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Suggestions for Medical Missionary Work

23 Feb

Christian mission hospitals should be God’s institutions of healing in a world of suffering. They have the potential to ‘close the gap’ in access to healthcare and provide high quality accessible services in the most remote and needy parts of the world to those who need them the most – the poor and marginalized.

In 1993, my wife Ann and me moved to a remote part of Assam in northeast India. We were led by verses in the Bible (Jeremiah 29:11-13 for me and Isaiah 6:8 for Ann) to what God wanted us to do with our lives. Over the following 27 years, God took us by our hands and provided us with all the encouragement, strength and wisdom required to transform a closed-down hospital to a thriving institution bringing healing and transformation to many surrounding communities. (1) We were not alone, God brought many committed staff to join us over the years to make this possible.

I was privileged to be invited to speak at six sessions on “Medical Missions” at the (virtual) South Asian regional conference of the International Christian Medical and Dental Association in November 2020. I am not an expert on medical missions but spoke from our experience in walking with God and witnessing a great transformation take place in our hospital.

The six talks can be viewed here along with a seventh talk given at the Annual Conference of the Allied Health Professionals section of the Christian Medical Association of India. Each link opens a blog-post with a short description of the content of the video that follows:

  1. An introduction to medical missionary work, its promise and the attitudes that are important to be successful: https://the-sparrowsnest.net/2021/01/31/medical-missionary-work-introduction-attitudes-and-promise/
  2. Strategic Planning for a mission hospital (for pioneering work as well as for existing hospitals) and stock-taking to finetune future plans: https://the-sparrowsnest.net/2021/02/03/medical-missionary-work-strategic-planning-and-stock-taking/
  3. Leadership in our hospitals, management/governance structure, recruitment and retention as well as succession planning for mission hospitals: https://the-sparrowsnest.net/2021/02/07/medical-missionary-work-leadership-and-human-resource-management/
  4. Nurturing and motivating students and staff so that they may be well prepared and work to their full potential in medical missions: https://the-sparrowsnest.net/2021/02/18/medical-missions-nurturing-and-motivating-students-and-staff/
  5. Sustainable trategies to make good quality healthcare accessible to the poor and marginalized: https://the-sparrowsnest.net/2021/02/19/medical-missionary-work-poor-centric-strategies/
  6. Other work that can be done in mission hospitals and concluding thoughts: https://the-sparrowsnest.net/2021/02/22/medical-missionary-work-non-medical-work-and-concluding-thoughts/
  7. Medical missionary work for the allied health professional – our technicians, pharmacists and other hospital support staff: https://the-sparrowsnest.net/2021/02/02/medical-missionary-work-for-the-allied-health-professional/

These talks are based on my experience of nearly 40 years in medical mission hospitals and medical college campuses. I hope that some of them may be applicable to every situation. May God be the source of all wisdom, strength and encouragement to the listeners to these messages and help us to plan our God-given work wisely.

Medical Missionary Work – Non-medical Work and Concluding Thoughts

22 Feb

Christian mission hospitals should be God’s institutions of healing in a world of suffering. They have the potential to ‘close the gap’ in access to healthcare and provide high quality accessible services in the most remote and needy parts of the world to those who need them the most – the poor and marginalized.

In 1993, my wife Ann and me moved to a remote part of Assam in northeast India. We were led by verses in the Bible (Jeremiah 29:11-13 for me and Isaiah 6:8 for Ann) to what God wanted us to do with our lives. Over the following 27 years, God took us by our hands and provided us with all the encouragement, strength and wisdom required to transform a closed-down hospital to a thriving institution bringing healing and transformation to many surrounding communities. (1) We were not alone, God brought many committed staff to join us over the years to make this possible.

I was privileged to be invited to speak at six sessions on “Medical Missions” at the (virtual) South Asian regional conference of the International Christian Medical and Dental Association in November 2020. I am not an expert on medical missions but spoke from our experience in walking with God and witnessing a great transformation take place in our hospital.

Besides running hospitals, our societies and trusts often run schools and colleges as well as nursing and paramedical training programs or have the right to start schools and colleges, this is a good option to consider as there are many benefits. Our founding documents may allow us to carry out many other activities as well.

We can run community health and development programs that benefit local communities either on our own or in partnership with other agencies. A lot of information can also be gained by community observations and this can be used to make our services more accessible to our target communities.

