mothers of any risks they have and advise them suitably. We have cared for 1,075 antenatal mothers in their homes and villages. The mothers are visited within seven days of birth to see if there are difficulties in breast feeding and are counseled on diet and nutrition. Within the first two months, babies are also assessed on weight at birth and health status. They are examined from head to foot to detect any problems. Their immunization status on BCG, 1st dose of pentavalent and polio is ascertained.

Paediatric Health

A total of 3,764 children under 5 years were monitored for growth. Their immunization data were obtained. Mothers were educated on nutrition, immunization, personal hygiene, breast feeding care during minor ailments. Children were tracked on the developmental milestones. Early detection of disability has been a focus area; 23 children were assessed for disability and those identified were referred for the special care required.

School Health

In 78 schools, programmes were organized. In these primary and middle schools, 3,583 students were given a health check up. They were given de-worming medicines twice in the year. Special attention was given to care of eyes, ears, dental, skin, disability and nutritional deficiencies. Deficiencies were treated with medicines and ear wax was removed. Referrals were made to our hospital and local Primary Health Centers.

Monthly education for the students include personal hygiene, safety and first aid, care during diarrhoea, head lice, scabies, care of eye, care of ear, nutrition and disability.

Dr. Kiruthika Educating Mothers at a Paediatric Camp

School Students Being Screened by Ms.Leela and Ms. Yashodha

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Adolescent Health

In 12 schools, sessions on alcoholism, disability, mental illness, suicide, violence, and pubertal changes were organized.

In the villages, adolescent boys and girls were trained in separate batches. Personal hygiene, nutrition, improving interpersonal relationships, anaemia and alcoholism were covered in this training. For girls, additional focus was given for improving their haemoglobin and for boys the necessity of consuming healthy food.

In more than 17 periodic programmes in the villages, about 2,400 adolescents benefited.

Women’s Health

In group education programmes, gynecological problems, osteoporosis, breast and cervical cancer, diabetes, hypertension, nutrition, HIV/AIDS, alcoholism and obesity were the topics covered. Nearly 580 programmes were organized and more than 9,000 women benefited.The awareness generated in these programmes resulted in women voluntarily coming forward to participate in health screening programmes held for them.

Support for Senior Citizens

Senior citizens are brought together at the cluster level and are offered counseling support for their health and family problems. In these programmes, we check their sugar and blood pressure levels and provide suitable advice on diet, exercise and medicines. They are also screened for cataract problems. In more than 220 programmes, about 1,850 senior citizens participated. Their family members are also included in counseling programs if necessary. They are referred to the Hospital for their ailments.

Ms. Chamundeswari Training Adolescent Girls in a Village

Ms. Nadiya Organizing a Women Education Programme

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Alcoholism Education and De-addiction

In our 21st 15-day residential de addiction camp, 33 alcoholics were treated by the TTK Hospital Team and Dr.Kabilan. Their wives attended education and counseling sessions every day. Their children and friends were also made aware about alcoholism, its treatment and need for understanding and support by the community. Education, screening and pre counseling and follow up counseling were the key activities. Nearly 280 people received counseling at our Thiruvalam Centre. Treated alcoholics participated in education programmes in the villages. Awareness programmes with posters exhibition were organized in 4 villages and 102 people visited the exhibition.

Dr. Shanthi Ranganathan Felicitating a Treated Alcoholic for His Sobriety

At the Alcoholism Camp - Dr. Kabilan, Ms. Bhooma, Mr. Mohan & Mr. Parasuraman

Disability and Mental Illness

The Disability Federation members facilitated government assistance schemes as follows:

► ID Cards 6► Insurance Card 22► Bus Pass & Train

Pass 27► Group Houses- 9► Maintenance grants,

pension 36► Scholarships 4

The Rotary Club of Besant Nagar distributed 5 artificial limbs made by Andhra Mahila Sabha.

Meetings of Disability Federation, parents of disabled children and care givers of the mentally ill have been organized over the year in 17 programmes to enable them to cope with some of their problems.

Artificial Limbs Distribution - Representatives from TCT and Rotary Club of Besant Nagar with Beneficiaries

Mr.Sridhar Training Parents of Disabled Children

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Eighteen year old Subhashini from Balayankuppam became orthopedically handicapped following a polio attack when she was 1½ years. At the insistence of TCT staff, she got her ID card at a Government assistance camp reluctantly. This card enabled her to get education scholarship till she completed school. Being a bright student, she got good scores in her higher secondary examination. Encouraged by TCT and her Teachers, she applied for a seat to pursue M.B.B.S. under disability quota. She got a seat in Villupuram Medical Collage and is studying for M.B.B.S degree now. She didnt understand why the TCT staff was insisting on her getting the ID card when she was in school. But now, she is thankful to TCT for guiding her properly.

K of Lalapet became mentally ill soon after the delivery of her first child. TCTs Multi-purpose Worker indentified her condition as depression and advised her mother to take her to CMC, Bagayam. She has been on treatment for over six months and now is recovering. Her husband has now taken her back to their home in Bangalore as she has shown a lot of improvement.

Treatment for Common Ailments &Injuries

Our Health Workers organized village clinics on a regular basis for treating minor ailments as well as organizing check ups for ante natal mothers , children under 5 years and known diabetics and hypertensives. They also carried out screening for diabetics and hypertensions both in these clinics and during village visits. In these clinics, 52,876 patients have been reached. The health workers also visited the very sick and the new born, during these clinic visits and have cared for 11,036 people during such visits with appropriate education and advice.

