Tag Archives: Medical Missions

St. Andrew’s Kirk Chennai – Bicentenary Sermon on Medical Missions

4 Apr

When I did my undergraduate medical studies in Madras (present-day Chennai) in the early 1980s, I had the privilege of attending the St. Andrew’s Church (The Kirk). There, I met Pastor David Singh with whom I had many long talks over several years. He was one of my early mentors and introduced me to community health work at the church’s community health program at Thirupalaivanam village. Many years later (in 2007), Ann and me met him again in Richmond, Virginia where he was pastoring a church. This resulted in him visiting us in Makunda and to several years of partnership between his church and organization in the USA with our hospital – yearly staff and student retreats as well as financial support to the expansion of the hospital’s work in obstetrics and paediatrics.

The St. Andrew’s Church (fondly called the Kirk) was built by Scottish missionaries and has a rich legacy over 200 years. Its building and architecture are unique and many great men and women were associated with it over the two centuries of its existence. A brief account of its work has been presented as a documentary here: https://www.youtube.com/watch?v=780_668IGG0 – further details of the church and its ministry can be found on its website: https://www.thekirk.in/index.php

As part of the Bicentenary Celebrations of the church, March 2021 was dedicated as “Healing Month” with sermons centered around the healing ministry of the church. Ann and me were privileged to be invited to sing/speak at the morning service (with the theme verse John 15:16) on the 14th of March 2021. I used this opportunity to talk about my association with the church, share a personal testimony and challenge healthcare professionals and the church to missionary service. Ann and me thank the pastor and the church committee for inviting us to speak at this great church on “Medical Missions – Journeys in Faith”.

Mission hospitals were established by the church in remote and needy parts of the world where they transformed healthcare, bringing life and healing to numerous poor people who had no other options. Unfortunately, a large number are sick today and many have closed. We need a new impetus to healing sick hospitals and starting new ones in areas of need. May God place this vital burden on the hearts of church elders and the congregation so that the medical ministry of the church is a blessing to many. May young men and women in our churches today consider medical missionary work as a part of their career when God puts them into healthcare courses.

This video is made by the media team of the church and starts with organ prelude, worship led by my college junior Dr. Anita Chelliah and welcome by the Pastor, Rev. Isaac Johnson with announcements and introduction at 24:27 by the Secretary of the church and my school classmate, Mr. Dulip Singh. A short documentary on the “Healing Ministry in Chennai” is shown from 32:20 and my sermon starts at 52:47 with Ann singing the song, “His Eye is on the Sparrow” at 1:43:50. This is followed by intercessory prayer and the closing part of the program. You may listen to the entire program or parts of it by clicking on the link below:

Chat with Eby

8 Mar

In this post, I wish to introduce my blog-readers to Dr. Eby Daniel, a physician working at the Christian Fellowship Hospital at Rajnandgaon in the Chattisgarh state of India. He has started a podcast with each episode containing an interview with someone working in Christian missions and has called it “Chat with Eby”. There are also other playlists containing Christian meditations, Mission hospital videos etc. – you can see all of them on his YouTube channel here: https://www.youtube.com/channel/UC9BiQMPpSkgIl2ecTtXJ8fg

I had the privilege of being interviewed by him in his latest podcast, responding to thought-provoking questions that are relevant to young medical (and other) people considering a career in missions.

In this interview, questions have been raised on several topics on which I have written earlier (references in brackets to earlier blog-posts and external links) including finding God’s will for our lives (1,2), early days at Makunda (3), strategic planning(4), the “Makunda Model” and poor-centric strategies (5,6), preventing “Mission Drift” (7), my experience with leprosy (8) and myocardial infarction (9), biodiversity documentation (10,11), choosing a life partner (12), excelling in studies (13) and concluding remarks on decisions relating to missions (14).

I hope that you will like listening to Eby’s channel and his interviews with other people – I’m sure that you will (like me) subscribe to his channel too. Please click on the video link after the following references to listen to this podcast containing Eby’s latest Chat – with me.

References:

  1. https://the-sparrowsnest.net/2017/09/13/obeying-a-call-to-medical-missions-a-testimony/
  2. https://the-sparrowsnest.net/2020/09/30/a-journey-of-faith/
  3. https://the-sparrowsnest.net/2018/05/12/early-days-at-makunda/
  4. https://the-sparrowsnest.net/2021/02/03/medical-missionary-work-strategic-planning-and-stock-taking/
  5. https://www.researchgate.net/publication/342551561_The_Makunda_Model_An_Observational_Study_of_High_Quality_Accessible_Healthcare_in_Low-Resource_Settings
  6. https://the-sparrowsnest.net/2021/02/19/medical-missionary-work-poor-centric-strategies/
  7. https://www.peterkgreer.com/mission-drift/
  8. https://the-sparrowsnest.net/2019/01/30/a-wrestle-with-leprosy/
  9. https://the-sparrowsnest.net/2011/11/01/an-encounter-with-a-myocardial-infarction/
  10. https://the-sparrowsnest.net/2020/04/29/all-things-bright-and-beautiful/
  11. https://the-sparrowsnest.net/2020/05/27/all-creatures-great-and-small/
  12. https://the-sparrowsnest.net/2012/05/22/wisely-choosing-a-life-partner-for-an-aspiring-medical-missionary/
  13. https://the-sparrowsnest.net/2012/04/15/excellence-in-studies-for-an-aspiring-medical-missionary/
  14. https://the-sparrowsnest.net/2021/02/23/suggestions-for-medical-missionary-work/

