Tag Archives: Medical Missionary Work

Early Days at Makunda

12 May

Medical work at Makunda was restarted on 3rd March 1993 (after about 10 years of closure). Ann and me had arrived in Silchar several days earlier but our suitcase containing all certificates and money had been lost – we recovered it 3 days later when a passenger (who had taken it with him to Aizawl) returned it to Indian Airlines. Hospital staff had created local awareness and publicity and the OP consultation room had been cleaned. One patient (a girl with diarrhoea) was admitted but very few patients turned up. The first day’s collection was Rs. 20/-. Over the next few days, some people turned up asking for home visits and I went with them (pillion riding on their bikes) to see sick people at home.

 

The slow start changed quickly when a patient was brought in labor from a forest village – she had obstructed labor and was quickly referred to the Government Hospital in Karimganj for a Caesarean section. However, when we went to the ward on our night rounds she was still there – they could not take her to Karimganj. The uterus was now tense with a Bandl’s ring signifying impending rupture. We did not want her to stay at the hospital when we were not confident of treating her with the facilities available but the relatives said that if we sent them out of the hospital, they would take her home to die. The operation room was quickly searched – linen autoclaved many years ago was found (still in its wrappings), instruments were boiled and a Caesarean section done (with two nurses holding kerosene lanterns for light) under local anaesthesia – infiltration with xylocaine. Blood was scooped out of the wound and the final stitches put in. The baby was sick (died a few days later) but the mother was alive – I remember her name, Sumvankhup. The news quickly spread – major surgeries could be done at Makunda – and we started getting large numbers of patients. Soon the next LSCS was done, this time with a live healthy baby – her name was Hoia Chorei. Elective surgeries followed – all done without the help of electricity or running water! – only those that could be done under local or spinal anesthesia. We had a Schimmelbusch mask for open drop ether as well as ethyl chloride but after a few procedures, were not very keen to use this technique.

 

We quickly did a complete inventory of the hospital. Many of the equipment (including gensets) had been sold in the past years to pay salaries. We were left with one working blood pressure apparatus, a large amount of assorted surgical instruments and old suture material. The pharmacy contained a large amount of chaulmoogra oil as well as dapsone and some other drugs for the leprosy patients, there were many barrels of “Sanimaster” – universal disinfectant. There was an ancient Picker 15 mA X-ray machine and a Bovie “Spark-Gap” cautery machine as well as a drum dermatome. The laboratory had a colorimeter and a microscope. There was ‘electricity’ from the government – a few hours of electricity with voltage so low that only the red filament of the bulb could be seen. We had been in correspondence with Emmanuel Hospital Association (EHA) in New Delhi and had received Rs. 10,000/- to start off the work. I thought that this was to purchase something that could not be locally bought and had invested it in a BPL Cardiart 108 ECG machine (I was very interested in medicine and cardiology although I had trained as a surgeon). Now, it looked like a foolish decision – there was not even enough current to charge the batteries in the machine! I sent a long list of the equipment that was urgently needed at Makunda to EHA and received a reply several days later – Makunda was an independent society that had to rely on its own income. EHA could try to raise some funds but there were needs elsewhere too. We did receive small amounts but soon realized that we were on our own…

 

When we first arrived, the local staff held a welcome for us at the local Church with paper garlands and told us that we were an answer to their many years of prayer. The leader of the church pointed us out during his messages in Bengali with murmurs of assent from the congregation. However, after the first few weeks, we realized that their hopes were to first get benefits for themselves – gifts, jobs, even land. We disagreed – all the staff (including us) lived in difficult conditions but we had come primarily to serve the poor people of the area and making our lives better was not the priority. Soon he was pointing us out to tell God that we were not being very helpful – we had to stop going to church and spent Sundays at home, waiting for the days when more like-minded staff would join.

 

The staff at the hospital had been receiving their salaries for years without any work. Now they rebelled at the expectation of work. There were a few nurses and aides – one was nearly blind, another deaf, another handicapped, we did not know the local language – it was going to be difficult to change this situation.

 

A lot of time was spent with the 60 leprosy patients – many of them had been in the hospital for decades. We quickly put them on modern chemotherapy and the fit ones were given, “Released From Treatment” certificates allowing them to mingle with the outside population. Many did not want to go, fearful of stigma – we slowly convinced the able-bodied ones to leave. The staff quarters were far away from the leprosy wards and many of the leprosy caretakers were themselves leprosy patients. This was with good reason – in the past leprosy was incurable. Having been taught that it was just an ordinary bacterial disease curable with drugs, we did not worry about contagion – until some years later when I developed leprosy and then went through two years of chemotherapy, severe reactions and drug induced problems. It was a painful reminder that we are not immune and cannot afford to be careless.

