Vijay Anand Ismavel | The Sparrow's Nest

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A Journey of Faith

My wife Ann and me were privileged to speak last year at the LEADTalks 2019 conference (1) in Bangalore – a forum that challenges and encourages young Christian people to live lives of purpose, integrity and excellence – we thank the organizers for the opportunity and pray that God would continue to bless their initiative in the years to come.

In 1992, within a year of our marriage we set out from Tamil Nadu in South India to Assam in northeast India (2,3). We were searching for a place that would provide us with an opportunity to be of the greatest transformational impact with the time, talents and treasure that God had blessed us with. For this, I had developed a simple formula to choose a location – the potential for the greatest transformational impact by an individual = the total population (in that location) that could avail his/her services divided by the total number of other people with his/her qualifications / skills etc. So, we were looking for a place that was thickly populated with few healthcare institutions which meant somewhere far away from home in urban Tamil Nadu.

28 years have passed since our first visit to Makunda, God took us by our hands and blessed us with wisdom, strength and encouragement. A small start in 1993 (4) has become a thriving institution today, providing services to many (5). It was all due to God’s grace and the hard work of many highly committed co-workers who laboured with us. Mission institutions provide transformational impact across the world in areas of great need and are key to ‘closing the gap’ in access to services to the poor and marginalized (6). Unfortunately, many are sick and the story of Makunda is an example of how God can revive and rebuild one of His institutions if we are willing to go with Him on a “Journey of Faith”. This is a short video of our talk:

References:

Tags: Christian Medical Missions, Christian Missions, Journey of Faith, Makunda Christian Hospital, Vijay Anand Ismavel

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Categories Christian Medical Missions

All Creatures Great and Small

27 May

My previous blog-post was about my experience documenting biodiversity over most of the previous decade. Readers may read it here: https://the-sparrowsnest.net/2020/04/29/all-things-bright-and-beautiful/

I closed that post with this song which we all sang during our school days:

All things bright and beautiful

All creatures great and small

All things wise and wonderful

The Lord God made them all

– Song by Cecil Frances Alexander

This post is entirely filled with photographs that God has enabled me to take over the years. Browse through them and I hope you enjoy them as much as I did when I took them. I have written short notes to accompany each image. If you want to see more of my images, please visit my Flickr site ( https://www.flickr.com/photos/ivijayanand/ ) and if you want to see them as observations, they are here ( https://www.inaturalist.org/observations/ivijayanand )

The Blue-throated Barbet (Psilopogon asiatica) is one of the commonest birds on our campus. This photo shows the rich colouring of this beautiful bird. It is also an example of an ideal bird photo – head turned just right with a good ‘bokeh’ in the background.

This is a Chestnut-winged Cuckoo (Clamator coromandus). Cuckoos are known to lay their eggs in the nests of other birds – brood parasitism. This species lays its eggs in the nests of the necklaced laughingthrushes.

One of the common birds of our campus, the White-rumped Shama (Copsychus malabaricus) – it has a beautiful song. A recording of its call is here: https://www.xeno-canto.org/248160

One of the night owls, the Brown Boobook (Ninox scutulata). It is very difficult to get a daytime photograph like this one.

Birds display behaviour and emotions like other living creatures. Two Spotted Owlets (Athene brama) enjoy sitting out side by side with some allo-preening.

Phayre’s Leaf Langurs *(Trachypithecus phayrei)* are a species of Endangered primate that is found in our area.

The common Rhesus Macaque (Macaca mulatta) – the first photo shows a couple eating a tuber and the second one shows juveniles at playtime.

One of our campus orchids (Eulophia zollingeri). Orchids are one of the two largest families (along with Asteraceae) of flowering plants. This one is a terrestrial orchid (growing on the ground). The first orchids discovered were terrestrial and had two tubers underground – they were therefore named orchids due to their resemblance to testes.

Another common campus species, this time an epiphytic one – growing on trees – Cymbidium bicolor

Aeginitia indica is a root-parasite. The shoots come up from the forest floor in the monsoon season and soon produce the colourful flowers.

Forests inside our campus are home to all sorts of flora. This is an unusual fern, Helminthostachys zeylanica.

Forests are full of fungi of all sizes and colours – including these tiny vivid red mushrooms – Hygrocybe sp.

North East India is home to unique herpetofauna. This is a pit viper from our campus – Trimeresurus erythrurus

Our campus is home to large non-venomous snakes as well. This is a Burmese Python – Python bivittatus

All living creatures employ a number of measures to survive, including mimicry. This tiny frog looks like a bird-dropping on a leaf – Theloderma baibungense

The largest bats in the world are found across India. This is the Flying Fox – Pteropus giganteus – a mother bat breast-feeding an infant inflight.

One of the common squirrel species here in our campus is the Pallas’s Squirrel – Callosciurus erythaeus

A family of Asian Small-Clawed Otters – Aonyx cinerea – found in our campus as well as in surrounding areas. These are the smallest species of Otters in the world.

One of the common species of Mongoose in our campus, the Crab-eating Mongoose – Herpestes urva

North East India has seen a lot of elephant-human conflict in recent years, not surprising as people encroach into their habitats. These are wild elephants – about to enter a tea-estate bordering jungle.

Makunda has a wonderful arachnid biodiversity. This is one of our tarantulas – Chilobrachys assamensis – about the size of one’s palm.

Another ground-level view of the same tarantula – showing iridiscent blue colouring on its legs. Tarantulas are kept as pets in some parts of the world.

Spiders come in all shapes and sizes. This is a tiny one that mimics ants – Amyciaea forticeps

This spider looks like a piece of thread – Ariamnes sp.

