The Azim Premji Foundation (1) was started in 2001 by Mr. Azim Premji, Chairman of Wipro (2) and India’s top philanthropist to promote primary education in the country. Wipro is one of India’s leading information technology companies and Mr. Azim Premji was the first Indian to sign up to the Giving Pledge (3), a campaign led by Warren Buffett and Bill Gates.
In 2020, when the first Covid wave struck India, many hospitals were overwhelmed. The Azim Premji Foundation stepped into the breach and funded several hospitals in remote rural places to combat the pandemic and stay afloat in the face of severe adversity (4). Makunda was one of the hospitals that was privileged to benefit from this initiative by the Foundation.
When we started our partnership, Mr. Narayan Krishnaswamy (Director – Human Resources at the Azim Premji Philanthropic Initiatives) took the extra step of understanding the work at Makunda. After a few interviews, he decided to write our story in the form of a cartoon strip in a publication brought out by the Foundation called “The Dispatch” to motivate young people to consider a life of rural service.
Ann and me are privileged to have our story told in this format by such an eminent Foundation. We thank Mr. Narayan Krishnsawamy and the creators of the cartoon strip, Mr. Bijoy Venugopal (Script) and Mr. Tadam Gyadu (Art) for the beautiful way in which they have brought out our story – we pray that it will inspire those who read it, bring glory to God and lead some to a journey of faith like the one that we were privileged to embark on. May God bless Mr. Azim Premji and all the staff of his companies and the Azim Premji Foundation and continue to make them a blessing to many.
In October 2008, at the age of 44, I had a heart attack (1) at our home in the Makunda Christian Leprosy and General Hospital (www.makunda.in ), where my wife Ann and me have been working for the past 28 years. Following this, I was asked to go for daily morning walks to keep myself physically fit. As I walked through our campus, I became interested in the different wildlife (both flora and fauna) in our 350-acre forested campus. Although I had lived and worked there since 1993, I was looking with new eyes – filled with curiosity and wonder at what I was seeing. I had bought a Canon EOS 88 film camera shortly after joining the hospital and a few years earlier, I had invested in my first digital camera, a Nikon D70 with a Nikkor 28-105mm lens – all my photos were of people, developments in the hospital, places I visited and interesting medical cases that I saw. Soon after starting my morning walks, I purchased a Nikkor 70-300mm lens – I was able to get high quality macro photos with my 28-105mm lens but I needed a better ‘tele’ lens to photograph the birds.
In 2010, I was walking past our primary school one day when I noticed a pair of woodpeckers excavating a nest on a large bamboo pole used to hold up the school’s volleyball net. They looked and sounded different from a more commoner species (Dendrocopos macei) and I took photos and posted them on my newly opened account on Flickr (2). They were identified as Dendrocopos atratus, one of the rarest woodpeckers in India (later, some experts disagreed with this ID). I became excited and started photographing and posting all the birds I saw and was excited when one of them was uncommon. I also started venturing out to nearby tea-estates and forest villages to photograph them. The 70-300 lens was a basic one without vibration reduction (VR), so I bought a new one, Nikkor 70-300mm VR. I needed a good computer to process the images and bought an iMac 27”. I also bought a Sony sound recorder and a Garmin GPS. I became active on Facebook naturalist sites – ones on butterflies, moths, birds, insects – to post my images for ID and comment on other photographer’s images. After a few more years, I bought a new camera, a Nikon D300s and a Sigma 150-500mm OS lens. With the new gear, I was able to do a lot of documentation throughout the year. In 2012, I opened an account on iNaturalist and started linking my Flickr images to this wonderful site (3). Experts from around the world commented on the observations and confirmed IDs. These, ‘research grade’ observations could then be used by scientists for their research. This is the wonderful world of citizen-science where images and sounds of wildlife observations with time and GPS details can be peer-reviewed, confirmed and used for scientific advances.
In succeeding years, my gear has been upgraded further as old equipment became heavily over-used and broke down. I now have a Nikon D800 and a Nikkor 300mm f2.8 VRII for telephoto, a Micro-Nikkor 105mm f2.8 VR for macro as well as a Nikkor 24-120mm VR for general use. The old iMac broke down and had to be replaced, hard drives became full and more needed to be added. All this was considerable expense for a doctor couple in a remote rural mission hospital, but Ann approved all the expenses, for their role in my cardiac rehabilitation!
At present, I take photos of anything interesting I see in RAW, convert to JPEG with basic editing (mostly cropping) in Adobe Lightroom and upload images to Flickr. These are stored with a CC license – I noted that many serious people (those looking for images for their theses, articles, websites etc.) often search for the CC mark so that they did not have to write and seek permission from the photographer (4). Today, I have about 17,000 public images on Flickr with over 2 million views of these images! I also have nearly 9,000 observations on iNaturalist which is currently the highest number by one observer for India. Many bird photographers in the Oriental region contribute their images to the “Oriental Bird Image Database” – the best images are accepted and stored online – I have over 700 of my images on this Database (5). I have also contributed to the Internet Bird Collection (6), Avibase (7), ArKive (before it closed), Xeno-Canto (8) and a few other sites. Bulk uploads of my data have been transferred to the India Biodiversity Portal (9) and eBird. My photos have been included in books like the “Woodpeckers of the World”, “Mongooses of the World”, “Parrots of the World”, “Encyclopaedia of Animal Behavior” and many others.
I had soon photographed most of the common birds of our area and started looking at other living creatures. I was introduced to Siddharth Kulkarni, a scientist with an interest in spiders, he was also the country representative on the World Spider Catalog and I invited him to Makunda. He made a few visits and taught us to observe and document the spider biodiversity of the campus.
In 2015, I started the “Makunda Nature Club” – a group of staff and students of Makunda with an interest in documenting biodiversity, creating awareness, conservation work and research. I had published a short note on the “Mating of the Greater Coucal” online in 2011 to the Bird Ecology Study Group (10). In March 2015, on a biodiversity documentation trek in nearby forests, I noted a new bird I had not seen earlier. It was a van Hasselt’s Sunbird – Leptocoma brasiliana sperata – the first time this species had been photographed in India. I wrote an article describing this observation and the distribution of this species (with Praveen Jayadevan – a bird expert) as the first publication of the Makunda Nature Club (11). This was followed by the publication of the observation of a rare spider, Platythomisus octomaculatus, the first time it had been seen in India and the second time it had been observed since its first sighting in Sumatra 120 years earlier (12) and two Coreid bugs (Schroederia feana and Prionolomia gigas) – these observations were made, ID confirmed and published with expert assistance from Siddharth Kulkarni (the Coreid bugs were confirmed by Prof. Hemant Ghate) (13). The spider was found by one of our school-girls – a Class 8 girl from a remote rural school finding a very rare spider – for the first time in India! (14). In 2017, I photographed a rare Ghost Moth (Hepialidae) at my home in Makunda. I searched the internet and found that the global authority on these was Dr. John Grehan from the Carnegie Museum of Natural History in the USA. I wrote to him and after an exchange of emails, we co-wrote an article on the Ghost Moths of northeast India (15). The “Makunda Nature Club” got its excellent logo from Sukumaran Sundaresan – a design specialist who took a short sabbatical away from his corporate work to spend some time with us (16). The club also has also got its own group on the India Biodiversity Portal (17).