Ms. Akhila Examining a Child in a Village Clinic

Ms. Sharmila During a Home Visit – Care for an Elderly

Savithri, 47 years from Ceylon Colony was reluctant for many months to get her blood sugar tested. She had all the symptoms of diabetes. After much follow-up and advice, she finally got a random test done for sugar by our Health Worker and it was alarmingly high. The diagnosis was confirmed at our hospital and now she is on follow-up care in the field. Her sugar is now beginning to be under control. She feels bad that she didnt seek help earlier, but is thankful to TCT for the advice and follow-up.

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Our Multi-purpose worker identified Priyas problem of swelling in the neck and throat region as thyroid deficiency. Priya was referred to our hospital where this was confirmed. Priya is now on continuous treatment. She has also conceived her second child now and is delighted.

Community Education

Besides education for the defined target groups, attention has been given to certain topics to educate the community. Violence, Suicide, Obesity, Womens Health and Issues, Diet, Life Style Modification, Diabetes, Hypertension, Osteoporosis, Cancer, Alcoholism, Disability and TCTs programmes and hospital services have been covered in over 250 community meetings.

Formative Evaluation

The Primary Healthcare Project was evaluated at the formative stage to assess if we are ready to implement the way we had designed it. The evaluation carried out by Mr. Saminathan, a Consultant and Social Worker highlighted the need for concrete steps towards integration of Primary and Secondary Healthcare and the gaps to be filled in to implement the project. The evaluation was followed up with detailed action plans. The project is being monitored by an internal and external team for effectiveness and efficiency on a quarterly basis.

Training for Staff

This is an on-going activity and mostly carried out in-house. Training for planning, reporting, communication and job functions are carried out on the job.

Multi-purpose Workers were given knowledge in training sessions on a weekly basis. The topics covered include Diabetes, Hypertension, Ante-natal Care, Osteoporosis, Cancer of Cervix and Breast.

Mr. Saminathan in Session with the Admin Staff

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Hospital View

II. Secondary Healthcare

FACILITIES

EMERGENCY

OUTPATIENT SERVICES IN - PATIENT SERVICES► General Medicine ► Surgery ► General Surgery ► Medical Care► Obstetrics And Gynecology ► Ante Natal Care► Pediatrics ► Wards► Orthopedics ► Pediatrics Ward► E.N.T. ► Private And Semi Private

Rooms

LABORATORY ULTRA SOUNDX- RAY DEXA SCANE.C.G COLPOSCOPY

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At the Thirumalai Mission Hospital, we continued to reach out to the community by organizing on-going programmes as we focused on developing the departments. The hospital worked round the clock.

The improvements and expansion we have made in the hospital include:

► The outpatient and inpatient coverage is showing sustained growth.► Our programmes in the community on diabetes, hypertension, womens

health and osteoporosis have been accepted and are beginning to show results.

► The community is involved in the programmes and the beneficiaries are also proactive to meet their needs.

► We have also started awareness education in Womens Health, Diabetes and Hypertension in industrial establishments and institutions, besides village communities.

► The attention given to quality systems in the lab has been of immense value to the consultants in diagnosis. The lab service has continued to improve under the guidance of Dr. A. S. Kanagasapabathy (Former Head of Biochemistry, CMC). A Vitamin D analyzer was added to the facility. We participate in the EQAS programme of CMC, Vellore and our results match well on quality standards.

► The Gynaec department has introduced Hysterosalphingram procedure and Intra Uterine Insemination.

► The Paediatric department has introduced Allergy and Asthma screening.► The Ortho department has started to devote special attention to arthritis

and is encouraging physiotherapy.► The Medicine department has devised a system for Management &

Control of Diabetes for patients coming from our target community.

Ultrasound In-Patient Service

Laboratory Physiotherapy

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► The most important addition to the programmes is the fortnightly Academic sessions for the benefit of the younger medical staff. Medical officers and junior consultants present and discuss case studies on patients that are treated at the hospital and get valuable input during the review by the senior consultants.

The progress of the hospital is seen not only in the increasing number of patients, but also in the number of referrals from the local medical community that are well managed by the senior consultants of the hospital, and the complex medical problems that are being solved with the inter-departmental coordinated approach of the hospital.

Patients Treated Details

April 2012 Cumulative Service March 2013 Since 18.04.2010

Out patients 22131 49612In Patients 380 693Check ups 1682 6311Surgeries 113 166Septic OT Procedure 98 123Emergency Cases 214 617Babies delivered 60 110Physiotherapy 503 883Total 24591 58515

Standing from Left to Right: Dr. Gayathri, Dr. Kavitha, Dr. Muthulakshmi, Dr. Kiruthika, Dr. SivarajSitting from Left to Right: Dr. Padmapriya, Dr. Lakshmi Seshadri, Dr. Seshadri and Dr. Thampi Moses

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In-Patient Details

Medical & Paediatric Problems 184Communicable Diseases 13Surgery 113Gynaecological problems 22Obstetrics 39Neonatal Care 9Total 380

Screening Programmes & Camps

Students Health Check-ups 1575Osteoporosis Screening 1060Women screening for cancer 1039Gynaecological camp 77Surgery camp 215Paediatric camp 159Eye camp 683Multi Specialty camp 631Total 5439

Surgery in Progress

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At the hospital, we attract a number of patients with interesting and complicated problems. Some examples are presented here.

