Obeying a call to Medical Missions – a Testimony

13 Sep

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.

Bibliography:

1. http://www.kmc.ac.in/kmc/
2. https://www.biblegateway.com/passage/?search=Jeremiah+29%3A11-13&version=NIV
3. https://www.cfhospital.org
4. http://www.mdmc.ac.in/mdmc/
5. https://www.eha-health.org
6. http://www.makunda.in
7. https://www.facebook.com/groups/380594120460/
8. http://cmcvelloremissions.org/
9. https://the-sparrowsnest.net/2011/11/01/an-encounter-with-a-myocardial-infarction/
10. https://the-sparrowsnest.net/2016/02/19/short-video-of-our-work-made-by-emmanuel-hospital-association/

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Short video of our work made by Emmanuel Hospital Association

19 Feb

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.

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Attitudes to cultivate for the aspiring medical missionary

28 Apr

 

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:

  1. 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.
  2. 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.
  3. 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?
  4. 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.
  5. 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.
  6. 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.
  7. 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

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Wisely choosing a life partner for an aspiring medical missionary

22 May


         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.

 

  1. 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.
  2. 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.
  3. 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.
  4. 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).
  5. 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.
  6. 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.
  7. 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.
  8. 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.
  9. 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.
  10. 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

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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

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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.

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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.

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