Telling others about the impact of God’s presence in our lives is important, especially when it is this spirit that has motivated us to our lives of service. Our motivation to talk about our personal experience as Christians is due to the peace, contentment and purpose in life that it has brought us and the desire to share this with others. We must however be aware of the changing rules of our nations and know that it is not by spending our material resources into this effort that we are able to talk about the life-changing experience of accepting Christ into our lives but by people experiencing a personal touch from Him. If we can simply live lives trusting and obeying God, opportunities for people to experience such a touch will come simply because God’s spirit lives in us and He will communicate His love for people through our lives.

Some hospitals have significant land and other assets which can be developed, not only for the institution itself but for surrounding communities. Research work can also be done on biodiversity documentation and environmental work, especially when many of our hospitals are located in remote areas where little work has been done over the years. Each hospital will have its own local opportunities which it should exploit.

We should also explore training opportunities to disseminate our learnings, these could be informal or formal and in partnership with other like-minded agencies.

Our hospitals are also good sites for research that is relevant to the low-resource settings in which we function. It is certainly a challenge to engage in research activities when we are hard-pressed for time in our busy hospitals but when situations improve and opportunities come, we should take them. Our learnings should be published so that they can benefit others too.

We should count the costs of missionary work – health issues, concerns about our families – parents and children, fear and security related issues, financial concerns, worldly disgrace – these are temporary trivial inconveniences that we should be willing to face in exchange for things that money cannot buy – contentment in this world and riches in heaven.

Medical missionary life is full of uncertainty and constant challenges but God will be by our side, strengthening and encouraging us and giving us the wisdom needed to take the right decisions.

We should work together to formulate plans to help sick hospitals recover and new ones started in areas of need. I have mentioned the TIRS project which could bring to attention of funders and volunteers the good work being done in remote low-resource settings by our mission hospitals.(2,3)

I close with some concluding thoughts. I hope that this series of talks were useful to those who have listened and there are some learnings that could be applied to different situations. May God bless us all.

References:

  1. https://the-sparrowsnest.net/2020/09/30/a-journey-of-faith/
  2. https://transformationalimpact.org/report.pdf
  3. https://transformationalimpact.org/index.html

Please click on the link below to watch the concluding talk:

Medical Missionary Work – Poor-centric Strategies

19 Feb

Christian mission hospitals should be God’s institutions of healing in a world of suffering. They have the potential to ‘close the gap’ in access to healthcare and provide high quality accessible services in the most remote and needy parts of the world to those who need them the most – the poor and marginalized.

In 1993, my wife Ann and me moved to a remote part of Assam in northeast India. We were led by verses in the Bible (Jeremiah 29:11-13 for me and Isaiah 6:8 for Ann) to what God wanted us to do with our lives. Over the following 27 years, God took us by our hands and provided us with all the encouragement, strength and wisdom required to transform a closed-down hospital to a thriving institution bringing healing and transformation to many surrounding communities. (1) We were not alone, God brought many committed staff to join us over the years to make this possible.

I was privileged to be invited to speak at six sessions on “Medical Missions” at the (virtual) South Asian regional conference of the International Christian Medical and Dental Association in November 2020. I am not an expert on medical missions but spoke from our experience in walking with God and witnessing a great transformation take place in our hospital.

If the poor are our target population, we must enter into their world and look at healthcare options from their perspective. We must understand the social and economic conditions that drive their health-seeking behavior. When poor people come to our hospitals, should develop protocols that recognize their financial vulnerability reliably and offer them subsidy or charity before they sell vital assets. A good understanding of this ‘world of the poor’ will lead to practices and protocols which tell them that ‘this hospital is for people like us’. This will lead to large volumes of patients coming to the hospital, high capacity utilization of services resulting in further lowering of costs and transformational impact in their communities.

Pro-poor strategies are sustainable and grounded on well-established principles. We must understand the market forces that affect healthcare locally and leverage them to the advantage of the poor. Quality can be ensured without losing cost-effectiveness or sustainability. In places where healthcare indices are poor, good practices can improve them significantly without much investment due to increased volumes of excluded people beginning to access quality affordable healthcare.

We have described successful innovations which make poor-centric strategies work with our experience over the past 27 years at Makunda but there are reasons why others hesitate to adopt them. Makunda was able to overcome the initial inertia and make changes and this can happen only if we understand the reasons why people do not want to change and address them.