Care for Senior Citizens with Multiple Problems

A 72 year old lady presented with large mass protruding from vagina for several years. Due to the mass, she had difficulty in voiding, had urinary retention and difficulty in passing motion. She was diagnosed to have a prolapsed uterus, urinary bladder and bowel (procidentia) and was admitted for surgery. She also had elevated blood pressure and intermittent irregular heartbeats (atrial fibrillation). These were corrected, and a vaginal hysterectomy with repair of bladder prolapse was performed. Post operatively, she had low blood pressure briefly and low urine output. Blood levels of sodium were also low. A diagnosis of inappropriate anti-diuretic hormone (ADH) secretion was made. Sodium levels were corrected. Medication that was administered for pain relief, which could have caused the problem was stopped. Patient developed peritonitis (infection) and was treated with appropriate antibiotics. She subsequently recovered and was discharged in good condition. Inappropriate ADH secretion in a 72 year old woman is a rare complication, difficult to diagnose and treat but due to prompt diagnosis and intervention, the patient was saved.

An elderly lady of 85 came to our hospital with the complaint of prolapsing mass through the anus for the last 8 years. It had turned painful for the last one week. She also has a prolapse of the uterus for more than 20 years and severe urinary complaints. She walks bent double as she has severe senile kyphosis which causes bending of the spine. X-ray of the abdomen and pelvis confirmed a stone in the bladder 2 inches in size which too had prolapsed outside with the uterus.

She was a great anaesthetic and surgical risk the doctors decided on operation under local anaesthesia, tackling the problems one by one.

First, the prolapse of the rectum was dealt with by Thierschs wiring, by which a steel wire loop is inserted around the anus to narrow the opening which prevents the prolapse coming out of anus. After 3 weeks, the bladder stone was removed through the vaginal wall under local anaesthesia. She tolerated both the procedures well. The Thierschs wiring had to be revised one week after the second surgery, as she had severe constipation.

She was offered a free DEXA scan which showed severe osteoporosis and she was given calcium supplements with Vitamin D3.

The patient was followed up 2 months after all the procedures and is doing well. She was offered Ring pessary to control the uterine prolapse, but she is happy with the way the things are, free of any pain.

Measurement of the Stone in the Bladder

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Doing Our Best for the Patient

A 45 year old lady came to the hospital with a complaint of abdominal distension over 3 years. On examination, she appeared to have a large ovarian cyst of size 10X8 cm on the right side, and ultrasound confirmed this finding. This kind of condition normally indicates malignancy, and the patient underwent hysterectomy and removal of ovarian tumor. However the pathology report revealed that it was only benign. The patient is now under follow up care.

Appropriate Treatment for Regulating Periods

A fourteen year old girl did not get her periods for over 4 months, after the first two periods on attaining menarche. She appeared to be of normal build and well nourished. She had hyper-pigmentation over the neck, forearm and nape of neck (acanthosis); her jaws were prominent, her fingers and toes big; her gums hypertrophied. She had excessive hair growth all over the body. Overall, her clinical features were suggestive of Insulin Resistance Syndrome and probably a defective hormone synthesis of the adrenal gland. Lab investigations revealed high blood sugar values consistent with insulin resistance syndrome. With treatment, she has regained her normal mentstrual cycles.

Caring Treatment for Toe Injury

A forty five years old female patient was admitted following a road traffic accident. She had sustained injury on her left foot. The patient was conscious.

Local Examination of left foot & ankle revealed ► Crushed 1st & 2nd toe over distal phalanx ► Internal de-gloving present over lateral aspect of dorsum of left foot ► 3 X 3 cm laceration present below lateral malleolus

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The initial presentation is given in the photos below:

Initial Presentation Initial Presentation

The patient was taken up for emergency surgery on the day of admission. Wound debridement with amputation of big toe at distal phalanx had to be done and K-Wire was fixed on 2nd toe was done on the same day.

The wound healed well with regular dressing and the patient was made to walk with full weight bearing after 4weeks of skin grafting. The patient became completely pain free and began to walk normally.

Final outcome of the treatment is presented in the photos below for the readers understanding.

Final Outcome Final Outcome

After 1st Debridement After 1st Debridement

After 2nd Debridement After Regular Dressing Following 2nd Debridement

Following Skin Grafting after a Month of the Injury

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Care for Patients with Chronic Diseases in the Community

This activity has been the focal point for integrating Primary and Secondary Healthcare. As the medical team evolved procedures, the field team worked on them. Diabetes, hypertension, osteoporosis, obesity, cancer and arthritis are the diseases that receive our attention.

Diabetes and hypertension screening for people above 30 years is carried out in the villages in twice a week programmes in the villages and mobile clinics. A total of 20,078 people were screened diabetes, hypertension with the help of glucometer and blood pressure kits. A total of 3,004 new patients were identified and referred to the hospital. Of the 3,004 referred, 1,730 were confirmed of the diagnosis and are on follow up care. In our approach, we encourage continuing treatment in any setting of the patients convenience, as we track their progress individually in their homes.

A total of 958 people (751 women, 207 men) above 55 years underwent bone density scan at the hospital. Those with mild, moderate and severe osteoporosis have been treated with calcium and vitamin D supplements, advised regular daily milk intake of 200ml and exposure to sun light for half an hour. This intervention has been cost effective and meaningful. Of the 890 women who need medicine on a regular basis, our follow up indicates that 470 of them are compliant and improving.