One day, I went to a nearby Jaintia village for the wedding of one of our staff and while waiting for the proceedings to start, met one of our old school-boys (from the Makunda Christian Higher Secondary School which we started on our campus in 2004), Rejoice Gassah. He told me that he had heard that I was going into local forests and that he was also interested. I questioned him, took him along with me on a few treks and found that he was excellent at describing birds and their calls – he had a natural talent. I requested our hospital management to appoint him as a full-time staff to help me. He was a keen-learner and I soon passed on most of what I knew to him. He accompanied me on all my field-trips and we discussed what we observed. The hospital also purchased equipment for him to use – a Sony bridge camera, an iMac 21”, a Sony sound recorder, a Garmin GPS and a Camera Trap as well as field guides. In 2017-18, he applied for and was sent to do the Green Hub Fellowship in wildlife videography – that was excellent training and we thank Ms. Rita Banerji and her team for the great program that they run (18). It is great to work with someone who has a passion for the work, has natural ability, good attitude and is willing to put a lot of effort into achieving excellence. As a full-time surgeon at the hospital, my biodiversity documentation work is limited to Sunday mornings or whenever I have free time after work. He was full time, young and healthy and we could now do field work whenever required and I could do the analysis of the data and write manuscripts for publication. He has been sent to several places (National Center for Biological Sciences, Bangalore and ATTREE to name two) to gain more knowledge and skills.
Publications on the Golden-crested Myna – Ampeliceps coronatus (19), Tawny-breasted Wren-babbler – Spelaeornis longicaudatus (20), Asian Stubtail – Urosphena squameiceps (21) and Siberian Blue Robin – Larvivora cyane (22) have come out of my work with Rejoice Gassah. He has become an expert at observations as well as documentation and has a keen eye for anything unusual. It has been a privilege to be able to mentor someone like him and I’m sure that he has a great future in biodiversity documentation and conservation in the years to come. Writing these articles also exposed me to the world of wildlife research, writing to curators of museums across the world, tracking observations from journal articles in the past and social media in the present to provide a concise description of that particular species and its distribution. Editors like Praveen Jayadevan from IndianBIRDS have helped me to learn to do this well. At present, more research is under way – on mammals, dragonflies, butterflies, birds etc. We have also had visits to our hospital by Prof. Ganesan from ATTREE (23) and hope to start work on research on the floral biodiversity of this area – one of the last bits of semi-evergreen low-altitude dipterocarp forests that remain with significant amounts of wildlife – both flora and fauna – outside protected areas.
I must also acknowledge the help and encouragement provided by Dr. Anwaruddin Chowdhury – a wildlife expert and Secretary to the Government of Assam with a huge amount of academic research and publications to his credit (24). We invited him to open the “Biodiversity Resesarch Trail” in our campus. He also invited me to contribute two short chapters – on the Golden Jackal (25) and Otters (26) in his book on the Mammals of Northeast India. We have also been visited by many wildlife and biodiversity documentation experts – Shashank Dalvi, Ramit Singhal, Jainy Kuriakose, Sankararaman, Shantanu Joshi, Sarala Khaling, Rohit George and many others. I don’t use a tripod and the equipment is heavy, not good for someone with an ejection fraction of 35% to carry – especially the Nikkor 300mm f2.8 VR II lens – I thank Club members, Basanto Fulmali and Babryl Chorei who helped carry the equipment on long treks when I was tired. My wife, Ann and daughters, Hannah and Deborah, have also helped with observations, especially with bird behavior and with rescuing some injured/sick birds and animals. As days go by, more staff see the enchanting beauty of God’s creation, learn fascinating facts and become entranced with the world of biodiversity observation and documentation. More people are buying cameras or take photos on their cell-phones and enquire about the identification or habits of the species that they have observed, this type of activity also relaxes people and makes the overall experience of working in a remote rural situation more enjoyable. I’m sure that this work will continue and bring satisfaction and happiness to many.
Sometimes, God uses shock treatment to help us to look at our worlds through different eyes and that is what happened to me after my heart-attack – whenever something happens to nudge us out of our well-trodden paths, we should always ask why did this happen, is there something that I need to change and is there another road that I need to explore. It is also a confirmation of the fact that God has given us such wonderful brains that someone like me with no interest or knowledge of wildlife could become an accomplished citizen-scientist in a short time – starting at midlife. More of us, whatever may be our background, should consider looking at the biodiverse world around us, maybe that world is beckoning to us too – we need to take that first step and enter into the world of God’s creations, where everything is bright and beautiful.
This post is based on a message I gave today (through videoconferencing) to the staff of our hospital, Makunda Christian Leprosy and General Hospital (1) – the numbers in brackets refer to links given in the references at the end of this post:
Today is Palm Sunday, the beginning of the Christian “Passion Week”. Normally, today, Christians all over the world would have walked streets outside their churches with palm fronds, enacting Jesus’s entrance into Jerusalem, leading on to the train of events that led to His death and resurrection. Palm Sunday 2020, however, is different. Churches all over the world are closed. Most villages, towns and cities are under various restrictions – from social distancing to lockdowns. People are on their phones – talking, chatting and posting on social media, the discussions are all about one thing – the Covid19 pandemic. Till today, over 1.2 million people are infected and over 65,000 have died (2).
Instead of a Palm Sunday message, today’s talk will be about our response to a crisis situation. The Jewish world is about to start their Passover festival – this year it will also be celebrated across the world in similar conditions as Passion Week – from the 8th to the 16th of this month.
We read the story of the Passover in Exodus 12:12-18 (3). The nation of Israel was in bondage to the Egyptians. The ruler of the Egyptians, the Pharaoh, would not let them free – they were his source of cheap labor. The early chapters of Exodus talk about this situation, the story of Moses and God using him to deliver the Israelites from the clutches of the Egyptians through 10 plagues. The last plague was the death of every firstborn in the land. The Israelites were pre-warned of the impending plague and were told to anoint their doorposts with blood from a sacrificial lamb. When the Angel of Death swept through the land killing the firstborn, he “passed over” the homes where there was blood on the doorposts. We too, like the Israelites, should put our faith on the shed blood of the Lamb. The world today is gripped by a powerful pestilence, killing large numbers of people from even the wealthiest and most powerful of nations – all their power and wisdom is unable to stop it. We too have no power over this pestilence, but like the Israelites, we can put our faith on our God, who made heaven and earth. He sends His angels to watch over His people and like the Israelites in the days of Moses, we too can be at peace and without fear.
Let us look at a Biblical model for our hospital as we approach this crisis situation. For our meditation today, I have taken the first 6 chapters of the book of Nehemiah.
Nehemiah starts his story from the city of Susa, where he hears about the sad predicament of the people of Judah and the city of Jerusalem. It is like our situation today, as we hear about the worsening crisis across the world. He knows that this situation is due to the disobedience of God’s people (Nehemiah 1:8) (4) but at that point in time, the problem was to restore the integrity of the city and its walls. He approached the king and is given supplies and assistance to complete this task. He is given authority, in fact, he is made the governor. He (Nehemiah 2:12-16) (5) inspects the city and its walls and takes stock of the situation. We too should understand and take stock of the situation. Through electronic mass media, we are uptodate on what is happening around the world. We know that this pandemic originated in China and then rapidly spread across the world through traveling infected people. It is now spreading from person to person. Each infected person is expected to spread the disease to two others, if given the opportunity to interact with uninfected people. If nothing is done, millions will be infected and many will die. Scientists are constantly studying this disease as it evolves and we are learning how to manage the situation and minimize morbidity and mortality.
Having understood what he was up against, Nehemiah made elaborate plans. He appointed key leaders to take responsibilities for rebuilding different parts of the walls of Jerusalem. When faced with ridicule by his enemies, he responded by ignoring them, showing single-minded determination to complete the task given to him and by prayer. When there was a threat of physical violence (Nehemiah 4:15-16) (6) he arranged for workers to continue working – with construction materials in one hand and a weapon in the other. We too have the responsibility of treating our patients while protecting ourselves and others from getting infected. At our hospital, the local government has designated us as a non-Covid emergency hospital. People need a safe place to go for their deliveries, strokes and heart attacks, bowel perforations and obstructed hernias. In the future, we may be called upon to work with Covid patients too – if government facilities are overwhelmed. Our hospital has created a task force that has readied the hospital to tackle this situation. Separate teams have been formed, personal protective equipment (PPE) is being made with what we have, different areas have been designated for different patients and protocols are in place – we too are preparing to fight on two fronts.