We should make well-thought business plans and finetune them till they are just right. If external support is needed, we should choose the right partners to work with who do not compromise on our mission and values. Many mission hospitals were established by the founders in remote locations but over many decades find themselves now in the center of towns that have grown around them facing competition from many other private and government healthcare providers. A sound business plan should also take this situation into consideration and design a strategy that will enable the work to thrive inspite of external competition.

In the question-and-answer session at the end of the talk, the questions have not been recorded in the video. They are:

  • What can we do if our staff can’t manage with our low salaries? – it is a sacrifice that staff have to bear with the only assurance that God would take care of them.
  • You mentioned that you identify poor people by how little they eat, won’t rich people do the same to get charity?
  • How can we prevent ourselves from being cheated into giving charity?
  • What are some other successful models in healthcare for the poor?
  • What can be done if we don’t have sufficient long-term staff?
  • How can we handle corruption and demands for bribes?
  • If I am interested in mission work, where can I join?

References:

  1. https://the-sparrowsnest.net/2020/09/30/a-journey-of-faith/
  2. https://www.researchgate.net/publication/342551561_The_Makunda_Model_An_Observational_Study_of_High_Quality_Accessible_Healthcare_in_Low-Resource_Settings

Medical Missionary Work – Nurturing and Motivating Students and Staff

18 Feb

Christian mission hospitals should be God’s institutions of healing in a world of suffering. They have the potential to ‘close the gap’ in access to healthcare and provide high quality accessible services in the most remote and needy parts of the world to those who need them the most – the poor and marginalized.

In 1993, my wife Ann and me moved to a remote part of Assam in northeast India. We were led by verses in the Bible (Jeremiah 29:11-13 for me and Isaiah 6:8 for Ann) to what God wanted us to do with our lives. Over the following 27 years, God took us by our hands and provided us with all the encouragement, strength and wisdom required to transform a closed-down hospital to a thriving institution bringing healing and transformation to many surrounding communities. (1) We were not alone, God brought many committed staff to join us over the years to make this possible.

I was privileged to be invited to speak at six sessions on “Medical Missions” at the (virtual) South Asian regional conference of the International Christian Medical and Dental Association in November 2020. I am not an expert on medical missions but spoke from our experience in walking with God and witnessing a great transformation take place in our hospital.

The video starts with a short clinical illustration to show why we need to have all our faculties focused on our work lest we miss a vital observation (a point discussed in the previous day’s question and answer session).

Where will our staff come from? – this is a burning question facing most mission hospital leaders. We cannot wait for people to apply for jobs in our hospital, we need to get involved in the lives of medical, nursing and paramedical students in their colleges. Only then will we have sufficient numbers of high-quality committed staff joining us. From experience 33 years earlier to the present, I talk about suggestions on how this can be done. A slip of the tongue at 6.30 – in the illustration, I meant “my mother” not “my wife”!

Mission minded students start their missionary work as students in colleges, I have mentioned several observations on how good practices lead to transformational impact in college fellowships.

What about staff who join our hospitals today? How can we engage with them so that they live and work to their full God-given potential? How do we retain committed staff in our institutions? How can we make our hospitals professionally challenging places for our staff – where they feel that their skills and knowledge are being fully utilized?

How can we provide a pleasant and fulfilling life on campus to our staff? I close the session with a story that illustrates how God can surmount the greatest obstacles and provide us with the staff we need.

  1. https://the-sparrowsnest.net/2020/09/30/a-journey-of-faith/

Medical Missionary Work – Leadership and Human Resource Management

7 Feb

Christian mission hospitals should be God’s institutions of healing in a world of suffering. They have the potential to ‘close the gap’ in access to healthcare and provide high quality accessible services in the most remote and needy parts of the world to those who need them the most – the poor and marginalized.

In 1993, my wife Ann and me moved to a remote part of Assam in northeast India. We were led by verses in the Bible (Jeremiah 29:11-13 for me and Isaiah 6:8 for Ann) to what God wanted us to do with our lives. Over the following 27 years, God took us by our hands and provided us with all the encouragement, strength and wisdom required to transform a closed-down hospital to a thriving institution bringing healing and transformation to many surrounding communities. (1) We were not alone, God brought many committed staff to join us over the years to make this possible.

I was privileged to be invited to speak at six sessions on “Medical Missions” at the (virtual) South Asian regional conference of the International Christian Medical and Dental Association in November 2020. I am not an expert on medical missions but spoke from our experience in walking with God and witnessing a great transformation take place in our hospital.