In the screening programme for breast and cervical cancer, 1,039 women participated. An investigative procedure, Colposcopy was done in 45 women. Eight of them needed treatment for probable cancer and gynaecological problems. Cancer preventive surgery was carried out for 3 women. Three women were referred to Kanchipuram Cancer Institute for further treatment.

The screening programme data revealed that cervical and breast cancer are rare problems. A surprising finding is that more than 60% of the women are either obese or overweight, indicating a different kind of malnutrition or changing life habits among women. The hospital has introduced screening for sugar and cholesterol in these programmes. Seventy women have been tested for these two conditions and those needing care were referred to the hospital for proper treatment and advice.

The screening programme highlighted the need for organizing a gynaec clinic periodically in the community. Fortnightly gynaec clinics were conducted and 77 women with problems were treated in these clinics. 35 of them needed additional investigation and detailed assessment at the hospital and were referred. We are following up with them in the field.

Many of the women also complained of arthritis and severe joint pain. When they visit the hospital for the DEXA scan, the doctor advised physiotherapy.

Sample Collection for Sugar Testing at the Women’s Screening Camp

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Our Consultant studied the data available from these programmes mid-year and have presented them here.

DEXA Scan to Detect Osteoporosis

Based on these observations, awareness campaign has been developed regarding sufficient calcium intake, adequate sunlight exposure and vitamin D

Of the 431 Women Studied, 91% were Found to Have Either Osteopenia or Osteoporosis.

Of the 96 Men Studied, 63% had Abnormality.

supplementation. Overall, life style modification has been introduced.

Mrs. K, a 60 year old lady from Ammundi, had been attending the village clinic for past 3 years with backache, body ache, difficulty in getting up from sitting position and other vague complaints. She was prescribed paracetamol tablets during most of her visits to the clinic and she did not find any benefit. She happened to attend an awareness campaign regarding osteoporosis and learnt that a free DEXA scan is being offered at TMH. She utilized the facility, was diagnosed to have osteoporosis and vitamin D deficiency, was started on appropriate medication. She is remarkably better now and is able to work as before.

In an attempt to identify the health needs and common problems in our community, we reviewed the data of men and women who attended the village camps and medications prescribed in these camps. We realized that the most common problem was older women presenting with aches and pains. Paracetamol and non-steroidal anti-inflammatory drugs were commonly used. On the basis of this observation and based on previous studies on semi-urban Vellore, we hypothesized that osteoporosis and vitamin D deficiency could be the cause of aches and pains in older women and men. We offered free Dexa scans to evaluate bone mineral density for women aged 50 and above and men aged 60 and above at Thirumalai Mission Hospital.

527 subjects (431 women and 96 men)* underwent DEXA scan.

* Data available at the time of study

Studying Problems in the CommunityOsteoporosis

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Mrs P, a 48 year old lady had noticed vaginal discharge for sometime but did not know what to do about it. She heard from the multi-purpose worker from TMH about womens health screening camps and attended the same. On screening, she tested positive, was taken to TMH for colposcopy and was told that she had early precancerous lesion of the cervix. She was treated for the same and was advised to come for regular follow up.

Cervical cancer is the most common cancer in women in rural India. Breast cancer comes next. Screening by Pap smear has reduced the incidence of cervical cancer in the developed world. Routine screening by Pap smear is not feasible in India due to practical problems like cost, non-availability of expertise and lack of accessibility. Hence direct visual inspection of cervix after application of acetic acid (VIA) has been recommended. For breast cancer screening clinical examination of the breast is the most feasible. Awareness about common cancers

was poor in the women in the villages served by TMH and there were no screening programs in place. Therefore we organized peripheral camps in these villages where women between ages of 25 and 50 were screened for cervical cancer by VIA and breast cancer by clinical examination. Women in whom any abnormality was detected were referred to main hospital for colposcopy. Of the 994 women who were screened, 89 had positive screening test by VIA , 43 women had other gynecological problems and 3 had breast lesions which were later proven to be benign.

An unexpected observation was that 48% of women screened were obese and an additional 20% were overweight. Obesity can lead to the

development of diabetes, lipid abnormalities and cardiovascular disease. One in 20 women also had premature or early menopause. In a population in which dietary intake of calcium and vitamin D are grossly inadequate, this can add significantly to the development of osteoporosis.

Based on the above observations, we have started awareness programs, counseling sessions and are getting these women to adopt a healthy life style, diet, exercise weight reduction. These simple

Cervical Cancer

89

43

3 10

38 20

48

0

50

100

Tota

l Mem

bers

GYN Problems,Menopause,Obesity

Women's Screening report

Screen Positive Other gynecological disorders Breast lesions

interventions are likely to yield results in terms of reduced morbidity and mortality. Women with back pain and knee pain due to osteoporosis and osteoarthritis are also taught simple physiotherapy spinal flexion extension exercises and quadriceps exercises in our physiotherapy facility.

Counselling at a Women’s Screening Camp Dr. Gayathri Consulting in a Women’s Screening Camp

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Rajammal, 70 years, from Milagaikuppam, satisfied with thetreatment of her osteoporosis, has now recommended 4 women from her village to go through osteoporosis screening and treatment at our hospital.

Jegajothi, aged 50 years, of Vanniya Kattoor was diagnosed with osteoporosis after undergoing a DEXA bone scan. After six months of regular in-take of calcium and vitamin D supplements, she reports relief from pain in knee and other joints.