Suggestions for Medical Missionary Work

23 Feb

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

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

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

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

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

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

Medical Missionary Work – Non-medical Work and Concluding Thoughts

22 Feb

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

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

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

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

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

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

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

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

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

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

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

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

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

References:

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

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

Medical Missionary Work – Poor-centric Strategies

19 Feb

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

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

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

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

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

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

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

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

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

References:

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

Medical Missionary Work – Introduction, Attitudes and Promise

31 Jan

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

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

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

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

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

A Christian Hospital in the time of Covid19

5 Apr

            This post is based on a message I gave today (through videoconferencing) to the staff of our hospital, Makunda Christian Leprosy and General Hospital (1) – the numbers in brackets refer to links given in the references at the end of this post:

            Today is Palm Sunday, the beginning of the Christian “Passion Week”. Normally, today, Christians all over the world would have walked streets outside their churches with palm fronds, enacting Jesus’s entrance into Jerusalem, leading on to the train of events that led to His death and resurrection. Palm Sunday 2020, however, is different. Churches all over the world are closed. Most villages, towns and cities are under various restrictions – from social distancing to lockdowns. People are on their phones – talking, chatting and posting on social media, the discussions are all about one thing – the Covid19 pandemic. Till today, over 1.2 million people are infected and over 65,000 have died (2).

            Instead of a Palm Sunday message, today’s talk will be about our response to a crisis situation. The Jewish world is about to start their Passover festival – this year it will also be celebrated across the world in similar conditions as Passion Week – from the 8th to the 16th of this month.

            We read the story of the Passover in Exodus 12:12-18 (3). The nation of Israel was in bondage to the Egyptians. The ruler of the Egyptians, the Pharaoh, would not let them free – they were his source of cheap labor. The early chapters of Exodus talk about this situation, the story of Moses and God using him to deliver the Israelites from the clutches of the Egyptians through 10 plagues. The last plague was the death of every firstborn in the land. The Israelites were pre-warned of the impending plague and were told to anoint their doorposts with blood from a sacrificial lamb. When the Angel of Death swept through the land killing the firstborn, he “passed over” the homes where there was blood on the doorposts. We too, like the Israelites, should put our faith on the shed blood of the Lamb. The world today is gripped by a powerful pestilence, killing large numbers of people from even the wealthiest and most powerful of nations – all their power and wisdom is unable to stop it. We too have no power over this pestilence, but like the Israelites, we can put our faith on our God, who made heaven and earth. He sends His angels to watch over His people and like the Israelites in the days of Moses, we too can be at peace and without fear.

            Let us look at a Biblical model for our hospital as we approach this crisis situation. For our meditation today, I have taken the first 6 chapters of the book of Nehemiah.

            Nehemiah starts his story from the city of Susa, where he hears about the sad predicament of the people of Judah and the city of Jerusalem. It is like our situation today, as we hear about the worsening crisis across the world. He knows that this situation is due to the disobedience of God’s people (Nehemiah 1:8) (4) but at that point in time, the problem was to restore the integrity of the city and its walls. He approached the king and is given supplies and assistance to complete this task. He is given authority, in fact, he is made the governor. He (Nehemiah 2:12-16) (5) inspects the city and its walls and takes stock of the situation. We too should understand and take stock of the situation. Through electronic mass media, we are uptodate on what is happening around the world. We know that this pandemic originated in China and then rapidly spread across the world through traveling infected people. It is now spreading from person to person. Each infected person is expected to spread the disease to two others, if given the opportunity to interact with uninfected people. If nothing is done, millions will be infected and many will die. Scientists are constantly studying this disease as it evolves and we are learning how to manage the situation and minimize morbidity and mortality.

            Having understood what he was up against, Nehemiah made elaborate plans. He appointed key leaders to take responsibilities for rebuilding different parts of the walls of Jerusalem. When faced with ridicule by his enemies, he responded by ignoring them, showing single-minded determination to complete the task given to him and by prayer. When there was a threat of physical violence (Nehemiah 4:15-16) (6) he arranged for workers to continue working – with construction materials in one hand and a weapon in the other. We too have the responsibility of treating our patients while protecting ourselves and others from getting infected. At our hospital, the local government has designated us as a non-Covid emergency hospital. People need a safe place to go for their deliveries, strokes and heart attacks, bowel perforations and obstructed hernias. In the future, we may be called upon to work with Covid patients too – if government facilities are overwhelmed. Our hospital has created a task force that has readied the hospital to tackle this situation. Separate teams have been formed, personal protective equipment (PPE) is being made with what we have, different areas have been designated for different patients and protocols are in place – we too are preparing to fight on two fronts.