The video (link below) starts with a few comments on questions raised by participants in the previous day’s session (this can be skipped by starting the video at 04.30). The first comment is on cost vs benefit of different healthcare interventions.  I have explained the expenditure against population covered using 3 slides – maybe difficult to understand without the background discussion! This is followed by a few points on Christian private practice and marriage before the talk on leadership and human resource management.

In this third session, we will look at leadership in mission hospitals – please skip to 04.30 on the video.  In this talk, I have spoken about ‘Title’ and ‘Towel’ leaders, management/governance structure, suggestions for recruitment and retention of staff and succession planning.

I have made a few references in the session – on marriage (2), online course on governance in health (3)

  1. https://the-sparrowsnest.net/2020/09/30/a-journey-of-faith/
  2. https://the-sparrowsnest.net/2012/05/22/wisely-choosing-a-life-partner-for-an-aspiring-medical-missionary/
  3. https://www.globalhealthlearning.org/course/governance-and-health-101

In the question and answer session at the end, only the answers have been put into the video. The questions were:

  1. Should I consider Government service or a corporate hospital as a place of work if God is calling me there?
  2. How important is Quiet Time?
  3. Who were your mentors?
  4. What is the place of Urban Medical Missions?

Medical Missionary Work – Strategic Planning and Stock-taking

3 Feb

Christian mission hospitals should be God’s institutions of healing in a world of suffering. They have the potential to ‘close the gap’ in access to healthcare and provide high quality accessible services in the most remote and needy parts of the world to those who need them the most – the poor and marginalized.

In 1993, my wife Ann and me moved to a remote part of Assam in northeast India. We were led by verses in the Bible (Jeremiah 29:11-13 for me and Isaiah 6:8 for Ann) to what God wanted us to do with our lives. Over the following 27 years, God took us by our hands and provided us with all the encouragement, strength and wisdom required to transform a closed-down hospital to a thriving institution bringing healing and transformation to many surrounding communities. (1) We were not alone, God brought many committed staff to join us over the years to make this possible.

I was privileged to be invited to speak at six sessions on “Medical Missions” at the (virtual) South Asian regional conference of the International Christian Medical and Dental Association in November 2020. I am not an expert on medical missions but spoke from our experience in walking with God and witnessing a great transformation take place in our hospital.

In this second session, we will look at areas of medical mission work that are not taught in medical college. How do we take stock of the situation in our hospitals and make wise plans for the future?

At the end of the session, I have answered questions from the group. Unfortunately, the recording does not include the questions (only the answers). The questions are:

  1. How do we manage burnout in our staff? – sometimes we really are physically exhausted beyond out capacity but often there are other reasons.
  2. How do we manage differences in opinion with other senior officers of the institution? – we can’t win arguments, but we need to win hearts.
  3. What can we do if there are irreconcilable differences with our partners? – we can list out our differences and give time for change, sometimes we may need to break the partnership.
  4. What do you do when workloads become too much to bear? – God will give strength from above – through verses, songs, people…
  5. Do we need to be serious about our work at all times, can we entertain ourselves too? – it is a tremendous responsibility to treat patients, their lives are in our hands and we cannot afford to be careless.
  6. When can we stop learning? – Never!
  1. https://the-sparrowsnest.net/2020/09/30/a-journey-of-faith/

Medical Missionary Work – for the Allied Health Professional

2 Feb

Allied Health Professionals (pharmacists, laboratory and other technicians, optometrists, neurophysiologists etc.) are often the unheard and unseen background support system of our mission hospitals. I thank the Christian Medical Association of India for inviting me to speak to them at their 2020 Annual Conference for Allied Health Professionals. I have spoken from our experience at the Makunda Christian Leprosy and General Hospital over 27 years – a testament to God’s blessings and the hard work of numerous co-workers (1). I hope that this video is an encouragement to allied health professionals (and students) in Christian mission hospitals all over the world. May God bless them and make them a blessing to many. I apologize for short segments of the recording that are inaudible (it was recorded over the internet).

  1. https://the-sparrowsnest.net/2020/09/30/a-journey-of-faith/

Medical Missionary Work – Introduction, Attitudes and Promise

31 Jan

Christian mission hospitals should be God’s institutions of healing in a world of suffering. They have the potential to ‘close the gap’ in access to healthcare and provide high quality accessible services in the most remote and needy parts of the world to those who need them the most – the poor and marginalized.