Mrs. M, 45 years of age, came for womens screening. She had complaints of mass descending per vaginum for 3 years, had difficulty in passing urine and had a white discharge for over one year. Our Gynaecologist diagnosed it as third degree uterine prolapse with cystocele and rectocele warranting vaginal hysterectomy. This surgery was carried out and she is now normal.

Mrs. M, 30 years of age from M.G.R. Nagar tested positive for possible cancer. After Colposcopy, she was a suspected candidate for Cervical Intraepithelial Neoplasia II and Human Papilloma Virus and was informed that she might need to go through a procedure at Christian Medical College Hospital, Vellore after three months. However at CMC, she was assessed further and was informed that she need not go through any procedure as she was found to be normal.

Paediatric Screening

The children in Balwadis are assessed by our Paediatrician in fortnightly screening programmes. Among the 159 children screened, a major problem appears to be inappropriate dietary care for very young children leading to low resistance, frequent infections and hence undernourishment. Sustained follow up with the mothers will improve the health of the children. At a Special camp held, 53 children were screened in a village.

Surgery Camps

In six surgery camps, 215 were assessed and 49 of them turned up at the hospital for further care and 14 of them underwent surgery.

Bagyaraj, 42 years from Balayankuppam Colony underwent piles surgery at our hospital. Satisfied with his treatment at the hospital, he has now referred his relative to our hospital for the same condition.

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Multi- Specialty Camps

Our hospital consultants participated in 5multi-specialty camps held in different locations 461 patients were assessed in these camps. Till November 2012, the Hindu Mission Hospital organized monthly multi-specialty camps at the hospital.

Dr.Thampi Moses at a Camp Dr.Kalidas, E.N.T. Surgeon at a Camp

Dr. Sivaraj at a Camp

Eye Camps

This monthly programme at the hospital has been a major attraction for two years. Eye specialists from Hindu Mission Hospital screen patients with eye problems and select patients for cataract surgery. The selected patients then undergo cataract surgery at Hindu Mission Hospital and are followed up at our hospital in the next two monthly camps. Following surgery, these patients are also given glasses at the Hindu Mission Hospital. A total of 683 patients attended these camps and 203 patients underwent cataract surgery.

Academic Sessions and Training

The fortnightly academic sessions for medical staff provide opportunities for learning. Real patient cases are presented and discussed. These sessions covered the following topics.

1. Hyponatremia due to syndrome of inappropriate secretion of anti-diuretic hormone

2. Dengue 3. Rectal prolapse 4. Osteoarthritis of the knee

Patients on Return after Cataract Surgery at Hindu Mission

Academic Session in Progress

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5. Partial hypopituitarism as cause for hyponatremia 6. Alcohol related neurological disorder 7. Approach to patients with menopause related symptoms 8. Osteoporosis 9. Management of paediatric febrile seizure10. Anaemia11. Compartment syndrome

Training for Hospital Staff

Training is an ongoing activity. The training topic is dependent on the prevailing issue to be tackled at the hospital and the specific knowledge or skill to be acquired by the staff dealing with the issue. The Consultants have conducted several sessions for the other doctors and nurses. The senior staff nurses have facilitated discussion on many topics. Topics for the

sessions were much varied - Resuscitation in children and adults, dehydration and diarrhoea management, dengue, spinal anaesthesia, care of the new born, kangaroo mother care, management of febrile seizures in children, procedure for application of plaster of paris, catheterisation, osteoporosis, cervical examination with acetic acid, colposcopy, ante-partum haemorrhage, post partum haemorrhage, hysterosalphingram, procedure for sterilization, hand washing, preparation of trays for different places like septic theatre, surgery, emergency, etc., obesity, cancer of cervix and breast, diabetes- control and management, foot care in diabetics, hygienic and sterile practices, incision and drainage procedure and many more topics.

The nursing and technical staff were introduced to the use of MS Office. The supervisory staff underwent training on Delegation. All the hospital staff had a one day programme on Communication.

Dr. Jayaraj -Training on ‘Communication Skills’

Training on ‘Delegation’ by Mr. Sadasivam

Training in Progress

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Five Multi-purpose Workers from the field were trained on Management and control of diabetes for two days at the hospital.

Training to Augment Skills for Cancer Screening

Our Gynaecologist and two of our staff nurses underwent training for two days to acquire knowledge and skills to perform Screening for Cancer of Cervix. They were given input on procedures to carry out visual inspection after acetic acid, colposcopy and cryotherapy. They were also taught to counsel the women. As the screening is already in process at our hospital, this training has augmented the skills and the staff are now better equipped to screen and counsel the women, in addition to treating them.

Training for an Intervention for Infertility

Our Gynaecologist and our lab technician attended a one-day workshop to acquire some skill to do the procedure, Intra-uterine Insemination.

Training to Community Health Workers to Prevent Infant Mortality

Our Paediatricians, Dr. Padma Dore and Dr. Kiruthika involved themselves in two training programme for field staff and the nurses. Nearly 70 persons participated in this training. This training was sponsored by the Indian Academy of Paediatrics and Dr. Narmada Ashok, its District Secretary was also an active trainer. The training was on Basic Newborn care and Neonatal Resuscitation. Skills in areas such as postnatal monitoring, detection of hypothermia, adherence to asepsis and Kangaroo Mother Care were imparted.