In the 5th chapter of the book of Nehemiah (7), we see him hearing about the plight of the poor and needy. Although his task was to repair the walls, that could not be his only priority. His target population was suffering and they were the focus of the exercise, not the stone walls and wooden gates. Therefore, he steps in and asks people to forgive the debts of the poor and give loans without interest. In this moment of crisis, let us also consider the people we have been called to serve. Many of them were already poor and marginalized, this situation will make them destitute – they have just become financially vulnerable and in danger of losing their vital assets. If we force the poor to pay their bills – for bringing their loved ones to our hospitals and their children to our schools, we would inflict greater pain than the virus. Let us think about how we can be a blessing to the underprivileged communities that we have been called upon to serve. We may ask, aren’t we running out of money too? We don’t have enough to pay our bills and salaries. We must remember that God is no man’s debtor. The Bible tells us that when we treat the poor, He will pay their bills and reward us (Proverbs 19:17) (8)
Later in the 5th chapter, we see Nehemiah counting the costs of the work entrusted to him. He finds that resources are short and the task is great. He decides to set a personal example by not claiming what is his due as a governor. When crisis situations arise, we (and our families and friends) should consider a period of austerity and sacrifice for the people we are called to serve. Makunda went through periods of severe crisis in the past. Each time, bills accumulated, due amounts were demanded by various people – salaries were deferred and many staff donated from what they had to keep the work going. Projects had been started which could not be closed – staff contributed to enable them to continue, today they are institutions on their own, the 1200 student Makunda Christian Higher Secondary School, the School of Nursing and the branch hospital at Ambassa in Tripura – to enable these to become reality, staff were willing to wait for 14 years for running water and electricity to be supplied to their homes. Some staff did not take their eligible leave so that the hospital did not have to spend on paying for replacements. Today, we too have an opportunity to help our institution continue to serve its target people by giving of our time, talents and treasure. We are lending to God and will be repaid with things that money cannot buy – peace and contentment in this world and riches in heaven.
We read in Chapter 6 (9) that Nehemiah firmly denied lies from his enemies and finally completed the task in 52 days. Only then did he start working on solving the root causes of the problem – the disobedience of God’s people. We too need to work hard and diligently to get through this crisis now, when we have got over it we can study the entire experience and put in place protocols and practices to help us do better the next time we face another crisis.
We now come to the last part of today’s message. We hear about fear in people facing this crisis, but we have nothing to fear. Romans 14:8 (10) says that whether we live or die, we are the Lord’s. For us, Christians, life does not end with our physical death but continues on forever. We are God’s ambassadors from the kingdom of Heaven, temporarily posted to this world. We will all die one day but we are at peace. We have handed over our lives into the hands of our loving Commanding Officer – we are dispensable and He can choose the manner and timing of our deaths. Our only concern is that during the time given to us in this world, we live lives that find approval in His sight by trust and obedience and complete the tasks given to us.
Let me close with a few verses from that much loved chapter in the Bible, Psalm 23 (11). In verse 4 we read, “Even though I walk through the valley of the shadow of death, I fear no evil, for thy rod and thy staff, they comfort me”. I remember suffering an acute myocardial infarction (12), rolling about in pain on the 12th of October 2008 – I felt as if someone was trying to pull the life out of me but I was holding on because God was telling me that He had some more work for me to do before I go to be with Him. In verse 6, we read, “ Surely goodness and mercy will follow me all the days of my life and I will live in the house of the Lord forever” – may we submit our lives to Him as we face this crisis and be worthy of this promise, for this world and the one to come.
With the background of my short testimony in the previous posts (1,2), let me reflect on some common queries regarding Medical Missions in the minds of Christian medical students and on ways forward:
Who is a missionary? I found this definition from Wikipedia (3) quite comprehensive, “A missionary is a member of a religious group sent into an area to do evangelism or ministries of service, such as education, literacy, social justice, health care and economic development. The word “mission” originates from 1598 when the Jesuits sent members abroad, derived from the Latin missionem (nom. missio), meaning “act of sending” or mittere, meaning “to send”. The word was used in light of its biblical usage; in the Latin translation of the Bible, Christ uses the word when sending the disciples to preach in his name. The term is most commonly used for Christian missions, but can be used for any creed or ideology.” A Christian medical missionary would therefore be someone sent to provide health care on behalf of a Christian church or group and Christian medical missions would be the work done collectively by a group of such people.
What are some of the characteristics of medical missionary work? I think that medical missionaries (like all other missionaries) need to be sent out to areas where they are relatively out of their comfort zone (vulnerable) and to help people who are poor and marginalized. They must excel in their professional work as well as serve in the Spirit of Christ, so that others may see Christ in and through their work. This would enable other Christian services to be offered through the activities of the mission compound.
Does Medical Mission work have to be only in remote rural areas? Many of the present locations of mission hospitals in India were once rural – towns have developed around the mission compounds! However, after Indian independence, there has been a significant movement of people to urban areas and many live in slums. These people are also poor and marginalized – they do not have access to high quality medical care at affordable cost and this is an opportunity for mission hospitals in urban areas. Mission hospitals have great potential as they are among the few entities which focus on people whom nobody else is interested in.
Are there opportunities for pioneering new Medical Mission work in India? Yes, Arunachal Pradesh is at present the only state in India without a Christian mission hospital. (Tripura too did not have one until we started a hospital there in 2005). There are large tracts of land in forgotten corners of our country where new hospitals are needed and can be started. However, due to local land and entry laws, it is not easy for outsiders.States such as Arunachal Pradesh, Mizoram and Nagaland require an Inner Line Permit – similar to a visa – for non-locals to enter and several states have restrictions on non-locals purchasing land). Similarly, great opportunities for transformation exist in other needy parts of the world where few want to go.
Can Medical Mission work be done in hostile areas? When Makunda started the work in Tripura, Dhalai district was the most affected by militancy with murder and abduction being common and all public transportation possible only through armed convoys. However, the work at the hospital was never affected as it was seen as a humanitarian service to the poor. I had the privilege to visit Africa last year – mission hospitals are the only long-term health facilities that work well in conflict areas because of the commitment of staff. Other NGOs (like Red Cross and MSF) offer short-term medical support services. Warring groups usually do not target missionary services, recognising their humanitarian value and universal appeal.
Is Medical Mission work a sacrifice? We are called to be ‘living sacrifices’ – meaning that we offer ourselves to a life of obedience to God. Medical mission work (especially in remote rural areas) is front-line work and not easy. However, in the light of the words of the Bible, I would say that the trials and difficulties are ‘temporary and trivial inconveniences’! We should not dwell on sacrifice as it makes people into ineffective self-styled martyrs! There is no sacrifice too great for a missionary – when we feel that we have been brought to life from death by the sacrifice of Jesus on the cross, we should be ready to die for Him. When we look at missionary history, many missionaries (often unheard and unsung) gave their lives so that the church may be built in remote areas all over the world – truly the present Christian church in these areas has been built on their sweat and blood. In comparison, the problems we face today in India are indeed trivial.