In 1993, my wife Ann and me moved to a remote part of Assam in northeast India. We were led by verses in the Bible (Jeremiah 29:11-13 for me and Isaiah 6:8 for Ann) to what God wanted us to do with our lives. Over the following 27 years, God took us by our hands and provided us with all the encouragement, strength and wisdom required to transform a closed-down hospital to a thriving institution bringing healing and transformation to many surrounding communities. (1) We were not alone, God brought many committed staff  to join us over the years – without them this transformation would not have been possible.

I was privileged to be invited to speak on the theme “Medical Missions” at the (virtual) South Asian regional conference of the International Christian Medical and Dental Association in November 2020. I am not an expert on medical missions but spoke from our experience in walking with God and witnessing a great transformation take place in our hospital as well as from observations on medical missions over many years.

The first session is here – I have given a short testimony, an introduction to medical missions and suggest several important attitudes to cultivate to be fruitful in God’s service:

  1. https://the-sparrowsnest.net/2020/09/30/a-journey-of-faith/
  2. https://the-sparrowsnest.net/2014/04/28/attitudes-to-cultivate-for-the-aspiring-medical-missionary/

A Journey of Faith

30 Sep

My wife Ann and me were privileged to speak last year at the LEADTalks 2019 conference (1) in Bangalore – a forum that challenges and encourages young Christian people to live lives of purpose, integrity and excellence – we thank the organizers for the opportunity and pray that God would continue to bless their initiative in the years to come.

In 1992, within a year of our marriage we set out from Tamil Nadu in South India to Assam in northeast India (2,3). We were searching for a place that would provide us with an opportunity to be of the greatest transformational impact with the time, talents and treasure that God had blessed us with. For this, I had developed a simple formula to choose a location – the potential for the greatest transformational impact by an individual = the total population (in that location) that could avail his/her services divided by the total number of other people with his/her qualifications / skills etc. So, we were looking for a place that was thickly populated with few healthcare institutions which meant somewhere far away from home in urban Tamil Nadu.

28 years have passed since our first visit to Makunda, God took us by our hands and blessed us with wisdom, strength and encouragement. A small start in 1993 (4) has become a thriving institution today, providing services to many (5). It was all due to God’s grace and the hard work of many highly committed co-workers who laboured with us. Mission institutions provide transformational impact across the world in areas of great need and are key to ‘closing the gap’ in access to services to the poor and marginalized (6). Unfortunately, many are sick and the story of Makunda is an example of how God can revive and rebuild one of His institutions if we are willing to go with Him on a “Journey of Faith”. This is a short video of our talk:

References:

  1. https://www.leadtalks.org/
  2. https://the-sparrowsnest.net/2016/02/19/short-video-of-our-work-made-by-emmanuel-hospital-association/
  3. https://the-sparrowsnest.net/2017/09/13/obeying-a-call-to-medical-missions-a-testimony/
  4. https://the-sparrowsnest.net/2018/05/12/early-days-at-makunda/
  5. https://www.researchgate.net/publication/342551561_The_Makunda_Model_An_observational_study_of_high_quality_accessible_healthcare_in_low-resource_settings
  6. https://www.researchgate.net/publication/322476512_’Closing_the_Gap’_-_Using_Global_Health_Doctors

A Wrestle with Leprosy

30 Jan

When we were medical students (in the early 1980s), leprosy patients were ubiquitous, found at every street corner, train station and bus stand with open sores and deformities, spending their lives begging from passersby. As we passed through college, we learnt that leprosy (or Hansen’s Disease as it was also known) was caused by Mycobacterium leprae, an acid-fast bacillus similar to the one that causes tuberculosis.  The disease affects the skin and nerves and causes skin lesions, loss of eyebrows and lashes, corneal damage, blindness and a host of deformities – most of them secondary to loss of sensation and resulting injury to the insensitive parts of the body (1). The disease is completely curable without any deformities if diagnosed at an early stage. However, the majority of patients at that time never came on time – they did not tell anyone about their lesions, hid their deformities and when it was finally diagnosed, kept the diagnosis secret. This was because of the horrible stigma and fear attached to the disease. No one wanted to be seen with a leper, leave alone have one in the family. This was because this ancient disease (with many references in the Bible) did not have a cure until modern chemotherapy arrived and untreated patients developed grotesque deformities and non-healing wounds. Leprosy patients were herded into colonies, in effect open jails, where they were admitted by their friends and relatives, to spend a lifetime and die unknown. The theory behind the colonies at that time was sound – leprosy could only be transmitted by prolonged close contact and since it was incurable at that time, the best way to limit its spread was to quarantine all known patients and segregate them (2).