A rare colourful spider. This one is Platythomisus octomaculatus – rediscovered in India after 120 years by members of our “Makunda Nature Club”. The story is here: http://diversityindianews.blogspot.com/2017/02/rare-spider-spotted-in-remote-hospital.html

There are cunning spiders too. This one is a Portia sp. – known to be an ‘intelligent’ spider, this one uses different strategies to fool and eat other spiders, including drumming on a web to appear as prey.

Many butterflies are named after Shakespeare characters and ranks of the Armed Forces. This is a rare one from our campus – the Harlequin – Taxila haquinus

We have many colourful dragonflies. This one is especially bright and beautiful with a mettallic iridescence – The Greater Bluewing – Rhyothemis plutonia

Most people think that moths are dull and boring. These are male and female Thyidid moths of the species Glanycus insolitus. Identifying moths is not easy – I still struggle, sometimes not even able to identify which family a moth belongs to – I thank experts like Roger Kendrick who have patiently identified moths for me on Facebook and iNaturalist over the years for my limited knowledge of moths.

Two more spectacular moths. Carriola sp. on the left with its intricate green veins within clear windows and Nevrina procopia on the right with its delicate patterning.

I’m closing this post with a snail. This one has small spines on its shell and belongs to the genus Endothyrella. I hope you enjoyed these photos as much as I did taking them and learning about these creatures – great and small, the Lord God made them all.

Tags: Biodiversity Documentation, Makunda Christian Hospital, Makunda Nature Club, The Sparrows Nest, Vijay Anand Ismavel

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Categories Biodiversity Documentation

All Things Bright and Beautiful

29 Apr

In October 2008, at the age of 44, I had a heart attack (1) at our home in the Makunda Christian Leprosy and General Hospital (www.makunda.in ), where my wife Ann and me have been working for the past 28 years. Following this, I was asked to go for daily morning walks to keep myself physically fit. As I walked through our campus, I became interested in the different wildlife (both flora and fauna) in our 350-acre forested campus. Although I had lived and worked there since 1993, I was looking with new eyes – filled with curiosity and wonder at what I was seeing. I had bought a Canon EOS 88 film camera shortly after joining the hospital and a few years earlier, I had invested in my first digital camera, a Nikon D70 with a Nikkor 28-105mm lens – all my photos were of people, developments in the hospital, places I visited and interesting medical cases that I saw. Soon after starting my morning walks, I purchased a Nikkor 70-300mm lens – I was able to get high quality macro photos with my 28-105mm lens but I needed a better ‘tele’ lens to photograph the birds.

In 2010, I was walking past our primary school one day when I noticed a pair of woodpeckers excavating a nest on a large bamboo pole used to hold up the school’s volleyball net. They looked and sounded different from a more commoner species (Dendrocopos macei) and I took photos and posted them on my newly opened account on Flickr (2). They were identified as Dendrocopos atratus, one of the rarest woodpeckers in India (later, some experts disagreed with this ID). I became excited and started photographing and posting all the birds I saw and was excited when one of them was uncommon. I also started venturing out to nearby tea-estates and forest villages to photograph them. The 70-300 lens was a basic one without vibration reduction (VR), so I bought a new one, Nikkor 70-300mm VR. I needed a good computer to process the images and bought an iMac 27”. I also bought a Sony sound recorder and a Garmin GPS. I became active on Facebook naturalist sites – ones on butterflies, moths, birds, insects – to post my images for ID and comment on other photographer’s images. After a few more years, I bought a new camera, a Nikon D300s and a Sigma 150-500mm OS lens. With the new gear, I was able to do a lot of documentation throughout the year. In 2012, I opened an account on iNaturalist and started linking my Flickr images to this wonderful site (3). Experts from around the world commented on the observations and confirmed IDs. These, ‘research grade’ observations could then be used by scientists for their research. This is the wonderful world of citizen-science where images and sounds of wildlife observations with time and GPS details can be peer-reviewed, confirmed and used for scientific advances.

In succeeding years, my gear has been upgraded further as old equipment became heavily over-used and broke down. I now have a Nikon D800 and a Nikkor 300mm f2.8 VRII for telephoto, a Micro-Nikkor 105mm f2.8 VR for macro as well as a Nikkor 24-120mm VR for general use. The old iMac broke down and had to be replaced, hard drives became full and more needed to be added. All this was considerable expense for a doctor couple in a remote rural mission hospital, but Ann approved all the expenses, for their role in my cardiac rehabilitation!

At present, I take photos of anything interesting I see in RAW, convert to JPEG with basic editing (mostly cropping) in Adobe Lightroom and upload images to Flickr. These are stored with a CC license – I noted that many serious people (those looking for images for their theses, articles, websites etc.) often search for the CC mark so that they did not have to write and seek permission from the photographer (4). Today, I have about 17,000 public images on Flickr with over 2 million views of these images! I also have nearly 9,000 observations on iNaturalist which is currently the highest number by one observer for India. Many bird photographers in the Oriental region contribute their images to the “Oriental Bird Image Database” – the best images are accepted and stored online – I have over 700 of my images on this Database (5). I have also contributed to the Internet Bird Collection (6), Avibase (7), ArKive (before it closed), Xeno-Canto (8) and a few other sites. Bulk uploads of my data have been transferred to the India Biodiversity Portal (9) and eBird. My photos have been included in books like the “Woodpeckers of the World”, “Mongooses of the World”, “Parrots of the World”, “Encyclopaedia of Animal Behavior” and many others.

I had soon photographed most of the common birds of our area and started looking at other living creatures. I was introduced to Siddharth Kulkarni, a scientist with an interest in spiders, he was also the country representative on the World Spider Catalog and I invited him to Makunda. He made a few visits and taught us to observe and document the spider biodiversity of the campus.