Training on ‘Blood Storage’

Two of our Medical Officers were trained at Hindu Mission Hospital for a week on management of Blood Storage Unit.

Training for Health Workers in Progress

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Participation in Medical Conferences

Our Medical Director Dr. Seshadri is a speaker at several medical conferences. The recent conferences attended by him include:

Sl. No. Organization and Place Topic of the talk

1. Endocrine Society of India, Diabetes Insipidus Kolkata 2. Task Force for stem cell Review and recommend therapy and regeneration research projects medicine, New Delhi 3. Christian Medical College, Stem cell therapy for Vellore diabetes 4. Vellore Institute of Technology, Developing a Model of Vellore rural health care

Dr. Padmapriya Dore, our Senior Consultant Pediatrician and Neonatologist, presented a poster titled Study on evaluation of the knowledge and skills of community health workers following Navjaat Sishu Suraksha Karyakram - Basic Newborn care and Resuscitation Program NSSK-BNCRP Training - Pilot phase at the 32nd Annual Convention of National Neonatology Forum in New Delhi. The poster presented an evaluation of the training given to our workers at the hospital in August. There were 200

posters presented and this was one among them.

Dr.Padmapriya at Urban Neonatal Health Conference in New Delhi

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III. Events & Special Programmes► Mr. V. Rajendran, Deputy General Manager, Union Bank of India, Salem

accompanied by the Banks local representatives dedicated a 20 Seater Swaraj Mazda Van to the hospital. The ceremony was attended by the hospital staff.

Mr. V. Rajendran, Deputy General Manager and Mr. N. Selvarajan, Manager, Union Bank of India with Hospital Staff at the Van Inaugurating Ceremony

► Mrs. Vasantha Vasudevan dedicated a Blood storage Unit to the memory of Mr. S. N. Vasudevan. The function was attended by her family members.

► Sviss Labss donated a Vitamin D Analyzer. There was a function in which the Manging Director of Sviss Labss Mr. Baskar Rao and his wife Mrs. Girija Rao participated and dedicated the analyzer equipment to the hospital .

Family Members of Mr. Vasudevan at the Blood Storage Unit Dedication

Vitamin D Analyzer Inaugurated by Sviss Labss Mr. & Mrs. Baskar Rao as Dr. A.S. Kanagasabapathy Explains

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► A competition highlighting the importance of breast feeding was held for mothers of small children, to assess their awareness on breast feeding, immunization and child rearing practices. Over 30 mothers with their babies and 9 antenatal mothers participated.

Dr.Padma Priya Educating MothersAssembly of Mothers on ‘Breast Feeding Day’

► Education in Many Villages

► Nutrition week was observed with a series of programmes for over 5 days. The programmes included cookery competition for mothers, exhibition and video shows, talks in schools, valaikappu (a ceremony to celebrate the first pregnancy of a mother where she is adorned with flowers and bangles by elderly women relatives) ceremony for ante-natal mothers, and inter school competitions for school and college students.

The Nutrition Week Exhibition Dr.Govindarajan Educating on ‘Diabetes’

Ms. Geetha Educating Mothers on ‘Breast Feeding Day’

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► As an effort to create awareness on Osteoporosis, 40 people were screened with dexa scan on Osteoporosis Day.

► On Diabetes Day, the patients who responded to our appeal to check for diabetes were educated on control of diabetes.

► Rotary Club of Ranipet organized a Health Check up for Police personnel

► A blood donation camp was organized in which 57 members voluntarily donated blood. The blood collected at the camp was handed over to a blood bank in Vellore.

► Students health check-up was carried out in four schools. 1,575 students were covered in this programme.

► Our senior consultant, Dr. Lakshmi Seshadri spoke on Womens Health and Osteoporosis in 4 industrial establishments and one Ladies Club.

Blood Donation Camp

Dr. Padma and Dr. Kiruthika Examining School Students

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► Different kinds of mass awareness programmes were held for World AIDS Day.

Distribution of Handbills in Bus

Talk in a Community Awareness Rally with School Students

For Auto Drivers

► World Disabled Day

Participants on World Disabled Day

A Beneficiary Speaks Ms. Ramani Speaking on World Disabled Day

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► On Womens Day, a Seminar was organized for over 300 women on Women Health at Thiruvalam. Dr. Lakshmi, Dr. Padma Priya and Ms. Bhooma were the speakers. The staff staged a skit .

Gathering for Women’s Day

Dr. Lakshmi Addressing on Women’s Day

Dr.Seshadri and Mr. V. Mohan Speaking at the All Staff Meeting

► All Staff Meeting

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IV. FundingThe response to request for support for our programmes has been very encouraging. We thank all our donors.

Long Term DonorsUltramarine & Pigments Ltd.

Thirumalai Chemicals Ltd.

C.S. Foundation

Other Donors

Sundaram Finance Ltd.

Union Bank of India Social Foundation

SVISS Labss Pvt. Ltd.

Vasantha Krishnamurthy

V. K. Viswanathan Sudha Viswanathan

K. Thirumalai & Krishnaveni Thirumalai

Shri Maganbhi B. Patel Charitable Trust

Chandra Vijayaraghavan

R. Ramachandran

Geetha Sarabeswaran (Nathan Charitable Trust)

Radha K. Swamy

U.R. Prasad

Smith Engineering Company

V. Bharathram

V. Subramanian

S. Narasimhan

Dr. S. Hariharan

G. V. Raman

Shri Khamma Bai Jain Charitable Trust

Sri Sai Ram

Lakhi Parmatma Charitable Trust

S. Srikant

Shirley Murray

International Conveyors Ltd.