In 1993, my wife Ann and me joined the Makunda Christian Leprosy and General Hospital (3,4). This hospital had just become a member of the Emmanuel Hospital Association (EHA) (5). In 1935, Dr. Crozier, a Christian medical missionary from the Baptist Mid-Missions in USA had started the Alipur Mission Hospital near Silchar (later named the Burrows Memorial Christian Hospital). Soon many patients started to come for treatment and among them were leprosy patients. Unable to admit them (for fear of infecting others and the all-pervasive stigma), the missionaries searched for a large piece of land to start a colony. In 1950, such a piece of land was found, 1000 acres of land in the other end of the Cachar District (now Karimganj District) was being sold by the widow of a man who had purchased the land hoping to convert it into a tea-estate. The land was purchased (at present the hospital has only 350 acres of land, the remaining having been taken over by the government), and a team of mission staff started to develop the land, build homes for the staff and wards for the patients, aluminium Quonset huts (6) for the sick ones and large Assam type barracks for the others and develop a large farm to feed the rapidly growing colony. The result was a completely self-sufficient leprosy colony housing about 300 patients. Almost everything was grown on the campus – rice, fish, poultry, oil (from mustard seeds), cotton and silk for clothing, timber and bamboo for housing, sugar (from sugarcane), dal and vegetables. Only salt was purchased from outside. Leprosy patients were brought from everywhere – including all the northeast Indian states and surrounding countries. An American surgeon, Dr. Gene Burrows, joined the hospital and started general medical work (in addition to leprosy work). He started treatment of the leprosy patients, initially with chaulmoogra oil and later with dapsone. He did reconstructive surgery on those who had correctable deformities. Patients whose families were willing to keep them at home received treatment in mobile camps. Unfortunately, in the early 1980s, Dr. Burrows and all the expatriate staff were asked to leave India, never to return. The hospital remained closed till we joined, a decade later.

Our early days at Makunda were tough (7), there were no general patients, they came in small numbers in the initial weeks and months. All our time was spent examining the 60 leprosy patients, the remnants of the original colony, many of them staying since the time the colony had been started. They were being treated with all sorts of regimes by a few old staff, some with the old chaulmoogra oil, some with dapsone alone and some with dapsone and rifampicin. We examined each patient and started the modern Multi Drug Treatment (MDT), a 2 -year course of rifampicin, clofazimine and dapsone on those who needed it. Some patients with deformities were sent to the leprosy hospitals in Calcutta (8) and Tinsukia for reconstructive surgery and prosthetics. Ann spent hours cleaning and dressing wounds, applying plaster casts till chronic wounds healed. I did a number of amputations on limbs which could not be repaired. Those who completed the full course of treatment were given “Released from Treatment” certificates and discharged, certified free of disease and allowed to go out into the world. Some patients, especially the older ones, refused to go (as they feared that they would be thrown out by their family) and they were allowed to stay on. We encouraged the young, able-bodied patients to leave and rebuild a life for themselves and slowly most of them left. We helped some to marry, get good jobs, delivered their children and buried them when they died. We had the privilege of being foster-parents to this large family of reluctant prisoners.

Life in the colony for the inmates was routine, like an informal sort of prison. Many of the patients had resigned themselves to their fate and lived happy lives, doing daily chores in the farm and hospital, organizing meetings for singing and prayer, games and recreation. They were provided free food and pocket money and all their needs were met. They did not have any ambitions, except to live out their lives in peace. A few were angry, rebelling against the unjustified imprisonment for no fault of theirs. Most of them were grateful to us and the other staff for providing them everything they needed. Leprosy was a great leveller, we had inmates who were highly trained government officers and skilled workers as well as unemployed ordinary people, they had all become lepers, united by being infected by the same bacteria. It was interesting to note the attitude of their families. If we wrote to them that their relative was not doing well, no one came to see them or take them home for a break. However, when one of the patients died, one (sometimes a number) of quarrelling relatives would invariably turn up to see what he/she had and collect it (usually a tin box with some cash and personal belongings) – they did not care for the body which we buried on campus! They were exploited by relatives, some politicians, unions and others to try to get land and possessions using their ‘status’ as leprosy patients – these people were not interested in them as individuals and were trying to get land not for the patient but for themselves after the patient died!