In 2015, I started the “Makunda Nature Club” – a group of staff and students of Makunda with an interest in documenting biodiversity, creating awareness, conservation work and research. I had published a short note on the “Mating of the Greater Coucal” online in 2011 to the Bird Ecology Study Group (10). In March 2015, on a biodiversity documentation trek in nearby forests, I noted a new bird I had not seen earlier. It was a van Hasselt’s Sunbird – Leptocoma brasiliana sperata – the first time this species had been photographed in India. I wrote an article describing this observation and the distribution of this species (with Praveen Jayadevan – a bird expert) as the first publication of the Makunda Nature Club (11). This was followed by the publication of the observation of a rare spider, Platythomisus octomaculatus, the first time it had been seen in India and the second time it had been observed since its first sighting in Sumatra 120 years earlier (12) and two Coreid bugs (Schroederia feana and Prionolomia gigas) – these observations were made, ID confirmed and published with expert assistance from Siddharth Kulkarni (the Coreid bugs were confirmed by Prof. Hemant Ghate) (13). The spider was found by one of our school-girls – a Class 8 girl from a remote rural school finding a very rare spider – for the first time in India! (14). In 2017, I photographed a rare Ghost Moth (Hepialidae) at my home in Makunda. I searched the internet and found that the global authority on these was Dr. John Grehan from the Carnegie Museum of Natural History in the USA. I wrote to him and after an exchange of emails, we co-wrote an article on the Ghost Moths of northeast India (15). The “Makunda Nature Club” got its excellent logo from Sukumaran Sundaresan – a design specialist who took a short sabbatical away from his corporate work to spend some time with us (16). The club also has also got its own group on the India Biodiversity Portal (17).

One day, I went to a nearby Jaintia village for the wedding of one of our staff and while waiting for the proceedings to start, met one of our old school-boys (from the Makunda Christian Higher Secondary School which we started on our campus in 2004), Rejoice Gassah. He told me that he had heard that I was going into local forests and that he was also interested. I questioned him, took him along with me on a few treks and found that he was excellent at describing birds and their calls – he had a natural talent. I requested our hospital management to appoint him as a full-time staff to help me. He was a keen-learner and I soon passed on most of what I knew to him. He accompanied me on all my field-trips and we discussed what we observed. The hospital also purchased equipment for him to use – a Sony bridge camera, an iMac 21”, a Sony sound recorder, a Garmin GPS and a Camera Trap as well as field guides. In 2017-18, he applied for and was sent to do the Green Hub Fellowship in wildlife videography – that was excellent training and we thank Ms. Rita Banerji and her team for the great program that they run (18). It is great to work with someone who has a passion for the work, has natural ability, good attitude and is willing to put a lot of effort into achieving excellence. As a full-time surgeon at the hospital, my biodiversity documentation work is limited to Sunday mornings or whenever I have free time after work. He was full time, young and healthy and we could now do field work whenever required and I could do the analysis of the data and write manuscripts for publication. He has been sent to several places (National Center for Biological Sciences, Bangalore and ATTREE to name two) to gain more knowledge and skills.

Publications on the Golden-crested Myna – Ampeliceps coronatus (19), Tawny-breasted Wren-babbler – Spelaeornis longicaudatus (20), Asian Stubtail – Urosphena squameiceps (21) and Siberian Blue Robin – Larvivora cyane (22) have come out of my work with Rejoice Gassah. He has become an expert at observations as well as documentation and has a keen eye for anything unusual. It has been a privilege to be able to mentor someone like him and I’m sure that he has a great future in biodiversity documentation and conservation in the years to come. Writing these articles also exposed me to the world of wildlife research, writing to curators of museums across the world, tracking observations from journal articles in the past and social media in the present to provide a concise description of that particular species and its distribution. Editors like Praveen Jayadevan from IndianBIRDS have helped me to learn to do this well. At present, more research is under way – on mammals, dragonflies, butterflies, birds etc. We have also had visits to our hospital by Prof. Ganesan from ATTREE (23) and hope to start work on research on the floral biodiversity of this area – one of the last bits of semi-evergreen low-altitude dipterocarp forests that remain with significant amounts of wildlife – both flora and fauna – outside protected areas.

I must also acknowledge the help and encouragement provided by Dr. Anwaruddin Chowdhury – a wildlife expert and Secretary to the Government of Assam with a huge amount of academic research and publications to his credit (24). We invited him to open the “Biodiversity Resesarch Trail” in our campus. He also invited me to contribute two short chapters – on the Golden Jackal (25) and Otters (26) in his book on the Mammals of Northeast India. We have also been visited by many wildlife and biodiversity documentation experts – Shashank Dalvi, Ramit Singhal, Jainy Kuriakose, Sankararaman, Shantanu Joshi, Sarala Khaling, Rohit George and many others. I don’t use a tripod and the equipment is heavy, not good for someone with an ejection fraction of 35% to carry – especially the Nikkor 300mm f2.8 VR II lens – I thank Club members, Basanto Fulmali and Babryl Chorei who helped carry the equipment on long treks when I was tired. My wife, Ann and daughters, Hannah and Deborah, have also helped with observations, especially with bird behavior and with rescuing some injured/sick birds and animals. As days go by, more staff see the enchanting beauty of God’s creation, learn fascinating facts and become entranced with the world of biodiversity observation and documentation. More people are buying cameras or take photos on their cell-phones and enquire about the identification or habits of the species that they have observed, this type of activity also relaxes people and makes the overall experience of working in a remote rural situation more enjoyable. I’m sure that this work will continue and bring satisfaction and happiness to many.