            In the 5th chapter of the book of Nehemiah (7), we see him hearing about the plight of the poor and needy. Although his task was to repair the walls, that could not be his only priority. His target population was suffering and they were the focus of the exercise, not the stone walls and wooden gates. Therefore, he steps in and asks people to forgive the debts of the poor and give loans without interest. In this moment of crisis, let us also consider the people we have been called to serve. Many of them were already poor and marginalized, this situation will make them destitute – they have just become financially vulnerable and in danger of losing their vital assets. If we force the poor to pay their bills – for bringing their loved ones to our hospitals and their children to our schools, we would inflict greater pain than the virus. Let us think about how we can be a blessing to the underprivileged communities that we have been called upon to serve. We may ask, aren’t we running out of money too? We don’t have enough to pay our bills and salaries. We must remember that God is no man’s debtor. The Bible tells us that when we treat the poor, He will pay their bills and reward us (Proverbs 19:17) (8)

            Later in the 5th chapter, we see Nehemiah counting the costs of the work entrusted to him. He finds that resources are short and the task is great. He decides to set a personal example by not claiming what is his due as a governor. When crisis situations arise, we (and our families and friends) should consider a period of austerity and sacrifice for the people we are called to serve. Makunda went through periods of severe crisis in the past. Each time, bills accumulated, due amounts were demanded by various people – salaries were deferred and many staff donated from what they had to keep the work going. Projects had been started which could not be closed – staff contributed to enable them to continue, today they are institutions on their own, the 1200 student Makunda Christian Higher Secondary School, the School of Nursing and the branch hospital at Ambassa in Tripura – to enable these to become reality, staff were willing to wait for 14 years for running water and electricity to be supplied to their homes. Some staff did not take their eligible leave so that the hospital did not have to spend on paying for replacements. Today, we too have an opportunity to help our institution continue to serve its target people by giving of our time, talents and treasure. We are lending to God and will be repaid with things that money cannot buy – peace and contentment in this world and riches in heaven.

            We read in Chapter 6 (9) that Nehemiah firmly denied lies from his enemies and finally completed the task in 52 days. Only then did he start working on solving the root causes of the problem – the disobedience of God’s people. We too need to work hard and diligently to get through this crisis now, when we have got over it we can study the entire experience and put in place protocols and practices to help us do better the next time we face another crisis.

            We now come to the last part of today’s message. We hear about fear in people facing this crisis, but we have nothing to fear. Romans 14:8 (10) says that whether we live or die, we are the Lord’s. For us, Christians, life does not end with our physical death but continues on forever. We are God’s ambassadors from the kingdom of Heaven, temporarily posted to this world. We will all die one day but we are at peace. We have handed over our lives into the hands of our loving Commanding Officer – we are dispensable and He can choose the manner and timing of our deaths. Our only concern is that during the time given to us in this world, we live lives that find approval in His sight by trust and obedience and complete the tasks given to us.

            Let me close with a few verses from that much loved chapter in the Bible, Psalm 23 (11). In verse 4 we read, “Even though I walk through the valley of the shadow of death, I fear no evil, for thy rod and thy staff, they comfort me”. I remember suffering an acute myocardial infarction (12), rolling about in pain on the 12th of October 2008 – I felt as if someone was trying to pull the life out of me but I was holding on because God was telling me that He had some more work for me to do before I go to be with Him. In verse 6, we read, “ Surely goodness and mercy will follow me all the days of my life and I will live in the house of the Lord forever” – may we submit our lives to Him as we face this crisis and be worthy of this promise, for this world and the one to come.

References:

  1. http://www.makunda.in/
  2. https://infographics.channelnewsasia.com/covid-19/map.html
  3. https://www.biblegateway.com/passage/?search=Exodus+12&version=NIV
  4. https://www.biblegateway.com/passage/?search=Nehemiah+1&version=NIV
  5. https://www.biblegateway.com/passage/?search=Nehemiah+2&version=NIV
  6. https://www.biblegateway.com/passage/?search=Nehemiah+4&version=NIV
  7. https://www.biblegateway.com/passage/?search=Nehemiah+5&version=NIV
  8. https://www.biblegateway.com/passage/?search=Proverbs+19%3A17&version=NIV
  9. https://www.biblegateway.com/passage/?search=Nehemiah+6&version=NIV
  10. https://www.biblegateway.com/passage/?search=Romans+14%3A8&version=NIV
  11. https://www.biblegateway.com/passage/?search=Psalm+23&version=NIV
  12. https://the-sparrowsnest.net/2011/11/01/an-encounter-with-a-myocardial-infarction/

A Wrestle with Leprosy

30 Jan

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

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

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

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

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

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

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

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

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

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

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

 

 

References:

 

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

 

 

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/