Dhansar Engineering Co Pvt. Ltd.

Prajay Agarwal

Malvika Poddar

S. Jeyaraman

MIL Industries Ltd.

R. K. Raman

Ramanlal Maganlal

Asian Metals

P. Nithiyanandan, & P. Bhavani

D. K. Mukherjee

Chennai Electrical Engg. Works

K.R.S. Nair (High Tech Bitu.Guard Insulation)

Rajalakshmi Ravi

Prof. Dr. S.V. Chittibabu

V. Jayaraman

Seetha Krishnamurthy

Dinesh Sudhakar Dixit

Sunil Kukreti

Sreelekha Maitra

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Meera Subramanian

V. Venkateshwaran

G. R. Venkatraman

Ambareesh ChakrabortyPaulami Chakraborty

D. Raghunath

Shallen J. Sohoni & Damini Sohoni

Shantram Puthran & Joyce S. Puthran

Mukesh Anand

Sridhar Rao

Lakshmi

Chitra Ram

Goutam Pandi

Rudra Sen

Bennet Benjamin

V. Sujatha

Shudamani

Nirmala Nilakantan

Prakash Baliram Sonawne

R. Sampath & Family

R. Parthasarathy & Family

Indira Sundararajan

Other Donors

Mr. Ashok Gupta General Manager and N. Rajendran, Deputy General Manager, Union Bank India with Ms. Bhooma, TCT

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IV. Visitors

Mr. V. MuthukumarSocial Worker

Mr. S. KannanFabriken

Mr. S. VenkatachalamBusinessman

Mr. N. SubramanianThirumalai Chemicals Ltd.

Dr. Deepa BraganzaChristian Medical College

Prof. D. Manoj ChelladoraiDJM Christian Mission Hospital, Chittoor

Mr. V. Raja SeenivasanDistrict Governor, Rotary 3230

Mr. Charukesi ViswanathanJournalist

Mr. V. RajendranMr. Ashok GuptaUnion Bank of India

Mr. C. DoraswamyAndhra Bank

Mr. Yoshinao MiyoshiMitsubishi Precision Tools Ltd.

Mr. S. MuralidharanDubai

Mr. T.T. SrinathHR Consultant

Mr. G. P. Mukherjee Mumbai

Ms. Harini ParthasarathyAustralia

Mr. P. M. C. NairThirumalai Chemicals Ltd.

Mr. A. R. Raghunathan Mr. P. B. RavikumarRotary Club of Madras Central

Mr. V. DesikanMr. V. SrinivasanMr. V. VedanthamMr. V. P. Narayanan

Ms. Renuka Induprakash SinghPardada Pardidi Education Society

Dr. Subhasri Dr. Rakhal

Dr. Anna OomenChristian Medical College

Mr. J. B. KamdarMr. N. K. GopinathRotary Club of Madras

Mr. Anilkumar Goel Mr. Shyam

Mr. A. MaheshChartered AccountantMs. Sukanya Mahesh

Mr. M. SankaranandEdify School

Mr. C.V. Karthik NarayananUCAL Auto Products Ltd. Ms. Uma Narayanan

Dr. W. D. Alli KirubaraniTamilnadu Medical and Rural Health Service and Family Welfare

Dr. K. V. ArulalanPaediatrician

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Rotary Governor Raja Seenivasan Visiting with Rotary Members from Ranipet

Mr. Raju, VIT Vice Chancellor, Dr. Sundar, MGH Boston, Mr. Subramaniam, TCL

Mrs. Sudha Srinivasan, Dr. Sugantha Srinivasan with Ms. Bhooma

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Dr. Mannam Ebenezer SIHRLC

Dr. V. RajuVIT University

Mr. & Mrs. S. Venkatraman

Mr. K. SureshMr. P. G. KuppuswamyMr. R. RamakrishnanMr. M. K. SubramaniamMr. S. KrishnanRotary Club of Madras Besant Nagar

Dr. N. SundarMassachussets General Hospital

Mr. Prabhas Surana, Ms. Riddhi ShahR.B.N.Q.A

Dr. Sugantha SrinivasanU.K.Ms. Sudha SrinivasanEurocon Tiles

Mr V. SeshadriMs. Prema Seshadri

Ms. Rohini JainMs. Ishanu DigheMs. NiharikaDr. Eri SrivatsanUniversity of California

Mr. John ChristensenMs. Agne ChristensenMr. Anders ChristensenMr. JoeMr. Shekar SwamyMs. Sangeetha ShekarC.S. Foundation

Ms. Vinita Vasudevan & Family

Ms. Keerthi Purushothaman

Dr. Hannke du PreezDr. Salomon de JagerSouth Africa

Mr. Benjamin Cherian Ms. Valsa CherianRotary Club of Madras

Mr. R. RamachandranTechnical Consultant

Vedavalli Vidyalaya School Students on an Exposure Visit to TCT

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Dr. Eri Srivatsan, University of California with Students

Mr. Shyam, Mr. Anil Kumar Goel with Mr. R. Sampath and Ms. Bhooma

Ms. Hanneke from South Africa

Dr. Rakhal and Dr. Subhasri (from Extreme Right) Interacting with Doctors and Staff

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Our Partner’s Visit

John and Agne Christensen, Shekar Swamy and Sangeetha, Anders Christensen and Joe from the C.S.Foundation spent two days with us visiting the hospital, programmes and interacting with the staff and beneficiaries.