Sometimes, God uses shock treatment to help us to look at our worlds through different eyes and that is what happened to me after my heart-attack – whenever something happens to nudge us out of our well-trodden paths, we should always ask why did this happen, is there something that I need to change and is there another road that I need to explore. It is also a confirmation of the fact that God has given us such wonderful brains that someone like me with no interest or knowledge of wildlife could become an accomplished citizen-scientist in a short time – starting at midlife. More of us, whatever may be our background, should consider looking at the biodiverse world around us, maybe that world is beckoning to us too – we need to take that first step and enter into the world of God’s creations, where everything is bright and beautiful.

All things bright and beautiful

All creatures great and small

All things wise and wonderful

The Lord God made them all

– Song by Cecil Frances Alexander (27)

References:

Please watch this 7 minute video:

This is a short video made about the Makunda Nature Club by Rejoice Gassah in 2018

Tags: All things bright and beautiful, Biodiversity Documentation, Citizen Science, Flickr, iNaturalist, Makunda Christian Hospital, Myocardial Infarction, Vijay Anand Ismavel

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Categories Uncategorized

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 8^th to the 16^th 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 5^th 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 5^th 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 12^th 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:

Tags: Christian Medical Missions, Christian Missions, Covid19, Makunda Christian Hospital, Medical Missionary Work, Medical Missions, Nehemiah, Passover, Psalm 23, Vijay Anand Ismavel

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Categories Uncategorized

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 (30^th 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:

Tags: Christian Medical Missions, Christian Missions, Emmanuel Hospital Association, Leprosy, Leprosy in a caregiver, Leprosy in a doctor, Makunda Christian Hospital, Medical Missions, Vijay Anand Ismavel, Wrestling with leprosy

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Categories Christian Medical Missions

Early Days at Makunda

12 May

Medical work at Makunda was restarted on 3^rd 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 – 3^rd 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:

Tags: Christian Medical Missions, Christian Missions, Emmanuel Hospital Association, Finding God's will for medical missions, Finding God's will for missions, Makunda Christian Hospital, Medical Missionary Work, Medical Missions, Obeying a call, Obeying a call to medical missions, Pioneering Medical Missionary Work, Preparing for medical missions, Vijay Anand Ismavel

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Categories Christian Medical Missions

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:

Who is a missionary? I found this definition from Wikipedia (3) quite comprehensive, “A missionary is a member of a religious group sent into an area to do evangelism or ministries of service, such as education, literacy, social justice, health care and economic development. The word “mission” originates from 1598 when the Jesuits sent members abroad, derived from the Latin missionem (nom. missio), meaning “act of sending” or mittere, meaning “to send”. The word was used in light of its biblical usage; in the Latin translation of the Bible, Christ uses the word when sending the disciples to preach in his name. The term is most commonly used for Christian missions, but can be used for any creed or ideology.” A Christian medical missionary would therefore be someone sent to provide health care on behalf of a Christian church or group and Christian medical missions would be the work done collectively by a group of such people.
What are some of the characteristics of medical missionary work? I think that medical missionaries (like all other missionaries) need to be sent out to areas where they are relatively out of their comfort zone (vulnerable) and to help people who are poor and marginalized. They must excel in their professional work as well as serve in the Spirit of Christ, so that others may see Christ in and through their work. This would enable other Christian services to be offered through the activities of the mission compound.
Does Medical Mission work have to be only in remote rural areas? Many of the present locations of mission hospitals in India were once rural – towns have developed around the mission compounds! However, after Indian independence, there has been a significant movement of people to urban areas and many live in slums. These people are also poor and marginalized – they do not have access to high quality medical care at affordable cost and this is an opportunity for mission hospitals in urban areas. Mission hospitals have great potential as they are among the few entities which focus on people whom nobody else is interested in.
Are there opportunities for pioneering new Medical Mission work in India? Yes, Arunachal Pradesh is at present the only state in India without a Christian mission hospital. (Tripura too did not have one until we started a hospital there in 2005). There are large tracts of land in forgotten corners of our country where new hospitals are needed and can be started. However, due to local land and entry laws, it is not easy for outsiders.States such as Arunachal Pradesh, Mizoram and Nagaland require an Inner Line Permit – similar to a visa – for non-locals to enter and several states have restrictions on non-locals purchasing land). Similarly, great opportunities for transformation exist in other needy parts of the world where few want to go.
Can Medical Mission work be done in hostile areas? When Makunda started the work in Tripura, Dhalai district was the most affected by militancy with murder and abduction being common and all public transportation possible only through armed convoys. However, the work at the hospital was never affected as it was seen as a humanitarian service to the poor. I had the privilege to visit Africa last year – mission hospitals are the only long-term health facilities that work well in conflict areas because of the commitment of staff. Other NGOs (like Red Cross and MSF) offer short-term medical support services. Warring groups usually do not target missionary services, recognising their humanitarian value and universal appeal.
Is Medical Mission work a sacrifice? We are called to be ‘living sacrifices’ – meaning that we offer ourselves to a life of obedience to God. Medical mission work (especially in remote rural areas) is front-line work and not easy. However, in the light of the words of the Bible, I would say that the trials and difficulties are ‘temporary and trivial inconveniences’! We should not dwell on sacrifice as it makes people into ineffective self-styled martyrs! There is no sacrifice too great for a missionary – when we feel that we have been brought to life from death by the sacrifice of Jesus on the cross, we should be ready to die for Him. When we look at missionary history, many missionaries (often unheard and unsung) gave their lives so that the church may be built in remote areas all over the world – truly the present Christian church in these areas has been built on their sweat and blood. In comparison, the problems we face today in India are indeed trivial.
Can Medical Mission work be professionally challenging? I have heard many people say that mission hospitals (especially remote rural ones) treat only diarrhea and ear discharge! When I completed my M.Ch in Pediatric Surgery at CMC Vellore, there were people who even asked why I wasted a M.Ch seat which could have been given to someone who was more likely to use it! I would like to say that I have seen and operated on some of the most professionally challenging conditions at Makunda. Since CT scans, nuclear scans and the services of other experts are often unavailable in these locations, missionary doctors need to innovate to be able to treat patients cost effectively with what is available.. I have operated on a teratoma in the right middle lobe of the lung (middle lobectomy with composite resection of two overlying ribs), ectopia cordis (unfortunately, this patient died), 35 kg ovarian tumor, retrograde jejunogastric intussusception, intra-abdominal cocoon (several cases) and so on. There have also been challenging medical as well as other specialties’ cases. All these years, I was the only full-time pediatric surgeon in the states of Mizoram, Tripura, Meghalaya, Manipur and southern Assam – so there are certainly a huge variety of patients who need treatment (and who cannot go elsewhere because they are poor), it is only logical to conclude that professionally, medical missionaries are in for exciting opportunities.
Is it not difficult to be in a ‘vulnerable’ situation? Humanly speaking, it is. However, I would say that from a spiritual perspective, this is the greatest factor in favor of Medical Missions. Vulnerability is a blessing in disguise – how else will we see God at work? God specialises in helping us as we face circumstances beyond our control. Miracles do not happen when we are in control of situations. When all else fails and we totally depend on God, we see Him at work. It is an exciting experience to see God at work and see Him build up His kingdom and be partners in this great ministry.
Is Medical Mission work drudgery with few opportunities to relax? When I was in school, I was interested in tennis, rifle shooting and rowing. In college, I cultivated an interest in electronics. However, many of these activities were not possible at Makunda. I discovered that nature observation and photography are excellent for relaxation. My observations in and around Makunda have been posted and published in many sites. (4,5) If someone is looking for the nearest mall to relax in, he may be disappointed but there are other (and maybe greater) opportunities to compensate.
Can work focused on the poor be self-sustaining? When we re-started Makunda, we were told that it was impossible to work primarily for the poor on a self-sustaining basis and that all successful mission hospitals subsidise treatment of the poor by treating the rich at higher rates. However, we decided to be a hospital primarily for the poor with no special facilities for the rich as a part of our ‘pro-poor’ branding strategy. All patients wait in the same queues irrespective of their social class or wealth and the same general wards are used to admit them. Charges are low and charity is liberal – the hospital is flooded with patients and high capacity utilisation leads to high efficiency and lowered costs. God has blessed the work and we have been able to invest in new equipment and buildings, start a new school, the branch in Tripura and nursing school without major grants (the external funding received each year was less than 1 percent of income for many years). When we treat the poor who cannot afford to pay, God pays their bills – often in ways that money cannot buy – by giving us satisfaction, contentment and wealth in heaven.
Why is there a high attrition rate in mission hospitals? Work in mission hospitals is not easy and not for every one. There is peer-pressure from families and friends. People look for comforts and sometimes are unable to adjust to life in mission hospitals. Many are short-term and do not want to stay on to solve local problems. There is a high attrition rate in Medical Mission work all over the world – maybe <10 per cent of new staff stay on long-term. However, most staff leave after tasting God at work and often say that the best years of their lives were at the mission hospital!
Are many mission hospitals today ‘beyond redemption’? Sadly, many mission hospitals are ‘sick’. This is due to inability to adapt to rapid changes, poor governance and the absence of committed long-term staff at a leadership level. Being at the cutting edge of mission work, I am sure there would also be an element of spiritual warfare. However, no hospital is beyond redemption. Major changes may need to be done to resolve problems but all of them can be revived. If a completely shut hospital (like Makunda) with severe local problems can be revived to become a thriving community, there is hope for all the other sick ones too! God is able to do great things. He just needs a few volunteers willing to submit to Him.

What should be done to revive and revitalize Medical Missions?

I feel that Medical Mission hospitals require a transition to effective and efficient governance mechanisms, without losing the vision of the founding fathers. They may need repositioning due to changing contexts – laws have changed and the world has changed. For this to happen, highly committed people should be willing to stay till they see change. It is a call to persevere – changes may take years to happen. Objective stock-taking exercises, strategic planning and an excellent system of accountability, transparency and integrity based ‘checks and balances’ is essential.
The church should ‘own’ and support medical mission work. When I was young, I never went to church, thinking it was a waste of time! Parents and people at church disapproved. Later, when I started going to church, everyone was happy. However, when I felt God’s call to remote rural missions, many felt I was going too far, becoming extremist! If every church encouraged medical members of its congregation to give a year or two of their lives to missions, there would be more than enough people to run the hospitals.
Many young doctors and specialists going to mission hospitals today do not have the training and experience to manage administrative (legal, financial and other) work. They need to have some exposure, as they are often required to take leadership roles. Some years ago, Makunda offered a mission-training programme of 2 years duration where doctors who are keen to work in long-term missions could work as apprentices and finally learn to manage a small hospital (our branch at Tripura) on their own.
There is a lot of Christian work in medical colleges in India – EMFI and UESI as well as other groups. However, such work should lead to changed lives. We need people to experience the life-changing power of the Gospel and then take decisions that will take them to the best plans God has for them. Important attitudes need to be cultivated too. (6)
Excellence in studies is important. Obscure facts learnt in medical college serve to be life-saving information(7). Students interested in a career in medical missions should ensure that every day in college is well-spent and no opportunity to study is lost.
The choice of who one marries has a very strong effect on which medical missionary stays on in Medical Missions and which one does not. (8)
When young Christian medical professionals talk of working abroad, the conversation is almost always about the developed world – the western nations, Australia and even the wealthy ones in the Middle East. Why don’t we look at the ones that need help instead – Myanmar, African and South American nations, small island nations – for those with a greater adventurous spirit, these opportunities beckon!
There is a ’rut’ placed in time at the end of MBBS or other medical professional qualification. If nothing is done at this point, all graduates tend to follow the tracks left by their peers – corporate work, government work or private practice. So, for those considering Medical Missions, important steps need to be taken much prior to graduation – sensitizing parents, and exploring varied options.