Can Medical Mission work be professionally challenging? I have heard many people say that mission hospitals (especially remote rural ones) treat only diarrhea and ear discharge! When I completed my M.Ch in Pediatric Surgery at CMC Vellore, there were people who even asked why I wasted a M.Ch seat which could have been given to someone who was more likely to use it! I would like to say that I have seen and operated on some of the most professionally challenging conditions at Makunda. Since CT scans, nuclear scans and the services of other experts are often unavailable in these locations, missionary doctors need to innovate to be able to treat patients cost effectively with what is available.. I have operated on a teratoma in the right middle lobe of the lung (middle lobectomy with composite resection of two overlying ribs), ectopia cordis (unfortunately, this patient died), 35 kg ovarian tumor, retrograde jejunogastric intussusception, intra-abdominal cocoon (several cases) and so on. There have also been challenging medical as well as other specialties’ cases. All these years, I was the only full-time pediatric surgeon in the states of Mizoram, Tripura, Meghalaya, Manipur and southern Assam – so there are certainly a huge variety of patients who need treatment (and who cannot go elsewhere because they are poor), it is only logical to conclude that professionally, medical missionaries are in for exciting opportunities.
Is it not difficult to be in a ‘vulnerable’ situation? Humanly speaking, it is. However, I would say that from a spiritual perspective, this is the greatest factor in favor of Medical Missions. Vulnerability is a blessing in disguise – how else will we see God at work? God specialises in helping us as we face circumstances beyond our control. Miracles do not happen when we are in control of situations. When all else fails and we totally depend on God, we see Him at work. It is an exciting experience to see God at work and see Him build up His kingdom and be partners in this great ministry.
Is Medical Mission work drudgery with few opportunities to relax? When I was in school, I was interested in tennis, rifle shooting and rowing. In college, I cultivated an interest in electronics. However, many of these activities were not possible at Makunda. I discovered that nature observation and photography are excellent for relaxation. My observations in and around Makunda have been posted and published in many sites. (4,5) If someone is looking for the nearest mall to relax in, he may be disappointed but there are other (and maybe greater) opportunities to compensate.
Can work focused on the poor be self-sustaining? When we re-started Makunda, we were told that it was impossible to work primarily for the poor on a self-sustaining basis and that all successful mission hospitals subsidise treatment of the poor by treating the rich at higher rates. However, we decided to be a hospital primarily for the poor with no special facilities for the rich as a part of our ‘pro-poor’ branding strategy. All patients wait in the same queues irrespective of their social class or wealth and the same general wards are used to admit them. Charges are low and charity is liberal – the hospital is flooded with patients and high capacity utilisation leads to high efficiency and lowered costs. God has blessed the work and we have been able to invest in new equipment and buildings, start a new school, the branch in Tripura and nursing school without major grants (the external funding received each year was less than 1 percent of income for many years). When we treat the poor who cannot afford to pay, God pays their bills – often in ways that money cannot buy – by giving us satisfaction, contentment and wealth in heaven.
Why is there a high attrition rate in mission hospitals? Work in mission hospitals is not easy and not for every one. There is peer-pressure from families and friends. People look for comforts and sometimes are unable to adjust to life in mission hospitals. Many are short-term and do not want to stay on to solve local problems. There is a high attrition rate in Medical Mission work all over the world – maybe <10 per cent of new staff stay on long-term. However, most staff leave after tasting God at work and often say that the best years of their lives were at the mission hospital!
Are many mission hospitals today ‘beyond redemption’? Sadly, many mission hospitals are ‘sick’. This is due to inability to adapt to rapid changes, poor governance and the absence of committed long-term staff at a leadership level. Being at the cutting edge of mission work, I am sure there would also be an element of spiritual warfare. However, no hospital is beyond redemption. Major changes may need to be done to resolve problems but all of them can be revived. If a completely shut hospital (like Makunda) with severe local problems can be revived to become a thriving community, there is hope for all the other sick ones too! God is able to do great things. He just needs a few volunteers willing to submit to Him.
What should be done to revive and revitalize Medical Missions?
I feel that Medical Mission hospitals require a transition to effective and efficient governance mechanisms, without losing the vision of the founding fathers. They may need repositioning due to changing contexts – laws have changed and the world has changed. For this to happen, highly committed people should be willing to stay till they see change. It is a call to persevere – changes may take years to happen. Objective stock-taking exercises, strategic planning and an excellent system of accountability, transparency and integrity based ‘checks and balances’ is essential.
The church should ‘own’ and support medical mission work. When I was young, I never went to church, thinking it was a waste of time! Parents and people at church disapproved. Later, when I started going to church, everyone was happy. However, when I felt God’s call to remote rural missions, many felt I was going too far, becoming extremist! If every church encouraged medical members of its congregation to give a year or two of their lives to missions, there would be more than enough people to run the hospitals.
Many young doctors and specialists going to mission hospitals today do not have the training and experience to manage administrative (legal, financial and other) work. They need to have some exposure, as they are often required to take leadership roles. Some years ago, Makunda offered a mission-training programme of 2 years duration where doctors who are keen to work in long-term missions could work as apprentices and finally learn to manage a small hospital (our branch at Tripura) on their own.
There is a lot of Christian work in medical colleges in India – EMFI and UESI as well as other groups. However, such work should lead to changed lives. We need people to experience the life-changing power of the Gospel and then take decisions that will take them to the best plans God has for them. Important attitudes need to be cultivated too. (6)
Excellence in studies is important. Obscure facts learnt in medical college serve to be life-saving information(7). Students interested in a career in medical missions should ensure that every day in college is well-spent and no opportunity to study is lost.
The choice of who one marries has a very strong effect on which medical missionary stays on in Medical Missions and which one does not. (8)
When young Christian medical professionals talk of working abroad, the conversation is almost always about the developed world – the western nations, Australia and even the wealthy ones in the Middle East. Why don’t we look at the ones that need help instead – Myanmar, African and South American nations, small island nations – for those with a greater adventurous spirit, these opportunities beckon!
There is a ’rut’ placed in time at the end of MBBS or other medical professional qualification. If nothing is done at this point, all graduates tend to follow the tracks left by their peers – corporate work, government work or private practice. So, for those considering Medical Missions, important steps need to be taken much prior to graduation – sensitizing parents, and exploring varied options.
I would like to invite every committed Christian medical professional to consider a life-long career in mission hospitals, or at least a few years of their life. We spend a lot of effort in investing our money so that it gains the greatest value over time. I think Medical Mission work gives a Christian medical professional the greatest value over time – an exciting and fulfilling life in this world and a great reward in heaven.
This post is updated and adapted from the chapter, “A privileged call to Medical Missions” published in the book, “Wings of Dawn” – used here with permission from the publisher, Evangelical Medical Fellowship of India. The book, which also contains chapters by several other authors is available in hard copy and Kindle versions on Amazon.
In 1982, as a second year under-graduate medical student at the Kilpauk Medical College in Madras (1), I made a lifelong commitment to Jesus Christ. I started a Bible Study group in college and we discussed how to live the Christian life and make decisions that were approved in God’s sight. We heard many messages on the topic, “Finding God’s Will” but many of us were not able to get a clear convincing personal answer to this burning question. My query was answered one day when I was reading Jeremiah 29:11-13 (2) – I felt God telling me that I was not able to find His will for my life because I was not seeking with all my heart and that He was waiting to answer as soon as I realised that He had the best possible plans for my life. I also realised that I did not want to hand over my life totally into His hands; I wanted to retain control and this attitude was preventing me from seeing His plans for me. I felt God speaking to me and made a vow that I would obey Him and go where He wanted me to go and do what He wanted me to do with all my time, talents and treasure. It soon became clear to me that I should go where few others wanted to go, so that I could make a difference to people who had no access to good health care. Since the southern four states of India were well provisioned with healthcare, I had to go far away from home.
After my internship, I was not confident to run a remote hospital by myself and joined the Christian Fellowship Hospital (3) at Oddanchatram in 1987 and spent 3 wonderful years there, learning to become a more confident doctor. I also spent the 3 years (every Thursday) exploring villages in the hills of Pachalur (30 kilometers from Oddanchatram), doing medical work with some local missionaries and seeing God answering the simple prayers of poor people powerfully. For the next few years, I was involved in conducting the annual Medical Missionary Meets for medical college students of Tamil Nadu at Pachalur organised by the CF Hospital – I visited medical college fellowships in Tamil Nadu, wrote numerous letters to a large number of students and learnt many things about working with medical students.