In 1997, Ann and me left for our postgraduate studies, me to do my MCh in Paediatric Surgery and Ann to do her MD in Anesthesia at the Christian Medical College at Vellore (9). After completing my MCh, I joined as a Lecturer in General Surgery Unit-III under Dr. Booshanam Moses for a year. One day, I noticed an area of insensitive skin on the dorsum of my right foot and we went with a sense of foreboding to see Dr. Leishiwon Kumrah, our close friend and working in the dermatology department. She did a skin biopsy and the result was borderline tuberculoid leprosy. We knew that leprosy was contagious but never thought that one of us would get it. Ann spent more time with the leprosy patients than me but apparently developing the disease is dependent more on the body’s immunity (T-cell function) than on contact. Later, when we did Lepromin Tests at the big leprosy hospital in Karigiri, Ann was strongly positive while I had no reaction, showing that my T-cell function was poor and hers excellent. Now that we had a diagnosis and no deformities, I thought that I just had to take my course of MDT and I would be fine, not realizing that the worst was yet to come!

I was initially started on a new regime, swapping Ofloxacin for Clofazamine (10), to avoid the dark bronze pigmentation that occurs with Clofazamine. Within a few days of starting treatment, I became hyperactive, keeping Ann awake all night talking nonsense. We soon realized that I had developed psychosis due to Ofloxacin and I was put on the standard 2-year MDT of Dapsone, Rifampicin and Clofazamine. I had difficulty taking the medication but put up with it, counting the days till I would be free. A short time after starting the drugs, I developed swelling and pain of the right lower limb and tender thickened nerves. I was having a Lepra Type I (or reversal) reaction – and was started on steroids. I soon developed severe side-effects of the steroids, tremors, hypocalcemia, hypokalemia, acne and a sort of depression. Although life and limb-saving, steroids are horrible drugs. Some people tolerate them well but others (like me) don’t. They should be used very carefully. After my experience, my blood boils if I see anyone prescribing steroids inappropriately. We were soon back in Makunda. My mother (my father had just passed away) was already upset with me for going off to a mission hospital (to waste my life) and after learning that I had developed leprosy there and was returning to that God-forsaken place, she was quite sure that I must be mad.

When we got back to Makunda, life became very difficult. My close friend, Dr. Samuel Siddharth Swamidoss MD had very graciously volunteered for a posting to Makunda to relieve us to go to Vellore for 3 years – I don’t think anyone else would have wanted to go to Makunda at that time. Unfortunately, he was overwhelmed with problems and struggled to keep the hospital going – he was a physician and had to manage obstetrics and surgery with only one other doctor, besides a lot of administrative and legal issues all by himself. We took over a really sick hospital, with me still on MDT and steroids for my reaction. There was no money, enormous dues payable to a lot of people and no help from anyone. We wrote to many people, to our Association and to possible donors but there were only promises of prayer and demands to settle some of their bills! A number of serious internal problems came to a head at that time resulting in violence on the campus (me being beaten up), Section 144 of CrPC imposed, local people (sadly some former employees, leprosy patients and church members included) occupying the land and demanding that we leave. We (Ann, me and the junior doctors and some others) ploughed the land every morning with a power-tiller and got back control of the land. The trouble-makers then filed a number of false criminal cases against us (hoping that we would leave and allow them to take over the land). We spent the next two years attending court every month till we were acquitted. They also filed a number of labor court cases which kept me occupied. We had made a 30-year strategic plan and this was the middle decade when we were hoping to start major projects to impact local and regional communities. In the midst of all this confusion, we therefore started work on a new English medium school, a school of nursing and a branch hospital in the state of Tripura. It was an audacious move, simply trusting God to provide in the midst of so much uncertainty and most people thought that it was an unsustainable gamble. Through all this, my leprosy reaction subsided and finally my 2-year course of MDT was over. I still have the shiny patch of atrophied skin on my foot to show that I had leprosy and several nerves are still thickened but I am well again.

Looking back at the experience, I know that I got leprosy so that God’s name may be glorified. I never ask why He allowed me to go through all the problems – they are insignificant in the light of eternity, one of those temporary trivial inconveniences that every Christian is called upon to bear. God permitted it to happen to me and that is enough, I don’t have to ask why. To understand a disease from the patient’s perspective, there is no better way than to have the disease yourself. There were times when I wondered whether I would be able to operate again (paediatric surgery demands meticulous attention to fine detail) and when I would be free of drugs, disease and complications but I never doubted the presence of God beside me. Ann was a wonderful person to be with me through all these trials and I constantly thank God for giving her to me – what a precious, wonderful gift.

