Excellence in studies for an aspiring medical missionary

15 Apr

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:

  1. 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.
  2. 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.
  3. 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.
  4. 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.
  5. 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.
  6. 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).

  1. 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.
  2. 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)
  3. 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

An encounter with a myocardial infarction

1 Nov

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.

Welcome to the Sparrows Nest

27 Jul

I am Vijay Anand Ismavel, a pediatric surgeon working at Makunda Christian Hospital (www.makunda.in), a remote rural Christian mission hospital in the state of Assam in northeast India. My wife, Ann Miriam, an anesthesiologist, works with me in the same hospital. We went there in 1992, a year after our marriage in December 1991, in response to a request to restart this closed down hospital. The hospital was taken over by the Emmanuel Hospital Association (www.eha-health.org) in 1992 and we joined in 1993. We have been here since then (excluding a period of 3 years when we were at the Christian Medical College at Vellore doing our postgraduate studies). We have seen God at work in our lives as well as in the lives of colleagues, students and patients who have come to this hospital over the years and consider it a privilege to be a part of this wonderful work. I am also keenly interested in photography (especially birds) and it has been a great experience walking around the large campus here discovering and photographing all sorts of insects, plant life, birds and mammals. Our two daughters, Hannah (14) and Deborah (9) stay with us and study at the Makunda Christian High School which was started by the hospital in the same campus.

We have had great encouraging experiences as well as times of discouragement in the past 20 years. Whenever we went through difficulties we were reminded of the song, “His eye is on the sparrow…” ; hence the name of this site. God reminds us that He is always watching over us.

We look forward to sharing thoughts on work, photography, wildlife, medicine and any others that come to mind on this site.