I was married to Ann in 1991, during my Postgraduate Residency days in General Surgery at the Madurai Medical College (4) – we met over our common interest in medical missionary work. I had met Dr. Vinod Shah, a paediatric surgeon, then working with the Indian Evangelical Mission in Gujarat, at the Medical Missionary Meet at Pachalur in 1987. In 1989, I spent two months with him at the Chinchpada Christian Hospital in Dhule District of Maharashtra (he had just joined the hospital as its Medical Superintendent) – I spent time thinking about and discussing where God wanted me to go during my time at Chinchpada and shared with Dr. Vinod Shah a list of key points that I felt God was asking me to look for. Some of these key points were a remote rural area where no hospitals/doctors were present, a thickly populated area with great healthcare need, a large campus which could be developed over the years and the scope for working with medical students of the area. In 1992, when I was completing my MS in General Surgery, Dr. Vinod Shah, who had become the Medical Secretary of the Emmanuel Hospital Association (5), asked us to visit a mission hospital in Assam (bordering Mizoram and Tripura) that was closed for the past 10 years, called the Makunda Christian Leprosy and General Hospital (6,7) – he wrote me a letter saying that he was inspired to recommend this place to us as most of my ‘key points’ were fulfilled at this hospital. We visited the campus for a week in October 1992 and found a desolate place with broken buildings, no patients, no income and a violent group of people from the old church and staff of the campus who planned to steal the land and assets of the hospital for themselves. They told us that if we wanted to work peacefully in the hospital, we should join them. If not we would have to fight them and that they would make life difficult for us! We prayed for wisdom and guidance. God opened our eyes to the magnificent campus (at that time, 1000 acres of forested land), to the great need (we heard stories of many mothers who died as they were unable to cross flooded areas during childbirth to travel to faraway hospitals) and to the potential of working with young people in a new area where God was leading us, north-east India. We felt God assuring us that we were under His protection, He would take us by His hands and be the source of all the wisdom, strength and encouragement that we needed as we stepped into this new responsibility that He was giving us.
In 1993, we joined this hospital as its first doctors (after its years of closure) and have continued to serve there since then. Between 1997 and 1999, I did my M.Ch in Paediatric Surgery at the Christian Medical College (8) (CMC) at Vellore and between 1999 to 2000, I worked as a Lecturer in General Surgery in the same college (Ann, who had waited 7 years to do her Postgraduate studies, did her MD in Anaesthesia at CMC during the same 3-year period). During our stay at CMC, we were equipped with new skills and knowledge to expand the services we offered at Makunda – we started the only paediatric surgical centre for the states of Manipur, Mizoram, Tripura, Meghalaya and the southern half of Assam. When we initially joined the hospital, we were told by the leaders of Emmanuel Hospital Association in New Delhi (which took over the Board function of Makunda from the previous Baptist Mid-Missions Trustees India) that we had to make a long-term commitment to Makunda, as they would not be able to find anyone else willing to work there if we quit. We were also told that they were taking the risky decision to accept Makunda as a Member of the Association based on our willingness to stay long-term. When I asked, what they meant by ‘long-term’, we were told, ‘preferably retire from there’! We agreed and made a 30-year commitment to the hospital and started work on a 30-year strategic plan to rebuild the hospital. We thank God that He has enabled us to stay on till the present – we are in Year 25.
There were many battles to fight – we had no experience in administration, law or finance, there was no one on the campus who had the same vision, we did not know the language, there was no running water or electricity, no patients or money, we had to confront the so called ‘trade union’ members and a group of old leprosy patients who had joined them on a daily basis and the nearest phone was 50 kilometers away on a bad road! Makunda was considered a God-forsaken place – in those early days, if someone was posted to Makunda, the first question would be, “what wrong have I done?”!
In the past 24 years, God has blessed the work at Makunda. In 2016-17 (which was not a good year – due to three months of floods), the hospital saw 84,557 outpatients, admitted 11,017 inpatients, delivered 4886 mothers and performed 2194 major operations. A survey of northeast India showed that many remote rural areas (such as Arunachal Pradesh which is presently the only state in India without a Christian mission hospital) had low population density and could not support a hospital like Makunda. It was felt that nurse-missionaries could run healthcare services in such areas and a nursing school was started in 2006 – 25 students join every year and over 200 have passed out so far. A survey of local villages showed that poor tribal children had no scope of acquiring a good education and career, improving the social and economic status of their villages unless they had access to affordable English medium education as they were not comfortable and quickly dropped out of the locally available Bengali language schools (many tribal languages in northeast India use the English script – a testimony to the linguistic work done by Christian missionaries in the past). An English medium school, the Makunda Christian High School, was therefore started in 2004 and today there are nearly 1000 students studying up to class XII (Arts and Science) with 220 children in two hostels. It was also decided to start a new hospital in another state of northeast India to expand Makunda’s horizons, to serve as a training/experience centre for young staff interested in missions and learn how to start and run a new hospital – with a view of starting many more! A branch hospital was therefore started in the neighbouring state of Tripura, at Kamalacherra in the Dhalai District, in 2005 and it is providing service in one of the most needy parts of the state – it is the only Christian hospital in the state and at that time heavily infested with militants. An agriculture and fishery department looks after the large campus and in 2015, the “Makunda Nature Club” was started to document biodiversity, conserve wildlife and conduct research. A community college was started the same year. The hospital is focused on the poor and there are no facilities for the rich such as private rooms or private consultations. Yet, it has adequate income to meet the running expenses, able to offer charity liberally to the poor and still have enough for critical capital expenditure – a self-sustainable model focused on the poor with only 1-2% of income derived from external sources. Large numbers of poor people have found healing on the campus. During the day, more than 1000 staff and students work and learn on the campus. Spiritual work for patients, students, staff and for others outside the campus (villagers and college students) is carried out throughout the year. The medical work has therefore enabled the entire campus to thrive and this has been the story of successful Medical Missions all over the world. The hospital has partnered with the Government too – it has one of the best-run Private Public Partnerships with National Health Mission, Assam for maternal and child health care. It also provides a 6 month residency to doctors from Netherlands doing the MD (Global Health and Tropical Medicine) course from the Royal Dutch Tropical Institute, Amsterdam – enabling highly committed medical doctors from the Netherlands to acquire the skills and experience required to serve in even more needy parts of the world such as South Sudan and Ethiopia. I must acknowledge the selfless and joyful work put in by the staff in all departments who have gladly ‘walked the second mile’ – they have been the greatest strength of the hospital and all these developments would not have been possible without them. It has been a privilege to work with so many highly committed staff whom God has brought from many places.
Ann and me have faced many difficult situations (violence, health issues – I had a heart attack in 2008, court cases against us, to name a few) but count it all joy to be a part of God’s great work in this corner of the world. (9,10) We look forward to what God has in store for us in the years to come and our ambition is that we will continue to trust and obey Him and when our days in this world are over, be welcomed back to heaven as good and faithful servants who accomplished the work given to them.
This post is updated and adapted from the chapter, “A privileged call to Medical Missions” published in the book, “Wings of Dawn” – used here with permission from the publisher, Evangelical Medical Fellowship of India. The book, which also contains chapters by several other authors is available in hard copy and Kindle versions on Amazon.
Emmanuel Hospital Association (EHA) has made short videos on the life of some of its doctors to challenge mission-minded people to step out in faith and see God work through them. I would like to thank Dr. Ashok Chacko who took the initiative to make this short video in 2014 based on work in the different departments at Makunda and an interview with me and Ann. God continues to do a great work at Makunda and the credit goes to Him and to the large number of highly committed staff who have worked hard inspite of many difficulties over the years.