When leprosy became a major problem, the British government, enacted the Lepers Act, 1898 (11) which provided for the arrest of any person who had leprosy and their incarceration in leper asylums. Along with it came numerous other laws that discriminated against leprosy patients – if you had leprosy, you could be divorced, kept out of jobs and public services etc. Over a hundred years later, even after leprosy became curable and the colonies ceased to exist, some of these laws are still in force, although the main Lepers Act was repealed in 1983. We were told that leprosy was eliminated (brought below the elimination threshold of an arbitrary prevalence rate of 1: 10,000), people started to become complacent and we are now told that the disease is slowly making a comeback (12), with many new patients presenting with disability for the first time as well as presenting in childhood. Aided by a slow natural course and a natural resilience, it is a tough disease to defeat and we could be in serious trouble indeed if adequate timely action is not taken. Leprosy caregivers getting the disease is not new. In the years when the disease was incurable, there was the famous story of Father Damien of Molokai (13), living and caring for leprosy patients, who soon developed the disease and became one among them.

Today (30th January, the death anniversary of Mahatma Gandhi) is Anti Leprosy Day in India (the rest of the world commemorates World Leprosy Day on the last Sunday of January). I am grateful that I lived in a time when the disease was overcome, when it was just an inconvenience and not a life sentence. We must be ever grateful to many scientists and pioneers like Dr. Paul Brand (14) who toiled to find a cure and rehabilitation for those suffering from this scourge and to organizations like The Leprosy Mission (15), AIFO (16), Gremaltes (17), American Leprosy Mission (18), the Missionaries of Charity (19), the government and many others who provided care and cure for the disease – for some years our leprosy work was partially supported by AIFO and The Leprosy Mission.

But for the grace of God and the timely discovery of a cure, I would have been a leper in a prison too. I had a myocardial infarction some years later (20) and now live with an ejection fraction of 30% – I could have easily died that day in 2008. God has taken me through many trials but kept me alive and able to work hard and remain productive. Many of us wrestle with our demons. For some they are sickness, like leprosy, HIV, mental illness and cancer; for others there are issues with parents, spouses and children, each one has his/her own ‘thorns in the flesh’ (21) but we can all find peace and reassurance in that beautiful verse in the Bible, Psalm 37:24, “Though he fall, he shall not be utterly cast down, for the Lord upholdeth him with his hand” (22).  I know that God in His grace has given me many second chances and value every moment I am privileged to live and hope that everything that I think, say and do finds His approval and that when my days in this world are over, I would be welcomed back as a good and faithful servant who accomplished the task given to him.

 

 

References:

 

  1. https://emedicine.medscape.com/article/220455-overview
  2. https://en.wikipedia.org/wiki/Leprosy
  3. http://www.makunda.in
  4. https://the-sparrowsnest.net/2016/02/19/short-video-of-our-work-made-by-emmanuel-hospital-association/
  5. https://eha-health.org
  6. https://en.wikipedia.org/wiki/Quonset_hut
  7. https://the-sparrowsnest.net/2018/05/12/early-days-at-makunda/
  8. https://www.leprosymission.in/what-we-do/institutions-and-projects/hospitals/tlm-kolkata-hospital/
  9. https://the-sparrowsnest.net/2017/09/13/obeying-a-call-to-medical-missions-a-testimony/
  10. https://en.wikipedia.org/wiki/Clofazimine
  11. https://www.legalcrystal.com/act/133845/lepers-act-1898-complete-act
  12. https://timesofindia.indiatimes.com/india/leprosy/articleshow/67689369.cms
  13. https://en.wikipedia.org/wiki/Father_Damien
  14. https://en.wikipedia.org/wiki/Paul_Brand
  15. https://www.leprosymission.in
  16. https://aifoindia.org
  17. http://www.gremaltes.in
  18. https://www.leprosy.org
  19. https://en.wikipedia.org/wiki/Missionaries_of_Charity
  20. https://the-sparrowsnest.net/2011/11/01/an-encounter-with-a-myocardial-infarction/
  21. https://en.wikipedia.org/wiki/Thorn_in_the_flesh
  22. https://www.biblegateway.com/passage/?search=Psalm+37&version=KJV