I would like to invite every committed Christian medical professional to consider a life-long career in mission hospitals, or at least a few years of their life. We spend a lot of effort in investing our money so that it gains the greatest value over time. I think Medical Mission work gives a Christian medical professional the greatest value over time – an exciting and fulfilling life in this world and a great reward in heaven.

This post is updated and adapted from the chapter, “A privileged call to Medical Missions” published in the book, “Wings of Dawn” – used here with permission from the publisher, Evangelical Medical Fellowship of India. The book, which also contains chapters by several other authors is available in hard copy and Kindle versions on Amazon.

Bibliography:

Tags: Christian Medical Missions, Christian Missions, Finding God's will, Finding God's will for medical missions, Finding God's will for missions, Makunda Christian Hospital, Medical Missionary Work, Medical Missions, Obeying a call to medical missions, Preparation for Medical Missions, Preparing for medical missions, Vijay Anand Ismavel

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Obeying a call to Medical Missions – a Testimony

13 Sep

In 1982, as a second year under-graduate medical student at the Kilpauk Medical College in Madras (1), I made a lifelong commitment to Jesus Christ. I started a Bible Study group in college and we discussed how to live the Christian life and make decisions that were approved in God’s sight. We heard many messages on the topic, “Finding God’s Will” but many of us were not able to get a clear convincing personal answer to this burning question. My query was answered one day when I was reading Jeremiah 29:11-13 (2) – I felt God telling me that I was not able to find His will for my life because I was not seeking with all my heart and that He was waiting to answer as soon as I realised that He had the best possible plans for my life. I also realised that I did not want to hand over my life totally into His hands; I wanted to retain control and this attitude was preventing me from seeing His plans for me. I felt God speaking to me and made a vow that I would obey Him and go where He wanted me to go and do what He wanted me to do with all my time, talents and treasure. It soon became clear to me that I should go where few others wanted to go, so that I could make a difference to people who had no access to good health care. Since the southern four states of India were well provisioned with healthcare, I had to go far away from home.

After my internship, I was not confident to run a remote hospital by myself and joined the Christian Fellowship Hospital (3) at Oddanchatram in 1987 and spent 3 wonderful years there, learning to become a more confident doctor. I also spent the 3 years (every Thursday) exploring villages in the hills of Pachalur (30 kilometers from Oddanchatram), doing medical work with some local missionaries and seeing God answering the simple prayers of poor people powerfully. For the next few years, I was involved in conducting the annual Medical Missionary Meets for medical college students of Tamil Nadu at Pachalur organised by the CF Hospital – I visited medical college fellowships in Tamil Nadu, wrote numerous letters to a large number of students and learnt many things about working with medical students.

I was married to Ann in 1991, during my Postgraduate Residency days in General Surgery at the Madurai Medical College (4) – we met over our common interest in medical missionary work. I had met Dr. Vinod Shah, a paediatric surgeon, then working with the Indian Evangelical Mission in Gujarat, at the Medical Missionary Meet at Pachalur in 1987. In 1989, I spent two months with him at the Chinchpada Christian Hospital in Dhule District of Maharashtra (he had just joined the hospital as its Medical Superintendent) – I spent time thinking about and discussing where God wanted me to go during my time at Chinchpada and shared with Dr. Vinod Shah a list of key points that I felt God was asking me to look for. Some of these key points were a remote rural area where no hospitals/doctors were present, a thickly populated area with great healthcare need, a large campus which could be developed over the years and the scope for working with medical students of the area. In 1992, when I was completing my MS in General Surgery, Dr. Vinod Shah, who had become the Medical Secretary of the Emmanuel Hospital Association (5), asked us to visit a mission hospital in Assam (bordering Mizoram and Tripura) that was closed for the past 10 years, called the Makunda Christian Leprosy and General Hospital (6,7) – he wrote me a letter saying that he was inspired to recommend this place to us as most of my ‘key points’ were fulfilled at this hospital. We visited the campus for a week in October 1992 and found a desolate place with broken buildings, no patients, no income and a violent group of people from the old church and staff of the campus who planned to steal the land and assets of the hospital for themselves. They told us that if we wanted to work peacefully in the hospital, we should join them. If not we would have to fight them and that they would make life difficult for us! We prayed for wisdom and guidance. God opened our eyes to the magnificent campus (at that time, 1000 acres of forested land), to the great need (we heard stories of many mothers who died as they were unable to cross flooded areas during childbirth to travel to faraway hospitals) and to the potential of working with young people in a new area where God was leading us, north-east India. We felt God assuring us that we were under His protection, He would take us by His hands and be the source of all the wisdom, strength and encouragement that we needed as we stepped into this new responsibility that He was giving us.