Visits of Trustees

Dr. Balasubramaniam of Swami Vivekananda Youth Movement visited us for a day and interacted with beneficiaries and staff.Mr.Thirumalai visited a few times and helped us with infrastructure arrangements at the hospital.Mr. Antony Samy, Mr. Srinivasan, Mr. Thirumalai, Mr. Sampath, Mr. Parthasarathy visited a village along with Dr. Seshadri and Ms. Bhooma interacted with the beneficiaries. At the hospital they had discussion with the staff. Mrs.Shanthi Ranganathan of TTK Hospital visited a village and got a feel of the field activities.

The staff and beneficiaries got a lot of encouragement because of these visits.

We appreciate Mr. D. K. Srinivasan and the Hindu Mission Hospital for the many kinds of continuous support given to us.

Visit to Agravaram- Ms. Leela and Ms. Sripriya Presenting Programmes to Trustees

Mr. Antony Samy, Mr. Sampath

Mr. Thirumalai

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VI. PlansWe plan to expand our services to include ophthalmology, dental, intensive medical care, high dependency care and laparoscopic surgery. We are designing programmes to serve the community to offer comprehensive care for diabetes, hypertension, obesity, osteoporosis, osteoarthritis, womens health and paediatric and adolescent health.

VII. ConclusionWe want to develop a model of healthcare that will be relevant for our community. We are uniquely positioned to do that because of our engagement in community work for thirty years. Our medical staff are eager to make this happen and are designing appropriate programmes. The support we have drawn from the donors has been immense and reassuring. We are hopeful of extending our services in many ways and we are confident of interesting more donors who will want to join us in our journey.

Staff remuneration (in rupees)

Highest paid 37140 per month

Lowest paid 4085 per month

Less than 5000 Male: 0, Female: 26

5000 to 10000 Male: 14, Female: 29

Greater than 10000 Male: 5, Female: 3

Thirumalai Charity Trust

➢ Registered as a Public Charitable Trust

➢ Recognised as a Charitable Organisation

➢ Recognised under Foreign Contributions Regulation Act

➢ Donation eligible for 50% exemption u/s 80G of IT Act

For Details, ContactMrs. Bhooma Parthasarathy Phone No. 91-4172 245195, 247950

Thirumalai Charity Trust E-Mail: bhooma.p@tmhospital.org

Thirumalai Nagar, Vanapadi Road & Post Website: www.thirumalaicharitytrust.org

Ranipet, TamilNadu – 632 404

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Map of the Project Area

41

Registration Desk Measuring Height and Weight Before Consultation

Patients Waiting Area

42

Consultation

Pharmacy

Practical Training for Nurses

43

THIRUMALAI CHARITY TRUST No. 103, SEWREE WADALA

MUMBAI 400 031.

INCOME AND EXPENDITURE ACCOUNT FOR THE YEAR ENDED 31ST MARCH 2013

(AMOUNT IN RUPEES)

ExpEnDiTurE inComETo Expenditure on objects of the Trust:

– Medical Relief & Health 14,390,509.50 (Net of Hospital Collections of Rs.1,00,09,078)

– Other Objects 32,000.00

To Administration Expenses To Excess of income over Expenditure

ToTAL

14,422,509.50

1,240,779.49

1,094,623.40

16,757,912.39

By Donations

By Interest from Deposits

By Dividend on Mutual Funds

By Profit on Sale of Vehicle

By Stock in Hand

ToTAL

15,383,418.00

550,587.39

31,675.00

41,500.00

750,732.00

16,757,912.39

BALANCE SHEET AS ON 31ST MARCH 2013

LiABiLiTiES ASSETSTrust Fund

Opening Balance

Corpus Fund

Opening Balance 24125720.00Add: Received during the year 5021001.00

income and Expenditure Account

Opening Balance 2921743.87

Add: Excess of Income over Expenditure 1094623.40

Caution Deposit

Advance Received

TDS Recovered

ToTAL

4,047,500.00

29,146,721.00

4,016,367.27

10,000.00

8,484.00

60,606.00

37,289,678.27

Fixed Assets 23046713.38

Less: Amount due for machinery purchase 11500.00

investments:

Reliance Vision Mutual Fund 450000.00

Bank Fixed Deposits 1423326.39

Advances:

Advances: 209165.00

Deposits 163020.00

Tax Deducted at Source 80554.00

Stock in Hand

Cash on Hand 1057.55

Cash at Bank:

In Current Account 1174254.39

In Savings Bank Account 9590724.56

In Short Term Deposits 411631.00

ToTAL

23,035,213.38

1,873,326.39

452,739.00

750,732.00

11,177,667.50

37,289,678.27

For m. S. KriSHnASWAmY & Co. CHArTErED ACCounTAnTS

(m. K. SAnTHAnArAmAn)pArTnErDATED: 25.09.2012 DATED: 25.09.2013

For THirumALAi CHAriTY TruST

BHoomA pArTHASArATHY(TruSTEE)

As per our report of date

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45

46

47

48

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Nd

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N. S

. Iye

ngar

N. R

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amy

Visit of John Christensen and Shekar Swamy from C. S. Foundation

Visit of Trustees

Integrating

Healthcare

Primary & Secondary

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