Medical missionary work (especially in remote rural areas) is frontline Christian work and needs highly committed people. There are several important attitudes that are essential for a medical missionary to be confident with his or her work and comfortable with the situation he or she is placed in.
I was impressed with Hebrews 11:1 to 12:2. This passage appears to be specially written for those who are considering missionary work as a vocation with real life examples from the Bible.
11.1 says that we must have faith in God and believe what we cannot see. This is a basic requirement. In verse 6, it says that without faith it is not possible to please God. This is also a basic requirement in any relationship. Let us look at some of the examples and see what we can learn from their lives:
Noah: We read that Noah was warned by God about the coming flood and built an ark according to the specifications God had given him. When I think of the story of Noah, I feel it is an encouragement to those who need to face ridicule. We are not told how long it took for the flood to come after Noah started to build the ark. The patriarchs lived for hundreds of years and it could easily have been a hundred years. Imagine explaining to everyone that there would be a flood and you were building an ark to save God’s people – year after year the rains came on time and there was nothing unusual – I am sure that everyone must have teased Noah and many would have decided that he was mad. So, it is with God’s instructions to His people. Often, they do not find acceptance in the eyes of the world – friends, family and peers. It is difficult to proceed forward with God given faith believing in something yet unseen but this is the first requirement. Another lesson from Noah’s story is the diligence with which the ark was constructed – perfectly fashioned to meet the measurements given by God. Are we perfect workmen and women? I hate to see sloppy work – as a surgeon, I like to see each stitch fall perfectly into its place – correctly placed, correctly tightened giving the assurance that the anastomosis will not leak or stenose. We should take pride in the work we have been given, so that the work done in God’s name brings Him glory. I am sure Noah had a team to build the ark, so also we need to ensure quality performance from our team – nurses, doctors, technicians, pharmacists, maintenance people and others who work towards making a hospital’s work a beautiful thing in the eyes of God.
Abraham: We read that when God told Abraham to go, he went, even though he did not know where he was going. Complete, trusting and immediate obedience – a matchless quality for God’s missionaries. It is written that he lived in tents – he did not acquire lands to build permanent buildings. Why? What is an important advantage of a tent over a permanent building? The tent can be built on any open temporary space and it can be folded away when we decide to travel again. Abraham was tuned to God’s voice and he lived in tents so that when God told him to move, he could do so within a short time. We are called to be citizens of the kingdom of God posted as His ambassadors in this world. We are not to acquire permanent roots here, we are rather asked to build up our riches in heaven by living lives of obedience and surrender. Abraham was not a poor man and could have easily acquired permanent assets in this world but he knew that there was a much greater city waiting for him to dwell in when he died and went to be with God in heaven. I also see in Abraham’s life a desire not to waste a moment in going the wrong way. An awareness of the passage of time is a key requirement. Time is the most precious asset in our hands. We do not know how long we are going to live and our opportunity to do something of eternal value is limited by the time that is available to us. We need to use time wisely and not waste it – be prompt in our obedience so that every minute takes us more purposefully to the goal that God has placed before us.
The sacrifice of Isaac: We are told that Abraham and his wife Sarah were childless for many years. However, God had promised a son and this miraculous son was given to them in their old age. Abraham must have been overjoyed and must have doted on his only son – the apple of his eye. Imagine listening to God telling him to take his son, his only son Isaac and sacrifice him as an offering – a very difficult thing to do – yet, Abraham obeyed instantly. I was wondering whether Abraham became so attached to his son that God was taking second place in some areas. God wanted to know where Abraham’s priorities lay. Do we have Isaacs in our life – something that is coming between us and God – it could be a relationship or personal ambition or material desire. God is asking us to give up our deepest desires as an offering to Him so that we desire only to please him. He is sufficient for all our needs and will supply them according to His infinite wisdom – do we trust Him with our whole life?
Moses: was brought up as the son of Pharaoh. He could have easily lived a comfortable life. However, when the time came, he chose to be identified with his despised people and give up the comfort that he was entitled to. When we give up our time, our possessions and our lives to God, God creates something precious and beautiful with what we have given Him. We will live our lives to the full potential that He has for His children, a life of excitement and fulfillment. We also learn about perseverance from Moses’ life – everything took time. There are no easy or instant solutions to most problems on the mission field. We must learn to change the things we can and live with the things we can’t till God acts and be willing to wait joyfully till then.
Persecution: the latter verses talk of people who were tortured and killed for God’s sake. This is the history of modern missions too. When the first missionaries went to Papua New Guinea, the natives ate them. The average lifespan of a Western missionary in Africa in the early days was only 8 months. Missionaries who went to provide education, health services and talk about the life giving word of God perished in large numbers along with their wives and husbands and their children – the mission work was built with their sweat and blood. Today, most missionaries live comparatively comfortable lives. The problems we face today can be best termed as trivial temporary inconveniences and in return for facing these, we are assured of God’s riches in heaven. We need to look at our lives and circumstances with a heavenly perspective.
This passage closes with the great exhortation in chapter 12, verses 1 and 2 – “since we are surrounded by such a great cloud of witnesses, let us cast aside all that hinders us and the sin that entangles us and run with endurance the race that is set before us, fixing our eyes on Jesus, the pioneer and perfecter of our faith, who for the joy set before Him, endured the cross and is seated on the right hand of the throne of God”. I thought that we are not only encouraged as we read the stories in the Bible and as we read the life stories of many missionaries who have gone on ahead of us, we can also imagine that they are up there in heaven cheering us on as we come face to face with all sorts of difficulties, so that we may not lose heart but with new energy and God given vision complete the task set before us.
Can we live lives like these great heroes? Yes, we can. If we are able to face ridicule and work diligently like Noah, obey completely and instantly like Abraham and give up our own ambitions and desires to Him; if we can reject the attractions of the world like Moses and face our problems with fortitude looking at our problems with a heavenly perspective, we too can live lives of faith and see God do great things through us. We are unable to do all this with our own strength but with God all things are possible.
We are not asked to go alone to work for God in unknown places and face unknown dangers. God wants us to take us by His hands – He will come with us and with Him beside us, the dangers and inconveniences of the road are forgotten and we are able to joyfully run the race and complete the task set before us. May God be with us.
Dr.Vijay Anand Ismavel MS, M Ch
Medical Superintendent – Makunda Christian Hospital, Assam
P.S. – you can contact me on ivijayanand@yahoo.in or on Facebook “Vijay Anand Ismavel’. Our hospital is also on Facebook “Makunda Christian Hospital” with some interesting case discussions. Please also look at our websites www.makunda.in and www.eha-health.org
I have had the privilege of interacting with Christian medical students and medical missionaries for about 25 years. The process of looking for and finding a worthy partner in medical missionary service is an important one as it can enrich or mar the work done together. These are some thoughts (my personal thoughts and observations) for the aspiring medical missionary who is still a student.
The choice of whom to marry should ideally wait till God has given other important directions first – where to go and what to do. Until this data is available, it is not advisable to make this choice (witness the problems that William Carey faced with his first marriage). When a logical decision is made taking into account God’s directions, the choice will be ideal (like the choice made by Jim and Elisabeth Elliott). Since these directions are still not clear during college life, this is not the time to fall in love.
When Christian medical students fall in love (or in other words ‘get infatuated’), they will not ask God “Is this your choice for me?”. Instead they usually declare “Thank you God for bringing this person into my life!” This cleverly shifts the blame on God. They will then look for suitable Bible verses and songs to justify and support their decision (Romans 8:31 is a popular choice of verse and “Is anything too hard for the Lord” a good song for this purpose). They will seek approval among others who are doing the same thing or from someone who they know will approve of what they are doing.