In 1993, we joined this hospital as its first doctors (after its years of closure) and have continued to serve there since then. Between 1997 and 1999, I did my M.Ch in Paediatric Surgery at the Christian Medical College (8) (CMC) at Vellore and between 1999 to 2000, I worked as a Lecturer in General Surgery in the same college (Ann, who had waited 7 years to do her Postgraduate studies, did her MD in Anaesthesia at CMC during the same 3-year period). During our stay at CMC, we were equipped with new skills and knowledge to expand the services we offered at Makunda – we started the only paediatric surgical centre for the states of Manipur, Mizoram, Tripura, Meghalaya and the southern half of Assam. When we initially joined the hospital, we were told by the leaders of Emmanuel Hospital Association in New Delhi (which took over the Board function of Makunda from the previous Baptist Mid-Missions Trustees India) that we had to make a long-term commitment to Makunda, as they would not be able to find anyone else willing to work there if we quit. We were also told that they were taking the risky decision to accept Makunda as a Member of the Association based on our willingness to stay long-term. When I asked, what they meant by ‘long-term’, we were told, ‘preferably retire from there’! We agreed and made a 30-year commitment to the hospital and started work on a 30-year strategic plan to rebuild the hospital. We thank God that He has enabled us to stay on till the present – we are in Year 25.

There were many battles to fight – we had no experience in administration, law or finance, there was no one on the campus who had the same vision, we did not know the language, there was no running water or electricity, no patients or money, we had to confront the so called ‘trade union’ members and a group of old leprosy patients who had joined them on a daily basis and the nearest phone was 50 kilometers away on a bad road! Makunda was considered a God-forsaken place – in those early days, if someone was posted to Makunda, the first question would be, “what wrong have I done?”!

In the past 24 years, God has blessed the work at Makunda. In 2016-17 (which was not a good year – due to three months of floods), the hospital saw 84,557 outpatients, admitted 11,017 inpatients, delivered 4886 mothers and performed 2194 major operations. A survey of northeast India showed that many remote rural areas (such as Arunachal Pradesh which is presently the only state in India without a Christian mission hospital) had low population density and could not support a hospital like Makunda. It was felt that nurse-missionaries could run healthcare services in such areas and a nursing school was started in 2006 – 25 students join every year and over 200 have passed out so far. A survey of local villages showed that poor tribal children had no scope of acquiring a good education and career, improving the social and economic status of their villages unless they had access to affordable English medium education as they were not comfortable and quickly dropped out of the locally available Bengali language schools (many tribal languages in northeast India use the English script – a testimony to the linguistic work done by Christian missionaries in the past). An English medium school, the Makunda Christian High School, was therefore started in 2004 and today there are nearly 1000 students studying up to class XII (Arts and Science) with 220 children in two hostels. It was also decided to start a new hospital in another state of northeast India to expand Makunda’s horizons, to serve as a training/experience centre for young staff interested in missions and learn how to start and run a new hospital – with a view of starting many more! A branch hospital was therefore started in the neighbouring state of Tripura, at Kamalacherra in the Dhalai District, in 2005 and it is providing service in one of the most needy parts of the state – it is the only Christian hospital in the state and at that time heavily infested with militants. An agriculture and fishery department looks after the large campus and in 2015, the “Makunda Nature Club” was started to document biodiversity, conserve wildlife and conduct research. A community college was started the same year. The hospital is focused on the poor and there are no facilities for the rich such as private rooms or private consultations. Yet, it has adequate income to meet the running expenses, able to offer charity liberally to the poor and still have enough for critical capital expenditure – a self-sustainable model focused on the poor with only 1-2% of income derived from external sources. Large numbers of poor people have found healing on the campus. During the day, more than 1000 staff and students work and learn on the campus. Spiritual work for patients, students, staff and for others outside the campus (villagers and college students) is carried out throughout the year. The medical work has therefore enabled the entire campus to thrive and this has been the story of successful Medical Missions all over the world. The hospital has partnered with the Government too – it has one of the best-run Private Public Partnerships with National Health Mission, Assam for maternal and child health care. It also provides a 6 month residency to doctors from Netherlands doing the MD (Global Health and Tropical Medicine) course from the Royal Dutch Tropical Institute, Amsterdam – enabling highly committed medical doctors from the Netherlands to acquire the skills and experience required to serve in even more needy parts of the world such as South Sudan and Ethiopia. I must acknowledge the selfless and joyful work put in by the staff in all departments who have gladly ‘walked the second mile’ – they have been the greatest strength of the hospital and all these developments would not have been possible without them. It has been a privilege to work with so many highly committed staff whom God has brought from many places.

Ann and me have faced many difficult situations (violence, health issues – I had a heart attack in 2008, court cases against us, to name a few) but count it all joy to be a part of God’s great work in this corner of the world. (9,10) We look forward to what God has in store for us in the years to come and our ambition is that we will continue to trust and obey Him and when our days in this world are over, be welcomed back to heaven as good and faithful servants who accomplished the work given to them.

Bibliography:

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

Tags: Christian Medical Missions, Christian Missions, Emmanuel Hospital Association, Finding God's will, Finding God's will for medical missions, Finding God's will for missions, Makunda Christian Hospital, Medical Missions, Obeying a call, Obeying a call to medical missions, Preparing for medical missions, Vijay Anand Ismavel

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Short video of our work made by Emmanuel Hospital Association

19 Feb

Emmanuel Hospital Association (EHA) has made short videos on the life of some of its doctors to challenge mission-minded people to step out in faith and see God work through them. I would like to thank Dr. Ashok Chacko who took the initiative to make this short video in 2014 based on work in the different departments at Makunda and an interview with me and Ann. God continues to do a great work at Makunda and the credit goes to Him and to the large number of highly committed staff who have worked hard inspite of many difficulties over the years.

Tags: Christian Medical Missions, Christian Missions, Emmanuel Hospital Association, Makunda Christian Hospital, Medical Missions, Vijay Anand Ismavel

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Wisely choosing a life partner for an aspiring medical missionary

22 May

I have had the privilege of interacting with Christian medical students and medical missionaries for about 25 years. The process of looking for and finding a worthy partner in medical missionary service is an important one as it can enrich or mar the work done together. These are some thoughts (my personal thoughts and observations) for the aspiring medical missionary who is still a student.