 

Supplies soon ran out and we went to Silchar to buy more – we soon realized that dues were outstanding with most shops. All of them wanted cash and we spent hours going in and out of all the wholesale drug stores looking for the best bargains. I was the pharmacist and store-keeper and had to learn quickly to maintain the right amount of stock. We went once a month, on a Saturday evening, bought our medicines, spent time with Christian medical students at the Silchar Medical College, a night with one of the officers of the Baptist compound in Silchar and returned the next day. At Makunda, we were soon engulfed in legal and land problems which we did not understand. We did not know who was a dependable person and who was not. We did not understand why documents were worded in the manner that they were. It took many months of visits and talking with many different people before some clarity appeared and we could understand what was happening within this community. We could not understand how people could be so violent and hostile just to get land and property illegally – many criminal cases would be filed against us in the years to come in an attempt to get rid of us but we did not know it at that time – it is good that each day is revealed in its time!

 

Life at home was also a different experience. When we started work, Ann and me had been married for a little over a year. She had done her MBBS and I had completed my MS. We had a combined salary of Rs. 2000/- per month in Madurai and now at Makunda this had doubled! When we arrived, we were allotted the Doctor’s Bungalow – 3rd Bungalow – connected by ‘party-line’ intercom to the hospital and other Bungalows. There was a wood-burning stove in the back in a separate kitchen. We quickly invested in a kerosene stove. It took a long time to get a gas connection – only one cylinder would be given after waiting for many anxious hours at Karimganj. There was no electricity at home but we had kerosene lanterns and hand-fans. We hoped this would change quickly – it did, 14 years later! Water was carried to our homes at Re.1/- per bar of two 15 liter cans. This was muddy water from the fishery ponds, we allowed it to settle or used alum to clear it. The weather could be quite cold – we could not afford the warm blankets in the shops or it could be really hot and humid – we just prayed to God to turn on his ‘airconditioner’ – for the rains. There were cement tanks in all the toilets and as soon as the sound of rains was heard, both of us ran out to fill these tanks with buckets – clean water which was free! There were colorful birds and butterflies as well as tarantulas and snakes – Ann found a bamboo pit viper in our hall one night when we returned from hospital. Communication was difficult – the nearest phone was in Karimganj, 50 kms away on a really bad road (often blocked completely by floods). When we reached Karimganj and placed our ‘trunk’ call, it would often not go through and we would return without talking. Talking on the phone was not very encouraging – many friends and relatives thought that we were quite mad! Telegrams arrived many days after the incidents that they described. Many small inconveniences – but temporary and trivial compared to eternal life with God in heaven – we should learn to look at them from a heavenly perspective.

 

This is just a short glimpse of life 25 years ago. It was what we had expected when we signed up with God to go as medical missionaries. At the EHA (Emmanuel Hospital Association is an Association of many independent hospital running societies created in the 1970s to support several Christian mission hospitals which were teetering on the brink of closure following the departure of expatriate missionaries) office in Delhi (in October 1992), we had given a 30-year commitment to work at Makunda till retirement and we were planning to keep our promises.

 

The early life at Makunda was full of surprises – we looked forward to the future not knowing what it would bring. Would we be able to stay on? There were threats – could we be beaten up or even killed? It was also full of promise – God’s promise that He was with us. He had given us a vision of a great work that would transform communities in the future, only visible through God-given eyes of faith! Our human eyes could only see it as an impossible dream. We do not appreciate God’s presence until we are vulnerable and helpless. Our obedience was our duty, the results were His. He had promised to take us by our hands and lead us one day at a time. Most of the early days were not pleasant, they were difficult days, but we can testify that God was with us. The vision of a flourishing work would come true in the years to come – He simply wanted us to stay on and plod on, one day at a time, simply trusting Him. He would be the source of all wisdom, strength and encouragement. That vision has become reality in the following 25 years and God has allowed us to see it with our eyes. Great is His faithfulness…

References:

  1. https://the-sparrowsnest.net/2016/02/19/short-video-of-our-work-made-by-emmanuel-hospital-association/
  2. https://the-sparrowsnest.net/2017/09/13/obeying-a-call-to-medical-missions-a-testimony/

 

Reflections on Medical Missions

14 Sep

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:

 

  1. 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.
  2. 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.
  3. 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.
  4. 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.
  5. 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.
  6. 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.
  7. 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.
  8. 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.
  9. 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.
  10. 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.
  11. 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!
  12. 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?

 

  1. 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.
  2. 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.
  3. 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.
  4. 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)
  5. 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.
  6. 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)
  7. 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!
  8. 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.

 

Bibliography:

 

  1. https://the-sparrowsnest.net/2017/09/13/obeying-a-call-to-medical-missions-a-testimony/
  2. https://the-sparrowsnest.net/2016/02/19/short-video-of-our-work-made-by-emmanuel-hospital-association/
  3. http://en.wikipedia.org/wiki/Missionary
  4. https://www.flickr.com/photos/ivijayanand/
  5. http://www.inaturalist.org/people/8853
  6. https://the-sparrowsnest.net/2014/04/28/attitudes-to-cultivate-for-the-aspiring-medical-missionary/
  7. https://the-sparrowsnest.net/2012/04/15/excellence-in-studies-for-an-aspiring-medical-missionary/
  8. https://the-sparrowsnest.net/2012/05/22/wisely-choosing-a-life-partner-for-an-aspiring-medical-missionary/

 

 

 

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