If the relationship breaks down, they suffer a spiritual breakdown which is similar to having a hemiplegia. They think “God got me into this relationship (remember the first prayer in the previous point). If I can’t trust God in this matter, does He really exist? Have I been living in a make-believe world? ) They will then need rehabilitation before they can get back to normal life. This often takes time, broken relationships and leaves behind scars.
The problem with infatuation is that there is no logic in it – decisions are made on emotions alone. It has been shown that the parts of the brain that are involved in logical thinking are not used when someone is infatuated. Gross compromises (like saying that a materialistic person would become a missionary after marriage) are made to ensure that the other person is not lost. Falling in love is good after the right choice has been made (especially after marriage when small non-critical differences between the partners need to be reconciled).
If the relationship ends in marriage and it had not been made on well-planned lines and taking into account God’s prior guidance, the scales fall off their eyes and they see that they will have to live with major compromises if they are to remain married. It is often the end of any missionary plans.
When this happens in a Bible study group (especially when the leaders are involved), usually the others comment about it but do nothing to help. They say ‘it is their life – who are we to interfere?” We must remember that these people are unable to think and to them our silence approves their relationship. When the choice is obviously wrong, they have a feeling that something is not right. They just need someone to point this out. After this, if they still go ahead with their relationship, then it is their choice. How can we point it out without offence? When I was involved with student groups in Tamilnadu, we printed out a checklist on Infatuation. This was called “Infatuation or Love”. It has subsequently been edited. If you find that someone who has declared an interest in missions is making the wrong choice, you can give them a copy of this checklist. If they were not infatuated, they will say “that was well written” or something similar. If they are infatuated, they will often say, “I lost the copy” – this is because, it has disturbed them. This is the time to give a second copy! We found this technique very effective in helping people to think. It is also a good idea to have a discussion on the topic with some senior missionaries or local Christians.
As written in the checklist, infatuation has its costs. Other relationships suffer, studies and the relationship with God also suffers. I call it a ‘time-occupying lesion’! So, if you are in a relationship or contemplating one, this checklist may be something that you could read too.
An important question to answer “Is marriage for me?”. Being single is neither a disgrace nor a liability. Many great missionaries were single. If you look at the history of medical missions in India, a lot of the pioneering work was done by single women. Some remained single because of choice and others because they could not find suitable husbands or wives. It is not easy to be single. However, for the person who has gone ahead with missionary work and has remained single, God will be their partner. This may be the portion that God has for some of his missionaries.
As we move ahead, we need to add points to the checklist of things to look for in a prospective partner. If we have too many requirements, it becomes difficult (or impossible) to find a suitable person. We should make a list of imperative requirements and superficial ones. Imperative ones are commitment to God and to missions. Superficial ones are tribe/caste, wealth, physical appearance etc. If we want to marry only a doctor who is pretty, belongs to the same tribe and state and is wealthy as well as committed to God and missions, we may be looking for too much. Just like doing a Medline search, we can increase the numbers by pruning our list of requirements. In communities where parental involvement is essential, it may be necessary to keep talking to them over a period of time about the list so that parents also slowly start to accept and then eventually look for the same requirements.
When the correct match has been made, the union does not distract from God’s work. It becomes a situation where 1 + 1 > 2. This happens because personality, abilities, knowledge, skills and aptitudes differ between the partners – each partner brings to the marriage a different set of these but committed to the same vision. This will be a God approved match. There will be unity, stability and a feeling of peace in such a relationship. When things go wrong in the mission field, the husband and wife can encourage one another and when they go well, they can rejoice together.
Only God knows us and the person we are thinking about comprehensively (Psalm 139). He knows us fully – not only what we are now but also what we will be in the future. Let us leave this matter into His hands, seek His guidance and listen to His still small voice. We will know we are on the right direction when we have the peace that passeth understanding. There is no hurry – He is in control. He is the source of all wisdom, strength and encouragement. May God be with you.
Dr.Vijay Anand Ismavel MS, M Ch
Medical Superintendent – Makunda Christian Hospital, Assam
Regional Director – Emmanuel Hospital Association, New Delhi
P.S. – you can contact me on ivijayanand@yahoo.in or on Facebook “Vijay Anand Ismavel’. Our hospital is also on Facebook “Makunda Christian Hospital”. Please also look at our websites www.makunda.in and www.eha-health.org
I have written this for my student friends – simple strategies that helped me to be a good student:
I am sure we all want to study well. Somehow it does not seem to happen. We open one of the reference books (Gray’s Anatomy or Harrison’s Medicine) and read a page. When we have gone through the first 3 paragraphs, our eyelids start to droop and we find ourselves unable to proceed (an effective cure for insomniacs !). The next day we start off at the same spot, maybe progress onto the next page and then find the same thing happening all over again…
I was not interested in Medicine (I wanted to be an engineer) . When I finally joined for my MBBS (at Kilpauk Medical College, Chennai in 1981), I found it all Greek and Latin! I was also embarrassed by the lack of my knowledge in the first class test in Anatomy (whereI obtained the lowest mark and was humiliated in front of the whole class by the professor). I resolved that I would never be embarrassed again and began to study hard. I had a few other friends who studied hard with me and we did very well and took top positions during the MBBS course (many of these were Bible Study group members). I followed the same strategies during my MS (at Madurai Medical College in 1990) and M.Ch (at Christian Medical College, Vellore in 1997). Even though I joined for my M.Ch after many years, God helped me to gain the first rank in the university in the subject! Let me share some of my thoughts with you in the folllowing 10 points:
Anyone can do well at studies. This is not reserved for the geniuses. We need to be bookworms. How do we become one? It starts by declaring that we are a bookworm. When you meet friends, talk about the subjects you are studying. You will soon be labelled as a bookworm! Other bookworms will join you and you will soon find yourself firmly established as a member and it ill be difficult to leave the group. Pray – God has promised his help – James 1:5.
If you have 1 year for the exams in a particular subject, choose a good textbook and read through the entire book in 9 months. This is the first revision. Revise repeatedly till the exams.These succeeding revisions take lesser time.
If you need to read 50 pages a day, read through these in 15 minutes first. This will extablish in your short term memory what the book says about the topic (for example if you look at diabetes: there is a definitiion, natural history and presentation, acute and chronic complications, investigation, management of the disease and complications and some special points – like the Somogyi effect and insulin resistance). Then read through the text once more and underline the key points to these headings. Write them out on the top and sides of the text in the book (this may disfigure your book, but you will find it easy to have your notes already in the textbook and you need to have only one book for both – reference and notes). This discipline has to become routine (like having a short quiet time of Bible study and prayer in the morning). If you want to take a break for a few days, make sure that you have worked harder on the previous days so that you are still on schedule when you come back after the break.
You will notice that some of what you learn is logical – that fluid deficit , hyperglcaemia and electrolyte disturbances are corrected in the management of ketoacidosis and treatment is also directed at the cause. However some have no logic – the names of enzyme deficiencies that cause various inborn errors of metabolism. We should underline and write out the points that are not easy to remember.
We find it reassuring to reread the areas we know well (just to remind ourselves that there are some parts of the syllabus we know well!). However, this is a waste of time. From the first revision onwards, we should concentrate our efforts on the points that we cannot remember. As we learn more and more, we will find that the time taken for each succeeding revision becomes shorter and shorter. At the end, we can look at the chapter, mentally recollect its contents and move on to the next without reading.
I feel that the brain shifts memories from short to long term by:
ñ Repetition – if we keep repeating something long enough, we can’t forget it – a good strategy for the illogical points.
ñ Reward – if learning is associated with a good feeling (like winning a prize or commendation from someone or even showing yourself that you know the subject better than others) we tend to remember what we learn. This does not happen when we just go through the subject for the sake of doing it.
ñ Association – if what we are learning can be associated with something already known (already in long-term memory), it is easier to add it (the ‘flesh to bones’ technique).