The choice of whom to marry should ideally wait till God has given other important directions first – where to go and what to do. Until this data is available, it is not advisable to make this choice (witness the problems that William Carey faced with his first marriage). When a logical decision is made taking into account God’s directions, the choice will be ideal (like the choice made by Jim and Elisabeth Elliott). Since these directions are still not clear during college life, this is not the time to fall in love.
When Christian medical students fall in love (or in other words ‘get infatuated’), they will not ask God “Is this your choice for me?”. Instead they usually declare “Thank you God for bringing this person into my life!” This cleverly shifts the blame on God. They will then look for suitable Bible verses and songs to justify and support their decision (Romans 8:31 is a popular choice of verse and “Is anything too hard for the Lord” a good song for this purpose). They will seek approval among others who are doing the same thing or from someone who they know will approve of what they are doing.
If the relationship breaks down, they suffer a spiritual breakdown which is similar to having a hemiplegia. They think “God got me into this relationship (remember the first prayer in the previous point). If I can’t trust God in this matter, does He really exist? Have I been living in a make-believe world? ) They will then need rehabilitation before they can get back to normal life. This often takes time, broken relationships and leaves behind scars.
The problem with infatuation is that there is no logic in it – decisions are made on emotions alone. It has been shown that the parts of the brain that are involved in logical thinking are not used when someone is infatuated. Gross compromises (like saying that a materialistic person would become a missionary after marriage) are made to ensure that the other person is not lost. Falling in love is good after the right choice has been made (especially after marriage when small non-critical differences between the partners need to be reconciled).
If the relationship ends in marriage and it had not been made on well-planned lines and taking into account God’s prior guidance, the scales fall off their eyes and they see that they will have to live with major compromises if they are to remain married. It is often the end of any missionary plans.
When this happens in a Bible study group (especially when the leaders are involved), usually the others comment about it but do nothing to help. They say ‘it is their life – who are we to interfere?” We must remember that these people are unable to think and to them our silence approves their relationship. When the choice is obviously wrong, they have a feeling that something is not right. They just need someone to point this out. After this, if they still go ahead with their relationship, then it is their choice. How can we point it out without offence? When I was involved with student groups in Tamilnadu, we printed out a checklist on Infatuation. This was called “Infatuation or Love”. It has subsequently been edited. If you find that someone who has declared an interest in missions is making the wrong choice, you can give them a copy of this checklist. If they were not infatuated, they will say “that was well written” or something similar. If they are infatuated, they will often say, “I lost the copy” – this is because, it has disturbed them. This is the time to give a second copy! We found this technique very effective in helping people to think. It is also a good idea to have a discussion on the topic with some senior missionaries or local Christians.
As written in the checklist, infatuation has its costs. Other relationships suffer, studies and the relationship with God also suffers. I call it a ‘time-occupying lesion’! So, if you are in a relationship or contemplating one, this checklist may be something that you could read too.
An important question to answer “Is marriage for me?”. Being single is neither a disgrace nor a liability. Many great missionaries were single. If you look at the history of medical missions in India, a lot of the pioneering work was done by single women. Some remained single because of choice and others because they could not find suitable husbands or wives. It is not easy to be single. However, for the person who has gone ahead with missionary work and has remained single, God will be their partner. This may be the portion that God has for some of his missionaries.
As we move ahead, we need to add points to the checklist of things to look for in a prospective partner. If we have too many requirements, it becomes difficult (or impossible) to find a suitable person. We should make a list of imperative requirements and superficial ones. Imperative ones are commitment to God and to missions. Superficial ones are tribe/caste, wealth, physical appearance etc. If we want to marry only a doctor who is pretty, belongs to the same tribe and state and is wealthy as well as committed to God and missions, we may be looking for too much. Just like doing a Medline search, we can increase the numbers by pruning our list of requirements. In communities where parental involvement is essential, it may be necessary to keep talking to them over a period of time about the list so that parents also slowly start to accept and then eventually look for the same requirements.
When the correct match has been made, the union does not distract from God’s work. It becomes a situation where 1 + 1 > 2. This happens because personality, abilities, knowledge, skills and aptitudes differ between the partners – each partner brings to the marriage a different set of these but committed to the same vision. This will be a God approved match. There will be unity, stability and a feeling of peace in such a relationship. When things go wrong in the mission field, the husband and wife can encourage one another and when they go well, they can rejoice together.

Only God knows us and the person we are thinking about comprehensively (Psalm 139). He knows us fully – not only what we are now but also what we will be in the future. Let us leave this matter into His hands, seek His guidance and listen to His still small voice. We will know we are on the right direction when we have the peace that passeth understanding. There is no hurry – He is in control. He is the source of all wisdom, strength and encouragement. May God be with you.

Dr.Vijay Anand Ismavel MS, M Ch

Medical Superintendent – Makunda Christian Hospital, Assam

Regional Director – Emmanuel Hospital Association, New Delhi

P.S. – you can contact me on ivijayanand@yahoo.in or on Facebook “Vijay Anand Ismavel’. Our hospital is also on Facebook “Makunda Christian Hospital”. Please also look at our websites www.makunda.in and www.eha-health.org

Tags: Choice of life partner for a missionary, Makunda Christian Hospital, Medical Missions, Preparing for medical missions, Vijay Anand Ismavel, Wisely choosing a life partner for an aspiring medical missionary

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The Sparrow's Nest

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All Creatures Great and Small

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A Christian Hospital in the time of Covid19

A Wrestle with Leprosy

Early Days at Makunda

Reflections on Medical Missions

Obeying a call to Medical Missions – a Testimony

Short video of our work made by Emmanuel Hospital Association

Wisely choosing a life partner for an aspiring medical missionary

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