Discuss with your friends. You will find that as you discuss, what you studied becomes more clearer to you as you learn from another person’s perspective.
Teach students who are poor at studies. This is not just social service! You will find that when you have explained the reasons for the various components of auscultatory findings in mitral stenosis to someone who is finding it difficult (for the tenth time!) you will not be able to forget it anymore (you have used two strategies – repetition and reward)
Write all the prize exams (if you are eligible). There is nothing to lose. Since these are held before the main exam, they are like a dress rehearsal and you will find yoursef much calmer when you go for the main exam. You may even win the prize! (the reason why some people keep winning prizes – they write the exams!)
10.Reward yourself when you have completed a target – you could read your favorite book or spend some time on the internet looking at Facebook. Remember that God has put you in medical college so that you will be an excellent doctor – one day the difference between life and death for a patient in a remote area may be because you remembered something you studied years ago. You can (and should) get involved in other healthy activities at college but you should not forget that studies take a high priority. When you are confident with your studies, you are better able to enjoy the other activities.
This discipline will ensure that you do well in studies throughout your life. You will pass all your exams with ease. You will get into good postgraduate courses without a struggle and you will be excellent doctors. You will also find that when you are a busy postgraduate student or a busy doctor later, even small amounts of free time are enough to keep up with studies. They will be a joy and a satisfaction to you. May God be with you.
Dr.Vijay Anand Ismavel MS, M Ch
Medical Superintendent – Makunda Christian Hospital, Assam
P.S. – you can contact me on ivijayanand@yahoo.in or on Facebook “Vijay Anand Ismavel’. Our hospital is also on Facebook “Makunda Christian Hospital” with some interesting case discussions. Please also look at our websites www.makunda.in and www.eha-health.org
It is now 3 years since I had my MI (heart attack). My wife, Ann (an anesthesiologist), my two young daughters and myself had just returned from a 200 km road journey (through ghat roads) from Agartala (capital of Tripura) after a brief stopover at Ambassa, where we have a branch hospital. I was driving and tired. We went straight to the hospital were I did a neonatal colostomy (for anorectal malformation) and a Caesarean section. The baby took time to come out of anesthesia, so I left Ann to extubate the child and went home. I parked the vehicle (a Mahindra Bolero) in the garage and walked home in the dark. When I reached the bottom of the stairs to my home (there is a steep climb of about 40 feet), I found it very difficult to take a step forward. I tried shouting for help but no sound came out. I managed to crawl up all the steps and reach home where I sat on the floor. I told Hannah, our eldest daughter to call Ann. Ann thought that I was just tired. A little later, I vomited and started experiencing severe chest discomfort. Ann and other doctors came home and lifted me down in a blanket and took me to the hospital. An ECG confirmed an acute anterior wall MI. We did not have streptokinase in stock. Ann sedated me and called my classmate, Ravikannan at the Cachar Cancer Hospital in Silchar (120 kms away) and he brought the streptokinase. I had severe chest pain for a day. Ann managed me calmly (although she confesses to having some unease when she arranged the resuscitation tray with endotracheal tube at my bedside). In a few days, I was well enough to be wheeled around the hospital. All the staff, family and friends prayed for my recovery and took good care of me. I did an echocardiography on myself and found a poorly contracting heart with an ejection fraction of about 35% – I could not believe that it was my heart ! After about a week, one of the staff nurses had acute appendicitis and I managed to do the surgery from a wheelchair with the operating table lowered completely. Our obstetrician assisted me and closed the abdomen. I was then brought to the Christian Medical College at Vellore where I underwent angiography and stenting of my left anterior descending artery. I spent about a month at Vellore and Bangalore – there was no further change in my heart and we returned back to Makunda.
My father and some other close relatives had coronary heart disease and my father had died of an acute MI. Ann had taken me to a cardiologist a few months before my MI – all biochemical tests were normal and i was able to complete a full treadmill test without any signs of ischemia or discomfort. I had also started to exercise. I had no other risk factors (except family history). I was told (after my MI) that I had developed an acute coronary thrombosis.
After my return to Makunda, we found that I had to work as much as before my MI. There was no additional help, a lot of pending bills had accumulated and workloads had increased. I started tentatively at first but was soon doing as much surgery, ultrasound and other work as before. After an experience like this, every twinge in the chest is taken seriously (as you don’t want to have another one) ! I avoided long surgeries. Sometimes, I was forced to do some long surgeries. There was a patient with tracheo-esophageal fistula who would have died if I had not operated. There was a patient undergoing laparoscopic cholecystectomy who developed a biliary leak and I had to do a hepaticoduodenostomy. Since I knew that there was no one else to take over, I just took deep breaths and completed these and other such surgeries one stitch at a time. When I was tired, I had a bed put in the hospital where I could lie down for some time.
I was asked to walk 2 kms every day. I found this tiresome and took my daughters along. One day I noticed a tapping sound and found an unfamiliar woodpecker pecking on a dead bamboo stump (which was being used as a post for holding the volleyball net at the school). I photographed it and posted it on Flickr and it was identified as a relatively rare woodpecker (Stripe-breasted woodpecker – Dendrocopos atratus). I became very interested and started noticing all sorts of interesting birds and insects. I upgraded my equipment to a Nikon D300s with Sigma 150-500mm OS lens (from my old Nikon D70 with Nikkor AF 70-300mm lens) and also bought a 27″ iMac for editing the photographs. The equipment budget was passed by Ann under the head “Cardiac Rehabilitation Expenses” ! I found that observing, photographing and reporting these wildlife in the campus and surrounding areas was very relaxing and added new meaning to my walks.
I have been to cardiac reviews every year. I have not become any better ( the ejection fraction is still around 35% ) but I haven’t become any worse. I am able to do almost all the things I did before my MI. I cannot run or do anything which demands exertion. I am happy with my lot – it is God’s portion for me. We have to accept the whole package and cannot pick and choose the things that please us. It is also God’s way of telling us that He is sufficient and that in our weaknesses, we experience His strength. I have never questioned why I should experience this – in His infinite wisdom, God permitted it and that is enough. We need to trust God absolutely and in everything.
This experience has brought our family closer. We have realized the shortness and unpredictability of life. It also has made me look at everything with a greater heavenly perspective. We are citizens of the kingdom of heaven temporarily posted to this earth. We should not develop any deep roots here. The values of this world are temporary and not eternal. We should rather invest on those things that have eternal value – those things that find God’s approval. We should live for His approval – that the thoughts, plans and purposes of our hearts find His approval. This is our strength and that is sufficient.
Should my life be different ? I think I should just go on being the person He wants me to be. I am not perfect but will become more and more like Him. Our physical bodies degenerate with the passage of time but spiritually we become stronger as we experience His faithfulness and learn to trust and obey Him. When I was young, I did not want to commit my life into the hands of my Lord and Saviour Jesus Christ. I felt that this would lead to a loss of control over my life and I wanted to enjoy life in the way I wanted. Later, when I made the commitment, I knew it would be for life – a vow had been made like the one at the time Ann and me married – I will seek your will and follow it all the days of my life (in sickness or in health etc.). Many people advise me to take rest and relax. I find that doing the work that is pleasing in God’s sight brings the greatest rest and relaxation. Contentment and happiness are the rewards of obedience. Strength and health are given as the need arises. I spent several years after my undergraduate days spending time with young Christians, challenging them to find the same fulfillment that comes only by walking in God’s path, holding His hand. After joining Makunda, this became difficult as work took a lot of time. I think that I may again be able to do this as more time becomes available. I find that even if I don’t physically travel to other places, I can still communicate with people over the internet. I look forward to whatever God has in store in the days to come. My ambition is to live a life pleasing to Him when on this world and to be welcomed back as a servant who has completed the task given to him when I go to be with God in heaven.
The Sparrow's Nest 